Don’t reserve your best business thinking for your career..docx

Don’t reserve your best business thinking for your career.
How Will You
Measure Your Life?
[ B Y C L A Y T O N M . C H R I S T E N S E N ]
EDITOR’S NOTE: When the members of the class of 2010
entered business school, the economy was strong and
their post-graduation ambitions could be limitless.
Just a few weeks later, the economy went into a tailspin.
They’ve spent the past two years recalibrating their
worldview and their defi nition of success.
The students seem highly aware of how the world
has changed (as the sampling of views in this article
shows). In the spring, Harvard Business School’s gradu-
ating class asked HBS professor Clay Christensen to ad-
dress them—but not on how to apply his principles and
thinking to their post-HBS careers. The students wanted
to know how to apply them to their personal lives. He
shared with them a set of guidelines that have helped
him fi nd meaning in his own life. Though Christensen’s
thinking comes from his deep religious faith, we believe
that these are strategies anyone can use. And so we
asked him to share them with the readers of HBR.
46 Harvard Business Review July–August 2010
1252 JulAug10 Christensen Layout.indd 461252 JulAug10
Christensen Layout.indd 46 6/8/10 1:29:41 PM6/8/10

1:29:41 PM
Before I published The Innovator’s Dilemma, I got a
call from Andrew Grove, then the chairman of Intel.
He had read one of my early papers about disruptive
technology,
and he asked if I could talk to his direct reports and explain my
research and what it implied for Intel. Excited, I fl ew to Silicon
Valley and showed up at the appointed time, only to have Grove
say,
“Look, stuff has happened. We have only 10 minutes for you.
Tell us what
your model of disruption means for Intel.” I said
that I couldn’t—that I needed a full 30 minutes
to explain the model, because only with it as
context would any comments about Intel make
sense. Ten minutes into my explanation, Grove
interrupted: “Look, I’ve got your model. Just tell
us what it means for Intel.”
I insisted that I needed 10 more minutes
to describe how the process of disruption had
worked its way through a very diff erent industry,
steel, so that he and his team could understand
how disruption worked. I told the story of how
Nucor and other steel minimills had begun by
attacking the lowest end of the market—steel re-
inforcing bars, or rebar—and later moved up to-
ward the high end, undercutting the traditional
steel mills.
When I finished the minimill story, Grove

said, “OK, I get it. What it means for Intel is…,”
and then went on to articulate what would be-
come the company’s strategy for going to the
bottom of the market to launch the Celeron
processor.
I’ve thought about that a million times since.
If I had been suckered into telling Andy Grove
what he should think about the microproces-
sor business, I’d have been killed. But instead of
telling him what to think, I taught him how to
think—and then he reached what I felt was the
correct decision on his own.ILL
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July–August 2010 Harvard Business Review 47
HBR.ORG
1:30:08 PM
That experience had a profound influence on
me. When people ask what I think they should do,
I rarely answer their question directly. Instead, I run
the question aloud through one of my models. I’ll

describe how the process in the model worked its
way through an industry quite diff erent from their
own. And then, more often than not, they’ll say, “OK,
I get it.” And they’ll answer their own question more
insightfully than I could have.
My class at HBS is structured to help my students
understand what good management theory is and
how it is built. To that backbone I attach different
models or theories that help students think about
the various dimensions of a general manager’s job in
stimulating innovation and growth. In each session
we look at one company through the lenses of those
theories—using them to explain how the company
got into its situation and to examine what manage-
rial actions will yield the needed results.
On the last day of class, I ask my students to turn
those theoretical lenses on themselves, to fi nd co-
gent answers to three questions: First, how can I be
sure that I’ll be happy in my career? Second, how can
I be sure that my relationships with my spouse and
my family become an enduring source of happiness?
Third, how can I be sure I’ll stay out of jail? Though
the last question sounds lighthearted, it’s not. Two of
the 32 people in my Rhodes scholar class spent time
in jail. Jeff Skilling of Enron fame was a classmate of
mine at HBS. These were good guys—but something
in their lives sent them off in the wrong direction.
As the students discuss the answers to these
questions, I open my own life to them as a case study
of sorts, to illustrate how they can use the theories
from our course to guide their life decisions.
One of the theories that gives great insight on the

fi rst question—how to be sure we fi nd happiness in
our careers—is from Frederick Herzberg, who asserts
that the powerful motivator in our lives isn’t money;
it’s the opportunity to learn, grow in responsibilities,
contribute to others, and be recognized for achieve-
ments. I tell the students about a vision of sorts I had
while I was running the company I founded before
becoming an academic. In my mind’s eye I saw one
of my managers leave for work one morning with a
relatively strong level of self-esteem. Then I pictured
her driving home to her family 10 hours later, feel-
ing unappreciated, frustrated, underutilized, and
demeaned. I imagined how profoundly her lowered
self-esteem aff ected the way she interacted with her
children. The vision in my mind then fast-forwarded
to another day, when she drove home with greater
self-esteem—feeling that she had learned a lot, been
recognized for achieving valuable things, and played
a signifi cant role in the success of some important
initiatives. I then imagined how positively that af-
fected her as a spouse and a parent. My conclusion:
Management is the most noble of professions if it’s
practiced well. No other occupation off ers as many
ways to help others learn and grow, take responsi-
bility and be recognized for achievement, and con-
tribute to the success of a team. More and more
MBA students come to school thinking that a career
in business means buying, selling, and investing in
companies. That’s unfortunate. Doing deals doesn’t
yield the deep rewards that come from building up
people.
I want students to leave my classroom know-
ing that.

