Healthcare https://www.morningsidecenter.org/ en Comparing Healthcare Systems: A Roleplay Debate https://www.morningsidecenter.org/teachable-moment/lessons/comparing-healthcare-systems-roleplay-debate <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>Comparing Healthcare Systems: A Roleplay Debate</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"> <!-- THEME DEBUG --> <!-- THEME HOOK: 'filter_caption' --> <!-- BEGIN OUTPUT from 'core/modules/filter/templates/filter-caption.html.twig' --> <figure role="group"> <img alt="Medicaid checkup" data-entity-type="file" data-entity-uuid="603f3599-8670-44ec-8a0d-76a10180e162" src="/sites/default/files/inline-images/Checkkup.jpg" width="1024" height="576" loading="lazy"> <figcaption><em><a href="https://www.flickr.com/photos/breadfortheworld/22295250392">https://www.flickr.com/photos/breadfortheworld/22295250392</a></em></figcaption> </figure> <!-- END OUTPUT from 'core/modules/filter/templates/filter-caption.html.twig' --> <h3><br> <strong>Introduction</strong></h3> <p><br> Explain to students that today they will divide into five different teams.&nbsp; Each team will play the role of a different group with a particular perspective on healthcare – such as doctors, the wealthy, or people without insurance.&nbsp; While playing the role assigned to their team, students will research and compare different countries’ healthcare systems from their group’s point of view. Then they will debate what changes might need to be made to the American healthcare system to improve it.</p> <p>Once students are ready, divide them into five teams and give each team their <a href="https://www.morningsidecenter.org/sites/default/files/documents-pdfs/Healthcare%20Systems%20Handout.pdf"><strong>team agenda</strong></a> (at the bottom of this lesson and also included in <a href="https://www.morningsidecenter.org/sites/default/files/documents-pdfs/Healthcare%20Systems%20Handout.pdf">this handout</a>). Tell students that they might not agree with some or all of their team’s agenda, but they get to pretend to believe it just for this debate.</p> <p>Have each team read and discuss their agenda, come up with a personalized team name if they wish, and write the name on a sign.<br> &nbsp;</p> <hr> <h3><br> <strong>Discuss in Teams</strong></h3> <p><br> Give all teams the “<a href="https://www.morningsidecenter.org/sites/default/files/documents-pdfs/Healthcare%20Systems%20Handout.pdf">Healthcare Systems Handout</a>” comparing four countries’ healthcare systems (see the bottom of this lesson&nbsp;as well as the&nbsp;<a href="https://www.morningsidecenter.org/sites/default/files/documents-pdfs/Healthcare%20Systems%20Handout.pdf">handout</a>). You may wish to go over key vocabulary in advance (premium, deductible, subsidies, single-payer, etc.).</p> <ul> <li>Ask students to read the handout and make notes about the reading and the chart to highlight what they like about each system.</li> </ul> <ul> <li>In their teams, students should discuss together what kind of healthcare system is best according to the agenda of their roleplay team. Teams might choose an existing system described in the reading, or design a combination. If time permits, invite teams to do additional research on the different countries’ systems in order to develop their arguments further.<br> &nbsp;</li> </ul> <hr> <p>&nbsp;</p> <h3><strong>Roleplay Debate</strong><br> &nbsp;</h3> <p>As teams finish deciding which system they support, explain to the class that now the different teams will work together try to agree on an improved healthcare system for the U.S., using a fishbowl discussion format. (In a fishbowl, a small inner circle of students discuss an issue. Others from their team stand behind them and listen to the discussion.)</p> <p>Invite each team to choose one member to send as a representative to the fishbowl.</p> <p>Have each representative sit in the fishbowl behind their team sign, and have the rest of their team sit near their representative in support. At any point, team members can tap on the shoulder of their representative to switch out as the new team representative. No one outside the fishbowl should speak (though conferring in whispers between team members might be okay).<br> &nbsp;</p> <h4>Begin the debate</h4> <p>Ask students:&nbsp;How should we improve the healthcare system in the U.S.?</p> <p>Make sure to have a copy of the team agendas in front of you, so that if the teams begin arguing something that is obviously incongruent with their agenda, you can slip them a quick note to get them back on track.</p> <p>Encourage a rapid exchange of participants in the fishbowl by inviting those who look eager to speak to tap into the debate. You may also call time-outs in order to allow teams to confer and plan arguments. Other than that, try to stay out of the debate.<br> &nbsp;</p> <h4>Debrief the debate</h4> <ul> <li>End the debate with a round of applause to help everyone transition out of character.</li> <li>Briefly discuss which team’s arguments were most convincing and why.</li> </ul> <p>&nbsp;</p> <hr> <h3>&nbsp;</h3> <h3><strong>Closing</strong></h3> <p>Ask students to share, in one sentence, one new realization they have about healthcare after today.</p> <p>&nbsp;</p> <ul> </ul> <hr> <h3><br> <strong>Extension Activities</strong></h3> <p>Invite students to write individually, from their own perspective (not their role), what should happen to improve the healthcare system in the U.S.</p> <p>To extend the learning, students might research what actions people are currently taking to improve the healthcare system, or which current political proposals come closest to their preferred system.</p> <p>One resource for researching different healthcare political proposals is <a href="https://www.commonwealthfund.org/many-varieties-universal-coverage">https://www.commonwealthfund.org/many-varieties-universal-coverage</a>.</p> <p>&nbsp;</p> <p>&nbsp;</p> <hr> <p>&nbsp;</p> <h3><strong>Healthcare Systems Handout</strong></h3> <p><em><a href="https://www.morningsidecenter.org/sites/default/files/documents-pdfs/Healthcare%20Systems%20Handout.pdf">Also see this pdf version.</a></em></p> <p>&nbsp;</p> <h3><strong>Group Agendas</strong><br> &nbsp;</h3> <ul> <li><strong>Doctors: </strong>You got into medicine in order to help people, but now many of your patients can’t afford their medications and avoid going to the doctor because they&nbsp; have to pay too much out of pocket – even if they have health insurance. You must see many patients in order to cover the cost of your office staff, who are responsible for billing and fighting with insurance companies to get them to pay for patients’ care. As a member of the medical profession, your priority is to have a healthcare system where doctors and hospitals still get paid a fair amount, but you also want to focus on caring for people, not worrying about billing.<br> &nbsp;</li> </ul> <ul> <li><strong>Wealthy People:</strong> You represent the rich people of America who are able to get excellent care under the U.S.’s current healthcare system. You have high-quality private health insurance coverage and can easily cover out-of-pocket expenditures as needed. You ask the tough questions about what the changes everyone else is proposing will really mean. Your priority is to stop everyone else from doing anything too drastic, especially eliminating private health insurance—who knows what would happen! You advocate for a healthcare system that fixes a few of the problems of the current system, but without going too far. You want to make sure the system is responsible and doesn’t waste resources on people who don’t really need it.<br> <br> &nbsp;</li> <li><strong>Self-Employed People: </strong>You work for yourself or own your own small business. Before the Affordable Care Act (Obamacare), you often had a hard time affording insurance, and it’s still not be easy to pay for it. &nbsp;However, Obamacare provides you with some subsidies to help you cover some of the cost. Your priority is to have a healthcare system where health coverage is affordable— but that could mean a lot of different things. You listen carefully to the arguments of the other groups and think about how their ideas would affect the financial bottom line for your business.<br> <br> &nbsp;</li> <li><strong>People Without Insurance: </strong>You represent all the people who still have a hard time getting insurance or care for whatever reason. Maybe you earn just enough money that you don’t qualify for Medicaid (the government-funded program for low-income people). Or maybe your job doesn’t offer insurance and you can’t afford to buy it on your own. Or, your job does&nbsp;offer insurance, but the premiums (monthly insurance payments) are so high, you can’t afford to pay for it. Your priority is to have a system where you get the healthcare you need without racking up medical bills that you can never pay.<br> <br> &nbsp;</li> <li><strong>Very Sick People: </strong>You or your family need a lot of medical care, a lot more than most people, so you have a special perspective on how healthcare systems can break down. You live in fear that you will lose access to health insurance coverage for the medications or special treatments you need to survive. You want a healthcare system where nobody ever goes without care because of their health or finances. You care about making sure that doctors get to decide what gets paid for (not insurance companies), that&nbsp;people never lose their insurance, and no one ever goes without tests or treatment they need.&nbsp;</li> </ul> <p>&nbsp;</p> <hr> <p>&nbsp;</p> <h3><strong>Comparing Healthcare Systems</strong></h3> <p>&nbsp;</p> <p><strong>Instructions:</strong> Make notes on the handout about&nbsp;what you like about each country’s healthcare system. Which country’s system is best, according to your team’s agenda?</p> <p>Healthcare systems in the U.S., Switzerland, Canada, and the U.K. are set up very differently in terms of who pays for the care and how care is provided. Broadly, the U.K. government pays for and runs all medical care; Canada pays for all medical care but does not run it; Switzerland requires all citizens to buy insurance but subsidizes the cost; and the U.S. uses a mishmash of all of the above.</p> <p><br> <strong>The U.S.</strong> has many different systems to pay for healthcare.</p> <ul> <li>About half of people have private insurance through jobs, while some buy private insurance themselves.</li> <li>The Affordable Care Act (Obamacare) provides subsidies to help lower income &nbsp;people purchase their own private insurance plans.</li> <li>Many private insurance plans have high deductibles in addition to monthly premiums, forcing people to pay for care out of pocket until the deductible is met. Many people skip care because they can’t afford to pay this money.</li> <li>About one-third of the population is on some kind of government health insurance plan, including Medicare (for people over 65 and the disabled), Medicaid (for low-income people), and military care.</li> <li>Nine percent of the population is uninsured and must pay for care directly – or else go without care.</li> <li>This complexity makes medical billing particularly expensive in the U.S.</li> <li>Hospitals are privately run, except for those for military veterans (VA hospitals) which are run by the government.</li> <li>U.S. medical care is the most technologically advanced and innovative in the world, and its doctors are the best paid.</li> <li>But the U.S. leaves more people uninsured than any other industrialized country, and health outcomes (like infant mortality and longevity) are not as good.</li> <li>The overall cost of U.S. healthcare is far higher than in any other country.</li> </ul> <p>&nbsp;</p> <p><strong>Switzerland </strong>requires everyone to buy private health insurance on healthcare exchanges (similar to the health exchanges under the U.S.’s Affordable Care Act).</p> <ul> <li>Insurance companies are non-profit organizations but compete for customers.</li> <li>Jobs do not provide insurance, and no one is allowed to go without insurance. As a result, the overall cost of private insurance goes down because the cost of medical care is spread over more people.</li> <li>Thirty percent of people get subsidies based on their income to help them buy insurance.</li> <li>Hospitals are privately run.</li> <li>The government negotiates drug prices and regulates fees for medical services to control costs.</li> <li>Swiss health outcomes are excellent, but costs are higher than many other countries (though still lower than in the U.S.).</li> </ul> <p>&nbsp;</p> <p><strong>In Canada</strong>, the government uses taxes to pay for health insurance for everyone.</p> <ul> <li>This “single-payer” system (meaning that the government is the single payer of health insurance) greatly reduces costs for medical billing compared to Switzerland and the U.S.&nbsp;</li> <li>Everyone in the country has health insurance and can go to any doctor or clinic and get care.</li> <li>Hospitals are privately owned, not run by the government.</li> <li>Canadian health insurance covers basic care but does not cover things like prescriptions, dentistry, and vision care. Sixty percent of Canadians get private insurance, usually through their jobs, to cover those things.</li> <li>Canadians have longer wait times to see doctors than many other countries, but when they have an urgent issue, they move to the top of the wait list.</li> <li>Their health outcomes are better than in the U.S.</li> <li>The country spends half what the U.S. spends on healthcare.</li> </ul> <p>&nbsp;</p> <p><strong>In the U.K., </strong>the National Health Service uses taxes to pay for almost all medical care (meaning it is single-payer) and also employs almost all doctors (meaning it is socialized).</p> <ul> <li>All U.K. citizens are covered for any medically necessary care including free prescriptions, dentistry, and mental health care.</li> <li>Copays are generally not required except for dentistry, and those are less than $15.</li> <li>About 10 percent of Brits get private insurance, usually through their jobs, to cover medical care that their doctor decides is “elective” (optional).&nbsp;</li> <li>U.K. hospitals can be overcrowded and not as fancy as U.S. hospitals, without the latest tech.</li> <li>But overall costs are among the lowest in the industrialized world, and health outcomes are better than in the U.S.</li> </ul> <p>&nbsp;</p> <hr> <p>&nbsp;</p> <h3>Costs, Access, and Health Data</h3> <p>&nbsp;</p> <table style="width: 803px;"> <tbody> <tr> <td style="width: 417px;"> <p>&nbsp;</p> </td> <td style="width: 84px;"> <p><strong>U.S.</strong></p> </td> <td style="width: 97px;"> <p><strong>Switzerland</strong></p> </td> <td style="width: 82px;"> <p><strong>Canada</strong></p> </td> <td style="width: 88px;"> <p><strong>U.K.</strong></p> </td> </tr> <tr> <td style="width: 417px;"> <p>Total cost (% of GDP)</p> </td> <td style="width: 84px;"> <p>17%</p> </td> <td style="width: 97px;"> <p>11%</p> </td> <td style="width: 82px;"> <p>11%</p> </td> <td style="width: 88px;"> <p>9%</p> </td> </tr> <tr> <td style="width: 417px;"> <p>Yearly cost per person</p> </td> <td style="width: 84px;"> <p>$9,086</p> </td> <td style="width: 97px;"> <p>$6,325</p> </td> <td style="width: 82px;"> <p>$4,569</p> </td> <td style="width: 88px;"> <p>$3,364</p> </td> </tr> <tr> <td style="width: 417px;"> <p>% who avoided medical care due to cost in past year</p> </td> <td style="width: 84px;"> <p>33%</p> </td> <td style="width: 97px;"> <p>22%</p> </td> <td style="width: 82px;"> <p>16%</p> </td> <td style="width: 88px;"> <p>7%</p> </td> </tr> <tr> <td style="width: 417px;"> <p>% who waited two months or more for specialist appointment</p> </td> <td style="width: 84px;"> <p>6%</p> </td> <td style="width: 97px;"> <p>9%</p> </td> <td style="width: 82px;"> <p>30%</p> </td> <td style="width: 88px;"> <p>19%</p> </td> </tr> <tr> <td style="width: 417px;"> <p>Infant deaths / 1000 births</p> </td> <td style="width: 84px;"> <p>6.1</p> </td> <td style="width: 97px;"> <p>3.9</p> </td> <td style="width: 82px;"> <p>4.8</p> </td> <td style="width: 88px;"> <p>3.8</p> </td> </tr> <tr> <td style="width: 417px;"> <p>Preventable deaths/100,000 people</p> </td> <td style="width: 84px;"> <p>112</p> </td> <td style="width: 97px;"> <p>55</p> </td> <td style="width: 82px;"> <p>78</p> </td> <td style="width: 88px;"> <p>85</p> </td> </tr> <tr> <td style="width: 417px;"> <p>Cost of medical billing as % of total hospital expenses</p> </td> <td style="width: 84px;"> <p>25%</p> </td> <td style="width: 97px;"> <p>Less than 25%</p> </td> <td style="width: 82px;"> <p>12%</p> </td> <td style="width: 88px;"> <p>12%-16%</p> </td> </tr> <tr> <td style="width: 417px;"> <p>Average doctor salary (adjusted for cost of living)</p> </td> <td style="width: 84px;"> <p>$161,000</p> </td> <td style="width: 97px;"> <p>$116,000</p> </td> <td style="width: 82px;"> <p>$107,000</p> </td> <td style="width: 88px;"> <p>$118,000</p> </td> </tr> </tbody> </table> <p>&nbsp;</p> <p><strong>Sources:</strong><br> <a href="https://international.commonwealthfund.org/">ttps://international.commonwealthfund.org/</a><br> <a href="https://www.nytimes.com/2018/07/16/upshot/costs-health-care-us.html">https://www.nytimes.com/2018/07/16/upshot/costs-health-care-us.html</a><br> <a href="https://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/">https://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/</a></p> <p>&nbsp;</p> <hr> <h3>&nbsp;</h3> <h3>Questions for Teams to Consider</h3> <p><br> Discuss these questions as your team considers which system to support:</p> <ol> <li>Should we work to make sure everyone has health insurance, or are there better ways to improve our system?<br> &nbsp;</li> <li>Should a public health insurance plan be an option that people can buy into only if they don’t want to keep their current insurance, or should everyone automatically be enrolled in the public health plan covered by taxes? (Note that having everyone in one system saves bureaucracy and paperwork, which&nbsp;is one reason single-payer systems can cover everyone at less expense.)&nbsp;<br> &nbsp;</li> <li>Should people have to pay whenever they use medical care (through copays and deductibles) to make sure they only use what’s necessary, or should medical care always be free?<br> &nbsp;</li> <li>Should hospitals be run by the government to control costs and quality directly, or privately to keep them competing on the free market?</li> </ol> <p>&nbsp;</p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>Laura McClure</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2019-07-02T09:32:53-04:00" title="Tuesday, July 2, 2019 - 09:32">July 2, 2019</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Tue, 02 Jul 2019 13:32:53 +0000 Laura McClure 1337 at https://www.morningsidecenter.org What happened to the repeal of Obamacare? https://www.morningsidecenter.org/teachable-moment/lessons/what-happened-repeal-obamacare <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>What happened to the repeal of Obamacare?