Health, Well-Being, and Cost Effectiveness
Second Draft, August 2013
This seminar will be concerned with (a) the concept of health, (b) the nature of well-being, (c) the basis of evaluation (d) the value of health and its contribution to well-being, (e) measuring health (or its value), and (f) employing measurements of health to judge the cost-effectiveness of alternative health policies. Much of the seminar will focus on a book manuscript by Hausman tentatively titled Health, Well-Being, and Cost Effectiveness. Other readings will include works on the concept of health, including especially Christopher Boorse’s views, works on well-being including especially works by Griffin, Sumner, Kraut, Scanlon, Sen, and Nussbaum, and works on health, its determinants, and the use of cost-effectiveness information by philosophers such as Brock, Broome, and Daniels and by health economists and demographers such as Dolan, Nord, Murray and Salomon.
The structure of the seminar will largely mimick that of the book. After some discussion of the nature and purposes of generic health measurement (that is, measurements of "overall" health ) (chapter 1, week 1), the seminar will begin with a consideration of the concept of health (chapters 2 and 3), on the assumption that the measurement of health is bound to depend on what exactly health is. It will then consider whether health is measurable and examine existing methods of measuring health (weeks 3 and 4), which for the most part purport to measure the "health-related quality of life" of health states while in fact measuring preferences among health states. To consider whether health can or should be measured by its bearing on well-being or by preferences, we will then turn to theories of well-being and preferences (weeks 5-7). Having concluded that neither health nor well-being can be measured by preferences (week 8), we will then consider (week 9) whether attempting to measure health by subjective well-being fares any better. The right conclusion, I argue (weesk 10-11) is to eschew preference measurement and to focus on what I call "the public value" of health. The course then concludes with a consideration of the use of quantitative health measures in policy making.
Note: Students are encouraged to discuss problems concerning the teaching of this course with the instructor. If students wish to pursue a complaint with someone else, they should contact Jesse Steinberg, Assistant to the Chairperson, Philosophy Department, 5185 H.C. White Hall, 263-5162.
Dan Hausman, Health, Well-Being, and Cost Effectiveness (HWCE) (manuscript available on Learn@UW course web site)
L.W. Sumner, Welfare, Happiness & Ethics
James Griffin, Well-Being, Its Meaning, Measurment and Moral Importance
PDFs of Articles and Book Chapters will be available on the Learn@UW course web site.
Course Web Site:
A variety of material, including the syllabus will also be available on the web. Some of it will be on a public web page: http://philosophy.wisc.edu/hausman/955-Fall2013/955-Fall2013.htm. Other resources will be available via the Learn@UW web site: https://learnuw.wisc.edu/. The course readings in pdf form can be found under the "content" tab on the learn@uw site.
I hope to make this course as accessible as is feasible to anyone with a disability. Please let me know as early in the course as possible if you need accommodations in the curriculum, instruction, or assessments in this course to enable you to participate fully. I will attempt to maintain confidentiality of any information you share with me.
Those enrolled for credit will be expected to write a substantial seminar paper, to lead discussion of one of the seminar topics, to post a brief and careful response each week to a discussion question, and (of course) to participate actively in discusion in the seminar. The seminar paper will count for 60% of your semester grade. Your presentation in seminar will count for 10% of the semester grade. Participation in discussion in seminar and via the discussion postings will count for 30% of the semester grade.
These should be substantial, though there is no specific length limit. Unless brilliantly conceived, a paper of less than ten pages will not be sufficiently substantial. Papers over 25 pages will typically be too ambitious or unfocused, and I'm not keen on reading a 30-page seminar paper whose arguments could have been expressed in 15 pages without loss of content. A draft of the seminar paper is due on December 2, and the final version is due a week later at the last meeting of the seminar, December 9. A paragraph description of the topic for your seminar paper is due no later than November 18, and I urge you to discuss your choice of a paper topic with me.You can write on any subject that is relevant to this seminar..