Create a Strategy for Your Life
A theory that is helpful in answering the second question—How
can I ensure that my relationship with my family proves to be
an enduring source of happiness?—
concerns how strategy is defi ned and implemented.
Its primary insight is that a company’s strategy is
determined by the types of initiatives that manage-
ment invests in. If a company’s resource allocation
process is not managed masterfully, what emerges
from it can be very diff erent from what management
intended. Because companies’ decision-making sys-
tems are designed to steer investments to initiatives
that off er the most tangible and immediate returns,
companies shortchange investments in initiatives
that are crucial to their long-term strategies.
Over the years I’ve watched the fates of my HBS
classmates from 1979 unfold; I’ve seen more and
more of them come to reunions unhappy, divorced,
and alienated from their children. I can guarantee
you that not a single one of them graduated with the
deliberate strategy of getting divorced and raising
children who would become estranged from them.
And yet a shocking number of them implemented
that strategy. The reason? They didn’t keep the pur-
pose of their lives front and center as they decided
how to spend their time, talents, and energy.
It’s quite startling that a significant fraction of
the 900 students that HBS draws each year from the
world’s best have given little thought to the purpose
of their lives. I tell the students that HBS might be
one of their last chances to reflect deeply on that
I came to busi-

ness school
knowing exactly
what I wanted to do—
and I’m leaving choosing
the exact opposite. I’ve
worked in the private
sector all my life, because
everyone always told me
that’s where smart people
are. But I’ve decided to
try government and see if
I can fi nd more meaning
there.
“I used to think that
industry was very safe.
The recession has shown
us that nothing is safe.”
RUHANA HAFIZ
Harvard Business School
Class of 2010
HER PLANS: To join the
FBI as a special adviser
(a management track
position)
HOW WILL YOU MEASURE YOUR LIFE?
1:30:20 PM

question. If they think that they’ll have more time
and energy to refl ect later, they’re nuts, because life
only gets more demanding: You take on a mortgage;
you’re working 70 hours a week; you have a spouse
and children.
For me, having a clear purpose in my life has been
essential. But it was something I had to think long
and hard about before I understood it. When I was a
Rhodes scholar, I was in a very demanding academic
program, trying to cram an extra year’s worth of work
into my time at Oxford. I decided to spend an hour
every night reading, thinking, and praying about why
God put me on this earth. That was a very challeng-
ing commitment to keep, because every hour I spent
doing that, I wasn’t studying applied econometrics.
I was confl icted about whether I could really aff ord to
take that time away from my studies, but I stuck with
it—and ultimately fi gured out the purpose of my life.
Had I instead spent that hour each day learning
the latest techniques for mastering the problems of
autocorrelation in regression analysis, I would have
badly misspent my life. I apply the tools of econo-
metrics a few times a year, but I apply my knowledge
of the purpose of my life every day. It’s the single
most useful thing I’ve ever learned. I promise my
students that if they take the time to fi gure out their
life purpose, they’ll look back on it as the most im-
portant thing they discovered at HBS. If they don’t
fi gure it out, they will just sail off without a rudder
and get buff eted in the very rough seas of life. Clar-
ity about their purpose will trump knowledge of

activity-based costing, balanced scorecards, core
competence, disruptive innovation, the four Ps, and
the fi ve forces.
My purpose grew out of my religious faith, but
faith isn’t the only thing that gives people direction.
For example, one of my former students decided that
his purpose was to bring honesty and economic pros-
perity to his country and to raise children who were
as capably committed to this cause, and to each other,
as he was. His purpose is focused on family and oth-
ers—as mine is.
The choice and successful pursuit of a profession
is but one tool for achieving your purpose. But with-
out a purpose, life can become hollow.
Allocate Your Resources
Your decisions about allocating your per-sonal time, energy,
and talent ultimately shape your life’s strategy.I have a bunch
of “businesses” that
compete for these resources: I’m trying to have a re-
warding relationship with my wife, raise great kids,
contribute to my community, succeed in my career,
contribute to my church, and so on. And I have ex-
actly the same problem that a corporation does.
I have a limited amount of time and energy and talent.
How much do I devote to each of these pursuits?
Allocation choices can make your life turn out to
be very different from what you intended. Some-
times that’s good: Opportunities that you never
planned for emerge. But if you misinvest your re-
sources, the outcome can be bad. As I think about my
former classmates who inadvertently invested for

lives of hollow unhappiness, I can’t help believing
that their troubles relate right back to a short-term
perspective.
When people who have a high need for achieve-
ment—and that includes all Harvard Business School
graduates—have an extra half hour of time or an ex-
tra ounce of energy, they’ll unconsciously allocate
it to activities that yield the most tangible accom-
plishments. And our careers provide the most con-
crete evidence that we’re moving forward. You ship
a product, fi nish a design, complete a presentation,
close a sale, teach a class, publish a paper, get paid,
get promoted. In contrast, investing time and energy
in your relationship with your spouse and children
typically doesn’t off er that same immediate sense
of achievement. Kids misbehave every day. It’s re-
ally not until 20 years down the road that you can
put your hands on your hips and say, “I raised a good
son or a good daughter.” You can neglect your rela-
tionship with your spouse, and on a day-to-day basis,
You could see a
shift happening
at HBS. Money
used to be number one
in the job search. When
you make a ton of money,
you want more of it.
Ironic thing. You start to
forget what the drivers of
happiness are and what
things are really important.
A lot of people on campus
see money diff erently now.