</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>&nbsp;</p> <p>On September 26, 2017, Senate Majority Leader Mitch McConnell announced that the Senate Republicans did not have enough votes to pass yet another bill designed to "repeal and replace" the Affordable Care Act – also known as Obamacare.&nbsp;</p> <p>Let's take a look at why the Republicans, with a majority in both houses of Congress and the presidency, have not been able to pass a health insurance law. First, take this quiz to see how much you remember about the fight over the ACA, which has been ongoing since it became law in 2010.<br> &nbsp;</p> <hr> <h4><br> Quiz</h4> <p>1.&nbsp; True or false:&nbsp; The basics of Obamacare were first proposed by the conservative think tank The Heritage Foundation.</p> <p>2.&nbsp;&nbsp; True of false: Obamacare enabled all Americans to receive health insurance.</p> <p>3. Among nations of the world,&nbsp; what is the U.S. rank for expenditures per person for healthcare?</p> <p class="rteindent1">a) 6<br> b) 121<br> c) 1<br> d) 27<br> e) unknown, because countries use different currencies<br> f) unknown, because many countries do not keep statistics on health spending</p> <p>4. What is the rank of the United States in life expectancy (at birth)?</p> <p class="rteindent1">a) 6<br> b) 121<br> c) 1<br> d) 26<br> e) unknown, because "life expectancy" is defined differently in different countries</p> <p>5.&nbsp; What is the difference between Medicaid and Medicare?</p> <p class="rteindent1">a) There is no longer any difference<br> b) Medicare is mostly for older people; Medicaid mostly for low–income people<br> c) Medicare is more expensive and covers such things as dental care, and mental healthcare<br> d) Medicaid is more expensive and covers such things as eye care and medical devices<br> e) Under Obamacare, Medicare covers everyone</p> <p><br> <strong>Answers:</strong></p> <p>1. True</p> <p>2. False. As many as 29 million Americans are uninsured, even with the ACA. Many more have inadequate insurance coverage, or coverage that is so expensive they avoid going to the doctor.</p> <p>3. c: The U.S. ranks first in healthcare cost.</p> <p>4. d: The U.S. ranks 26th&nbsp;in life expectancy.</p> <p>5.&nbsp; b: Medicare is for older people and the disabled; Medicaid mostly for low–income people. Also, while Medicare is a mostly public system of insurance, Medicaid, while publicly funded, relies on private insurance providers.<br> &nbsp;</p> <hr> <h4><br> Key concepts</h4> <p><strong>Individual mandate</strong>—The requirement that individuals buy health insurance. In a health plan with an individual mandate, young and healthy people would essentially subsidize the healthcare of those who need it more. (And as they age, they in turn will be subsidized by younger/healthier people.)</p> <p><strong>Employer mandate</strong>—Employers must provide health coverage for employees.</p> <p><strong>Pre–existing conditions</strong>—Insurance companies have long been able to deny paying insurance claims for medical problems that you already had when you purchased the insurance.&nbsp; The ACA barred insurance companies from doing this.</p> <p><strong>Medicaid expansion</strong>—Obamacare loosened the requirements for Medicaid to allow anyone with incomes up to 138% of the poverty level to be eligible for low–cost care. States could choose to accept the expansion or not.&nbsp; Many Republican–dominated states chose not to accept expansion.</p> <p><strong>Block grants</strong>—these are funds provided by the federal government to the states for a general purpose, with the specifics decided by the states.</p> <p><strong>Single payer</strong>—A healthcare insurance system that relies on one federally funded program, rather than a patchwork of public and private entities, to insure everyone.&nbsp; Supporters of a single payer system in the U.S. sometimes call it "Medicare for all," meaning that the publicly funded Medicare program would cover every American, not just seniors and the disabled. A central argument in favor of single payer is that it is efficient: countries &nbsp;that have it (such as Canada and the UK) spend far less on healthcare than the U.S., while covering everyone.</p> <p>&nbsp;</p> <hr> <h4><br> What happened?</h4> <p>In 2010, the Democrats held majorities in Congress and Democrat Barack Obama was president.&nbsp; Healthcare was a high priority for the party. Obama supported legislation modeled on a healthcare system that was in place in Massachusetts and originally devised by the Heritage Foundation.&nbsp; The plan provides support for states to extend their Medicaid programs to many more people. It requires Americans to purchase insurance (often private insurance) and provides financial support to help lower income people cover the cost.&nbsp; The bill created a new tax on the very rich to help pay for this federal support. The plan was supported by the insurance and pharmaceutical industries because it would provide them with many more customers.</p> <p>As the bill moved through the House of Representatives and the Senate committees, it began to face stiff opposition&nbsp; from the Republicans. Senators and representatives who had previously&nbsp; supported the basics of the bill, including the individual mandate, now opposed it.</p> <p>Each house of Congress makes its own rules for conducting business. The rules of the Senate are notoriously complex. Different majorities are required for different kinds of legislation.&nbsp; In 2010, the Democrats had just enough votes to reach the 60 votes necessary for passage.&nbsp; The Affordable Care Act was passed without any Republican votes.</p> <p>In 2017, the positions are reversed. The Republicans have majorities in the House and Senate, but only a 2–vote majority in the Senate, where most legislation requires 60 votes to end discussion. To get around the 60 vote problem, the Republican leadership has invoked a rule which allows "fast–track" legislation for budgetary bills that require only a simple majority (50 votes would work, since Vice President Pence gets to break a tie). That special process (called a "budget reconciliation") comes with a deadline of September 30.</p> <p>In July, the Senate voted on three proposals to repeal Obamacare. Many of those who oppose Obamacare are philosophically opposed to publicly provided healthcare and to what they call the "welfare state." They often cite the high and growing cost of the program. Many oppose the individual mandate as government overreach.</p> <p>Each of the three plans Republicans devised, when analyzed by the Congressional Budget Office, was predicted to end up with over 20 million people losing their health insurance. Grassroots protests broke out all over the country, with voters mobbing their Congresspeople to tell them not to take away people’s healthcare. Virtually every health–related organization (representing hospitals, doctors, senior citizens, nurses, disease specific groups, and insurance companies) opposed repeal of Obamacare. Polls showed that the Republican bill was enormously unpopular among Americans in every state (only 8% to 30% approval).</p> <p>On September 13, two Republican senators (Lindsay Graham and Bill Cassidy) made a new attempt. The Graham–Cassidy bill would:</p> <ul> <li>eliminate the individual mandate</li> <li>keep most of the taxes associated with the Affordable Care Act</li> <li>end the expansion of Medicaid</li> <li>provide "block grant" healthcare funds for the states to allocate as they see fit. This would eliminate the Obamacare requirements that every insurance policy have certain minimum coverages—for example, mental health services, maternity care, lab services and care of chronic conditions.</li> </ul> <p>Once again, protests sprang up around the country to oppose the elimination of health coverage for millions of Americans.</p> <p>With only 52 Republican senators and Democrats united in opposition to the Graham–Cassidy bill, the leadership could afford to lose just two Republican votes. In the three &nbsp;previous (post–Trump election) attempts to repeal and replace Obamacare, thirteen Republicans&nbsp; had defected on one or more of the bills. Three (Lisa Murkowski, Susan Collins and John McCain) had opposed all three pieces of legislation.&nbsp;</p> <p>So with the close deadline and unknown number of defectors, it was a tense moment for the Republican leadership, which had been promising to appeal Obamacare for seven years. One by one, senators committed themselves to a "no" vote, until the day before the scheduled vote when the third definite "no," that of Susan Collins, was made public. The bill was withdrawn.<br> &nbsp;</p> <hr> <h4><br> What's Next?</h4> <p>Senators Graham and Cassidy promise to bring their bill back after convincing enough senators to pass it. But there are other possibilities:</p> <ul> <li>Obamacare could simply continue as the law of the land. It will face obstacles from the Trump administration to weaken its coverage and decrease its popularity. Already, the budget for advertising Obamacare and providing information about the law have been cut to a fraction of what they were under President Obama. Over time, this will make Obamacare more and more expensive, as fewer younger, healthy people are paying into the system.<br> &nbsp;</li> <li>The leaders of the Senate Committee on Health, Education, Labor and Pensions have been working on a bipartisan bill which would continue the insurance company subsidies, but would also relax the standards for what policies must cover.&nbsp;<br> &nbsp;</li> <li>The "Medicare for All" bill introduced by Independent Sen. Bernie Sanders in the Senate&nbsp; has 16 Democratic co–sponsors and the House version introduced by Democrat Rep. John Conyers has well over 100 co–sponsors. As Sanders explains it, Medicare is popular among its recipients, it eliminates the waste of insurance companies and polls show a majority of Americans now support the concept of the federal government ensuring healthcare for all.<br> &nbsp;</li> </ul> <hr> <h4><br> For Discussion</h4> <ol> <li>What kind of health plan do you think is best for the country? How would you convince someone who favors a different plan?<br> &nbsp;</li> <li>Do you think that the government should be forcing individuals and businesses to purchase private health insurance?<br> &nbsp;</li> <li>In 2010, the Tea Party was successful in creating enough grassroots opposition to Obamacare that even moderate Republicans were reluctant to support it. Do you think the Republicans should lose votes because of their opposition to government–funded healthcare?<br> &nbsp;</li> <li>Opponents of single payer systems––like the Medicare for All idea––have traditionally labeled the plans as "socialist" in order to warn people away from them. Is a government program that provides healthcare socialist? Is Medicare (which provides health insurance for older Americans) socialist? Are libraries socialist?<br> &nbsp;</li> <li>Would you want some of your tax dollars to help pay for the medical care of someone who could not pay for it themselves?</li> </ol> <p>&nbsp;</p> <hr> <h4><br> Sources</h4> <p><a href="https://www.nytimes.com/2017/09/26/us/politics/mcconnell–obamacare–repeal–graham–cassidy–trump.html?mcubz=3" target="_blank">https://www.nytimes.com/2017/09/26/us/politics/mcconnell-obamacare-repeal-graham-cassidy-trump.html</a></p> <p><a href="http://stats.oecd.org/Index.aspx?DataSetCode=SHA" target="_blank">http://stats.oecd.org/Index.aspx?DataSetCode=SHA</a></p> <p><a href="https://www.washingtonpost.com/national/health–science/gop–senate–leader–calls–for–bipartisan–compromise–on–aca–marketplaces/2017/09/06/2e85710a–9309–11e7–aace–04b862b2b3f3_story.html?utm_term=.824064551bbf" target="_blank">https://www.washingtonpost.com/national/health–science/gop–senate–leader–calls–for–bipartisan–compromise–on–aca–marketplaces/2017/09/06/2e85710a–9309–11e7–aace–04b862b2b3f3_story.html?utm_term=.824064551bbf</a></p> <p><a href="https://data.oecd.org/healthstat/life-expectancy-at-birth.htm">https://data.oecd.org/healthstat/life-expectancy-at-birth.htm</a></p> <p><a href="http://www.latimes.com/politics/la–na–pol–healthcare–deadline–qa–20170925–story.html" target="_blank">http://www.latimes.com/politics/la–na–pol–healthcare–deadline–qa–20170925–story.html</a></p> <p><a href="https://www.cbpp.org/research/federal–budget/introduction–to–budget–reconciliation" target="_blank">https://www.cbpp.org/research/federal–budget/introduction–to–budget–reconciliation</a></p> <p><a href="https://www.cnn.com/2017/05/31/politics/healthcare-ahca-poll/index.html">https://www.cnn.com/2017/05/31/politics/healthcare-ahca-poll/index.html</a>&nbsp;</p> <p><a href="http://www.pewresearch.org/fact–tank/2017/06/23/public–support–for–single–payer–health–coverage–grows–driven–by–democrats/" target="_blank">http://www.pewresearch.org/fact–tank/2017/06/23/public–support–for–single–payer–health–coverage–grows–driven–by–democrats/</a></p> <p><a href="https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act" target="_blank">https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act</a></p> <p>&nbsp;</p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2017-10-03T09:32:28-04:00" title="Tuesday, October 3, 2017 - 09:32">October 3, 2017</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Tue, 03 Oct 2017 13:32:28 +0000 fionta 304 at https://www.morningsidecenter.org Ebola in Africa: Fostering Empathy in an Interconnected World https://www.morningsidecenter.org/teachable-moment/lessons/ebola-africa-fostering-empathy-interconnected-world <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>Ebola in Africa: Fostering Empathy in an Interconnected World</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><h4><strong>Gathering</strong></h4> <p>Share one thing that has stood out for you about reporting on the Ebola outbreak since a Liberian man infected with the disease died in Dallas.</p> <p>If you did the <a href="http://www.morningsidecenter.org/teachable-moment/lessons/lesson-ebola">earlier lesson plan on Ebola</a>, consider asking instead:</p> <p>Share one thing that has stood out for you about Ebola reporting since we last met to talk about the outbreak of the disease.&nbsp;</p> <hr> <h4><strong>Ideal World?</strong></h4> <p>Ask a volunteer or two to read the following excerpt from the <em><a href="http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/01/ebola-panic-in-america-might-help-save-lives-in-africa/">Washington Post</a></em></p> <p style="margin-left:.5in;">[The panic that followed the announcement of the first confirmed case of Ebola in the U.S.] is understandable but unnecessary.&nbsp;Ebola has a worryingly high mortality rate, and its spread in West Africa, most notably in Liberia, Sierra Leone and Guinea, has been unprecedented, but for a person to contract Ebola, they need direct contact with an infected person's blood, vomit or feces during the&nbsp;contagious period. The U.S.&nbsp;healthcare system is well-prepared to isolate and treat the infected person before they have a chance to infect others, limiting the risk of a large-scale outbreak.</p> <p style="margin-left:.5in;">In an ideal world, America's Ebola panic will come with a silver lining: a recognition that Ebola is a truly global problem, and protecting the health of Americans will probably start by saving the lives of thousands of people in West Africa.</p> <p><strong>Debrief questions to consider:</strong></p> <ul> <li>What is the "ideal world," according to this excerpt?</li> <li>What do you think about that in light of diversity and equality?</li> <li>What is the "silver lining" about America’s Ebola panic, according to this excerpt?</li> <li>What do you think about the idea that only worries about Ebola infecting Americans will spur interest in saving the lives of thousands of people in West Africa?</li> <li>Does this represent an ideal world?&nbsp; Explain.</li> <li>Does this represent a real world?&nbsp; Explain.</li> </ul> <p>&nbsp;</p> <hr> <h4>Small group discussion:<br> Disease and the Media</h4> <p>Ask students to read quietly by themselves, the following excerpt from the Huffington Post.&nbsp; Then in small groups discuss the questions below:</p> <p style="margin-left:.5in;"><em>"Epidemics on the other side of the world are a threat to us all. No epidemic is just local." Peter Pilot, Director, London School of Hygiene &amp; Tropical Medicine</em></p> <p style="margin-left:.5in;">Ebola was most fervently declared a global epidemic the moment it touched down in Dallas, Texas. It's a scary word with a scary history and with the media pulsing it in our faces 24-hours-a-day our fear continues to intensify. And yet here's the spread breakdown according to Dan Diamond <a href="http://www.forbes.com/sites/dandiamond/2014/10/03/yes-ebola-is-scary-but-its-also-beatable-heres-why/">over at Forbes</a>:</p> <ul> <li style="margin-left: 1in;">Liberia Deaths: 1830</li> <li style="margin-left: 1in;">Guinea Deaths: 648</li> <li style="margin-left: 1in;">&nbsp;Sierra Leone Deaths: 605</li> <li style="margin-left: 1in;">&nbsp;Nigeria Deaths: 8</li> <li style="margin-left: 1in;">United States Deaths: [1]</li> </ul> <p style="margin-left:.5in;">Sure, the fear isn't so much of the present but of the "what if" and of the "potential" for mass (Western) casualties. So USAID and the Department of Defense and a host of other US-based organizations are strapping up and wading through the worst Ebola-stricken areas for the noble sake of ending its devastating impact on humanity. Or is it for the sake of protecting ourselves? Does intent even matter?</p> <p>In their small groups ask students to discuss the questions raised in this excerpt:</p> <ul> <li>Are US (and European) organizations going to Ebola-stricken areas for the "noble sake of ending its devastating impact on humanity" or are they going to protect themselves?&nbsp;</li> <li>Does intent matter?&nbsp; Why?</li> </ul> <p>Back in the large group, ask some volunteers to share what they discussed in their small groups by asking the following questions:</p> <ul> <li>What were some of the things that you discussed in your small groups?</li> <li>What did you agree on?&nbsp; What did you disagree on?</li> <li>How did your group feel about the Western response to Ebola in Africa?&nbsp; Explain.</li> </ul> <p>Next project <strong>Tweet #1</strong> below onto the smart board or print it out for students to see:</p> <hr> <h4><strong>Tweet #1 by Scott Weathers:</strong></h4> <p><img alt src="/sites/default/files/pictures/Tweet%231.png" style="width: 486px; height: 526px;"></p> <hr> <p>&nbsp;</p> <p><strong>Discuss in small groups:</strong></p> <ul> <li>What is this cartoon trying to say about Ebola?</li> <li>Why does Scott Weathers think this photo is still necessary?</li> <li>Why does he use the word "still"?</li> <li>What are your thoughts about this?</li> <li>How does this tie into what you’ve discussed in your small groups so far?