PRESENTATIONS AND POSTINGS OF DISCUSSION QUESTIONS
In the first class I will distribute a schedule for presentations and ask you to think about your preferences and email me before the second meeting of the seminar. I am hoping to begin the presentations with the second seminar, but if no one feels able to prepare that quickly, the presentations will begin with the third seminar. Seminar presentations involve the following tasks:
POSTING DISCUSSION RESPONSES
Every week by noon on the Friday before the seminar meets, I will post on the discussion page on the learn@uw site between three and six discussion questions concerning the issues to be discussed at the forthcoming seminar. The seminar discussion leader may also, if he or she chooses, post one or two questions. All members of the seminar will be expected to post a single polished and brief (150 word maximum) response either to one of the posted questions or to another student's response. (The earlier you post, the more likely someone will comment on your posting.) Responses should be posted no later than 6 p.m. on the Sunday night before the seminar. Once or twice during the semester I will criticize your posting pedantically, fussing about your punctuation, wording, grammar, and style (as well as content), and the expectation is that the postings will be extremely clear, well-written, perceptive, and of interest to everybody in the seminar.Just a few sentences are fine, but they should be perfectly lucid, indeed even memorable sentences. You should compose your discussion responses using a word processor on your own computer and paste them on to the discussion page only after you have carefully revised and rewritten them. The briefer, clearer, and better written are the postings, the more valuable they will be for everyone. Although the postings will require hard work to write, they should be a pleasure for everyone to read. It goes without saying that the postings should show the same courtesy, kindness, and gentleness that discussion within the seminar shows -- and, at the same time, a willingness to press one's disagreements -- especially disagreements with me and my book manuscript. Though I may go home sulking and licking my wounds, I'm looking to you for harsh criticism. With the exception of the first seminar and the seminar immediately after Thanksgiving break, I will expect everybody to post responses every week. Though there is no requirement that you read each other's postings, I hope that you will want to do so and that sometimes you will post responses to the postings of others rather than directly to the discussion questions. I will assemble and duplicate the postings and distribute them in the seminar.
Seminar Outline (Tentative and Subject to Revision):
1 Monday, September 9: The problems and purposes of health measurement
HWCE, Introduction and Chapter 1
Chatterji, et al. "The conceptual basis for measuring and reporting on health"
Alan Williams, "Calculating the Global Burden of Disease: Time for a Strategic Reappraisal?"
Christopher Murray and Alan Lopez, "Progress and Directions in Refining the Global Burden of Disease Approach: A Response to Williams"
Alan Williams, "Comments on the Response by Murray and Lopez"
2. Monday, September 16: What is health?
Christopher Boorse, “Health as a theoretical concept.” (1977)
HWCE, chapters 2 and 3
Chistopher Boorse, “A Rebuttal on Health.” (1997)
Christopher Boorse, “Concepts of Health.” (2011)
Dan Hausman, "Health and Functional Efficiency" (unpublished)
Andrew Schroeder, “Rethinking Health: Healthy or Healthier Than?” (2013)
Dan Hausman, "Good Health or Better Health: A Comment on Andrew Schroeder" (unpublished)
Arthur Caplan, James McCartney, and Dominic Sisti, eds. Health Disease and Illness Washington, DC: Georgetown University Press, 2004.
James Humber and Robert Almeder, eds. What Is Disease? Totowa, NJ: Humana Press, 1997.
3 Monday, September 24: Can health be measured? Existing health measures.
HWCE, chapter 4, 5
Paul Dolan, "Modeling Valuations for EuroQol Health States"
Salomon, et al. "Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010" (2013) and "Appendix"
Marthe Gold, David Stevenson and Dennis Fryback, "HALYS and QALYS and DALYS,Oh My: Similarities and Differences in Summary Measures of Population Health"
4 Monday, September 30: Health-related quality of life and well-being (I)
HWCE, chapter 6
Torrance, et al. "Health Utility Estimation" (2002)
The HUI(3) http://www.healthutilities.com/hui3.htm
Kaplan et al. "The Quality of Well-Being Scale: Critical Similarities and Differences with the SF-36"
start L.W. Sumner, Welfare, Happiness & Ethics, ch. 1-3 (1996)
Derek Parfit, Reasons and Persons, Appendix I.