They think, ‘What’s the
minimum I need to have,
and what else drives my
life?’ instead of ‘What’s the
place where I can get the
maximum of both?’”
PATRICK CHUN
Class of 2010
HIS PLANS: To join Bain
Capital
Doing deals doesn’t yield the deep rewards
that come from building up people.
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1:30:27 PM
In using this model to address the question, How
can I be sure that my family becomes an enduring
source of happiness?, my students quickly see that
the simplest tools that parents can wield to elicit co-
operation from children are power tools. But there
comes a point during the teen years when power
tools no longer work. At that point parents start
wishing that they had begun working with their chil-
dren at a very young age to build a culture at home
in which children instinctively behave respectfully
toward one another, obey their parents, and choose
the right thing to do. Families have cultures, just
as companies do. Those cultures can be built con-
sciously or evolve inadvertently.
If you want your kids to have strong self-esteem
and confi dence that they can solve hard problems,
those qualities won’t magically materialize in high
school. You have to design them into your family’s

culture—and you have to think about this very early
on. Like employees, children build self-esteem by do-
ing things that are hard and learning what works.
Avoid the “Marginal Costs” Mistake
We’re taught in fi nance and economics that in evaluating
alternative invest-ments, we should ignore sunk and fixed costs,
and instead base deci-
sions on the marginal costs and marginal revenues
that each alternative entails. We learn in our course
that this doctrine biases companies to leverage what
they have put in place to succeed in the past, instead
of guiding them to create the capabilities they’ll need
in the future. If we knew the future would be exactly
the same as the past, that approach would be fi ne.
But if the future’s different—and it almost always
is—then it’s the wrong thing to do.
This theory addresses the third question I dis-
cuss with my students—how to live a life of integrity
(stay out of jail). Unconsciously, we often employ the
marginal cost doctrine in our personal lives when
we choose between right and wrong. A voice in our
head says, “Look, I know that as a general rule, most
people shouldn’t do this. But in this particular ex-
tenuating circumstance, just this once, it’s OK.” The
marginal cost of doing something wrong “just this
once” always seems alluringly low. It suckers you in,
and you don’t ever look at where that path ultimately
is headed and at the full costs that the choice entails.
Justifi cation for infi delity and dishonesty in all their
manifestations lies in the marginal cost economics
of “just this once.”
it doesn’t seem as if things are deteriorating. People

who are driven to excel have this unconscious pro-
pensity to underinvest in their families and over-
invest in their careers—even though intimate and
loving relationships with their families are the most
powerful and enduring source of happiness.
If you study the root causes of business disasters,
over and over you’ll fi nd this predisposition toward
endeavors that off er immediate gratifi cation. If you
look at personal lives through that lens, you’ll see
the same stunning and sobering pattern: people al-
locating fewer and fewer resources to the things they
would have once said mattered most.
Create a Culture
T here’s an important model in our class called the Tools of
Cooperation, which basically says that being a visionary
manager isn’t all it’s cracked up to be. It’s one thing to see into
the foggy future with acuity and chart the course cor-
rections that the company must make. But it’s quite
another to persuade employees who might not see
the changes ahead to line up and work cooperatively
to take the company in that new direction. Knowing
what tools to wield to elicit the needed cooperation
is a critical managerial skill.
The theory arrays these tools along two dimen-
sions—the extent to which members of the organiza-
tion agree on what they want from their participation
in the enterprise, and the extent to which they agree
on what actions will produce the desired results.
When there is little agreement on both axes, you
have to use “power tools”—coercion, threats, pun-
ishment, and so on—to secure cooperation. Many
companies start in this quadrant, which is why the

founding executive team must play such an assertive
role in defi ning what must be done and how. If em-
ployees’ ways of working together to address those
tasks succeed over and over, consensus begins to
form. MIT’s Edgar Schein has described this process
as the mechanism by which a culture is built. Ulti-
mately, people don’t even think about whether their
way of doing things yields success. They embrace
priorities and follow procedures by instinct and as-
sumption rather than by explicit decision—which
means that they’ve created a culture. Culture, in
compelling but unspoken ways, dictates the proven,
acceptable methods by which members of the group
address recurrent problems. And culture defi nes the
priority given to diff erent types of problems. It can
be a powerful management tool.
The fi nancial
crisis helped me
realize that you
have to do what you really
love in life. My current
vision of success is based
on the impact I can have,
the experiences I can
gain, and the happiness
I can fi nd personally, much
more so than the pursuit
of money or prestige. My
main motivations are (1) to
be with my family and
people I care about; (2) to
do something fun, exciting,
and impactful; and (3) to
pursue a long-term career