</li> </ul> <p>Next, project Tweet #2 onto the smart board or print it out for students to see:</p> <hr> <h4><strong>Tweet #2 by Bart Knols:</strong></h4> <p><img alt src="/sites/default/files/pictures/Tweet%232.png" style="width: 486px; height: 189px;"></p> <hr> <p><strong>Discuss in small groups:</strong></p> <ul> <li>What is this Knols trying to say about Malaria?</li> <li>What are your thoughts about this?</li> <li>How does this tie into what you’ve discussed in your small groups so far?</li> </ul> <p>&nbsp;</p> <hr> <h4><strong>The History of Tropical Medicine</strong></h4> <p>Ask another volunteer or read out the following excerpt from the Huffington Post.&nbsp; Then in small groups discuss the questions below:</p> <p style="margin-left:.5in;">Without diving too much into history, this is essentially how our modern efforts to eradicate malaria began. Western researchers, many of whom wanted to exploit African countries in one way or another, kept getting sick and even dying from malaria. In order to be exploitative, they had to first be healthy. So began some of our most comprehensive anti-malaria campaigns. We learned much about the disease and this knowledge has helped those most afflicted, but the intention was clear: to look out for No 1.</p> <p style="margin-left:.5in;">Professor John Farley, author of <a href="http://www.amazon.com/Bilharzia-Imperial-Tropical-Medicine-Cambridge/dp/0521530601">Bilharzia</a>, spoke bluntly of this:</p> <p style="margin-left:.5in;">"Tropical medicine from 1898 to the 1970s was fundamentally imperialistic in its basic assumptions, its methods, its goals, and its priorities."</p> <p style="margin-left:.5in;">Are we becoming increasingly aware of... our global interconnectedness? Philosopher Roman Krznaric seems to think so, yet he also sees the <a href="http://www.theguardian.com/lifeandstyle/2014/jan/25/roman-krznaric-my-children-my-greatest-teachers">modern forces at play</a> in our age of ... "... hyper-individualism, where a barrage of free-market thinking, advertising propaganda and simplistic self-help is telling us we should busy ourselves with looking after No 1."</p> <p style="margin-left:.5in;">His answer?&nbsp; "Empathy is the antidote we need to create a world where we embrace a philosophy of 'You are, therefore I am.'"</p> <p>&nbsp;</p> <p><strong>Discuss in the full group:</strong></p> <ul> <li>What are your thoughts and feelings about this excerpt?</li> <li>According to this excerpt what motivated people to eradicate malaria during the colonial era?</li> <li>How have things changed since the colonial era?&nbsp;</li> <li>How does this relate to the quote we read earlier in the lesson by Peter Pilot, Director of the London School of Hygiene &amp; Tropical Medicine?: "Epidemics on the other side of the world are a threat to us all. No epidemic is just local."</li> <li>How role does empathy play in all this, according to Roman Krznaric?</li> </ul> <p>&nbsp;</p> <hr> <h4><strong>Closing</strong></h4> <p>Do a go-round, asking students to share one word about today’s lesson.&nbsp; Or, if very little time remains, ask students on the count of three to give today’s lesson a thumbs up, down or in between.</p> <p>If you have time for a more interactive approach, ask students to rate the lesson from 1 to 5, where 1 means "not interesting" and/or "I didn’t learn anything," and 5 means "very interesting" and/or "I learned a lot."&nbsp; Invite students to stand up if they consider the lesson a 1, and invite volunteers to share why. Then continue with each number up to 5.</p> <p>&nbsp;</p> <hr> <h4><strong>EXTENSION MATERIALS </strong>on interconnectedness and empathy</h4> <p>&nbsp;</p> <p><strong>VIDEO - <a href="http://www.nytimes.com/video/world/africa/100000003071418/burial-boys-of-ebola.html">The Burial Boys of Ebola</a>&nbsp;</strong></p> <p>After viewing the video, ask students to break into groups of 4-5 and discuss the questions below.&nbsp; Then open things up to the larger group, asking volunteers from the smaller groups to share some of what was discussed in the smaller groups.&nbsp;</p> <p><strong>Questions for small- and large-group discussion</strong></p> <ul> <li>What are your thoughts and feelings about this clip?</li> <li>Who are the burial boys of Sierra Leone?</li> <li>What does a day in the life of the burial boys look like?</li> <li>How are the burial boys treated by the communities they go into?</li> <li>What are your thoughts and feelings about that?</li> <li>How do the burial boys feel about their work? What do you think about this?</li> </ul> <p>&nbsp;</p> <p><strong>ARTICLE - </strong><a href="https://time.com/3453907/plagues-ebola-malaria-research/"><strong>Plagues on the Poor: What Ebola Can Learn From Malaria </strong></a></p> <p>By Karen M. Masterson, October 2, 2014</p> <p>Ask students to read the article.&nbsp; Then discuss the following questions:</p> <ul> <li>What are your thoughts and feelings about this article?</li> <li>What is the primary message the author is trying to send?</li> <li>What does the author say about how the U.S. spends the money it has committed to global health programs targeting infectious diseases?</li> <li>How does this relate to the spread of Ebola?</li> <li>How does this article relate to the excerpts from the Huffington Post we discussed earlier in this lesson?</li> <li>The article talks about Ebola as "the latest plague on impoverished people."&nbsp; It refers to how the disease spreads quickly in places where people lack basic health care.&nbsp; How does this relate to the main argument the author tries to make?</li> </ul> <p>&nbsp;</p> <p><strong>PHOTOGRAPHS/SLIDESHOW - <a href="http://www.nytimes.com/interactive/2014/10/31/world/africa/photos-of-workers-and-survivors-braving-ebola-at-a-clinic-in-liberia.html">Braving Ebola</a></strong></p> <p>Photographs and Interviews by Daniel Berehulak</p> <p>Portraits of those who labor and those who survived at an Ebola treatment center in Rural Liberia.</p> <p>Ask students to break into small groups.&nbsp; Give each group four to five of the slides, including the interview quotes and short profiles of the person in the photograph. Each group will look at different slides: &nbsp;You might give group 1 slides 1-5, group 2 slides 6-10, etc. &nbsp;If computers are available, use those instead.</p> <p>Ask students in each group to look at their photographs, read who these people are and read their quotes about what they do in the fight against Ebola.&nbsp;</p> <p><strong>Discuss:&nbsp;</strong></p> <ul> <li>How do you feel looking at the people in these photos and reading their quotes?</li> <li>How do you think the people in the photos are feeling?</li> <li>How does looking at these photos and reading the quotes, confirm or change how you look at the Ebola outbreak in Liberia (and the rest of West Africa)?</li> <li>How do you feel about the patients the people in these photos are referring to?</li> </ul> <p>&nbsp;</p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2014-11-04T09:42:38-05:00" title="Tuesday, November 4, 2014 - 09:42">November 4, 2014</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Tue, 04 Nov 2014 14:42:38 +0000 fionta 506 at https://www.morningsidecenter.org A Lesson on Ebola https://www.morningsidecenter.org/teachable-moment/lessons/lesson-ebola <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>A Lesson on Ebola</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><h4>Note to teacher: &nbsp;&nbsp;</h4> <div>This lesson provides factual information to students about Ebola. &nbsp;Providing accurate information about the disease may help prevent misinformed students from targeting classmates who are from Africa (or thought to be from Africa), which has happened in some schools. &nbsp;If students have been targeted at your school because of Ebola fears, please see these <a href="http://www.morningsidecenter.org/teachable-moment/lessons/ebola-guidelines-handling-targeting-students">guidelines and resources</a> for addressing this challenge.</div> <div>&nbsp;</div> <div>&nbsp;</div> <div> <hr> <h4>Gathering</h4> </div> <div>In a go round, ask students to share one thing they’ve heard about Ebola in recent months. &nbsp;Chart what students share, by writing Ebola in the center of the chart or board, then writing student associations around it in one color. &nbsp;Ask students to try to limit their associations to a few words where possible and or summarize what they say as you chart it. &nbsp;</div> <div>&nbsp;</div> <div>In a second go round, ask students to share how they’re feeling about the recent cases of Ebola in the U.S. &nbsp;In a different color, chart the feeling words around the outside of what is already on the chart. &nbsp;</div> <div>&nbsp;</div> <div>In a third and final go round ask students to share how they think people in the five West African countries mainly affected by Ebola are feeling. &nbsp;Chart these feelings words, in a third color, on the outside of the chart. &nbsp;</div> <div>&nbsp;</div> <div>Ask students to take a look at the chart. &nbsp;What do they notice? &nbsp;Using the words on the chart, invite a volunteer to share what Ebola is and what’s happened recently with the disease. &nbsp;Ask other volunteers to add what they know. &nbsp;</div> <div>&nbsp;</div> <div>Next, invite students to share any questions they may have about the disease and its spread in West Africa and beyond. &nbsp;Chart these too and let students know that you’ll be returning to these questions by the end of today’s lesson. &nbsp;</div> <div>&nbsp;</div> <div> <hr> <div>&nbsp;</div> <h4>Discussion</h4> <div><strong>What is Ebola?</strong></div> <div>&nbsp;</div> <div>Elicit and explain that according to the <a href="http://www.cdc.gov/vhf/ebola/about.html">Center for Disease Control (CDC)</a></div> <div>&nbsp;</div> <div class="rteindent1">Ebola ... is a rare and deadly disease caused by infection ... Ebola can cause disease in humans and ... monkeys, gorillas, and chimpanzees. ... &nbsp;Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa.&nbsp;</div> </div> <div>&nbsp;</div> <div><strong>How does Ebola spread?</strong></div> <div>&nbsp;</div> <div>Elicit and explain that according to an article in the<em> Guardian</em> newspaper:</div> <div>&nbsp;</div> <div class="rteindent1">Ebola is a horrific disease that kills more than half of people infected by it, though with specialist western treatment that death rate would likely fall a little. It’s unsurprising that the prospect of catching it is a scary one. The relief is that it’s not all that infectious: direct contact with bodily fluids of a visibly infected person is required, meaning that, compared with many illnesses, it’s easily contained.</div> <div>&nbsp;</div> <div><strong>What has made this outbreak different from others? &nbsp;</strong></div> <div>&nbsp;</div> <div>Elicit and explain that Ebola has been all over the news in recent months. &nbsp;This may be in part because the most recent outbreak of the disease has been unprecedented in its death toll (currently in the thousands) across national borders in West Africa and the impact on health care workers. &nbsp;</div> <div>&nbsp;</div> <div class="rteindent1">According to the <a href="http://www.who.int/mediacentre/news/ebola/25-august-2014/en/">World Health Organization (WHO)</a>: &nbsp;In many cases, medical staff are at risk because no protective equipment is available - not even gloves and face masks. Even in dedicated Ebola wards, personal protective equipment is often scarce or not being properly used. &nbsp;[As a result,] Ebola has taken the lives of prominent doctors in Sierra Leone and Liberia, depriving these countries not only of experienced and dedicated medical care but also of inspiring national heroes.&nbsp;</div> <div class="rteindent1">&nbsp;</div> <div>But reporting of this most recent outbreak has been different too. &nbsp;Earlier outbreaks of Ebola in countries such as Congo, Sudan, Uganda and Gabon were barely given attention in the U.S. media, despite the fact that they were equally deadly to the people infected by the disease. &nbsp; As the <a href="http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/01/ebola-panic-in-america-might-help-save-lives-in-africa/"><em>Washington Post </em></a>noted, "In an ideal world, America's Ebola panic will come with a silver lining: a recognition that Ebola is a truly global problem, and protecting the health of Americans will probably start by saving the lives of thousands of people in West Africa." &nbsp;</div> <div>&nbsp;</div> <div>The first person to have returned to the U.S. with Ebola from Liberia, died in Dallas on October 8, 2014. Since then, social media and the 24-hour news cycle have kicked into high gear. &nbsp;They have helped feed a fear and panic, associating Ebola using words like "epidemic" "crisis" and "hysteria" rather than focusing on the fact that, though deadly, there is no Ebola "epidemic" in the U.S. Politicians across the political spectrum, moreover, have tried to use the public’s fear of Ebola to their advantage in advance of the upcoming mid-term elections. &nbsp;</div> <div>&nbsp;</div> <div><strong>What would it take to stop Ebola?</strong></div> <div>&nbsp;</div> <div>Invite volunteers to take turns reading &nbsp;<strong><a href="#Handout1">Handout 1</a>&nbsp;</strong>out loud. Have each student read up to one paragraph. &nbsp;If you have access to computers or a smart board, also show the video below the article. &nbsp;Next, discuss some or all of the following questions as a full group:</div> <ul> <li>What are your thoughts and feelings about the article and/or video clip?</li> <li>Is there anything new you’ve learned about Ebola so far?</li> <li>How was Nigeria able to contain the virus?</li> <li>What does that tell us about Ebola?</li> </ul> <hr> <h4>Small Group Work:<br> Why is there panic in the U.S.?</h4> <div>&nbsp;</div> <div>Split your class into small groups of four to five students. &nbsp;Provide some of the groups with <a href="#Handout2"><strong>Handout 2</strong></a>, a segment from a New York Times article on media and Ebola. &nbsp;Give other groups <a href="#Handout3"><strong>Handout 3</strong></a>, an excerpt from a <em>Washington Post</em> article on Ebola as the latest political football. &nbsp;(Note: For additional materials, see the links below.)&nbsp;</div> <div>&nbsp;</div> <div>Provide each group with around 7 minutes of reading time then another 7 minutes of small-group discussion time based on the questions at the bottom of the segment.&nbsp;</div> <div>&nbsp;</div> <div>After 15 minutes bring the group back together. Ask representatives from each small group to respond to the following:</div> <ul> <li>What was the main point the author was trying to make?</li> <li>Give an illustration of this main point with an example from the article. &nbsp;</li> </ul> <hr> <h4>Closing</h4> <div>Go back to the questions you created earlier today. &nbsp;See if any of them have been answered by today’s lesson. &nbsp;Consider assigning students to research any unanswered questions for homework. &nbsp;</div> <div>&nbsp;</div> <div>Next, go back to the web you created earlier today. &nbsp;Ask students if, based on today’s lesson, they feel they’d like to add anything else to the web. &nbsp;</div> <div>&nbsp;</div> <div> <hr> <h4><a name="Handout1"></a>HANDOUT ONE</h4> </div> <div><a href="http://in.reuters.com/article/2014/10/20/health-ebola-nigeria-idINKCN0I90UN20141020">According to ABC Australia Plus</a>: "Three of West Africa's poorest countries have so far borne the brunt of the [Ebola outbreak] ..., with 862 deaths in Guinea, 2,484 deaths in Liberia, and 1,200 in Sierra Leone."</div> <div>Nigeria, a neighboring country in West Africa, was also affected by this most recent outbreak of Ebola. But Nigeria was able to contain the virus. &nbsp;Despite the fact that the disease was brought into Nigeria’s crowded capital, Lagos, over the summer, only 10 people died in the end. &nbsp;This compares to the thousands who have contracted the disease elsewhere. &nbsp;Why did events unfold so differently in Nigeria? &nbsp;</div> <div>&nbsp;</div> <div>Nigeria was declared free of the Ebola virus in late October 2014, "after a determined doctor and thousands of officials and volunteers helped end an outbreak still ravaging other parts of West Africa and threatening the United States and Spain," according to <a href="http://in.reuters.com/article/2014/10/20/health-ebola-nigeria-idINKCN0I90UN20141020">Reuters.&nbsp;</a></div> <div>&nbsp;</div> <div>Nigeria had been "caught unaware" when a diplomat arrived with the disease from Liberia. &nbsp;But Nigerian authorities were alerted to the case by Doctor Ameyo Adadevoh, who kept the diplomat in the hospital despite protests from him and his government. The doctor later died from Ebola herself.</div> <div>&nbsp;</div> <div>Then the Nigerian government "set about trying to contain [Ebola] in an overcrowded city of 21 million." &nbsp;Nigeria kept the disease from spreading by identifying and isolating about 300 people who had been in direct or indirect contact with the diplomat.</div> <div>&nbsp;</div> <div>"This is a spectacular success story," said Rui Gama Vaz from the World Health Organization. &nbsp;Officials broke into applause when he announced that Nigeria had shaken off the disease.</div> <div>&nbsp;</div> <div>"It shows that Ebola can be contained, but we must be clear that we have only won a battle, the war will only end when West Africa is also declared free of Ebola."</div> <div>&nbsp;</div> <div><a href="http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/01/ebola-panic-in-america-might-help-save-lives-in-africa/">The Contact Tracing Cycle a Video</a></div> <div>&nbsp;</div> <div> <hr> <h4><a name="Handout2"></a>HANDOUT TWO&nbsp;</h4> </div> <div>From the <a href="http://www.nytimes.com/2014/10/20/us/fear-of-ebola-closes-schools-and-shapes-politics.html"><em>New York Times</em></a></div> <div>&nbsp;</div> <div>In the month since a Liberian man infected with Ebola traveled to Dallas, where he later died, the nation has marinated in a murky soup of understandable concern, wild misinformation, political opportunism and garden-variety panic. ...</div> <div>&nbsp;</div> <div>A crowd of parents last week pulled their children out of a Mississippi middle school after learning that its principal had traveled to Zambia, an African nation untouched by the disease. ...</div> <div>&nbsp;</div> <div>Carolyn Smith of Louisville, Ky., last week took a rare break from sequestering herself at home to take her fiancé to a doctor’s appointment. She said she was reluctant to leave her house after hearing that a nurse from the Dallas hospital had flown to Cleveland, over 300 miles from her home. "We’re not really going anywhere if we can help it," Ms. Smith, 50, said. ...</div> <div>&nbsp;</div> <div>"This is sort of comparable to when people were killed in terror attacks," said Roxane Cohen Silver, a professor of psychology in the department of psychology and social behavior at the University of California, Irvine.