Writing Assignment #2
The Four-Source Essay:
Summary of assignment
Task: The four-source essay asks you to synthesize the arguments of four sources.
Length: minimum of 1000 words. The instructor will give you comments on the first
draft and let you know if you need more development beyond 1000 words.
Sources: four sources, all of which you will find through library searches. You will
select a topic of your choice, conduct searches in the library databases, focus the topic,
and determine four sources to use in this essay.
o Please use only four sources. Please do not incorporate more than four sources
into this essay.
Articles to Use for the Essay
For this essay, you will select four articles on a topic of your choice. The articles should be on
the same topic but feature different perspectives, opinions, or conclusions about some aspects of
For example, if you are majoring in cybersecurity, you might locate four articles about the need
for improved training for employees on mobile security issues. The four articles might take
different angles on the topic, perhaps even disagreeing in some respects.
To use another example, if you are majoring in criminal justice, you might locate four articles on
the CSI Effect. The articles should take different perspectives on the topic. Perhaps one or two
of them say that the CSI Effect exists and one or two say that it does not exist. Or perhaps all
agree that it exists but they all take slightly different approaches to addressing the problem.
Organization for this Essay
You will write an introductory paragraph with a thesis statement. Your thesis statement will
demonstrate what the various sources say on the topic. You might use the Forrest Gump
exercise as an example, although keep in mind that that essay was written in a less formal style
than you want to use for this assignment.
You will also have various body paragraphs that show synthesis. In synthesizing sources, you
will divide your paper into themes.
For example, let us assume that you find four articles on the need for improved training for
employees on mobile security issues. In this situation, assume that the four articles emphasize
different issues. One emphasizes the costs of data breaches to companies. Another emphasizes
reasons that employees do not practice safe cybersecurity practices. Another discusses methods
for training employees. Another mentions costs of training for such initiatives.
You might divide the paper into two categories:
• Reasons for implementing a training program
• Methods of and costs involved in implementing a training program
Point of view
For this essay, you will use third-person point of view.
Please do not use first person point of view (e.g., “I,” “me,” “we”) in writing this essay.
In addition, please do not use second-person point of view (“you” or “your”) in writing this
essay. For example, instead of “Smith argues that, as a director, you have a duty to coordinate
cybersecurity efforts...” you would write, “Smith argues that directors have a duty to coordinate
The paper should be formatted in APA style. The video How to format your paper according to
APA style might be helpful to watch. In summary, you should observe the following:
Use one-inch margins.
Use size 12 Times New Roman font.
Include a running head.
Include page numbers.
Include a title page.
Include a “References” page on which you list the four articles in APA style
Do not include an abstract. This paper is not long enough to warrant an abstract.
Submitting the assignment:
You will submit a first draft of the essay to the assignment folder. The first draft will not be
graded. The instructor will provide comments to it.
After receiving comments from the instructor, you will submit a revised draft. The final draft
will be graded.
Kennedy, M.L. and Kennedy, W., “Synthesis,” from Writing in the disciplines: A reader
and rhetoric for academic writers. This chapter in in the e-reserves of our class. It
provides an excellent description of an exploratory synthesis essay, a literature review,
and a thesis-driven synthesis essay.
Graff, G. and Birkenstein, C., They Say / I Say: The Moves that Matter in Academic
Writing with Readings. This chapter in in the e-reserves of our class. It mentions
various techniques to apply in stating what an author said and your response to the
author. It is recommended that you read through that chapter so that you might apply
these techniques to this essay.
Running head: UNIVERSAL HEALTHCARE
Would America Benefit from Universal Healthcare?