in entrepreneurship, where
I can build companies that
change the way the world
works.”
MATT SALZBERG
Class of 2010
HIS PLANS: To work for
Bessemer Venture Partners
HOW WILL YOU MEASURE YOUR LIFE?
1:30:35 PM
I’d like to share a story about how I came to un-
derstand the potential damage of “just this once” in
my own life. I played on the Oxford University var-
sity basketball team. We worked our tails off and
finished the season undefeated. The guys on the
team were the best friends I’ve ever had in my life.
We got to the British equivalent of the NCAA tourna-
ment—and made it to the fi nal four. It turned out the
championship game was scheduled to be played on
a Sunday. I had made a personal commitment to God
at age 16 that I would never play ball on Sunday. So
I went to the coach and explained my problem. He
was incredulous. My teammates were, too, because I
was the starting center. Every one of the guys on the

team came to me and said, “You’ve got to play. Can’t
you break the rule just this one time?”
I’m a deeply religious man, so I went away and
prayed about what I should do. I got a very clear
feeling that I shouldn’t break my commitment—so
I didn’t play in the championship game.
In many ways that was a small decision—involv-
ing one of several thousand Sundays in my life. In
theory, surely I could have crossed over the line just
that one time and then not done it again. But look-
ing back on it, resisting the temptation whose logic
was “In this extenuating circumstance, just this once,
it’s OK” has proven to be one of the most important
decisions of my life. Why? My life has been one un-
ending stream of extenuating circumstances. Had
I crossed the line that one time, I would have done it
over and over in the years that followed.
The lesson I learned from this is that it’s easier
to hold to your principles 100% of the time than it
is to hold to them 98% of the time. If you give in to
“just this once,” based on a marginal cost analysis,
as some of my former classmates have done, you’ll
regret where you end up. You’ve got to define for
yourself what you stand for and draw the line in a
safe place.
Remember the Importance of Humility
I got this insight when I was asked to teach a class on humility
at Harvard College. I asked all the students to describe the most
humble person they knew. One characteristic of these
humble people stood out: They had a high level of

self-esteem. They knew who they were, and they
felt good about who they were. We also decided
that humility was defi ned not by self-deprecating
behavior or attitudes but by the esteem with which
you regard others. Good behavior flows naturally
from that kind of humility. For example, you would
never steal from someone, because you respect
that person too much. You’d never lie to someone,
either.
It’s crucial to take a sense of humility into the
world. By the time you make it to a top graduate
school, almost all your learning has come from
people who are smarter and more experienced than
you: parents, teachers, bosses. But once you’ve fi n-
ished at Harvard Business School or any other top
academic institution, the vast majority of people
you’ll interact with on a day-to-day basis may not be
smarter than you. And if your attitude is that only
smarter people have something to teach you, your
learning opportunities will be very limited. But if
you have a humble eagerness to learn something
from everybody, your learning opportunities will
be unlimited. Generally, you can be humble only if
you feel really good about yourself—and you want to
help those around you feel really good about them-
selves, too. When we see people acting in an abusive,
arrogant, or demeaning manner toward others, their
behavior almost always is a symptom of their lack of
self-esteem. They need to put someone else down to
feel good about themselves.
Choose the Right Yardstick
This past year I was diagnosed with cancer and faced the

possibility that my life would end sooner than I’d planned.
Thankfully, it now looks as if I’ll be spared. But the experi-
ence has given me important insight into my life.
I have a pretty clear idea of how my ideas have
generated enormous revenue for companies that
have used my research; I know I’ve had a substantial
impact. But as I’ve confronted this disease, it’s been
interesting to see how unimportant that impact is
to me now. I’ve concluded that the metric by which
God will assess my life isn’t dollars but the individ-
ual people whose lives I’ve touched.
I think that’s the way it will work for us all. Don’t
worry about the level of individual prominence you
have achieved; worry about the individuals you
have helped become better people. This is my fi nal
recommendation: Think about the metric by which
your life will be judged, and make a resolution to live
every day so that in the end, your life will be judged
a success. HBR Reprint R1007B
Clayton M. Christensen ([email protected])
is the Robert and Jane Cizik Professor of Business
Administration at Harvard Business School.
Because I’m
returning to
McKinsey, it
probably seems like not all
that much has changed for
me. But while I was at HBS,
I decided to do the dual
degree at the Kennedy

School. With the elections
in 2008 and the economy
looking shaky, it seemed
more compelling for me
to get a better under-
standing of the public and
nonprofi t sectors. In a way,
that drove my return to
McKinsey, where I’ll have
the ability to explore pri-
vate, public, and nonprofi t
sectors.
“The recession has made
us step back and take
stock of how lucky we
are. The crisis to us is ‘Are
we going to have a job by
April?’ Crisis to a lot of
people is ‘Are we going to
stay in our home?’”
JOHN COLEMAN
Class of 2010
HIS PLANS: To return to
McKinsey & Company
HBR.ORG
1:30:57 PM