</div> <div>&nbsp;</div> <div>Ms. Silver studied and wrote about people who heavily consumed media after the bombings at the Boston Marathon in 2013 and "what we found is that individuals who were exposed to a great deal of media within the first week reported more acute stress than did people who were actually at the marathon."</div> <div>&nbsp;</div> <div>In his work on panic in various disasters, Anthony Mawson, a visiting professor in the School of Health Sciences at Jackson State University in Mississippi, found that while physical danger is presumed to lead to mass panic, in actual physical emergencies "expressions of mutual aid are common and often predominate." But the threat of an illness that has infected only two people in the United States appears to have had the opposite effect, inciting a widespread desire to hide and shut things down.</div> <div>&nbsp;</div> <div>"Obviously there’s fear," said Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases, in an interview Sunday on ABC. He said fear of the disease is dramatically outstripping current risks. ...</div> <div>&nbsp;</div> <div><strong>Discussion Questions:</strong></div> <ul> <li>Discuss your thoughts and feelings about the article.&nbsp;</li> <li>What are some of the "garden-variety panic responses" the article refers to?</li> <li>What does professor of psychology Roxane Cohen Silver say is the reason for some of these responses?</li> <li>What does she say about how heavy media consumption affects people during disasters?</li> <li>What is the main point the author is trying to get across?</li> </ul> <div> <hr> <h4><a name="Handout3"></a>HANDOUT THREE</h4> </div> <div>From the <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2014/10/16/a-brief-history-of-politicized-health-scares-starting-with-ebola/"><em>Washington Post</em></a></div> <div>&nbsp;</div> <div>It's just weeks before the midterm elections, and the deadliest Ebola outbreak in history has become the latest political football. Americans' risk of infection is still very, very low, but fears of the disease are increasing amid some apparent missteps by the federal government and the Texas hospital where the three U.S. Ebola cases emerged.</div> <div>&nbsp;</div> <div>Republicans are criticizing the Obama administration for not doing more to keep Ebola from this country. Louisiana Gov. Bobby Jindal was among the first in his party to call for a travel ban. Meanwhile, some on the left have blamed Republican-backed funding cuts for the lack of an Ebola vaccine.</div> <div>&nbsp;</div> <div>How people view the federal government's handling of a public health crisis often depends on which party controls the White House ... &nbsp;We've seen this pattern before with past health scares. &nbsp;In 2009, the Obama administration was criticized by Democrats and Republicans for its handling of the swine flu outbreak after reports emerged that Wall Street firms were improperly getting first dibs on vaccines. Opponents of Obama's proposed health reform bill brought this up during the debate in Congress, arguing that the apparent mismanagement of the vaccine program raised doubts about the government's ability to take a greater role in the health-care system.</div> <div>&nbsp;</div> <div>Ahead of the 2002 mid-term elections, Democrats attacked the Bush administration's response to the 2001 anthrax attacks. And some Democrats accused the administration of using the anthrax scare to build its case for the Iraq war.</div> <div>&nbsp;</div> <div>So, when fears of a public health outbreak emerge, who should we turn to for reason and calm? For starters, we could all listen to Fox News' Shepard Smith, who put the Ebola risk into proper context Wednesday night. "Do not listen to the hysterical voices on the radio and the television or read the fear-provoking words online," Smith said in his broadcast. &nbsp;He added this observation: "In the middle of all this, you have to remember that there is politics in the mix," he said. "With the midterm elections coming, the party in charge needs to appear to be effectively leading. The party out of power needs to show there is a lack of leadership."</div> <div>&nbsp;</div> <div>And those are your Ebola politics in a nutshell.&nbsp;</div> <div>&nbsp;</div> <div><strong>Discussion Questions:</strong></div> <ul> <li>Discuss your thoughts and feelings about the article.&nbsp;</li> <li>What do you think the author means by "Ebola has become the latest political football"? &nbsp;Who is criticizing whom and for what reason?</li> <li>Why does the author quote Fox News’ Shepard Smith?</li> <li>What does Shepard say about the fear and hysteria around the Ebola outbreak?</li> <li>What do you think the use of the word hysteria indicates?</li> <li>What is the main point the author is trying to get across?</li> </ul> <div> <hr> <h4>Additional materials:</h4> </div> <ul> <li><a href="http://www.theguardian.com/commentisfree/2014/aug/05/ebola-worrying-disease">Concerned about Ebola? &nbsp;You’re Worrying about the Wrong Disease</a></li> <li><a href="http://www.washingtonpost.com/blogs/worldviews/wp/2014/10/22/what-the-world-thinks-of-the-american-ebola-panic/">What the World Thinks of the American Ebola Panic</a></li> <li><a href="http://america.aljazeera.com/articles/2014/9/16/ebola-is-deadly-butmalariastealsmorelives.html">Ebola is Deadly but Malaria Steals More Lives</a></li> <li><a href="http://www.australiaplus.com/international/2014-10-22/ebola-outbreak-a-timeline-of-the-worst-epidemic-of-the-virulent-disease-in-history/1381785">A timeline of the disease:&nbsp;</a></li> </ul> <div>&nbsp;</div> <div>&nbsp;</div> <div>&nbsp;</div> <div>&nbsp;</div> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2014-10-29T11:38:50-04:00" title="Wednesday, October 29, 2014 - 11:38">October 29, 2014</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Wed, 29 Oct 2014 15:38:50 +0000 fionta 507 at https://www.morningsidecenter.org Ebola: Guidelines for Handling the Targeting of Students https://www.morningsidecenter.org/teachable-moment/lessons/ebola-guidelines-handling-targeting-students <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>Ebola: Guidelines for Handling the Targeting of Students</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><div>The Ebola outbreak in West Africa and irrational reactions to it in the U.S. are creating challenges in some schools. &nbsp;In some cases, students from Africa - or students who are thought to be from Africa - are being targeted for abuse by uninformed classmates who fear they may spread the virus. &nbsp;</div> <div>&nbsp;</div> <div>This situation requires quick, intelligent action by adults. &nbsp;To correct student misinformation about the disease, please &nbsp;see our <strong><a href="http://www.morningsidecenter.org/teachable-moment/lessons/lesson-ebola">classroom lesson on Ebola</a>.</strong> &nbsp; Below are some steps aimed at restoring calm and safety when students are being targeted because of Ebola.</div> <div>&nbsp;</div> <div> <hr><br> <strong>1. &nbsp;</strong>Adults must make a clear, strong statement that students must stop their mistreatment of targeted classmates immediately. &nbsp;See these <strong><a href="http://www.morningsidecenter.org/teachable-moment/lessons/guidelines-stopping-oppressive-behavior">guidelines for stopping oppressive behavior</a></strong>.</div> <div>&nbsp;</div> <div><strong>2. &nbsp;</strong>Adults must provide protection and emotional support for the targeted student or students. &nbsp;The guidance counselor or other professional should provide one-on-one support for targeted students.</div> <div>&nbsp;</div> <div><strong>3. &nbsp;</strong>All school staff members should be given accurate information about the virus.</div> <div>&nbsp;</div> <div><strong>4. &nbsp;</strong>Adults should have a chance to meet and share their information about what has happened, as well as their feelings and concerns about Ebola and students’ reactions to it. One format for doing this is the <strong><a href="http://www.morningsidecenter.org/teachable-moment/lessons/listening-circles">Listening Circle</a>.</strong></div> <div>&nbsp;</div> <div><strong>5. &nbsp;</strong>Adults should then develop a clear plan for addressing the situation. &nbsp;In addition to the other steps described here, this might include convening a group of student leaders to discuss the targeting of students and how to stop it. &nbsp;Enlist students’ help in educating their fellow students and advocating for respect.&nbsp;</div> <div>&nbsp;</div> <div><strong>6. &nbsp;</strong>Teachers should discuss Ebola information and misinformation with their students.</div> <ul> <li>Please see our <strong><a href="http://www.morningsidecenter.org/teachable-moment/lessons/lesson-ebola">classroom lesson about Ebola</a>,</strong> which explores how the disease is spread, what the government is doing to prevent its spread in the United States, as well as the impact of the disease on people in West Africa, the brave health care professionals who are trying to help, and related issues. &nbsp;</li> <li>See these <strong><a href="http://www.morningsidecenter.org/teachable-moment/lessons/teaching-about-controversial-or-difficult-issues">guidelines for addressing difficult issues in the classroom</a>.</strong></li> <li>See these <strong><a href="http://www.morningsidecenter.org/teachable-moment/lessons/guidelines-stopping-oppressive-behavior">guidelines for stopping oppressive behavior</a></strong>.</li> </ul> <div>&nbsp;</div> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2014-10-29T10:32:20-04:00" title="Wednesday, October 29, 2014 - 10:32">October 29, 2014</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Wed, 29 Oct 2014 14:32:20 +0000 fionta 508 at https://www.morningsidecenter.org The Debate over Obamacare https://www.morningsidecenter.org/teachable-moment/lessons/debate-over-obamacare <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>The Debate over Obamacare</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><h4>To the Teacher:&nbsp;&nbsp;</h4> <p>Beginning in early October 2013, most of the major provisions of the healthcare law called the Affordable Care Act (popularly known as "Obamacare") began to take effect. These provisions include subsidies for low-income families, "health insurance exchanges" through which individuals and businesses can purchase insurance, a financial penalty for those who choose to remain uninsured, and a guarantee that insurance providers cannot deny coverage for pre-existing conditions. The Affordable Care Act has aroused a great deal of controversy and has become a target of opposition from Republicans in Congress. In fact, its implementation was one reason Republicans gave for shutting down the government for over two weeks in October. The ACA also faces criticism from many progressives who think it does not go far enough to reform the US healthcare system.<br> &nbsp;<br> This lesson includes a short introductory reading about this debate, followed by a small group activity in which students read three different views on Obamacare. After sharing what they've read, students then take part in a fishbowl activity aimed at exploring their own views on the issue.<br> &nbsp;</p> <h4>Objectives</h4> <p>Students will:&nbsp;</p> <ul> <li>learn about the Affordable Care Act and the debates surrounding it</li> <li>read and consider different points of view about the legislation</li> <li>consider their own point of view in small group discussion</li> <li>consider taking action on the issue</li> </ul> <p>&nbsp;</p> <hr> <p>Ask students:&nbsp; What have you heard about the Affordable Care Act, or Obamacare?<br> &nbsp;<br> Why has this plan been in the news?&nbsp;&nbsp;(Reasons include the government shutdown Republicans engineered to oppose the plan, and problems with healthcare.gov, the ACA website the administration launched in October.)<br> &nbsp;<br> Ask students to read the following summary of the debate over Obamacare, or read it out loud to the class.</p> <p>&nbsp;</p> <hr> <p>&nbsp;</p> <h4>Introduction:<br> The Obamacare Debate</h4> <p>&nbsp;<br> Beginning in early October 2013, most of the major provisions of the healthcare law called the Affordable Care Act (popularly known as "Obamacare") began to take effect. This law, which was passed by Congress in December 2009, still arouses a great deal of controversy, and has been the target of ongoing opposition from Republicans in Congress. In fact, the implementation of Obamacare was one of the reasons Republicans gave for shutting down the government for over two weeks in October. The law also has progressive critics.&nbsp; While Republicans think the law goes too far, some progressives believe it doesn't go far enough to reform the US healthcare system.<br> &nbsp;<br> The ACA attempts to address some widely acknowledged problems with the US healthcare system. These include:</p> <ul> <li>The US spends far more on healthcare than any other country in the world, yet leaves a high percentage of people uninsured.</li> <li>The US's health outcomes (including how long we live, infant mortality, and disease rates) are among the worst in the industrialized world.</li> <li>The system itself is extremely complex, a patchwork of private insurance and public insurance (like Medicare, for the elderly and disabled, and Medicaid, for the poor) - and the complexity contributes to its high cost.</li> <li>The US, unlike many other industrialized countries, still relies mostly on employers to provide private health insurance, rather than relying on government to insure everyone. However, increasingly employers don't provide insurance (or force workers to pay more than they can afford for it), leaving workers in the lurch.&nbsp;</li> </ul> <p>&nbsp;<br> For these and other reasons, a majority of Americans have long supported major reform of our healthcare system. For years before Obamacare was passed, thousands of people across the country organized actions, protests, petition drives, and letter-writing campaigns, and campaigned for candidates in support of healthcare reform.&nbsp;<br> &nbsp;<br> President Obama was elected in 2008 on the promise of achieving reform. However, any kind of healthcare reform poses huge political challenges. Many Republicans and other conservatives are opposed to expanding government's role in providing health insurance. Some even argue that existing public healthcare systems, such as Medicare, should be privatized (that is, turned over to private corporations to run). Conservatives argue that the US healthcare system would be improved if there was more private competition for people's healthcare dollars. And most conservatives are also ideologically opposed to what they call "big government."<br> &nbsp;<br> Another major challenge healthcare reformers face is that several very politically powerful industries have a huge stake in the system —in particular, private health insurance companies, as well as pharmaceutical companies. The ACA was a compromise that included these players:&nbsp; In exchange for restrictions on their practices, the insurance industry accepted a deal in which the federal government would require most individuals and many employers to buy health insurance from them, often with government subsidies. Insurance companies expect that this will result in a massive influx of new customers. The gain for those who wanted reforms: Expanded access to healthcare for millions of Americans, and restrictions on such insurance industry practices as denying coverage to people with "preexisting conditions." &nbsp;<br> &nbsp;<br> Many progressive critics of the legislation say that it does not address the fundamental problem with our healthcare system. These critics note that while ACA will provide much needed coverage to more Americans, it will not lead to high-quality, affordable healthcare for all. In fact, they maintain, it props up the existing system by bolstering the role of private health insurance companies.&nbsp; To solve the healthcare crisis, they believe the US should, like many other industrialized countries, adopt a form of "national health insurance." Under such a "single payer" plan, a public program such as Medicare would be expanded to cover all Americans, reducing or eliminating the role of the private insurance industry. Advocates argue that only under such a system will the US be able to ensure and afford high-quality healthcare for everyone.&nbsp; They point to countries around the world that have single-payer systems, which cost about half as much as the US system and have superior health outcomes.</p> <p>After students have read the reading, ask:&nbsp;Do you have questions about the reading?</p> <p>&nbsp;<br> Record questions on the board for further exploration.<br> &nbsp;</p> <hr> <p>&nbsp;</p> <h4>&nbsp;<br> Small Group Discussion</h4> <p>Divide the class into three groups, and ask each group to read one of the opinions in the <a href="/sites/default/files/files/ObamacareReadings.pdf">attached pdf.</a> (Alternatively, assign the three groups the reading as homework and continue with the rest of this lesson tomorrow.)<br> &nbsp;<br> Readings are:<br> &nbsp;<br> Group One - The case for Obamacare:<br> <a href="http://www.foxnews.com/opinion/2013/09/30/five-reasons-americans-already-love-obamacare-plus-one-reason-why-theyre-gonna/">Five reasons Americans already love ObamaCare&nbsp;</a><br> Sally Kohn, Fox News, September 30, 2013<br> &nbsp;<br> Group Two - Conservative critique of Obamacare:<br> <a href="http://www.gop.com/news/research/the-case-against-obamacare/">The Case Against ObamaCare</a><br> GOP.Com, March 23, 2011<br> &nbsp;<br> Group Three - Progressive critique of Obamacare:<br> <a href="http://www.salon.com/2013/10/10/republicans_biggest_misunderstanding_about_obamacare/">Republicans' biggest misunderstanding about Obamacare</a><br> Adam Gaffney, Salon, October 10, 2013</p> <p>&nbsp;<br> Tell students that the readings reflect three different views about the Affordable Care Act: One reading argues in support of ACA, one critiques it on conservative grounds, and a third critiques it on progressive grounds.<br> &nbsp;<br> Tell students that after reading the opinion, they should agree on a brief summary of what they read to share with the rest of the class. Specifically, they will share:<br> &nbsp;<br> 1)&nbsp; a brief summary of what they read<br> 2) &nbsp;the reading's strongest point, in the group's opinion<br> 3)&nbsp; the reading's weakest point, in the group's opinion<br> &nbsp;<br> Give students 10 minutes to read the article and another 5-10 minutes to prepare to share.<br> &nbsp;<br> Reconvene the class and ask each group for its summary. If you have time, allow for one or two clarifying questions from the rest of the class after each group's summary.<br> &nbsp;<br> Tell the class that what they read are opinions, but the"facts" they cite aren't necessarily true.&nbsp; Ask students to come up with three things they could do if they were trying to verify the accuracy of what they read. Record these on the board.<br> &nbsp;</p> <hr> <p>&nbsp;</p> <h4>Fishbowl Discussion</h4> <p>Now tell the class that we'll have a fishbowl discussion about Obamacare. In this discussion, students will be asked to give their own thoughts and opinions, not those expressed in their reading.