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Major Insight: Unraveling the National Debate on Healthcare

Sara Rosomoff

A production of Miami University and the Reframe podcast, Major Insight showcases the stories behind successful college students, their promising new research, and its relevance in our world.

While studying economics and political science at Miami, Sara Rosomoff researched the complex history of Medicare and Medicaid unraveling the the ongoing debate about nationalizing health insurance in the United States. Working with economics faculty member Dr. Melissa Thomasson, Sara's research will soon be published in a book about U.S. healthcare policy published by the University of Chicago.

Featured Majors

Economics, Political Science, Spanish

Featured Organizations

King Library, Department of Economics

Read the transcript

Announcer:

Major Insight is a production of Miami University and the Reframe podcast. This is where we showcase successful students, their promising new research, and its relevance in our world. 

(MUSIC)

Where some people see challenges, Sara Rosomoff sees opportunities. Sara proves what can be accomplished when we explore every avenue, ask every question, and take advantage of every available resource.

While studying economics and political science at Miami, Sara embraced this philosophy to research the complex history of Medicare and Medicaid, which will soon be published in an upcoming book about U.S. healthcare policy.

Her work not only furthers our understanding of how and why healthcare has become such a controversial issue. Her approach to this work also serves as a guide for all students who hope to overcome the unforeseen challenges of pursuing their own passion projects.

Now, here’s Sara Rosomoff, and Major Insight host Jacob Bruggeman, with more.

Jacob Bruggeman:

All right Sara, welcome to the podcast. So could you start by giving us a little bit of an overview of your research interests? You're in a combined BA/MA program, so you could talk about, you know, some of the more undergraduate specific research projects versus the master's thesis you're working on now. And then, just generally, any sort of outstanding experience you've had at Miami University.

Sara Rosomoff:

Yeah. Sounds great Jacob. So my undergraduate research interests were actually a little bit outside the box for most people. I do have a Spanish minor. So I primarily started in research with linguistics, specifically, and running my own randomized controlled trials for a variety of different Spanish linguistics topic areas. But as I moved into more of the graduate level, because I am in the BA/MA program, I wanted to really…

Jacob Bruggeman:

In economics.

Sara Rosomoff:

In economics, specifically. I also have a bachelor’s in political science. And I really wanted to combine all three degrees sort of into one. And I started working with Dr. Thomasson, the new chair of the Economics Department, on her latest book, which is going to be about healthcare policy. And I wanted to primarily look at things in a historical sense. So where my research now is focusing on Medicare and Medicaid, and specifically into how Medicare itself has come into being. The original 1965 bill. And what factors led to that? Because we've seen in history that nationalized health insurance has never been something that the U.S. has been able to pass in terms of Congress and legislation. Even in the state levels, and local levels. So why is Medicare and the Medicaid bill so different, really, is what I wanted to look at. And in addition to that, with Medicaid, once it's adopted, why did they adopt it? And why did they choose the level of benefits they did? And that's where my research primarily is focused today.

Jacob Bruggeman:

So when you were coming to this thesis in your master's program, how have you set parameters for yourself in terms of a research agenda? How has your adviser been essential or, you know, what methods have you been employing to keep on track?

I think a lot of students, particularly younger students, students who are maybe considering a BA/MA program or a substantive research project, often feel overwhelmed when they're looking at a project, particularly one that would be, as you say, like a history of Medicare, which is a huge issue. How do you pace yourself? A lot of questions wrapped in there. But generally comment on the process of research that you've been engaging with.

Sara Rosomoff:

Yeah. I think, you know, it's nice to be a part of like a master's program, especially in this hybrid one that I'm in to work alongside traditional master students, and see where everyone's theses have progressed to this point. And I will say the number one thing that I've learned is that it's all about time management. Really, that is … if anyone's written a paper of any kind, you know that setting those kinds of goals for yourself, you have to have them. And my advisor has been really helpful in that area, and also just guiding me as to what do I do next? How do I tackle this issue? And providing me with that advice. 

And so, I started actually over the summer. So I guess Summer 2018, sort of looking into the actual history. Started reading some books, and that kind of thing. And I didn't actually start collecting data until about August. So once the actual academic year started. And for me, my challenge, because it is a historical paper mainly has been gathering that kind of data. It's not as prevalent, and it's not as clean as you would like it to be. And some of it doesn't even exist. Because it is the year 1965. That was actually the first … 1960 was the first time the mail in census was sent out. If that gives you a perspective of what kind of technology was even available to collect data. I was …

Jacob Bruggeman:

That’s fascinating

Sara Rosomoff:

Yeah. So, before they had just gone door-to-door. Now we can actually gather a little bit more accurate pieces of data. But the data that I would like to have had, you know, concerning like the AMA, and like other interest groups funding, it's not available. It's just doesn't … it's not there. I don't even have, you know, state unemployment rates at that time. Because just doesn't exist. Or it's somewhere where I can't even access it. And that's another piece of the puzzle. You know, you don't think about that when you're writing a thesis is that maybe I don't even have all the tools that I need to start writing it.