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Du 1
16

ANALYSIS OF AFFORDABLE CARE ACT
Bus 102
November 25, 2016
Jasso Sean
Jie
Section 21
Contents
1.0 Introduction 3
2.0 Description of the law 4
3.0 Rational for affordable care act 7
4.0 Analysis of ACA efficacy 8
5.0 Implementation 9
6.0 Evaluation 9
7.0 Conclusion 10
8 0 Recommendations 10
9.0 References 12
1.0 Introduction
Quality and affordable healthcare is a basic and constitutional
right for every American citizen. However, a realization of this
basic need has been a challenge to the federal government. This
has resulted in the development of several policies and
programs such as the MEDICAID and Medicare programs which

aimed at ensuring that most of the citizens get access to the
health care services. These programs were initiated and directed
towards meeting the healthcare needs of the citizens with
limited resources. The programs were designed to allow the
collaboration of efforts between the federal and state
governments in the form of resource allocation and other
expertise to ensure that as many citizens as possible have access
to the healthcare. Despite such efforts, healthcare challenges
still continued to persist and then there was there was the
affordable care act of 2010 that was passed in the Congress to
increase the healthcare insurance cover (Hofer, Abraham
&Moscovice, 2011).
This assignment will focus on detailed analysis of the
affordable care ACT including its rational for enacting and
detailed description of what the law entails to achieve. This is
a long-term healthcare act that seeks to result in a lot of
restructuring of the healthcare sector. A lot of changes are
expected to take shape as the Act continue to be fully
implemented. The second part of the paper will, therefore,
focus on the analysis of the ACT efficacy and the practicability
of some of the suggested reforms in the healthcare sector.
Implementation brings along a lot of challenges some that were
forecasted and planned for but some are emergent and
unplanned for and such dynamics will be of importance to focus
on the analysis of the Affordable care Act. Finally, the paper
will offer some of the recommendations at the tail end based on
the content developed in the body part of the paper.
2.0 Description of the law
The long process that culminated in the passage of the
Affordable care act started back in 2009 when a group of
Democrats in Congress hatched the Obama administration
intention to initiate drastic changes in the healthcare sector.
The team led by then-speaker of the Congress revealed this plan
to the Congress through H.R.3962 which is commonly referred
as ACA. Despite the many obstacles that characterized the
passage of the bill into law including the death of the leading

crusader Senator Kennedy and his replacement with a
Republican candidate the bill was finally signed into law by
President Obama back in 2010. This was after the bill sailed
through both houses of the legislature and met the required
numbers to be passed into law (Rosenbaum, 2011).
The main objective of passing ACA was to ensure that all the
American citizens have access to quality and affordable
healthcare. It also meant that a certain restructuring of the
healthcare system to ensure that the costs of providing
healthcare services are revised down. It encouraged the
collaboration between various healthcare organizations and
other stakeholders in the sector to avoid duplication of efforts
and hence increase efficiency in the healthcare sector. The
Healthcare Act contained nine subtitles with each of it
addressing a certain aspect of the reform that will be
implemented for the full realization of its benefits.
The first subtitle deals with ensuring that there is affordable
health insurance cover for all American citizens. This would
require a total transformation of the existing healthcare
insurance by encouraging collaboration to increase the coverage
while maintaining the current insurance premium. It would
take time, but the systematic restructuring of health insurance
system will ensure that pre-existing discriminatory practices
which left several of the American citizens uncovered are
removed. Realization of this goal will mean that all Americans
must be part of the insurance system to maintain the premiums
while increasing the breadth of the cover. Some of the
immediate reforms included the elimination of unreasonable
annual restrictions on benefits, offer assistance for those not
covered due to pre-existing conditions among several other
major initiatives (Huntington, & et al. 2011)
The second title of the affordable act provides for the revisiting
the role to be played by the public programs such as the
Medicaid in ensuring that all American citizens get access to
affordable healthcare. The Act provided for the expansion of

MEDICAID program to ensure an expanded cover for people in
the lower income levels. The responsibility of meeting such
costs is largely shifted to the federal government. The Act also
provided for improved cover for CHIP program and even
simplified the process of both MEDICAID and CHIP enrollment
processes (Kocher, Emanuel &DeParle, 2010). Individuals
eligible for the enrollment into the MEDICAID and CHIP
programs will have the chance to do so through the state
websites and hospitals will be required to offer the health care
services during the presumptive eligibility period. The ACT
also provides for the state to offer the health care services
which were initially available in acute care hospitals to
intermediate healthcare facilities, nursing homes, and other
community-based care organizations. This would ensure more
access affordability and efficiency of the care to eligible
citizens across all the states.
The third title of the healthcare ACT also provides for the
improvement of the efficiency and quality of healthcare. The
ACT recommends the restructuring of the healthcare delivery
system to improve the efficiency and effectiveness of the
methods employed and especially to the beneficiaries of the
MEDICAID and MEDICARE programs. New models of care
would be made and driven by the research to analyze its
effectiveness based on the research outcomes. This would
result in different approaches to treatment and care of the
clients. The payments of the healthcare institutions will be
linked to the quality of their performance on high-cost diseases
such as pneumonia, surgical and cardiac care (Huntington, & et
al. 2011).
The fourth title of the affordable care act seeks to prevent
chronic diseases. Interagency prevention coordination will be
initiated to create a national prevention strategy and policies
that ensure that health of the citizens is promoted. The private
public partnership will ensure efficient utilization of resources.
These initiatives aim at promoting health eating and living
awareness campaigns and outreach to ensure healthy living of