November 03, 2018
Card, D., Dobkin, C., & Maestas, N. (2008). The Impact of Nearly Universal Insurance
Coverage on Health Care Utilization: Evidence from Medicare. American Economic
Review, 98(5), 2242-2258. doi: 10.1257/aer.98.5.2242
In the article “The Impact of Nearly Universal Insurance Coverage on Health Care
Utilization: Evidence from Medicare” authors David Card, Carlos Dobkin, and Nicole
Maestas analyzed health-related outcomes among people just before and just after the age
of 65. They used survey data from the 1992-2003 National Health Interview Study to
analyze changes in self-reported access to care, and in the number of recent doctor visits
and hospital stays. Data from hospital discharge records from California, Florida, and
New York between the years of 1992-2003 were used to measure changes in hospital
admissions for specific conditions and procedures, and by hospital type. They also
focused on the differential effects of Medicare eligibility on different subgroups (i.e.
racial groups, recipients of SSDI). They found that Medicare eligibility causes a sharp
increase in the use of health care services, with a pattern of gains across groups that
varies by the type of service. The onset of Medicare eligibility leads to an increase in use
for low-cost services mainly among groups with the lowest rates of insurance coverage
for individuals under the age of 65. High cost procedures, such as bypass surgery and hip
and knee replacement, are more utilized among individuals that are more likely to have
supplementary insurance coverage after age 65. One weakness to this study is the sample
size, it’s too small. California, Florida, and New York are the top three states with the
highest number of Medicare beneficiaries, but following them are Texas, Pennsylvania,
Ohio, Illinois, Michigan, North Carolina, and New Jersey. If additional states were
included in this study, then it would be a better representation of the American
Courtemanche, C.J., & Daniela, Z. (2014). Does Universal Coverage Improve Health? The
Massachusetts Experience. Journal of Policy Analysis & Management, 33(1), 36- 69. doi:
Authored by Charles J. Courtemanche and Daniela Zapata, the article “Does Universal
Coverage Improve Health? The Massachusetts Experience” analyzed the effects of the
health care reform legislation passed in Massachusetts in 2006. This reform legislation
was designed to achieve nearly universal coverage through a combination of insurance
market reforms, mandates, and subsidies and would later serve as the model for national
reform in the United States. They collected data from the Behavioral Risk Factor
Surveillance System, a telephone survey of health and health behaviors conducted by
state health departments in collaboration with the Centers for Disease Control and
Prevention, to demonstrate that the reform led to better overall self-assessed health
specifically physical health, mental health, functional limitations, joint disorders, and
body mass index. One weakness to this study is that the BRFSS does not indicate the
source of coverage nor does it provide any information on premiums, deductibles, or copayments. To compound this, any kind of health care coverage (i.e. HMOs and Medicare)
were treated as coverage. If the BRFSS did provide those elements, then the authors
could assess if one’s perception of their overall health was affected by those specific
factors of their health care coverage, reflecting their true perception of their overall
Gray, V., Lowery, D., Monogan, J., & Godwin, E. K. (2010). Incrementing Toward Nowhere:
Universal Health Care Coverage in the States. The Journal of Federalism, 40(1), 82-113.
In the article “Incrementing Toward Nowhere: Universal Health Care Coverage in the
States” authors Virginia Gray, David Lowery, James Monogan, and Erik K. Godwin
sought to answer if the factors stopping health reform at the national level also restrict
states and if the steps that states have taken toward coverage likely to lead to real reform.
Observing successful adoption of health care reforms, the states have not been any more
successful than the federal government in attaining universal coverage. The authors
analyzed state activity from 1988 to 2002 demonstrating that where Democrats are in
charge and where their allied interests predominate, state legislative activity on universal
care is more likely. The authors focused on five levels of legislative activity, scored from
one to regarding their proximity to the goal of delivering universal health access to
citizens: (1) commissioning a study on health reform that includes the option of universal
coverage, (2) either introduction of a bill in the legislature to establish such a program,
set a goal of universal coverage, initiate the process of amending the constitution, or call
for a referendum on universal coverage or other evidence of significant activity, such as a
hearing by a legislative committee, (3) passage of a bill by one chamber of the
legislature, (4) passage of a bill by two chambers, and (5) signing of a bill into law by the
governor. Results indicate that incremental efforts promoting universal health care
access are unlikely to succeed. One strength to this study was how the authors measured
state activity. They used archives of the Intergovernmental Health Policy Project (IHPP)
and the National Conference of State Legislatures (NCSL)- whose health policy experts
identified individual bills fitting the definition of universal health insurance. Bills for
three years come from the IHPP and for ten years come from NCSL. Using the NCSLs
definitions, they then identified universal coverage bills from the Lexis/Nexis Bill
Tracking database for four more years. They were then able to piece together systematic
information on all universal health care legislation considered in all fifty states back to
1988. In their dataset, they were able to include all states (except for Hawaii’s) very first
universal healthcare enactment and also included four other stages of policy activity in all
fifty states over fifteen years.