5 Monday, October 7 Well-being (II) Objective Theories, Hedonism and Desire Satisfaction
L.W. Sumner, Welfare, Happiness & Ethics, ch. 1-5 (1996)
James Griffin, Well-being, ch. 1 (1986)
Fred Feldman, Pleasure and the Good Life: Concerning the Nature, Varieties, and Plausibility of Hedonism
Shelly Kagan, " The Limits of Well-Being.: Social Philosophy and Policy. 9 (1992): 169-189
6 Monday, October 14 Well-being (II) Sumner's theory, and informed preferences
L.W. Sumner, Welfare, Happiness & Ethics, ch. 6
James Griffin, Well-Being, ch. 2
David Gauthier, Morals by Agreement, chapter 2.
Peter Railton, "Facts and Values"
7 Monday, October 21 Well-being, preferences and health measurement
Hausman HWCE, ch. 7-8
Richard Kraut, What Is Good and Whyi, sections 16-17, 25-30, 34, 35, 54 (2007)
Hausman, Preference, Value, Choice and Welfare
8 Monday, October 28 Against measuring health by preferences
Hausman HWCE, chapter 9
T.M. Scanlon, What We Owe to Each Other, ch. 3 (1998)
Hausman, "Valuing Health"
9 Monday, November 4 Hedonism and health measurement
Paul Dolan and Daniel Kahneman, "Interpretations of Utility and their Implications for the Valuation of Health" (2008)
Paul Dolan, Using Happiness to Value Health. London: Office of Health Economics, www.ohe.org
Hausman, HWCE, ch. 10
Kahneman, Daniel. 2000. “Experienced Utility and Objective Happiness: A Moment-based Approach.” In Choices, Values and Frames, ed. D. Kahneman and A. Tversky, 673-692. New York: Cambridge University Press and the Russell Sage Foundation.
Kahneman, Daniel and Alan Krueger. 2006. “Developments in the Measurement of Subjective Well Being.” Journal of Economic Perspectives 20: 3–24.
Kahneman, Daniel and Richard Thaler, 2006. Utility Maximization and Experienced Utility.” Journal of Economic Perspectives 20: 221–234.
10 Monday, November 11 Health, welfare and problems with measurement
Hausman HWCE, chapter 11-12
Griffin, Well-Being, chapters 5-6
Phillippa Foot, "Utilitarianism and the Virtues"
Alan Gibbard, “Interpersonal Comparisons: Preference, Good, and the Intrinsic Reward of a Life”
Thomas Scanlon, "Preference and Urgency" (1975)
11 Monday, November 18 Liberalism and the public value of health
Hausman HWCE, chapter 13
Thomas Scanlon, "Preference and Urgency" (1975)
PAPER TOPIC DESCRIPTION DUE
12 Monday, November 25 Cost-effectiveness and public values
ROUGH DRAFTS OF SEMINAR PAPERS DUE
Dan Brock, "Ethical Issues in the Use of Cost-Effectiveness Analysis for the Prioritization of Health Care Resources"
Hausman HWCE, ch. 14, 15
Tan-torres, T., R. Edejer, T. Baltussen, T. Adam, R. Hutubessy, A. Acharya, D. Evans and C. Murray, eds., WHO Guide to Cost-Effectiveness Analysis.
National Institute for Health and Clinical Excellence, How NICE Clinical Guidelines Are Developed: An Overview for Stakeholders, the Public and the NHS
13 Monday, December 2 Private values or public values?
Hausman HWCE, ch. 15, 16
14 Monday, December 9 Ethical policy-making
SEMINAR PAPERS DUE
Hausman HWCE, ch. 17
If my office hours, (Tuesday 1-2, Wednesday 1:30-2:30) are not convenient, see me after class to arrange another time to meet.
