WORRIED SICK: Analyzing the Health Insurance System in the United States

November 17, 2003

WORRIED SICK:
Analyzing the Health Insurance System in the United States

Grades: 6-8, 9-12

Subjects: Civics, Economics, Language Arts

Related New York Times Article
"For Middle Class, Health Insurance Becomes a Luxury, By STEPHANIE STROM", November 17, 2003

Overview of Lesson Plan:: In this lesson, students learn about the increasing number of uninsured middle class Americans; they then research and present information on various aspects of medical coverage and care at a classroom forum entitled "The Current State of Health Care in the United States."

SUGGESTED TIME ALLOWANCE:
1 hour

OBJECTIVES:
Students will:

Consider basic facts about health care coverage in the United States by taking part in a Warm-Up pop quiz.
Learn about the rising numbers of uninsured Americans by reading and discussing "For Middle Class, Health Insurance Becomes a Luxury."
Research various aspects of the United States health care and insurance systems; compile information in comprehensive information sheets.
Present research at a classroom forum titled "The Current State of Health Care in the United States."

RESOURCES / MATERIALS:

classroom board
pens/pencils
student journals
paper
computers with Internet access

ACTIVITIES / PROCEDURES:

WARM-UP/DO-NOW: Present students with the following pop quiz on the board:
- True or false? Any person with a job has health insurance.
- True or false? Unemployed people cannot have health insurance.
- The number of people without health care coverage in the United States is:
  1. 7 million
  2. 18 million
  3. 26 million
  4. 43 million
- Per month, health insurance can cost:
  1. less than $200
  2. $200
  3. around $350
  4. over $1000
  5. all of the above
Allow students a few moments to respond before continuing to the next step of the lesson.
As a class, read and discuss "For Middle Class, Health Insurance Becomes a Luxury," using the following questions:
1. How did Kevin Thornton pay for medical tests he needed to investigate his trouble swallowing?
2. What were the results of these tests?
3. Why does Kevin Thornton not have health insurance?
4. Why are the numbers of uninsured Americans rising, according to the article?
5. In what economic class are the majority of uninsured Americans?
6. Which state has the highest proportion of uninsured in the country, according to the article?
7. What percentage of people is uninsured in this state?
8. What are some reasons this state might have such a large percentage of people without health insurance, according to the article?
9. Who is Theresa Pardo, and what "tough choice" did she have to make regarding her daughter?
10. What is the difference between the cost of a nonprofit clinic and a doctor's office, according to the article?
11. What are some sacrifices uninsured people in Texas are making to meet their minimum health needs, according to the article?
12. What is "Cobra"?
13. What does Houston resident Carol Johnson mean when she asks, "Do I have to move to Iraq to get help?"
14. Why are public hospitals and clinics for the poor receiving more patients in recent times, according to the article?
15. Why might public hospital emergency rooms be particularly "hard hit"?
16. Why is the Arellano family without basic health insurance?
17. What is "CHIP," and why do the Arellanos not qualify for this program?
After reading and discussing The New York Times article, "For Middle Class, Health Insurance Becomes a Luxury," ask students to revisit their Warm-Up quizzes. Discuss the correct responses, based on information from the article. [The first and second questions are false, the third is "d" (43 million) and the fourth is "e" (all of the above).] Engage students in a brief discussion about the current state of health care in the United States. Why do health care costs vary so much? How is it possible, as the article states, that so many people who are neither poor nor unemployed are uninsured?
Explain to students that they will be researching basic information about various aspects of the health care and insurance systems in the United States to present at an in-class forum on "The Current State of Health Care in the United States."
Divide students into groups and assign each one of the following research tasks (written on the board or copied in a handout for easier student access):
- Group 1: The American Health Insurance System
  - Compile a comprehensive list, with brief descriptions of each type, of the different types of health insurance organizations found in the United States, including "Health Maintenance Organization," or "HMO," and "Preferred Provider Organization," or "PPO."
- Group 2: Insurance Terminology
  - Create a glossary of health insurance related terms, such "co-payment," "deductible," "out-of-pocket" "fee-for-service," etc.
- Group 3: Insurance Options
  - Create a chart that evaluates various types of health insurance policies available, including individual contract, group contract, blanket contract, indemnity insurance, specific disease insurance, catastrophic insurance, etc.
- Group 4: Law and Policy
  - Create an outline describing federal legislation, such as COBRA and HIPAA, as well as programs, such as Medicare and Medicaid.
- Group 5: Current Health Care Coverage Statistics
  - Create a list of the ten "most compelling" current health care statistics, such as the number of people in their age group without health insurance.
[Note: A comprehensive source of information and a good starting point for in-class research is the National Institute of Health's MEDLINEplus Web site on health insurance ( http://www.nlm.nih.gov/medlineplus/healthinsurance.html).]
After groups have completed research, they should prepare their presentations for the forum in the form of type-written lists, charts, outlines, or glossaries as homework. In a future class, students present their information at "The Current State of Health Care in the United States" forum, and distribute copies of their compiled research to the other presenting groups. If you wish, encourage students to articulate their own personal positions, based on their research regarding the United States health care system, in the form of letters to state representatives, health care companies, or the current presidential administration.

DISCUSSION QUESTIONS:

Do you think the fact that increasing numbers of middle-class, as opposed to poor, Americans are without health insurance will bring more attention to the issue? Why or why not?
Does your family have health insurance?
How many times have you needed to see a doctor in the past year? Was every time necessary, in your opinion?
Have you or any members of your family ever been hospitalized? If so, did health insurance cover the expenses?
What do you think might be done at private, state, and federal levels to offer more Americans affordable health care?
Do you think all people should be entitled to basic medical care? Why or why not?

EVALUATION / ASSESSMENT:
Students will be evaluated based on participation in Warm-Up quiz, class discussion, participation in group research and written information sheets, and presentation at the in-class health care forum.

VOCABULARY:
barium, radiologist, dot-com, bust, subsidies, uninsured, civil servants, legislative, nonprofit, proportion, service sector, inhaler, asthmatic, physical, salve, hormones, acid reflux, sporadically, indigent, aspirated, well-heeled, catastrophic

EXTENSION ACTIVITIES:

As you read in the article, insurance can also make a difference in the amount you pay for prescription medicine. Contact a pharmacy for an informational interview, and ask for the full retail prices of their top five most prescribed medications. How does the retail value differ from a $2.00 to $15.00 co-payment?
What is "health insurance fraud" and how does it affect both insurance companies and patients? Write an informative article for your local or school newspaper.
When physicians receive their medical degrees, they must take the "Hippocratic Oath." What are the origins of this oath? Who was Hippocrates and how might his views of human health differ from the current practice of medicine today?
Much of the health care controversy revolves around the notion of "private" versus "public" medicine and insurance. Expand this dialogue to the broader notion of "privatization." How are the realms of media, education, and energy affected by the public versus private control? Stage a local or school debate to tackle these questions.

INTERDISCIPLINARY CONNECTIONS:
Global Studies- Compare three other countries' health care systems to the United States. Create a chart comparing the categories you researched in class. What are the pros and cons of each? Based on your comparison, is there one system you think works more comprehensively, fairly, and efficiently than others?

Journalism- Interview two private practice doctors and two physicians who work for public or subsidized clinics. Considering the current state of the United States health care system, what advice would they have for young people who wish to become doctors someday?

Math- Find out the average cost of medical school, as well as the average amount of student loan debt incurred by medical students. How do these amounts compare with projected future incomes of doctors? (The amounts may vary by medical field.)