Kail, B. L., Quadagno, J., & Dixon, M. (2009). Can States Lead the Way to Universal Coverage?
The Effect of Health-Care Reform on the Uninsured. Social Science Quarterly, 90(5),
1341 – 1360. doi: 10.1111/j.1540-6237.2009.00658.x
Authored by Kail, B. L., Quadagno, J., & Dixon, M, the article “Can States Lead the Way
to Universal Coverage? The Effect of Health-Care Reform on the Uninsured” assessed
the impact of state policy reforms on health insurance coverage in the United States
considering three approaches to reform: consumer protection policies, policies relaxing
regulation on insurance companies, and policies expanding public benefits. They
collected data from numerous sources to estimate state insurance coverage using fixedeffects pooled time-series regression from 1992 to 2005. One weakness to this study is
that the authors did not measure the percentage of Asians as a control variable. They only
measured the minority population with the percentage of African Americans and the
percentage of Hispanics compared to whites. The study concluded that states can cover
the uninsured for a short term but are incapable of doing so in the long-run.
Shen, M. J., & LaBouff, J. P. (2016). More Than Political Ideology: Subtle Racial Prejudice as a
Predictor of Opposition to Universal Health Care Among U.S. Citizens. Journal of Social
and Political Psychology, 4(2), 493-520. doi: 10.5964/jspp.v4i2.245
Authored by Megan Johnson Shen and Jordan P. LaBouff, “More Than Political
Ideology: Subtle Racial Prejudice as a Predictor of Opposition to Universal Health Care
Among U.S. Citizens” analyzed if subtle racial prejudice predicted negative attitudes
towards policies, such as universal health care, which are assumed to benefit racial
minorities. Three studies, conducted in the U.S.A., found that universal health care
attitudes among U.S. citizens could be predicted by one’s subtle racial prejudice, a
display of the U.S.A.’s negative associations between subtle racial prejudice and aversion
to governmental assistance programs (which are generally utilized by the poor). One
strength to this study was its inclusion of additional variables to rule out alternative
explanations for the relationship between racial prejudice and universal health care
support. For example, 12-item scale was used to measure attitudes toward the poor on a
5-point Likert-type scale (i.e. I try to avoid contact with poor people; 1 = strongly
disagree, 5 = strongly agree). This is substantial because, statistically, poverty is higher
American Economic Review 2008, 98:5, 2242–2258
The Impact of Nearly Universal Insurance Coverage on Health
Care Utilization: Evidence from Medicare
By David Card, Carlos Dobkin, and Nicole Maestas*
One-fifth of nonelderly adults in the United States lacked health insurance coverage in 2005.
Most of these were from lower-income families, and nearly one-half were African American or
Hispanic (Carmen DeNavas-Walt, Bernadette Proctor, and Cheryl Hill Lee 2005). Many analysts
have argued that unequal insurance coverage contributes to disparities in health care utilization
and health outcomes across socioeconomic groups. Even among the insured there are differences
in copayments, deductibles, and other features that affect service use. Nevertheless, credible
evidence that better insurance causes better health outcomes is limited (M. E. Brown, A. B.
Bineman, and N. Lurie 1998; Helen Levy and David Meltzer 2001). Both the supply and demand
for insurance depend on health status, confounding observational comparisons between people
with different insurance characteristics.