Feel free to email me at email@example.com with any specific questions you have about assignments or requirements. If the question and answer are relevant to others, I will post them on the course discussion page. If you do not want your question posted, you should let me know. Otherwise I will assume that in emailing me, you’ve given me permission to post your question. You can send me substantive philosophical questions, too, though in most cases it is better to include the whole seminar in discussions of matters of substance.
Though this should obviously go without saying, particularly in a graduate seminar: Plagiarism is a serious offense. All sources and assistance used in preparing your papers must be precisely and explicitly acknowledged. If you have any questions about what constitutes plagiarism, please come talk with me. The web creates special risks. Cutting and pasting even a few words from a web page or paraphrasing material without a reference constitutes plagiarism. If you are not sure how to refer to something you find on the internet, you can always give the URL. It is generally better to quote than to paraphrase from material on the web, because in the absence of page numbers it can be hard to find passages that are paraphrased rather than quoted. When referring to material from the web, specify the date that you accessed the material in addition to the URL, because web pages (unlike books and articles) change.
Some elementary advice, which you probably already know:
On reading philosophy papers:
1. Use your highlighter sparingly. It is much more useful to pencil in marginal notes summarizing or querying specific points than to highlight passages. Actively engaging the author is much more valuable than merely trying to assimilate the prose. And if you do highlight, only highlight a small percentage of the text. (There is not much point to highlighting everything, apart from adding color to the page!)
2. You should plan on reading the assignments at least twice. During the first reading you should ask yourself:
a. What is the author's position?
b. What is the general structure of the paper? Is it a collection of separate arguments, or does it aim to make one main argument?
c. What are the author's main assumptions? (Where is the author coming from?)
d. Against whom does the author take him/herself to be arguing? What is the context in which the piece was written?
e. What is the main line of argument (or what are the main lines of argument)?
f. What objections does the author address and how successful is the author in answering them?
g. How does the author's position relate to your views? To what extent does the author reinforce or challenge your views?
h. How do the author's arguments relate to the arguments discussed in seminar or in other reading assignments? What criticisms would the author make of arguments developed in seminar or in other readings? To what extent is the position of the author open to criticisms made in seminar or in other readings?
During the second reading of the assigned material, you should proceed more slowly and critically. Rather than asking, as suggested above, questions about what the author's purposes, organization, and argument are, you should try to assess all of these and particularly the author's arguments. Try to study the discussion questions before doing your second reading.
Style and references:
1. You are expected to give references when you cite detailed claims or arguments made in the readings, and your papers should, where appropriate, show familiarity with relevant materials from the seminar or reading for the course. Be sure that your seminar paper is a well organized argument for some clearly articulated thesis.
2. When you quote, paraphrase, or make use of a point made by others, be sure to document the source. I am not particular about what reference style you use. All that matters is that your references be precise and usable. If you say that Parfit says that there are 13 theories of well-being, it should be clear from your text on what page Parfit supposedly says that. The easiest way to give a reference is simply to put the source and page number in parenthesis. Papers without clear references (where needed) will be marked down.
3. Papers must be typed or printed double-spaced with wide margins (at least one inch) on all sides, so that there is plenty of room for marginal comments.
Hints on essay writing:
1. The point is to write a well-organized and unified argument for some clearly enunciated conclusion. The task of writing a good essay is virtually identical with the task of thinking out a clear thesis or conclusion that you want to defend and then elaborating and defending it. You should be able to say clearly and precisely not only what your seminar paper is about, but also what your paper maintains or shows. Be sure your seminar paper has both a thesis--that it asserts something definite--and a logical organization. Once it is clear what you what to show, you will have a criterion to decide what is relevant and the basis for organizing your paper. Can you put your main point clearly in a sentence? Can you say clearly in a sentence what your paper shows or proves? Are all the parts of your paper relevant to your main point? Is the structure of your argument clear? No good essay merely summarizes things you have read and then offers your remarks or points of comparison or differences you noticed. Every acceptable essay integrates its remarks into an argument of its own. Exposition of the views of others should always be part of your argument for your thesis.