the citizens and prevent diseases across the entire nation. It
also entails increasing access to preventive care services. Act
authorize eligibility to access a variety of new programs that are
related to the preventive services and care.
Title five of the act aims at improving the quality of healthcare
professionals to encourage innovations in the recruitment,
retention, and training of the professionals. The Act establish a
workforce commission that will help to improve the supply of
the healthcare workforce. The provisions also aimed at
analyzing the health care workforce needs in the country and so
as to realign those needs with the training of the human
resource to meet them. The provisions of the act also propose
the need for increasing the supply of healthcare professionals.
The Act introduce new requirements to offer the public with the
necessary health information to help combat fraud and other
forms of abuse to private and public programs. The ACT also
requires for the availing information about the ownership of
nursing facilities under MEDICAID and Medicare programs
(Gable, 2011).
The sixth subtitle requires improvement in program integrity
and transparency. The bill creates new requirements where the
hospitals are required to avail adequate information to the
public to ensure that they combat any fraud on public funds.
This chapter also provides for increased staff training to
facilitate abuse prevention and also add dementia management.
This chapter also introduces other requirements and procedures
for screening CHIPP, MEDICAID and MEDICARE providers.
Such providers will be subjected to a set of new requirements
including disclosure of previous and current affiliations with
other supplier institutions whose integrity in participating in the
Medicare program has been questionable. These include
institutions which have uncollected debt or whose payments has
been put on suspension dude to different underlying issues. The
Affordable care Act also prohibits continued participation of
entities or individuals in the Medicaid program if such entities
have been terminated or excluded from participating in

Medicaid program in any other state.
Title seven provides for privileges to underserved communities
and children to have access to affordable medicines. It provides
for more access to discounted medicines for inpatients as well
as community hospitals, rural referral hospitals and cancer
hospitals. Title nine also talks about the taxation procedures and
financing of the newly expanded healthcare insurance programs.
The provision imposes pharmaceutical manufacturer fee among
other mandatory levies.3.0 Rational for affordable care act
The issue of affordable and quality healthcare has been a major
ethical concern in the history of American politics. Healthcare
reform that accommodates the needs and covers the less
privileged in America is considered an issue of justice and a
great step towards the achievement of human rights. The
sanctity of life is a valuable aspect of the federal constitution.
Individuals, the state, and the federal government have
struggled with brainstorming on the best strategies that ensure
quality and affordable healthcare for all.
Based on the national statics Access to quality and affordable
healthcare services for individuals aged 19-64 had continued to
deteriorate from 200-2010 (Hofer, Abraham & Moscovice,
2011). The access to healthcare services for this age group is
very critical to the success and development of the nation. It is
considered as the productive age that is actively involved in the
development and implementation agenda of the country. The
statistics indicated deterioration of health especially among
those who were not insured under any health insurance cover.
Further analysis indicated that although there existed some
healthcare cover programs that promoted healthcare access
among the marginalized in the society, there was the need to
focus on a more comprehensive and affordable approach that
puts on board every citizen. The rational for enacting this law
was to remove all the obstacles created by pre-existing
conditions which made it difficult for all to have access to
quality healthcare services. Healthcare is a complex sector and
thus addressing just one aspect or program is inadequate. ACA

aimed at restructuring the entire healthcare system through
several approaches and new initiatives. Key among them
included the prohibition of the healthcare insurers from
preventing beneficiaries from access to healthcare services due
to pre-existing obstacles, subsidizing the healthcare premiums,
expanding MEDICAID eligibility. 4.0 Analysis of ACA
efficacy
Close analysis of the available health data indicates that
Affordable Healthcare Act has had a tremendous positive impact
on the access of healthcare services to the American citizens. It
seems that the Healthcare Act has achieved strategic milestones
five years down the line of its implementation. It has
significantly cut down the figures of people who did not have
any insurance cover before its enactment. Recent studies
indicate that approximately seventeen million individuals have
been added to the health insurance cover. The percentage of
people above nineteen years without the health cover reduced
significantly to 11.9 percent for the first quarter of 2015.
Further analysis of the available statistics reveals that there has
been a significant increase in the number of people between 19
and 26 years who have been subscribed to one of the health
insurance covers. Before the enactment of the law in 2010,
approximately one in every three individuals between the age
of 19 and 26 had no access to healthcare insurance cover (Koh
& Sebelius, 2010). This was largely attributed to high cost of
the cover and lack of employer-provided health insurance cover.
Currently there more than three million individuals within the
above-prescribed age bracket have been subscribed to the health
insurance cover as a result of the subsidized premiums. This
has been described as one of the most rapid increasing trends of
young people gaining an insurance cover.
ACA has also made a significant success in including some
communities and races that have been historically marginalized
or disadvantaged by the pre-existing health care insurance
requirements. These segments of society were at very higher
rates of not subscribing to any insurance cover. They include

the Latino Americans, African Americans, and people with an
extremely low level of income. For instance, the percentage of
uninsured Latinos fell by thirteen percent to reach the low
levels of approximately 23 percent within the just year of the
implementation of the law. The Latinos have been among the
greatest winners of health insurance cover since the act came
into effect. 5.0 Implementation
Although the affordable care act has a long-term
implementation plan covering a longer time interval the impact
of its implementation blue print has already started to be felt.
Some healthcare restructuring has already being implemented
under Obama administration. Many of the key provisions of
the act have been effected since 2013. The implementation
process may also have had some challenges due to legal battles
of the legality of some of its aspects in the Supreme Court.
However even as the implementation process continue to be
rocked into political and legal conflict heavy and positive
impact about accessibility of the healthcare services have
already being felt. Increased enrollment into the healthcare
insurance cover as well as the subsidization of the healthcare
insurance premiums is part of the notable milestones achieved.
The reforms of the healthcare delivery system continue to
assume center stage. The statistics also indicated that by the
close of 15th of February 2015 a total a total of approximately
eleven million citizens initially uninsured had already selected
their health insurance cover plan. Three million additional
covers for people between 19-26 years has already being
realized through effecting the ACA provisions which require
employers to cover health insurance for their employee's
dependents until the age of 26 years (Cantor, Monheit, DeLia &
Lloyd, 2012). 6.0 Evaluation
Much has been achieved through the affordable healthcare
especially about the increased access to the healthcare insurance
among the American citizens regardless of their race, socio-
economic status or any other diversity. Perhaps after the few
years of its implementation, the only metrics that has been used