&nbsp; Of course students are free to cite arguments or information from the readings.<br> &nbsp;<br> Ask two students from Group One, two from Group Two and two from Group Three to sit in a circle facing each other. Ask the remaining students to form a circle around this fishbowl group. Students should stand roughly behind the two fishbowl members who were in their small group.<br> &nbsp;<br> After students have assembled, explain that only people in the fishbowl can speak. You will ask students in the fishbowl a question and invite students to speak to it in a "go-around." Each student responds without being interrupted. After a few minutes or so, you'll invite students from the larger circle to participate in the fishbowl conversation by tapping a fishbowl student on the shoulder and moving into that student's seat. Students should only replace the seat of someone who was in their group.</p> <p>Now ask the Fishbowl group students to listen to several statements. After each statement, they should say whether they agree or disagree, and why.&nbsp; Each student will have up to one minute to respond.<br> &nbsp;<br> Statement:&nbsp; The government should not be involved in providing health insurance for people.<br> Statement: &nbsp;Obamacare goes a long way to fixing our healthcare system.<br> Statement:&nbsp; The problem with Obamacare is that it just increases the role of the private insurance industry.<br> &nbsp;<br> Now stop and give students outside the fishbowl a chance to join the discussion by tapping the shoulder of someone from their group and taking their seat.<br> &nbsp;<br> Statement:&nbsp; Obamacare forces people to buy health insurance, and that's not right.<br> Statement:&nbsp; Obamacare is great because it ensures that a lot more people can get healthcare coverage.<br> Statement: Obamacare costs too much and doesn't cover everyone. We need a universal, public health insurance system.<br> &nbsp;<br> Stop again and give students outside the fishbowl a chance to join the discussion by tapping the shoulder of someone from their group and taking their seat.</p> <p>Statement: Obamacare could completely bankrupt the country.<br> Statement:&nbsp; Obamacare reins in the private health insurance companies.<br> Statement:&nbsp; Obamacare doesn't address the fundamental problems with our healthcare system.<br> &nbsp;<br> Reconvene the whole group and ask:</p> <ul> <li>What did you think of the discussion?&nbsp;</li> <li>Did you change your opinion about healthcare as a result of these readings and discussion?</li> </ul> <p>Return to the questions students had about the first reading.&nbsp; Have those questions been answered? If not, how might we answer them?</p> <p>Tell students that Obamacare was passed only after extensive grassroots organizing by people who wanted healthcare reform.&nbsp; Thousands of people across the country continue to organize on this issue, against Obamacare, in support of it, and in support of more thorough reform (such as national health insurance).&nbsp;&nbsp;</p> <p>Ask students if they are interested in taking an action step on this issue, and if so how they might proceed.<br> &nbsp;<br> &nbsp;<br> &nbsp;<br> &nbsp;<br> &nbsp;<br> &nbsp;<br> &nbsp;<br> &nbsp;</p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2013-10-27T11:42:58-04:00" title="Sunday, October 27, 2013 - 11:42">October 27, 2013</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Sun, 27 Oct 2013 15:42:58 +0000 fionta 566 at https://www.morningsidecenter.org A VERY CONTROVERSIAL HEALTH INSURANCE LAW https://www.morningsidecenter.org/teachable-moment/lessons/very-controversial-health-insurance-law <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>A VERY CONTROVERSIAL HEALTH INSURANCE LAW</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><strong>To the Teacher:</strong></p> <p>An introductory reading below provides students with an overview of the competing views about the new health insurance legislation. The first student reading below outlines: 1) provisions of the bill going into effect this year and 2) provisions phasing in over coming years. The second reading offers an array of views about various aspects of the new law. Discussion questions and a writing assignment follow.<br> &nbsp;</p> <hr> <h4><strong>Introduction:</strong></h4> <h3>A very controversial bill that became law</h3> <p>In the <em>New York Times</em>, the headline read, "Health Care Overhaul Becomes the Law of the Land." Financial columnist David Leonhardt called the bill "the federal government's biggest attack on economic inequality since inequality began rising more than three decades ago." (3/24/10)</p> <p>The Tampa Bay (Florida) Online headline on March 28, 2010, read, "Poll finds most Floridians oppose health reform law." Kevin Wiatrowski reported that "the strongest opposition [was] coming from those 65 and older, according to a poll released on Saturday." (<a href="http://www.tbo.com">www.tbo.com</a>, 3/28/10)</p> <p>"Love it or hate it. Across the nation, reaction to the landmark health care legislation that made it through the House late Sunday seemed to echo the bitter division in Washington, drawing either praise or excoriation," said Scott Neuman of National Public Radio. (<a href="http://www.npr.org">www.npr.org</a>, 3/22/10)</p> <p>Fox News' online headline was "Lawmakers Willing to Gamble on Public Anger Over Health Care." "You'll learn to like it," read the article. "That's the message from White House advisers and Democratic lawmakers to Americans opposed to the health insurance overhaul signed into law last week." (<a href="http://www.foxnews.com">www.foxnews.com</a>)</p> <p>Most Republicans see the new law as a "government takeover" produced by "back room deals" and "rammed through" Congress. Most Democrats hailed it as "historic," and President Obama declared that the law "will set in motion reforms that generations of Americans have fought for and marched for and hungered to see." Meanwhile, progressives who had long called for a "Medicare for all" system were disappointed by the legislation, which builds on the the U.S.'s private, employer-based insurance system.</p> <p>While people referred to the legislation as "health care," "health reform," "health care insurance reform," and "health insurance reform," the actual title of the bill is something else entirely: the Patient Protection and Affordable Care Act (PPACA).</p> <p><strong>For discussion</strong></p> <p>1. What do you know about the PPACA? What difference might it make in your life?</p> <p>2. What would you call the new law and why?</p> <p>3. What don't you know but would like to? How might you find out?<br> &nbsp;</p> <hr> <h3><strong>Student Reading 2:</strong></h3> <h2>Major provisions of the the new law</h2> <p>The PPACA is 2,309 pages long, and full of technicalities and complexities. A shorthand outline of what the law provides and prohibits:</p> <p><strong>Provisions going into effect this year</strong></p> <ul> <li>allow uninsured adults younger than 26 to be added to their parents' health plans<br> &nbsp;</li> <li>require new private health insurance plans to cover the full cost of preventive care, including annual physicals and children's immunizations<br> &nbsp;</li> <li>ban insurance companies from excluding children under 19 from their parents' health insurance plan because of preexisting health conditions<br> &nbsp;</li> <li>allow people who are considered "uninsurable" (they've been turned down by private insurers because of their health status) to qualify for insurance through a new federal program<br> &nbsp;</li> <li>prohibit private health insurers from imposing lifetime limits on coverage<br> &nbsp;</li> <li>offer tax incentives to small businesses if they pay at least half of employees premiums<br> &nbsp;</li> <li>phase out a gap, or "doughnut hole," in the Medicare prescription drug program<br> &nbsp;</li> <li>increase funding for community health centers<br> &nbsp;</li> <li>prohibit the government from providing or subsidizing insurance plans that cover abortion<br> &nbsp;</li> <li>prohibit the government from providing insurance for undocumented immigrants</li> </ul> <p><strong>Provisions to be phased in over several years</strong></p> <ul> <li>require most Americans without insurance to buy it, or else pay a fine<br> &nbsp;</li> <li>provide subsidies for those who can't afford the full cost of insurance<br> &nbsp;</li> <li>through these and other other provisions, see that about 32 million Americans currently without health insurance become insured<br> &nbsp;</li> <li>require insurers to accept all applicants regardless of "preexisting conditions"<br> &nbsp;</li> <li>allow an individual not covered by an employer and earning too much to qualify for Medicaid (a state-administered program for low-income people) to buy insurance through a state insurance exchange and, depending upon their income, be eligible for a subsidy<br> &nbsp;</li> <li>forbid insurers to discriminate on the basis of sex or to cancel a policy once a person becomes sick<br> &nbsp;</li> <li>expand Medicaid to cover 10-12 million new people<br> &nbsp;</li> <li>tax health benefits on the most expensive insurance plans<br> &nbsp;</li> <li>cut sharply government subsidies for Medicare Advantage, a private plan option, to make it similar to Medicare</li> </ul> <p>The first two items on this list are especially controversial. Those opposed to the new law argue that the government has no business forcing people to buy something they don't want, requiring private insurance companies to accept applicants they don't want, or supporting those with low incomes.</p> <p>Those supporting these provisions argue that the mandate to buy insurance will bring health insurance costs down by giving insurance companies a larger risk pool. Spreading out risk is a key idea behind insurance. Because of the mandate, insurers will get millions of new customers—including both healthy, young people who will cost them little and subsidized lower-income people and those in poor health, who will cost them more. (Most of the sickest Americans, however, will continue to be covered by government programs, especially Medicare, the federal program for seniors and the disabled.)</p> <p><strong>For discussion</strong></p> <p><strong>1. </strong>What questions do students have about any of the provisions? How might they be answered?</p> <p><strong>2. </strong>What is the answer to arguments that the government should not require people to buy insurance if they don't want it? Does it make sense to you? Why or why not?</p> <p><strong>3.</strong> What do you think are other objections to PPACA and why? What answers might there be to such objections?</p> <p><strong>4.</strong> What do you think are the most valuable elements in the PPACA and why?</p> <p><strong>5.</strong> Should the program have included government spending on abortion, a legal medical procedures? Why or why not?</p> <p><strong>6.</strong> Should it have included insurance for undocumented immigrants? Why or why not?</p> <p><strong>7.</strong> Why would a large risk pool bring down the cost of insurance?<br> &nbsp;</p> <hr> <h3><strong>Student Reading 3:</strong></h3> <h2>Differing points of view and questions about them</h2> <p><strong>President Obama</strong><br> "At a time when the pundits said it was no longer possible, we rose above the weight of our politics. We proved that this government...still works for the people." (3/21/10 at his signing the health insurance bill into law)</p> <p><em>Question:</em> Do you agree with the president that "this government...still works for the people"?</p> <p><strong>Senate Minority Leader Mitch McConnell (R, KY)</strong><br> "Democratic leaders and White House officials may be celebrating their victory this week, but most of the rest of the country is not. Most people are not interested in celebrating a bill that makes their lives more complicated, takes more out of their paychecks and puts decisions they are used to making themselves into the hands of federal bureaucrats." (radio address, 3/27)</p> <p><em>Question:</em> Does the law make people's lives "more complicated"? take "more out of their paychecks"? "put decisions" they have made for themselves "into the hands of federal bureaucrats"? Why or why not?</p> <p><strong>Rose Ann DeMoro, Executive Director, National Nurses United and California Nurses Association</strong><br> "The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth. ... Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need..."<br> (<a href="http://www.huffingtonpost.com">www.huffingtonpost.com</a>, 3/23/10)</p> <p><em>Question:</em> Does the new law strengthen "the economic and political power of a private insurance-based system based on profit rather than patient need"? If so, how? If not, why not?</p> <p><strong>Speaker of the House Nancy Pelosi (D, CA)</strong><br> This legislation may not have bipartisan support, but it has bipartisan imprint. There are over 200 amendments...that the Republicans advanced that are in this legislation. So, the fact that, before the president even went to see the Republicans in the House, when he became president, they said, whatever he asks for, the answer is no... Bipartisanship is not more important than a little child who is sick, being deprived of coverage because he has a preexisting condition. It's not more important that women can stop being — just being a woman is no longer a preexisting medical condition, that — that, if you lose your job, you lose your insurance, that, if you want to start a business or be self-employed or change jobs, you're not job-locked, that the insurance companies don't have it over your head that they can... increase your rates, and you're at their mercy. (<a href="http://www.pbs.org">www.pbs.org</a>, 3/24/10)</p> <p><em>Question:</em> Does the new law end the ability of insurance companies to keep you "at their mercy"? Why or why not?</p> <p><strong>Ed Hinkle, journalist</strong><br> The increased federal involvement in health care will become a pretext for increased federal involvement in — well, everything. The reasoning will be that individual health affects health care, which is now a federal enterprise. And everything can be said, with more or less sophistry, to affect individual health. So "managing" the "system" will become the all-purpose excuse for dictating the manner in which you live your life. (Richmond Times-Dispatch, <a href="http://www.timesdispatch.com">www.timesdispatch.com</a>, 3/31/10)</p> <p><em>Question:</em> Does the new law provide a government "excuse for dictating the manner in which you live your life"? Why or why not?</p> <p><strong>Virginia Attorney General Ken Cuccinelli</strong><br> Charging that the new law amounts to "unconstitutional overreach," Attorney General Cuccinelli announced that he will file a lawsuit against the legislation on behalf of Virginia. He said, "Virginia is in a unique situation that allows it the standing to file such a suit since Virginia is the only state so far to pass a law protecting its citizens from a government-imposed mandate to buy health insurance. The health care reform bill, with its insurance mandate, creates a conflict of laws between the federal government and Virginia." (<a href="http://www.csmonitor.com">www.csmonitor.com</a>, 3/22/10)</p> <p><em>Question:</em> Is it constitutional for the federal government to require citizens to buy health insurance? Why or why not and what is the constitutional authority for an answer?</p> <p><strong>Paul Krugman, economics professor and op-ed columnist</strong><br> Can we afford this? Yes, says the Congressional Budget office, which...concluded that the proposed legislation would reduce the deficit by $138 billion in its first decade and...$1.2 trillion, in its second decade...An ideal plan isn't on the table. And what is on the table, ready to go, is legislation that is fiscally responsible, takes major steps toward dealing with rising health care costs, and would make us a better, fairer, more decent nation. ("Why We Reform," New York Times, 3/19/10)</p> <p><em>Question:</em> In what ways does or doesn't the new law make us "a better, fairer, more decent nation"?</p> <p><strong>Terry O'Neill, President, National Organization for Women</strong><br> Forty percent of women have had or will have an abortion in their lifetime. It is a common medical procedure. It needs to be safe. It needs to be fully and equally accessible to all women. And what has been enshrined in this law is not so much the principle about whether federal dollars go to pay for abortion, what is really enshrined in this law is that ideology can trump health care needs of an entire class of people in this country. (<a href="http://www.pbs.org/moyers/journal">www.pbs.org/moyers/journal</a> 3/26/10)</p> <p><em>Question:</em> Does the new law enshrine the principle "that ideology can trump health care needs of an entire class of people in this country"?</p> <p><strong>Representative Steve King (R, IA)</strong></p> <p>Americans "must take their country back by methodically eliminating every vestige of creeping socialism, including socialized medicine." (quoted by Howard Fineman, Newsweek, 4/5/10)</p> <p>A dictionary definition of "socialism"</p> <p>1 : any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods<br> 2 a : a system of society or group living in which there is no private property b : a system or condition of society in which the means of production are owned and controlled by the state<br> (<a href="http://www.merriam-webster.com/dictionary/socialism">www.merriam-webster.com/dictionary/socialism</a>)</p> <p><em>Question:</em> Does the dictionary definition of socialism support Rep. King's view that the new law represents "socialized medicine"? Why or why not?<br> &nbsp;</p> <hr> <h4>For writing</h4> <p>Below are three options:</p> <p><strong>1)</strong> Select one provision of the PPACA that you either approve or disapprove of. Then write a one-paragraph paper in which you provide a reasoned basis for your point of view.</p> <p><strong>2) </strong>Explain in a one-paragraph paper and with specific details how the PPACA will affect your life.</p> <p><strong>3)</strong> In an one-paragraph paper cite two or three specific items that would support one of the following:</p> <p>a. David Leonhardt's statement that the health insurance law is "the federal government's biggest attack on economic inequality since inequality began rising more than three decades ago."</p> <p>b. Sen. McConnell's view that the new legislation makes people's "lives more complicated, takes more out of their paychecks and puts decisions they are used to making themselves into the hands of federal bureaucrats."</p> <p>c. Rose Ann DeMoro's view that the law "strengthens the economic and political power of a private insurance-based system based on profit rather than patient need."