I. Defining, Evaluating and Distributing Health Care: An Introduction
A. Defining Sickness: Break-out Text (BT) pp. 1- 20; Main Text (MT) pp. 1-27.
1. Katskee v. Blue Cross, BT p. 3, MT p. 17. Pay special attention to answering the reading questions below in preparing for class. Please type out the answers to these questions and turn them in at the start of class. Be sure to keep a copy for yourself to use in class.
2. Problem: “The Couple’s Illness,” BT p. 10, MT p. 26. Be prepared to discuss this problem. Use the answers to the questions below to help you analyze this problem.
3. Skills Training Exercise #1: "How to Analyze an Insurance Coverage Dispute Using the Katskee Case." We will be doing this exercise in class.
Katskee: Reading Questions (Please answer and bring to class)
1. What kind of services will a health insurance policy pay for as a general matter?
2. What are conditions that are deemed to be an "illness" within the meaning of the policy?
3. What role does "intent of the parties" play in deciding what is an "illness"?
4. What are the basic rules of contract construction and how do they play in Katskee? (List the rules of contract construction contained in the reading).
5. Was the term "illness" in Katskee found to be ambiguous?
6. How did the court define "illness"?
7. What is a "normal" condition and what is a "deviation" from normal?
8. How does the Silverstien case cited in Katskee help the analysis?
9. When is the "sick role" appropriate in our society?
10. What benefits and protects does our society offer to those we label as "sick"?