But it's been extremely helpful to really learn how to gather data, and how to conduct that kind of research. Because now I have access to all these databases, and I've called professors across the country, and said, “hey, can I have your data? Can we look at this together?” Some of it I've hand coded myself from books. I've gone into the depths of the library where no one goes, with the dust and the cobwebs, and said here's the statistical abstracts for the year 1970. Let's look at that and see what's there. And that's been an amazing experience, I think.

And my advisor has been there every step of the way. We meet every week, once a week, to talk about it. And she even has helped me analyze the data. She's pointed me and said, “take this book from my shelf. Go read it. Come back. Let's talk about it. Where do you want to go with this, and what do you think we need?” And so, although the idea may have started from her, and it was born with her book, ultimately she said, “what do you want to do? What do you think would be a good idea? Why do you hypothesize this is going to happen?” And I've had to create that on my own, and which is both frightening. But it's also great. Because it gives you creative license to go with your research, and actually find something that might be useful to someone. Maybe someone who's writing about the ACA might be able to build a predictive model from this and go, hey, we can start looking at what other pieces of legislation, you know, what factors were key in those passages.

That's the kind of thing that's amazing to me about research is that I'm contributing some small piece. Even though I'm just, you know, a student I'm not even 22 years old yet. I get to contribute, I think that's great.

Jacob Bruggeman:

So I'm curious about how, as you've been researching, you've dealt with the challenges, the unforeseen challenges, again, that's something that young researchers may not know that, you know, inevitably your project will evolve based on what sources you find. And to be successful, you ultimately have to be adaptable based on that, you know, the source environment, so to speak. And I'd be curious if you could just comment on how you've been dealing with that, especially because, you know, the data that you want have been absent, which is a big challenge. But one that you've surmounted. 

Sara Rosomoff:

Yeah. I think part of it has been knowing what resources you do have available to you, and you'd be surprised as to what is actually out there. So maybe the data isn't as perfect as you'd like it to be, and maybe it's not quite what you, you know, quite as accurate. But you can find some pretty good substitutes. I mean, one of the things that we discussed was that maybe we don't have funding. Maybe we can't talk about, you know, how these interest groups, in an empirical sense, affect the data. But we can find things like the number of doctors or the presence of hospitals in the state itself, who were members and supporters of these interest groups. And so, by that you can kind of shift the effect. So maybe it's not quite an accurate predictor of how the AMA’s presence was in that state. But you can gauge it. And then assume and presuppose that the presence was probably very large if there's a lot of doctors in that state. Or there's a lot of hospitals, you would see the demand rise for that. And that's one thing you can do is find substitutes for your data. 

But also seeking out creative ways to get around that too is important. So one of the things I've learned in the last several months is the library has incredible researchers as its staff, who are able to point me to things like national surveys. Maybe we don't have census data. But we do have a survey of 1% of the population that we can, you know, multiply out. And now you have a full sample that you can use for a particular piece, or a variable that you're looking for. And those have been crucial to the entire process. And, ultimately, it might be difficult. You might feel discouraged. But part of being a researcher is also kind of being a detective, in a way, particularly for historical papers.

Jacob Bruggeman:

Absolutely

Sara Rosomoff:

… more than anything, I think is the key.

Jacob Bruggeman:

Yeah and your mention of librarians is crucial. A librarians need love, first and foremost.

Sara Rosomoff:

They do.

Jacob Bruggeman:

They are often unrecognized resources in the sense that you've mentioned, which is that they are very well trained in terms of, you know, getting research and discovering sources. And for any student who is thinking about research, that resource should be utilized. It's a human capital that we have at the university that is essential to and crucial to success.

Sara Rosomoff:

Shout out to Eric Johnson. He’s been amazing.

Jacob Bruggeman:

It's obviously a hot and hotly debated topic at the moment. It seems like much of the news in our current political climate is about the question of health care. Who deserves access to health care? You know, different modes of delivering health care. And so, is there any way in which doing this research has prepared you or given you a particular lens to interpret the news as it's coming out. And, generally speaking, how has this sort of informed your perception of the current public debate?

Sara Rosomoff:

Yeah. I think it's actually extremely relevant to the topic, you know, that's being debated today, which is should we have compulsory, you know, health insurance in the U.S.? Much like, you know, the European models have shown us over decades.

And I think my research has definitely highlighted the fact that this has been an issue that's been a part of our national conversation since the early 1900's. We started seeing this conversation come up when the Europeans started adopting their model at that time. The AAL had started crafting legislation and trying to push for that. They were defeated in Congress. You saw it again with Roosevelt. FDR's time with the New Deal. Again it was defeated. And then once more with Truman. He also put forth a very similar bill. And three times over the U.S. wasn't going to adopt it. And then Medicare was enacted. Smaller, albeit. It's not national, in terms of including the entire population. But it is still a federal health insurance program.