</p> <hr> <p><em>This lesson was written for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email them to: <a href="mailto:lmcclure@morningsidecenter.org">lmcclure@morningsidecenter.org</a></em></p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2010-04-07T14:00:00-04:00" title="Wednesday, April 7, 2010 - 14:00">April 7, 2010</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Wed, 07 Apr 2010 18:00:00 +0000 fionta 851 at https://www.morningsidecenter.org THE HEALTHCARE DEBATE https://www.morningsidecenter.org/teachable-moment/lessons/healthcare-debate <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>THE HEALTHCARE DEBATE</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><strong>Objectives</strong></p> <p>Students will:</p> <ul> <li>share what they know about the healthcare debate</li> <li>look at the notion of healthcare versus health insurance</li> <li>engage in an activity about health insurance</li> <li>think critically about and compare different health insurance options</li> </ul> <p>Social and Emotional Skills:</p> <ul> <li>empathy and concern for others</li> <li>making choices and learning about consequences</li> <li>critical thinking</li> </ul> <p><strong>Materials needed:</strong></p> <ul> <li>M&amp;Ms or some other "currency" like pennies or pieces of paper</li> <li>Agenda on chart paper</li> <li>Yellow paper or card stock to make insurance cards</li> <li>A hat, box or other container in which to put students' names</li> <li>A bowl in which to collect the currency (M&amp;Ms)</li> </ul> <p><strong>Information about the healthcare debate for the teacher:</strong></p> <ul> <li>General information: <a href="http://www.kff.org/">http://www.kff.org/</a></li> <li>Information on single-payer healthcare (Medicare for all): <a href="http://www.pnhp.org/facts/single-payer-faq#costs_down">http://www.pnhp.org/facts/single-payer-faq#costs_down</a></li> </ul> <p>&nbsp;</p> <hr> <p><strong>Gathering</strong> <em>(5 minutes)</em></p> <p>Ask students to talk in pairs about a time they were sick or hurt. What was it like? Did anyone take care of them? What was that like? Instruct each student to take a minute or two to share, while the other student listens. Switch roles. When all students have shared, ask a few volunteers to tell ths whole class what they discussed.</p> <p>Before starting the lesson, make sure to emphasize that we all get sick at one point or another in our lives. Some people get sick or hurt more often than others, in some cases because a disease runs in their families, in other cases because people catch diseases from others, like with the H1N1 flu right now. Sometimes we get sick for no apparent reason or get hurt unexpectedly. At that point, we need other people to take care of us — which is what today's lesson is about.</p> <p>&nbsp;</p> <p><strong>Check Agenda</strong><em> (2 minutes)</em></p> <p>Explain that in today's lesson students will explore aspects of the healthcare debate that have been all over the news in recent months.</p> <p><strong>Setting the Stage</strong><em> (10 minutes)</em></p> <ul> <li>To start out, get a sense of what your students already know by asking some or all of the following questions:</li> <li>What have they heard about the healthcare debate?</li> <li>Do they know what the debate is about?</li> <li>What do they think healthcare is?</li> <li>What do they think health insurance is?</li> <li>Is there a difference?</li> </ul> <p>Explain to your students that you'll be doing an activity in which they will get to experience how insurance works.</p> <p>&nbsp;</p> <hr> <h3>The M&amp;M Health Insurance Game</h3> <p><em>(30 minutes)</em><br> &nbsp;</p> <p><strong>Create the Community</strong></p> <p>Start by asking all students to write their names on a piece of paper, or index card. Collect the names and put them into a jar, hat, or other container. These are the names of the people that make up your community.<br> &nbsp;</p> <p><strong>Distribute the Currency</strong></p> <p>Next provide your students with "currency" - 15 M&amp;Ms each. Instruct students not to eat the M&amp;Ms because they will need them for more important things. (If students do end up eating M&amp;Ms use it later on as a teachable moment. Sometimes when we go for instant gratification, we regret it later!)</p> <p>Let students know that the 15 M&amp;Ms are their income or budget for the month. With it they have to pay their monthly rent, transportation, food, etc. With it they also have to pay taxes, clothing, phone costs, health insurance and any other costs for the month, including extras like trips, music, movies, etc.<br> &nbsp;</p> <p><strong>The Cost of Health Insurance</strong></p> <p>So let's turn to our activity on insurance. This is how it works: if you want to get health insurance you will be required pay a certain amount each month (3 M&amp;Ms in this case) so that if you get sick or hurt, the healthcare costs will be covered by the insurance company. Healthcare costs are usually much higher than 3 M&amp;Ms, which is why you would want to get insurance. Of course it's also possible that you won't get sick or hurt at all. In that case you'd be paying for insurance but not receiving any benefits from the insurance company. Insurance is about protecting yourself "in case of."<br> &nbsp;</p> <p><strong>To Insure or Not to Insure?</strong></p> <p>Ask everyone to put aside the 10 M&amp;Ms for monthly costs like rent, transportation and food. That money can't be spent on anything else. Students each have 5 M&amp;Ms left for everything else they want (and need) to buy.</p> <p>Ask your students who would like to buy health insurance for 3 M&amp;Ms a month. If few kids decide to purchase insurance, explain again the risk in not having insurance. Maybe put a price ranging from 3-10 M&amp;Ms on a medicine, medical procedures and doctor's check ups to illustrate.</p> <p>If on the other hand, many/all kids decide to take out insurance, explain the other side of things again. This activity works best if you have some kids choosing to take out insurance and other kids choosing to go without.<br> &nbsp;</p> <p><strong>Pool the Insurance Money</strong></p> <p>Collect M&amp;Ms from the students who want to buy insurance and give them a yellow piece of paper to function as an insurance card. Pool their M&amp;Ms in a bowl, explaining that this "money" will pay for the medical procedures, hospitalizations, medicines, and check ups that those who took out insurance may need over the coming month.<br> &nbsp;</p> <p><strong>Case Study 1: Broken Leg</strong></p> <p>Get your jar or hat containing students' names. Explain that the first student whose name you'll pick will have broken his leg and will need to go to the emergency room, have an X-ray taken, and have the leg be put in a cast at the hospital. This will cost 6 M&amp;Ms this month alone. Next month he will have to go for check ups and start physical therapy, which will cost him another 4 M&amp;Ms.</p> <p>Pick the name and find out if the student took out insurance. If he did, go to the community insurance fund and take 6 M&amp;Ms to pay for his costs for the month. If he did not take out insurance, ask him for 6 M&amp;Ms to cover the costs (which he won't have).</p> <p>Use this moment to reflect on whether it makes sense to take this kind of risk with our health. Have a short class discussion.<br> &nbsp;</p> <p><strong>Case Study 2: Fever</strong></p> <p>The next student whose name you'll pick out of the "hat" has a high fever and is feeling very sick. She will need to go to the doctor to find out what's wrong with her. The checkup reveals that she'll need to take medication for two weeks to cure the illness or it will get worse. The medication will cost her 3 M&amp;Ms.</p> <p>Again, find out if the student took out insurance. If she did, take 3 M&amp;Ms from the insurance fund. If not, ask her for 3 of her M&amp;Ms to pay for the medication. In this case the student would be okay, at least this month. What about if costs go up though?<br> &nbsp;</p> <p><strong>Case Study 3: Injuries from a Car Accident</strong></p> <p>The next student whose name will be pulled out of the hat will have been in a car accident and will need to be in the hospital for two weeks, undergoing several surgeries, before being allowed to go home to get better. All of this is very expensive and will cost 15 M&amp;Ms this month alone. There will be follow up costs in the months to come which will add up to much, much more.</p> <p>Find out, once again, whether the student took out insurance, in which case you'll dip into the fund to pay for the hospital stay and care. If the student did not take out health insurance, what do the students think will happen to this person?</p> <p>Have a short discussion.<br> &nbsp;</p> <p><strong>Case Study 4: Appendicitis</strong></p> <p>The student whose name you'll pull out of the hat next will come down with acute appendicitis and will have to be hospitalized for a week after his surgery. The initial cost is 12 M&amp;Ms, but some complications require further hospitalization that will cost another 20 M&amp;Ms over the next two weeks.</p> <p>Check if the student has insurance.</p> <p>&nbsp;</p> <p><strong>Discussion of the Case Studies</strong></p> <p>Now, open up the discussion using some or all of the following questions:</p> <ul> <li>What did students think of the activity?</li> <li>Ask students who took out insurance and didn't get sick or hurt: How do they feel about having taken out insurance?</li> <li>Ask students who took out insurance and did get sick or hurt: How do they feel about having taken out insurance?</li> <li>What about those who didn't take out insurance? Was there anyone who got sick or hurt? What was it like for them when they were told how much money they owed?</li> <li>If no one without insurance ended up sick or hurt, ask students to imagine what it would have been like if their name had been picked.</li> <li>Does it make sense to gamble with your health in this way?</li> </ul> <p>Of course in this activity we assumed that everyone had the same income, which isn't the case in the real world. What if people's income is only 10 M&amp;Ms and they can't afford healthcare? Does that mean that they just shouldn't be able to get healthcare? What if they end up with appendicitis like the student above? Ask students to think about this as they continue to explore other issues in the debate over health insurance and healthcare.</p> <p>Ask students: Was there enough money in the insurance fund to cover those who got sick or hurt?</p> <p>Talk about what happens if everyone takes out insurance. When everyone is insured, there are more M&amp;Ms available in case someone gets sick. This is called "spreading the risk."</p> <p>But what if not everyone can afford to pay for health insurance?</p> <p>Do your students think that the M&amp;Ms collected from everyone else should cover their healthcare costs? Why? Why not?</p> <p>Do they think the government should make sure that everyone who can afford it pays for insurance? Remember, costs would go down and as a result a lot more people would be able to afford healthcare.</p> <p>Explain to the students that people have been debating these questions in our country, and that Congress is now considering a bill that would address some of these issues. Under this legislation, many people would be required to buy health insurance. The government would provide support to help some people buy insurance, either from a private company or from the government.</p> <p>In some countries, the government automatically insures everyone. The cost is covered by taxes on people's wages. This kind of system covers everyone for less money because it is simple and because private insurance companies aren't collecting profits from selling people insurance. This system is sometimes called "single payer," because the government is the only one paying for insurance. In countries with single-payer insurance, the assumption is that healthcare is a right that everyone has whether they can afford it or not.</p> <p>However, some people in this country oppose this kind of health insurance system, mainly because they think the government shouldn't play such a major role.</p> <p>To wrap up the lesson ask students:</p> <ul> <li>Reconsider: What is the different between health insurance and healthcare?</li> <li>Do they think everybody should have healthcare, no matter how much money they have?</li> <li>Is healthcare a human right?</li> </ul> <p>&nbsp;</p> <hr> <p><strong>Closing</strong> <em>(3 minutes)</em></p> <p>Ask a few volunteers to share what they learned today.</p> <p><strong>Possible Follow-up Discussion</strong></p> <p>If you have time and are interested you might explore the notion of insurance further at some point during the lesson, using the following questions:</p> <ul> <li>What word is contained within insurance?</li> <li>What does the word sure mean?</li> <li>Can anyone ever be sure about whether they'll get sick or hurt?</li> </ul> <p>So insurance provides a person with some "sureness," also known as certainty, about something that is very much uncertain. This way, people don't have to worry so much about the "What if?"</p> <p><em>Main Entry: in·sur·ance</em><br> Pronunciation: \in- shur-?n(t)s also in-\<br> Function: noun<br> 1 a : the business of insuring persons or property b : coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril c : the sum for which something is insured<br> 2 : a means of guaranteeing protection or safety <the against changes contract insurance is price your></the></p> <p><em>Main Entry: sure</em><br> Pronunciation: \shur, especially Southern shr\<br> Function: adjective<br> Etymology: Middle English seur, sure, from Anglo-French seur, from Latin securus secure<br> 6 a : bound to happen : inevitable <sure disaster> b : bound, destined <is sure to win></is></sure></p> <p>&nbsp;</p> <p>&nbsp;</p> <p><em>This lesson was written by Marieke van Woerkom for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email us at: <a href="mailto:info@morningsidecenter.org">info@morningsidecenter.org</a>.</em></p> <p>&nbsp;</p> <p>&nbsp;</p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2009-12-09T13:39:12-05:00" title="Wednesday, December 9, 2009 - 13:39">December 9, 2009</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Wed, 09 Dec 2009 18:39:12 +0000 fionta 872 at https://www.morningsidecenter.org OBAMA'S HEALTH INSURANCE PLAN & ITS CRITICS https://www.morningsidecenter.org/teachable-moment/lessons/obamas-health-insurance-plan-its-critics <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>OBAMA&#039;S HEALTH INSURANCE PLAN &amp; ITS CRITICS</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><strong>To the Teacher</strong></p> <div>&nbsp;</div> <div>The health insurance debate is likely to be with us at least until late in the fall and offers a teachable moment for students to consider what many regard as the country's most important domestic issue.</div> <div>&nbsp;</div> <div>The first student reading below presents the highlights of President Obama's plan as he discussed it in his address before a joint session of Congress. The second provides excerpts from the responses of critics and commentators. Discussion questions follow, as well as an inquiry/discussion proposal to involve students' family members in a dialogue about health insurance and healthcare issues.</div> <div>&nbsp;</div> <div>&nbsp;</div> <div> <hr></div> <h3>Student Reading:</h3> <h2>The president's health insurance plan</h2> <div>&nbsp;</div> <div>"It has now been nearly a century since Theodore Roosevelt first called for healthcare reform. And ever since, nearly every president and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way...Our collective failure to meet this challenge-year after year, decade after decade—has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy," said President Obama on September 9, 2009, before a joint session of Congress about his health insurance plan.</div> <div>&nbsp;</div> <div>"Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many others...are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover...Under my plan, individuals will be required to carry basic health insurance-just as most states require you to carry auto insurance."</div> <div>&nbsp;</div> <div>"The plan I'm announcing tonight would meet three basic goals: It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will slow the growth of healthcare costs for our families, our businesses and our government."</div> <div>&nbsp;</div> <div>He outlined his plan, called for the Congress to complete its legislative work and have a bill on his desk for signing into law before the end of the year, but added, "I will not sign a plan that adds one dime to our deficits-either now or in the future. Period."</div> <div>&nbsp;</div> <div>&nbsp;</div> <div>Highlights (*most controversial items)</div> <div>&nbsp;</div> <div>For those who have health insurance:</div> <div>&nbsp;</div> <ul> <li>Allows people who have health insurance they like to keep it</li> <li>Makes it illegal for insurance companies to deny coverage</li> <li>Ends premium discrimination based on gender; limits it based on age</li> <li>Prevents insurance companies from dropping coverage if medical condition was not listed on application, except in cases of fraud</li> <li>Prohibits insurance companies from placing annual or lifetime caps on benefit payments</li> <li>Eliminates extra charges for preventive care like a colonoscopy</li> <li>Eliminates gradually a gap in Medicare drug benefit that can now cost a senior $4,080</li> </ul> <div>For those who don't have insurance:</div> <div>&nbsp;</div> <ul> <li>Creates a marketplace that allows people without insurance and small businesses to &nbsp;compare plans and buy one they prefer at a competitive price</li> <li>Provides tax credits to help lower-income people and small businesses buy insurance</li> <li>*Offers a public health insurance option designed to promote competition and provide more choice</li> <li>Offers new low-cost coverage to provide insurance immediately to people with pre-existing conditions until the new marketplace of options is created by 2013</li> </ul> <p>For all Americans:</p> <ul> <li>*Is supposed to save money, not add to the deficit, and is to be paid for upfront</li> <li>Requires additional budget cuts if savings are not realized</li> <li>Creates an independent commission of doctors and medical experts to make annual recommendations to Congress on how to promote greater efficiency and higher quality in Medicare</li> <li>Requires large employers—those with more than 50 workers—to cover their employees</li> <li>Requires independent workers who can afford it to purchase coverage but provides &nbsp;a "hardship exemption" for those who cannot</li> </ul> <div>*The health insurance industry and Republicans strongly oppose a public option because, they argue, a nonprofit government-run plan will run private insurers out of business. Exactly how such a plan would operate is unclear.</div> <div>&nbsp;</div> <div>*There are many questions about whether the Obama plan will in fact reduce healthcare costs and avoid deficit spending.