to ascertain its effective implementation is only on the number
of additional citizens who have been included on the cover.
The department of health has estimated that a total of twenty
million initially uninsured citizens have been including the
cover. Another important evaluation metric is the number is the
additional people who have been covered through free-care and
subsidized healthcare insurance programs. Through the
expanded MEDICAID and Medicare programs, more people
have become eligible for cover thus improving its affordability
among several American citizens (Koh & Sebelius, 2010).
However despite such achievements the implementation efforts
have been characterized by heated political debates, court
battles that have continued to derail its implementation process.
A segment of the American population still feels that the
Affordable healthcare Act has been too much restrictive to the
individuals and hence against their constitutional liberties.
More criticism has been leveled against the Act for its negative
of increasing the country burden on debt.
Strengths and weaknesses
Apparently with the enactment and implementation of the
Obama-care there are more American citizens who have been
put under health insurance cover. These include citizens who
have been discriminated and left out of the healthcare system in
the past.
The Act also provides for more cover from private coverage
with the minimum coverage. The law also provides for a series
of reforms aimed at reducing the cost of offering healthcare
services. It also strengthens the healthcare delivery systems
and devolves more services to the community-based healthcare
facilities, nursing homes. The law also offers an opportunity for
more partnership and collaboration of efforts through
Accountable care organizations. This would improve the
efficiency and effectiveness of the healthcare delivery system.
It will promote a great deal of healthcare service modernization
and seal frauds in the systems (Kocher, Emanuel &DeParle,
2010).

The law is expected to promote the establishment of long-term
healthcare programs by the states which favor the community-
based support and services as opposed to institutional based
care. This approach is expected to accelerate innovation in the
health sector and from a grassroots levels. The law is also
expected to ease the procedures and requirements for enrollment
into Medicaid and Medicare programs in the states through
modernization of the enrollment procedures. The expansion of
the healthcare coverage would mean that more marginalized
individuals would get access to the healthcare this would result
in more primary care visits nationwide. It would also expand the
preventive care services and thus reducing the burden of
preventable diseases.
Weaknesses
The law recommends cut for Medicare and hence if this is
implemented as the law states it is likely to affect the access of
seniors to quality healthcare services. The insurance providers
are likely to limit the range of healthcare facilities and provider
networks. Consequently, seniors Amy be left with fewer
options and at times they may opt to pay to get quality care
(Cantor & et al. 2012).
The law is also expected to widen the budget deficit.
Apparently, the cost of healthcare sector under the new
healthcare will be higher than it was initially. More regulations
are required to cut long-term costs. It is also projected that due
to the current aging population in U.S the implementation of
ACA would lead to an acute shortage of healthcare
professionals especially on primary care givers (Foster, 2010).
The law will take a long time before it is fully implemented. It
is still early to project how the full benefits will look like and
the challenges that are likely to arise as the law get
implemented. The full meaning and benefits can only be
conceptualized after the expiry of that period. The main
weakness in the implementation also lies in the politics of the
country. Healthcare policies are highly political and raise a lot
of controversies (McDonough, 2012). This is already evidenced

by the kind of controversies that the Act elicited among the
political class. The Republicans were largely opposed to the
Act, and with the assumption of power of a Republican
president, the implementation process may lack the political
will. Implementation of the Affordable care act is therefore
expected to lack political enthusiasm required of its
implementation.
7.0 Conclusion
From the discussions above it is apparent that ensuring access
to quality and affordable healthcare services to all American
citizens is a very important function of the government. This
provides the rational for the Obama administrative initiative to
enact the Affordable health care Act into the law. This section
of the law has resulted in increased number of citizens under
health insurance cover. The health cover has extended to the
initially marginalized communities and expanded the
achievement of universal human rights. The law has been met
with the high level of criticism, political and legal battles with
some of them ending up in the U.S Supreme Court. A lot
remains undone, and the full benefits are yet to be realized. 8 0
Recommendations
There are more important sectors that the implementation of
affordable care act need to be simplified such as the complex
procedures of tax credit program. The provisions of the Act
need to expand their coverage to the citizens with Moderate
incomes. This would help to include more people and families
that are currently left out of the ACA.
Improving the health insurance consumer markets. It is
important for the Congress to consider enacting laws that
require the consumers to be adequately guided to select the
most appropriate cover plans that suit their resources and needs.
The government should demand more inter-agency collaboration
and coordination with the healthcare insurance providers to
ensure greater transparency and deploy strategies that will help
ensure the continuity of care.
Simplify the healthcare financing system. The United States has