2. Note that a well-organized paper is not merely orderly. For example, a paper that argues that Scanlon argues claims 1, 2, and 3 and that one can defend claim 1 as follows, claim 2 as follows, but not claim 3 is certainly orderly, and it certainly has a thesis. But it would only be well-organized--truly one paper rather than three--if the discussions of the three claims bore some relations to one another and if the paper added up to some unified and substantive statement. Section headings are fine, but only as a supplement to excellent transitions, not as a substitute for them
3. Avoid first paragraphs that say things such as, "First I will discuss the views of Griffin and Sumner. Then I will discuss their strengths and weaknesses. Then I will compare their conclusions and formulate my opinion." Passages such as these make it sound as if your argument will begin only on the last page. Exposition of the views of others has to find its place within your argument, not as a preface to your argument. If you think in terms of what you want to establish, and outline your paper in terms of stages in your argument, your essay will be much stronger.
4. Try to say exactly what you mean. Pay careful attention to your language. Sentences such as "Hausman consists of 17 chapters" does not, I hope, say what the author means. (I hope there is more to me than chapters.) Value your words and use them accurately.
5. To help in organizing your thinking, you should attempt to answer the following three questions:
1. What is your thesis--that is, what is it that you are trying to maintain or show or prove? What is your main argument for your thesis?
2. What is the most important objection to or criticism of your thesis that you need to consider? Formulate that objection or criticism as an argument.
3. What is your argument in response to the objection or criticism mentioned in answer to question 2?
If you cannot answer these questions clearly and easily, then there are serious problems with your paper. Do not regard your papers as finished or acceptable until each clearly implies answers to the above questions. (But an essay is not, of course, a list of answers to any set of questions.) Taking the task of answering these questions seriously can make a big difference in the quality of your paper.
Some recommendations on how to write badly: (adapted from Martin Hassel http://lacasahassel.net/cv/martin/howto.htm)
1. Begin with a sentence that is clear and direct:
Dan Hausman argues that health cannot be measured.
2. Change its verbs, adjectives, and adverbs into abstract nouns:
Dan Hausman's argument is that the measurement of health is impossible.
3. Make the sentence passive:
The impossibility of the measurement of health is argued by Dan Hausman.
4. Add unnecessary adjectives:
The complete impossiblity of the valid measurement of health is unequivocally argued by Dan Hausman.
5. Use two words where one will do:
The complete and total impossibility or infeasibility of the valid and justifiable measurement of health or illness is unequivocally asserted and argued by Dan Hausman.
6. Use plenty of 'in regard to,' 'as to' and similar terms:
With respect to the question of the valid and justifiable measureability of people's health, its complete and total impossibility or infeasibility is unequivocally asserted and argued by Dan Hausman
7. Sprinkle with words that do not add anything:
With respect to the question that one might pose concerning the possible or feasible valid or justifiable measurability of people's various different conditions or health or illness, its affirmative answere is ruled out definitively and unequivocably by arguments presented by Dan Hausman.
8. Use negatives:
With respect to the not yet discarded question that one might not dismiss concerning the not impossible nor infeasible valid or not unjustifiable measurability of people's various conditions of health or illness, its affirmative answer is ruled out definitively and unequivocably by arguments presented by Dan Hausman.
Why would settle for 1, when you can produce a baroque masterpiece like 8?
When working on your seminar papers, feel free to come talk with me. In addition, there are some excellent resources on the web for writing philosophy papers. I particularly recommend:
UW-Madison Writer's Handbook This excellent handbook is produced by The Writing Center here. Highly recommended!
www.sfu.ca/philosophy/writing.htm This is brief, clear, and helpful.
http://www.princeton.edu/~jimpryor/general/writing.html Excellent, but much lengthier.
www.unc.edu/depts/wcweb/handouts/philosophy.html For those who are serious about philosophy.
www.cofc.edu/~portmord/tips.htm Contains lots of references for further study.
A good general source on writing is Strunk and White's The Elements of Style. The first edition is available on the web at http://www.bartleby.com/141/