</div> <div>&nbsp;</div> <div>(This listing is an abbreviated and edited version of the full plan, which, along with a transcript of the president's speech to Congress on September 9, is available at</div> <div><a href="http://www.whitehouse.gov">www.whitehouse.gov</a>)&nbsp;</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><strong>For discussion</strong></div> <div>&nbsp;</div> <div><strong>1.</strong> What questions do students have about the reading? How might they be answered?</div> <div>&nbsp;</div> <div><strong>2. </strong>Why do you understand to be the main reasons why many people think that health insurance reform is essential and why others oppose reform?</div> <div>&nbsp;</div> <div><strong>3. </strong>The president says his plan "meets three basic goals." What are they? Do his specific proposals support these goals? Why or why not? Do they leave questions unanswered? If so, what?</div> <div>&nbsp;</div> <div><strong>4. </strong>Why is the "public option" controversial? If you don't know, how might you find out?</div> <div>&nbsp;</div> <div><strong>5.<span class="Apple-tab-span" style="white-space:pre"> </span></strong> What is controversial about what the president says will be the $900 billion cost of reform over ten years? What is his explanation for how this cost will be paid for? He "will not sign a plan that adds one dime to our deficits. Period." Why is he so emphatic? What does he mean? What questions do critics have about this explanation? If you don't know, how might you find out?</div> <div>&nbsp;</div> <div>&nbsp;</div> <div> <hr></div> <h3>Student Reading 2:&nbsp;</h3> <h2>Critics and commentators</h2> <div>&nbsp;</div> <div><strong>Republicans</strong></div> <div>&nbsp;</div> <div>Dr. Charles Boustany, a Republican congressman from Louisiana, chosen by his party to respond to President Obama, said, "Republicans are ready...to work with the president for common-sense reforms that our nation can afford," but oppose "replacing your family's current healthcare with government-run healthcare" that "will make healthcare much more expensive."</div> <div>&nbsp;</div> <div>He criticized a Democratic bill that he said "adds hundreds of billion to our national debt, and raises taxes on job-creators by $600 billion. And, it cuts Medicare by $500 billion, while doing virtually nothing to make the program better for our seniors."</div> <div>&nbsp;</div> <div>He said that Republicans agree with Democrats on "access to coverage, regardless of preexisting conditions"; making it possible for "individuals, small businesses and other groups...to join together to get health insurance at lower prices"; "assistance to those who still cannot access a doctor"; and "incentives for wellness care and prevention."&nbsp;</div> <div>&nbsp;</div> <div>For details on Republican healthcare ideas see <a href="https://www.gop.gov/issue/health-care/">www.gop.gov/issue/health-care</a>.)</div> <div>&nbsp;</div> <div>Other Republicans were far more critical. Senator Jon Kyl of Arizona, the No. 2 Republican, said: "I thought the speech was partisan, uninformative, disingenuous and not likely to encourage those who have honest disagreements with him to be able to work toward some kind of common solution." (<em>New York Times</em>, 9/11/09)<br> &nbsp;</div> <div>&nbsp;</div> <div><strong>Health insurance industry</strong></div> <div>&nbsp;</div> <div>The president's requirement that individuals must carry health insurance and could get subsidies if they needed help is great news for the health insurance industry. It means tens of millions of new customers, many of whom will receive government subsidies to buy their products. But the industry opposes Obama's "public option," which, it argues, would mean unfair competition. The president has indicated his willingness to consider alternatives. "'It's early,' said Bradley M. Fluegel, chief strategy officer for WellPoint, one of the country's largest health insurers. "There's a long road from his speech last night to a bill and law.'" (9/11/09)</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><strong>Physicians for a National Health Program (PNHP)</strong></div> <div>&nbsp;</div> <div>This organization of doctors has been a leading force in a campaign for a "single-payer" healthcare system, also known as "Medicare for all." A 2008 survey reported in the journal <em>Annals of Internal Medicine</em> found that 59% of doctors support this kind of plan (as did Obama himself earlier in his political career). However, the health insurance industry, which has made huge contributions to politicians in both parties, including Obama, are vociferously opposed to a single-payer plan.</div> <div>&nbsp;</div> <div>Under a single-payer plan, everyone would be part of a single federal health insurance plan, an upgraded version of what seniors now get from the government through Medicare. Countries around the world have single-payer systems, and many studies have shown that by eliminating insurance industry waste and profit, they are able to provide good healthcare coverage for everyone for less money.</div> <div>&nbsp;</div> <div>PNHP has strongly criticized Obama's plan, arguing that it is a boon to the insurance industry, will not provide universal coverage, and will not restrain healthcare costs. They fear that even people who do get insurance through the plan will pay too much for poor healthcare coverage.</div> <div>&nbsp;</div> <div>One "single-payer" supporter is President Obama's own doctor, David Scheiner, who treated Obama for two decades in Chicago. He said Obama was a "beloved" patient, but that the president had proposed a "bad program." According to PNHP, Scheiner argued that "a single-payer government-run system would cut costs by reducing the administrative overhead that doctors and other health providers must maintain to meet complex reimbursement rules from different insurance companies." He said that such a system would lead to better care for lower-income people and end the insurance industry practice of "discouraging patients from getting necessary treatment by setting up obstacles, and boosting profits in the process."&nbsp;</div> <div>(<a href="http://www.pnhp.org">www.pnhp.org</a>)</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><strong>Dr. Andrew Weil, Arizona Center for Integrative Medicine</strong></div> <div>&nbsp;</div> <div>Dr. Andrew Weil found "much to like" in the president's health insurance reform speech but, "Would I have liked to hear more from President Obama? Absolutely." (<a href="http://www.huffingtonpost.com">www.huffingtonpost.com</a>, 9/10/09) Some of that "more" would include the following:</div> <div>&nbsp;</div> <div><strong>1. </strong>Ban direct-to-consumer marketing and advertising by big pharmaceutical companies, which make people believe that "there's a pill for every health problem."</div> <div>&nbsp;</div> <div><strong>2. </strong>Create a "national institute of health and healing" to research less invasive and expensive therapies.</div> <div>&nbsp;</div> <div><strong>3.</strong> Create an office of "health promotion" to educate people about nutrition, exercise and other healthy activities. Says Weil: "We spend 40 times more on the health risks of terrorism than we do on the health risks of obesity, which kills about 400,000 people a year."</div> <div>&nbsp;</div> <div><strong>4.</strong> Teach health promotion and integrative medicine at medical schools and residency programs. ("Integrative medicine," according to the National Institutes of Health, "combines mainstream medical therapies and complementary/alternative medicine therapies." The Institute says that there is "high-quality scientific evidence of safety and effectiveness" of some of these therapies.)</div> <div>&nbsp;</div> <div><strong>5. </strong>Require insurers to cover health promotion and integrative care.</div> <div>&nbsp;</div> <div><strong>6.</strong> Establish an office of "health education" that would "make nutrition, diet, and exercise an integrated part of every child's education."</div> <div>&nbsp;</div> <div>("A Healthcare Call to Action," <a href="http://www.drweil.com">www.drweil.com</a>, 9/11/09).</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><strong>Michael Pollan, author of In <em>Defense of Food: An Eater's Manifesto.</em></strong></div> <div>&nbsp;</div> <div>"To listen to President Obama's speech...or just about anyone else in the healthcare debate, you would think that the biggest problem with healthcare in America is the system itself—perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed," Michael Pollan wrote in "Big Food Vs. Big Insurance," <em>New York Times</em>, 9/2009)</div> <div>&nbsp;</div> <div>Like Dr. Weil, Pollan, a professor of journalism at the University of California, Berkeley, sees "a rising tide of chronic disease linked to diet," and that this is one reason the United States spends so much more than other countries on healthcare. For Pollan, bringing those costs down means summoning "the political will to take on and reform a second, even more powerful industry"— the food industry.</div> <div>&nbsp;</div> <div>Pollan cites the findings of the Centers for Disease Control and Prevention that three-quarters of healthcare spending now goes to treat "preventable chronic diseases," many linked to diet. The costs: $147 billion to treat obesity, $116 billion for diabetes, and hundreds of billions more for cardiovascular disease and cancers that have been linked to the "so-called Western diet."</div> <div>&nbsp;</div> <div>But, Pollan points out, "reforming the food system is even more difficult than reforming the healthcare system...There's lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American healthcare industry."</div> <div>&nbsp;</div> <div>He believes that this situation may change if healthcare reform becomes law and requires insurers to provide insurance regardless of people's health and any preexisting conditions. Then, he hopes, insurance companies will "discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet...Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to profits."</div> <div>&nbsp;</div> <div>Pollan writes, "Agribusiness dominates the agriculture committees of Congress and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes?" His answer: The health insurance industry "will begin buying seats on those agriculture committees and demanding that the next bill be written with the interest of public health more firmly in mind."</div> <div>&nbsp;</div> <div>In short, Pollan believes that "to keep from bankrupting ourselves, we will...have to get to work on improving our health-which means going to work on the American way of eating."&nbsp;</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><strong>For discussion</strong></div> <div>&nbsp;</div> <div><strong>1. </strong>What questions do students have about the reading? How might they be answered?</div> <div>&nbsp;</div> <div><strong>2.</strong> What do you understand to be major reasons for opposition to, or criticism of the president's health insurance reform proposal? What are Republicans worried about? Health insurers? Advocates of a single-payer system?</div> <div>&nbsp;</div> <div><strong>3.</strong> On what health insurance issues do Republicans agree with Democrats? Is each one clear to you? If not, how might you find out more?</div> <div>&nbsp;</div> <div><strong>4. </strong>What is a single-payer plan? Why do you think most doctors support it? Why is the insurance industry opposed?</div> <div>&nbsp;</div> <div><strong>5.</strong> Why would Dr. Weil ban pharmaceutical company advertising?</div> <div>&nbsp;</div> <div><strong>6.</strong> Why does Dr. Weil think "nutrition, diet, and exercise" should be "an integrated part of every child's education"? Do you agree? Why or why not?</div> <div>&nbsp;</div> <div><strong>7. </strong>According to Pollan, what is America's biggest healthcare problem? Why? What statistics or arguments support his claim? Do you know of any that would contradict them?</div> <div>&nbsp;</div> <div><strong>8.</strong> Why does Pollan think that passage of health insurance reform will mean a that health insurers will want to reduce rates of obesity and chronic diseases linked to diet? Do you agree? Why or why not?</div> <div>&nbsp;</div> <div><strong>9. </strong>What does he mean by "one of the leading products of the American food industry has become patients for the American healthcare industry"?</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><strong>For inquiry and discussion</strong></div> <div>&nbsp;</div> <div>The health insurance debate offers an opportunity for family discussions this fall.</div> <div>&nbsp;</div> <div>Invite students to take the readings home and ask parents to read and discuss with them major questions:</div> <div>&nbsp;</div> <ul> <li>What are their reactions to Obama's plan and why?&nbsp;</li> <li>What particular concerns do they have? What do they think about a "public option" and what any health insurance reform bill needs to say about cost containment?&nbsp;</li> <li>What do they know about the "single-payer" proposal? What opinions do they have about it?</li> <li>What do they think about Weil's emphasis on "integrative medicine" and "integrative care"?&nbsp;</li> <li>Do they agree with Pollan's argument that the biggest healthcare problem for Americans is "a rising tide of chronic disease linked to diet"? Why or why not?</li> </ul> <div>Students might then report to the class parent responses to such questions for further class discussion.</div> <div>&nbsp;</div> <div>&nbsp;</div> <div>&nbsp;</div> <div>&nbsp;</div> <div><em>This lesson was written for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email them to: <a href="mailto:lmcclure@morningsidecenter.org">lmcclure@morningsidecenter.org</a></em></div> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2009-09-16T14:39:12-04:00" title="Wednesday, September 16, 2009 - 14:39">September 16, 2009</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Wed, 16 Sep 2009 18:39:12 +0000 fionta 880 at https://www.morningsidecenter.org The Bureaucratic Machine https://www.morningsidecenter.org/teachable-moment/lessons/bureaucratic-machine <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--title--teachable-moment-lesson.html.twig x field--node--title.html.twig * field--node--teachable-moment-lesson.html.twig * field--title.html.twig * field--string.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <span>The Bureaucratic Machine</span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--title.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--body--teachable-moment-lesson.html.twig * field--node--body.html.twig * field--node--teachable-moment-lesson.html.twig * field--body.html.twig * field--text-with-summary.html.twig x field.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><strong>To the Teacher:</strong></p> <p>The readings describe and present explanations for the behavior of people who work in bureaucracies of three large organizations and the effects of such behavior. In the first reading the organization is the healthcare insurance provider, Cigna; in the second, the investment banks, Countrywide and Goldman Sachs; and in the third, the military. Discussion questions and student activities follow.</p> <p>&nbsp;</p> <hr> <h3>Student Reading 1</h3> <h2>Health insurance industry:<br> "You don't think about individual people."</h2> <p>&nbsp;</p> <p>In 2007 Nataline Sarkisyan, a 17-year-old, desperately needed a liver transplant.</p> <p>Cigna, her health insurance company, states on its website, "Cigna offers a full range of medical and pharmacy plans to help keep you and your family well." (<a href="http://www.cigna.com">www.cigna.com</a>) But it turned down Nataline's claim. Wendell Potter, head of the company's corporate communications, aka public relations, explained that the procedure in the young woman's case was experimental and not covered by her policy.</p> <p>Potter had worked for Cigna for more than 15 years. During that time he had focused on Cigna's bottom line. His job, and the jobs of the other executives he worked with and for, was to make the company profitable. This meant vigorously opposing healthcare reform proposals and doing whatever was necessary to produce a rising stock price that satisfied investors.</p> <p>Keeping profits up often involved refusing to provide health insurance to those with pre-existing conditions likely to require high-cost care. It also involved concocting insurance policies that would allow the company to avoid paying for expensive procedures for people they did cover—like Nataline.</p> <p>Like any corporation, Cigna's central goal was maximizing company profits—not improving the health of the people it insured. To achieve its goal, the organization standardized its policies and assigned its staff to carry out those policies efficiently.</p> <p>What does "standardized" mean? Says French sociologist Antoine Mas: "Standardization means resolving in advance all the problems that might possibly impede the functioning of an organization. It is not a matter of leaving it to inspiration, ingenuity, nor even intelligence to find a solution at the moment some difficulty arises; it is rather in some way to anticipate both the difficulty and its resolution. From then on, standardization creates impersonality, in the sense that an organization relies more on methods and instructions than on individuals." (quoted in Jacques Ellul, <em>The Technological Society</em>)<br> &nbsp;</p> <p><strong>A reversal, a death, a healthcare event</strong></p> <p>Nataline's family told her story to the media. The California Nurses Association and others organized protests at Cigna's regional headquarters. This was bad news for Potter and his public relations. The company reversed its standardized company policy and its decision to deny Nataline a liver transplant. But two hours after her surgery was approved, Nataline died.</p> <p>Later in 2007 Potter was visiting relatives in Tennessee when he learned that a healthcare event was being held at the fairground in nearby Wise, Virginia. He decided to visit.</p> <p>"What I saw were doctors who were set up to provide care in animal stalls," Potter recalled in a recent interview with on Bill Moyers Journal (<a href="http://www.pbs.org/moyers/journal/index-flash.html">www.pbs.org/moyers/journal/index-flash.html</a>, 7/10/09). "Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.</p> <p>"And I saw people lined up...waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee—all over the region...They could have been people who grew up...in the house down the road from me. And that made it real to me.</p> <p>"It was absolutely stunning...It was almost—what country am I in?....It just didn't seem to be a possibility that I was in the United States. It was like a lightning bolt had hit me."</p> <p>Potter left Cigna early in 2008. Moyers asked him, "How can Wendell Potter sit here and say he was just finding out that there were a lot of Americans who didn't have adequate insurance and needed healthcare? He'd been in the industry for over 15 years."