a very complex health financing system. This is the case even
prior- to the effecting the current expanded healthcare system.
The implementation of the affordable care has even complicated
the system through expanding MEDICAID cover and
introducing the concept of insurance market places (Foster,
2010).
There is also need to increase the political will to fully
implement the system. The situation seems to be complicated by
the assumption of power by the Republican Party under the new
president. However, if the expanded healthcare act is to
achieve any significant milestones in healthcare, it needs to be
supported by the political will to ensure the establishment of
healthcare policies facilitate the realization of its objectives.
9.0 References
Huntington, W. V., Covington, L. A., Center, P. P., Covington,
L. A., &Manchikanti, L. (2011). Patient Protection and
Affordable Care Act of 2010: reforming the health care reform
for the new decade. Pain Physician, 14(1), E35-E67.
Rosenbaum, S. (2011). The Patient Protection and Affordable
Care Act: implications for public health policy and
practice. Public Health Reports, 130-135.
Shaw, F. E., Asomugha, C. N., Conway, P. H., & Rein, A. S.

(2014). The Patient Protection and Affordable Care Act:
opportunities for prevention and public health. The
Lancet, 384(9937), 75-82.
Gable, L. (2011). The Patient Protection and Affordable Care
Act, public health, and the elusive target of human rights. The
Journal of Law, Medicine & Ethics, 39(3), 340-354.
Koh, H. K., &Sebelius, K. G. (2010). Promoting prevention
through the affordable care act. New England Journal of
Medicine, 363(14), 1296-1299.
Kocher, R., Emanuel, E. J., &DeParle, N. A. M. (2010). The
Affordable Care Act and the future of clinical medicine: the
opportunities and challenges. Annals of internal
medicine, 153(8), 536-539.
Baker, T. (2011). Health insurance, risk, and responsibility after
the Patient Protection and Affordable Care Act. University of
Pennsylvania Law Review, 1577-1622.
Cantor, J. C., Monheit, A. C., DeLia, D., & Lloyd, K. (2012).
Early impact of the Affordable Care Act on health insurance
coverage of young adults. Health services research, 47(5), 1773-
1790.
Hofer, A. N., Abraham, J., &Moscovice, I. (2011). Expansion of
coverage under the Patient Protection and Affordable Care Act
and primary care utilization. Milbank Quarterly, 89(1), 69-89.
Foster, R. S. (2010). Estimated Financial Effects of the'Patient
Protection and Affordable Care Act,'as Passed by the US Senate
on December 24 2009. DIANE Publishing.
McDonough, J. E. (2012). The road ahead for the Affordable
Care Act. New England Journal of Medicine, 367(3), 199-201.
UNIVERSITY OF CALIFORNIA, RIVERSIDE
School of Business Administration

BUS 102 – Ethics and Law in Business and Society
FALL 2016
Dr. Sean D. Jasso
EXAM 2
The following are the questions to prepare for your second
exam. On the two exam days we will randomly
select among the four questions – the quantity of questions will
be determined on exam day. Please answer
each question as thoroughly as possible, providing rich detail
from our lectures, readings, and discussions. The
organization of your answers, the complexity of your analysis,
and the clarity of your critical thinking are the
key elements of your evaluation. You will need a clean blue
book for each day.
1. On Market Failure – We said that the rationale for public
policy is either market failure and/or government
failure. Address the following with this rationale in mind:
a. Define market failure from the perspective of the economist
and government failure from the
perspective of the political scientist (recall public choice

theory).
i. Which definition best fits the policy problem of the law you
are studying for your final
paper? Explain why.
b. Market failures are most commonly identified with negative
externalities. Provide an example of
this phenomenon as well as a pro and con of government
regulation as a corrective measure.
c. Lastly, provide an example of a public good and explain why
it is framed within the theory of market
failure. Be specific.
2. On Public Policy – We defined public policy as the way
forward through decision making of a nation, state,
or city.
a. Referring to the policy you are studying for your final paper,
select one of the policy foundations as
well as one of the policy types discussed in lecture (see slides)
that best describes the policy goal.
b. Building upon the policy goal, discuss the political feasibility
of the following:
i. What are/were the political hurdles in passing the bill into
law?
ii. Identify the major benefit and major cost associated with this
law.
iii. Is this law financially feasible – can it pay for itself?
c. American politics has always been about the competition of
ideas about what people really want.

Referring to the policy you are studying, identify the
characteristics of whether your policy is liberal
or conservative – or, perhaps it is neither. Explain.
3. On the Philosophy of the State – Civil society has been
characterized by the theory of the social contract
initially formalized by Thomas Hobbes and John Locke:
a. How do the two philosopher’s visions of the social contract
differ? Explain in detail.
i. Does your law show evidence of Leviathan reaching into the
American public policy domain?
b. Identify the following characteristics of the American social
contract:
i. How did the Federalist Papers influence the ratification of the
Constitution?
i. What is meant by “if angels were to govern men …”
ii. How does the U.S. government balance power?
iii. How does a bill become a law?
iv. How is a law implemented?
v. How is the constitutionality of a law affirmed?
4. On How Will You Measure Your Life –
a. This question pertains to the HBR article in Course Materials
i. Very simply – please address the following three questions
1. How can I be sure that I’ll be happy in my career?
2. How can I be sure that my relationship with my spouse and
family become an

enduring source of happiness?
3. How can I be sure I’ll stay out of jail?
ii. Pull from the article do demonstrate a command of the
reading while also strengthening
your answers to these imperative life questions.

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