In contrast to the heterogeneity among the nonelderly, fewer than 1 percent of the elderly population are uninsured, and most have fee-for-service Medicare coverage. The transition occurs
abruptly at age 65, the threshold for Medicare eligibility. Building on this fact, in this paper we
use a regression-discontinuity framework to compare health-related outcomes among people just
before and just after the age of 65. Our analysis extends existing research on the effects of the
age 65 threshold (Frank R. Lichtenberg, 2002; William H. Dow 2003; Sandra Decker and Carol
Rapaport 2002a; Decker 2002; Decker and Rapaport 2000b; J. Michael McWilliams et al. 2003)
in two main ways. First, we examine a wider range of outcomes. We use survey data from the
National Health Interview Survey (NHIS) to analyze changes in self-reported access to care, and
in the number of recent doctor visits and hospital stays. We supplement these data with hospital
discharge records from California, Florida, and New York, which allow us to measure changes
in hospital admissions for specific conditions and procedures, and by hospital type. Second, we
focus on the differential effects of Medicare eligibility on different subgroups, and use the pattern of intergroup differences to assess whether these impacts arise through changes in insurance
coverage, insurance generosity, or other channels. We also quantify the extent to which the onset
of Medicare eligibility reduces or increases disparities in use of different types of services.
Our main finding is that Medicare eligibility causes a sharp increase in the use of health care
services, with a pattern of gains across groups that varies by the type of service. For relatively
low-cost services, such as routine doctor visits, the onset of Medicare eligibility leads to increases
in utilization that are concentrated among groups with the lowest rates of insurance coverage
* Card: Department of Economics, University of California, Berkeley, 549 Evans Hall, #3880, Berkeley, CA 947203880 (e-mail: email@example.com); Dobkin: Department of Economics, University of California, Santa Cruz, 1156
High Street, Santa Cruz, CA 95064 (e-mail: firstname.lastname@example.org); Maestas: RAND Corporation, 1776 Main Street,
PO Box 2138, Santa Monica, CA 90407-2138 (e-mail: email@example.com). We are grateful to Elizabeth Weber and
Florence Neymotin for outstanding research assistance, and to Thomas Lemieux, Guido Imbens, and participants in
the RAND Health Economics Seminar, NBER Summer Institute, and the UCLA Applied Micro Seminar for comments and suggestions. This paper was supported by the National Institute on Aging through grant numbers 1 R01
AG026290-01A1 and 1 R03AG025155, by a pilot grant from the Center for the Economics and Demography of Aging
at UC Berkeley under P30 AG12839-09, and by the Center for Labor Economics at UC Berkeley. Its contents are solely
the responsibility of the authors and do not necessarily represent the official views of the National Institute on Aging.
VOL. 98 NO. 5
card et al: The effect of medicare on health care utilization
for persons under the age of 65. For relatively high-cost procedures—including hospitalization
for procedures like bypass surgery and hip and knee replacement—the gains are concentrated
among groups that are more likely to have supplementary insurance coverage after 65. These
patterns, coupled with evidence of a redistribution of patients across hospital ownership categories once Medicare is available, suggest that the distribution of gains in use of health services is
driven by an interaction between supply-side incentives and shifts in insurance characteristics
for different socioeconomic groups.
I. Measuring the Causal Effect of Health Insurance
We work with a simple reduced-form model of the causal effects of health insurance status:
yija 5 Xija a 1 fj (a; b) 1 gk Cija
d 1 uija,
where yija is a measure of health care use for individual i in socioeconomic group j at age a, uija
is an unobserved error component, Xija is a set of covariates (e.g., gender and region), fj 1a; b 2 is
a smooth function representing the age profile of outcome y for group j, and C kija 1k 5 1, 2, … , K2
are characteristics of the insurance coverage held by the individual. These can include a simple
coverage indicator as well as variables summarizing other features such as copayment rates or
the presence of gatekeeper restrictions.
A fundamental problem for the estimation of equation (1) is that insurance coverage is endogenous. The age threshold for Medicare eligibility at 65 provides a credible source of exogenous variation in insurance status. To illustrate this claim, Figure 1 shows the age profiles of health insurance
coverage estimated with data from the pooled 1999–2003 NHIS, where age is measured in quarters
(the sample is described below and in more detail in the online Appendix, available at http://www.
aeaweb.org/articles.php?doi=10.1257/aer.98.5.2242). Overall coverage rates (plotted with open diamonds) rise from 85 to 96 percent at age 65. Even more striking is the impact of Medicare eligibility on differences across socioeconomic ...
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