And I think today the opposition and proponents of Medicare for all and compulsory insurance are saying the same arguments that we've heard for decades, which is what I've sort of found in my research, which is this idea that there is a need to care for a greater part of the society. That people do need health insurance. It is a right. And for many people that health care is. And that's what a, you know, proponents are saying. And, on the opposition, it's like we can't afford this. This is socialized medicine. And that's something that the AMA, the American Medical Association, started talking about as soon as like the early 1930's. And even before that, they've declared their public opposition for it.

And I think even in … it was like the early 1950's, they launched a campaign against socialized medicine that, at the time, was 1.5 million dollars. It was the most expensive lobbying effort in the history of the U.S., at the time. And you can see that reflected again in today's society, and I think this research has really been showing me that, you know, history repeats itself. And people don't change. And they recycle those same arguments over and over. And there is a reason that we can't pass health insurance in the U.S. It's … a lot of it has to do with the messaging, and the money that's being flown, you know, in through these lobbying groups, in these efforts. And that's really what has caused the defeat of it. Because our conversations are not the same as what the Europeans were having. And our values, and things like that, are not the same. And that's really what's led to this topic of controversy. And I don't think … until we can overcome that, things aren’t going to change.

Jacob Bruggeman:

You mentioned interest groups. And so, another hotly debated topic, seemingly. People argue that from the pharmaceutical industry to, you know, the AMA even, interest groups have some sort of perverse impact on the policy outcomes, especially in health care. And so I'm curious, based on your research and how interest groups fall in there, what do you make of the public portrait of interest groups at this moment? I think it's more often than not a negative one. But one that might be contextualized by what you're learning and researching at the moment. 

Sara Rosomoff:

Mm-hmm. Definitely. You know, it's an interesting topic to think about. Because everyone wants to assume that people have the best intentions. Right. You want to believe that money isn't really your primary motivator for doing certain things, particularly in policy. That you would think with health care that you would want the best outcome for the right reasons. And that doesn't always happen. I won't point fingers as to who is, you know, really the villain. Because I think, honestly, with health care it's extremely muddled. It's a huge web of sources that are causing issues with the system, in terms of money especially.

But I will say, with interest groups, they do cause quite a bit of controversy, and they do have a lot of power, ultimately, if you look at it from a very objective point of view. But I think it definitely plays a role in it. You would be naive to think that money doesn't have power in U.S. Politics.

Jacob Bruggeman:

Absolutely. While looking to the future, the book’s coming out with the University of Chicago. So that's on the horizon for you. But what else is coming up. Graduation is looming. You're looking at jobs in the private sector, graduate school. Walk us through what you're thinking at this moment.

Sara Rosomoff:

I do already have a job secured in Cincinnati, so I'll still be local, with Deloitte. I will be working in the private sector with consulting - working on strategy and operations projects for a variety of different companies in the foreseeable future. I would like to be working towards federal policy consulting in that sort of environment in the near future, probably in the next five years would be the goal, ultimately. So that's kind of what's coming. I'm excited but, uh, it's a lot.

Jacob Bruggeman:

It's nerve-racking for sure. As is the prospect of a revamped healthcare system. Well, until then, thank you for coming on the podcast. It’s appreciated.

Sara Rosomoff:

Yeah. No problem.

(Music Up)

Announcer:

Sara Rosomoff earned dual degrees in Economics and Political Science. And her thesis on the history of Medicare and Medicaid will be published as a chapter in a new forthcoming book on U.S. healthcare, which will be out later this year.

Major Insight a production of Miami University and the Reframe podcast. If you enjoyed this episode, please share it with a friend. More episodes are free on Apple Podcasts and on Google Play Music.

SHOW NOTES:

A production of Miami University and the Reframe podcast, Major Insight showcases the stories behind successful college students, their promising new research, and its relevance in our world.

While at Miami, Sara researched the complex history of Medicare and Medicaid, which will be published in a new book about U.S. healthcare policy. Her findings help to unravel how we got to where we are and factors to be considered as the debate on nationalizing health insurance in the United States continues.

Featured Majors/Minors: 
Economics, Political Science, Spanish 

Featured Organizations:
King Library, Department of Economics

Major Insight

 

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Major Insight is a production of Miami University and the Reframe podcast. This is where we showcase successful students, their promising new research, and its relevance in our world.

Host Jacob Bruggeman

Jacob Bruggemam

The Major Insight podcast is hosted by Jacob Bruggeman. Bruggeman, a Miami Honors student and double-major in History and Political Science created the podcast to feature stories of students navigating 21st century academic life.

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