<br> &nbsp;</p> <p><strong>Potter's problem</strong></p> <p>"That was my problem," Potter answered. "I had been in the industry and I'd risen up in the ranks. And I had a great job. And I had a terrific office in a high-rise building in Philadelphia. I was insulated. I didn't really see what was going on. I saw the data. I knew that 47 million were uninsured, but I didn't put faces with that number...</p> <p>"But when you're in the executive offices...what you think about are the numbers. You don't think about individual people...and whether or not you're going to meet Wall Street's expectations. That's what you think about, at that level. And it helps to think that way...That enables you to stay there, if you don't really think that you're talking about and dealing with real human beings."</p> <p>Potter discussed "a measure of profitability that investors look to, and it's called a medical loss ratio... that's a measure that tells investors...how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by, for-profit insurance companies.</p> <p>"Back in the early '90s...95 cents out of every dollar was...used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent. So investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves."</p> <p>The salaries of Cigna employees who work to cut down health insurance payments contribute to the ever-rising, overall costs of healthcare to Cigna's customers.</p> <p>As for Potter, he left Cigna early in 2008 and recently told his story to the Senate Committee on Commerce, Science and Transportation, as well as to Bill Moyers.</p> <p>&nbsp;</p> <p><strong>For discussion</strong></p> <p><strong>1.</strong> What questions do students have about the reading? How might they be answered?</p> <p><strong>2. </strong>What is there about "standardization" that creates impersonality? How might this impersonality and a reliance on what Mas calls "methods and instructions" explain why Potter turned down Nataline's application for a liver transplant?</p> <p><strong>3.</strong> What are major Cigna policies? Why are they so important to the company?</p> <p><strong>4.</strong> How do you explain the effects on Potter of the Wise, VA, healthcare event?</p> <p><strong>5.</strong> Potter names says that as head of PR for Cigna, he was insulated, he saw "data" but not faces, and he understood the importance of the "medical loss ratio." Why was each so important to his personal success and to Cigna's success?</p> <p><strong>6. </strong>Potter does not explain why he left Cigna. How would you explain it?</p> <p>&nbsp;</p> <hr> <h3>Student Reading 2</h3> <h2>Financial industry:<br> "You are getting the best loan possible."</h2> <p>Theologian Alfred Schutze wrote that evil today often appears "in a manner detached from the individual. It shows up impersonally in arrangements and conditions of social industrial, technical and general life which, admittedly, are created and tolerated by man. It appears anonymously as injustice, or hardship...where nobody seems directly liable or responsible...It has become the gray eminence infiltrating all areas of human existence. (Andrew Kimbrell, in "Cold Evil: Technology and Modern Ethics")</p> <p>The "gray eminence" that infiltrated Cigna appears again and again.</p> <p><strong>Countrywide</strong></p> <p>About the same time that Potter visited Wise, Virginia, Gretchen Morgenson described in the <em>New York Times</em> how Countrywide Financial Corporation became the nation's largest mortgage lender during the housing boom years by encouraging its sales force to "court customers over the telephone with a seductive pitch that seldom varied. 'I want to be sure you are getting the best loan possible,' the sales representatives would say."</p> <p>But as former employees pointed out, "potential borrowers were often led to high-cost and sometimes unfavorable loans that resulted in richer commissions for Countrywide's smooth-talking sales force, outsize fees to company affiliates providing services on the loans, and a roaring stock price that made Countrywide executives among the highest paid in America.</p> <p>"Countrywide's entire operation," Morgenson wrote, "from its computer system to its incentive pay structure and financing arrangements is intended to wring maximum profits out of the mortgage lending boom no matter what it costs borrowers, according to interviews with former employees and brokers..." One document showed, for example, that Countrywide's computer system in its subprime unit "had the effect of steering [borrowers] away from lower-cost loans to those that were more expensive to homeowners and more profitable to Countrywide." (8/26/07)</p> <p>Unlike Cigna, though, Countrywide collapsed in the subprime mortgage disaster and was taken over by the Bank of America, which itself also profited, then suffered, from the disaster. However, Bank of America survived because it was one of the financial institutions "too big to fail" and received a $45 billion taxpayer bailout.</p> <p><strong>Goldman Sachs</strong></p> <p>Goldman Sachs was the gold standard among investment banks. But it too was caught up in the subprime mortgage frenzy. The <em>New York Times</em> reported that Goldman Sachs agreed "to pay up to $60 million to end an investigation by the Massachusetts attorney general's office into whether the firm helped promote unfair home loans in the state...While Goldman did not admit to any legal wrongdoing, it provided capital for mortgage lenders who provide the high-risk loans to marginal buyers." Goldman, in turn, packaged hundreds, even thousands, of subprime mortgages, into securities that it sold to investors worldwide. (5/11/09)</p> <p>An investigation by Massachusetts Attorney General Martha Coakley proved that investment banks like Goldman Sachs "acted as middlemen in loans that have resulted in foreclosure or contained terms so onerous that they were destined to fail at conception."</p> <p>The fine that Goldman Sachs agreed to pay will allow some homeowners to reduce their mortgage payments on principal balances by as much as 50%.</p> <p>Across the country, top executives and employees of investment banks and mortgage brokers like those at Goldman sold mortgages impersonally and according to standardized processes. Did they think beyond the money to be made? Did they consider the pain their actions would cause to millions of people? A very few bankers tried to blow the whistle on these widespread financial industry practices. But the money-making machine continued, inexorably, to grind out subprime mortgages until the machine broke down.</p> <p>Millions lost their jobs, their health insurance, their homes. Goldman Sachs got $10 billion in taxpayer bailout money it was soon able to repay. During the first quarter of this year, the company's profits were $3.4 billion. Analysts warned that this money Goldman made this money by taking "financial risks that many of its competitors are unable or unwilling to take." These profits will enable Goldman employees, on average, to "earn roughly $770,000 each this year—or nearly what they did at the height of the boom." (<em>New York Times</em>, 7/15/09)</p> <p>According to a study by the Center for Public Integrity, 11 other lenders, including four financial firms that received bank bailouts, have made payments "to settle claims of widespread lending abuses."</p> <p>&nbsp;</p> <p><strong>For discussion</strong></p> <p><strong>1. </strong>What questions do students have about the reading? How might they be answered?</p> <p><strong>2. </strong>Who or what is "the gray eminence"?</p> <p><strong>3.</strong> In what ways did the practices of Countrywide and Goldman Sachs resemble those of Cigna?</p> <p><strong>4.</strong> How would you explain why Goldman Sachs might act as a middleman "in loans that have resulted in foreclosure or contained terms so onerous that they were destined to fail at conception"?</p> <p>&nbsp;</p> <p>&nbsp;</p> <hr> <h3>Student Reading 3</h3> <h2>The military:<br> "An assigned homicidal task as a technical operation"</h2> <p>Near the end of the Vietnam War almost 40 years ago, Richard Barnet wrote Roots of War. In it, Barnet described a "bureaucratic revolution" in the military in which "Each cog in the bureaucratic machine does what it is supposed to do." Barnet said that in the process, personal responsibility dims; for most people involved in the machine, the sense of responsibility evaporates entirely.</p> <p>"Since man first built cities, from the Assyrians to Genghis Khan, from the Crusades to the Indian Wars, war has been an instrument of policy," wrote Barnet. "It is not homicide in the line of duty that is new, but the incredibly sophisticated organization of homicidal activities and techniques...The essential characteristic of bureaucratic homicide is division of labor. In general, those who plan do not kill and those who kill do not plan...</p> <p>"America's highly developed technology makes it possible to increase the distance between killer and victim and hence to preserve the crucial psychological fiction that the objects of America's lethal attention are less than human...</p> <p>"Twentieth-century man demonstrates...a sensitivity to human suffering which did not trouble fifteenth-century man. But the modest advances in civilization have been more than wiped out by technological developments which make it possible to kill without exertion, without passion, and without guilt. The airplane enables the cool contemporary killer to set his victims on fire without ever laying eyes on them...</p> <p>"The bureaucratic killer looks at an assigned homicidal task as a technical operation much like any other. He does not question its moral purpose. Indeed, he is not even interested in such questions."</p> <p><strong>Civilian deaths in Iraq, Afghanistan, Pakistan</strong></p> <p>Baghdad, Iraq: On February 13, 1991, during the first Iraq war, American missiles struck the Amiriya air-raid shelter in Baghdad. 408 civilians were incinerated. Later Laurie Garrett, a medical writer for <em>Newsday</em>, viewed a half-hour videotape of the results, which "showed scenes of incredible carnage. Nearly all the bodies were charred into blackness; in some cases the heat had been so great that entire limbs were burned off. Among the corpses were those of at least six babies and ten children, most of them so severely burned that their gender could not be determined."</p> <p>Baqubah, Iraq during the second Iraq war, June 2004: "Some 30 insurgents were stationed in buildings near the stadium in eastern Baqubah...Rather than clear the buildings—two vacant schools and a swimming pool—Colonel Pittard decided to demolish them with four 500-pound bombs." (<em>Christian Science Monitor</em>, 6/24/04)</p> <p>South Waziristan, Pakistan, June 2009: "Missiles apparently fired by unmanned aircraft first struck a purported Taliban training center in South Waziristan, then another barrage rained down on a funeral processions for some of those who had been killed earlier...The two missile strikes killed at least 80 people, including several senior militants, said the officials...Fifty-five of those killed were at the funeral." (AP, 6/24/09)</p> <p>Granai, Afghanistan, May 2009: Taliban fighters sought to seize the western village of Granai. A fierce battle lasting hours followed with a small American force, mostly Marines. The Americans suffered a number of casualties. The U.S. then conducted air strikes on at least three targets in Granai. Villagers said the bombing killed 147 civilians. It came after the Taliban had already left. U.S. military officials disagreed, the New York Times reported, but added "whatever the actual number of casualties, it is clear from the villagers' accounts that dozens of women and children were killed after taking cover." (5/15/09)</p> <p>A Pentagon report more than a month later estimated that "at least 26 civilians and 78 militants were killed" when the village was bombed. "The Afghan government claims that more than 140 civilians were killed that day." (<em>Wall Street Journal</em>, 6/20/09)</p> <p>One result of mounting Afghan and Pakistani civilian casualties is widespread anger at and distrust of Americans for their airstrikes. General Stanley McCrystal, American commander of NATO and U.S. forces in Afghanistan, announced new orders limiting airstrikes, unless American forces are in imminent danger. The general emphasized that success in Afghanistan demands respect for and protection of Afghan civilians. But weeks later:</p> <p>Tawalla, Afghanistan, July 2009: "At least five Afghan civilians were killed and 13 were wounded when a United States patrol was attacked on Wednesday night [July 15] and called in air support...Nine wounded villagers, including two women and four children reached a Kandahar hospital on Thursday. Several were unconscious, but others described helicopters firing into their compound at 11 p.m. as they fled the house and tried to hide in an orchard...The wounded civilians...were from a...remote district...which has long been a stronghold of Taliban forces...Mr. Niamatullah [who lives in Tawalla] said there were no Taliban fighters in the village. (New York Times, 7/17/09)</p> <p><strong>In service to technology</strong></p> <p>"We in the United States recognize butchery when we see it-the atrocity of the car bomb, the chlorine-gas truck bomb, the beheading. These acts are obviously barbaric in nature. But our favored way of war—war from a distance—has, for us, been precleansed of barbarism. Or rather its essential barbarism had been turned into a set of... 'accidents,' of 'mistakes,' repeatedly made over six decades...It is in our interest not to see air war as a—possibly the—modern form of barbarism...Civilian deaths from the air...are not mistakes or they wouldn't happen so repeatedly. They are the very givens of this kind of warfare." (Tom Englehardt, <a href="http://www.tomdispatch.com">www.tomdispatch.com</a>, 7/9/07)</p> <p>"Men in modern warfare are in service to technology...To be sure, soldiers who kill innocents pay a tremendous personal emotional and spiritual price. But with the universe of total war, equipped with weapons that can kill hundreds or thousands of people in seconds, soldiers only have time to reflect later. By then these soldiers often have been discarded, left as broken men in a civilian society that does not understand them and does not want to understand them." (Chris Hedges, <em>War Is a Force That Gives Us Meaning</em>)</p> <p>Thousands of these soldiers who break down after their return to the U.S. suffer from what was called shell shock in World War I, combat fatigue in World War II, and Post-Traumatic Stress Disorder (PTSD) in the Iraq and Afghan wars. Whatever it is called, the effects can include shame and guilt they cannot repress, emotional numbness, sleep and memory disorders, anger, self-destructiveness. A new study by the San Francisco Department of Veterans Affairs Medical Center and the University of California, San Francisco, found that one-third of Iraq and Afghanistan war veterans in the veterans health system after 2001 have been diagnosed with mental health problems, most often PTSD. (<em>New York Times</em>, 7/17/09)</p> <p>In January 2009 the U.S. Army reported the highest level of suicides among its soldiers since 28 years ago when it began keeping track of them.</p> <p><strong>For discussion</strong></p> <p><strong>1. </strong>According to Barnet, what happens to individual responsibility when "each cog in the bureaucratic machine does what it is supposed to do"?</p> <p><strong>2. </strong>According to Barnet, what technological advances make it possible for modern military people to kill "without exertion, without passion, and without guilt"? Do you agree? Why or why not?</p> <p><strong>3.</strong> Do you agree with Barnet's conclusion that the "bureaucratic killer" has no interest in moral questions? Why or why not? What might be some of these questions? Does General McCrystal have an interest in such questions? Why or why not?</p> <p><strong>4. </strong>Why are civilians so frequently killed in military engagements in Iraq, Afghanistan and Pakistan?</p> <p><strong>5.</strong> According to Englehardt, Americans favor "war from a distance." Do you agree? Why or why not?</p> <p><strong>6. </strong>According to Hedges, "Men in modern warfare are in service to technology." Do you agree? Why or why not?</p> <p><strong>7. </strong>How would you explain the changing terminology from World War I to today to define soldiers who suffer mentally after they return home?</p> <p><strong>8.</strong> How would you explain the increasing numbers of American soldiers who suffer from PTSD or other mental health problems today?</p> <p>&nbsp;</p> <hr> <h3>The believing game and the doubting game</h3> <p>Richard Barnet's point of view about the effects of technology on warfare, among them the creation of "the bureaucratic killer," is obviously controversial and worth examining from various perspectives through the believing and doubting games.</p> <p>The believing game invites students to enter into a point of view that may be unfamiliar or even disagreeable, to suspend judgment and experience it, to look for virtues and strengths that might otherwise be missed.</p> <p>The doubting game asks students to examine a point of view critically, to ask penetrating questions, to find statements to argue with, to look for weaknesses.</p> <p>For a detailed explanation of both games as well as a concluding exercise that aims to achieve integration of one's thinking after playing them, see "<a href="http://www.morningsidecenter.org/teachable-moment/lessons/teaching-critical-thinking-believing-game-doubting-game">Teaching Critical Thinking</a>."</p> <p>&nbsp;</p> <hr> <h3>For writing and discussion:</h3> <h2>Experiences with bureaucracy</h2> <p>Ask students to name bureaucracies they have had at least some direct contact with: schools, department stores, hospitals. What personal experiences can they cite to support or refute such features as impersonality; rigid standardized policies that "rely more on methods and instructions than on individuals"; failure to treat people as individual human beings; or difficulty in determining who is responsible for problems?</p> <p>After some introductory discussion, assign students to write a paper reporting on a personal experience with bureaucracy. When papers have been drafted, divide the class into groups of four to six students to listen to a reading of each paper in the group and to select the one they regard as best for a reading to and discussion by the class.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p><em>This lesson was written for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email them to: <a href="mailto:lmcclure@morningsidecenter.org">lmcclure@morningsidecenter.org</a></em></p> <p>&nbsp;</p> <p>&nbsp;</p> </div> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/field/field.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--uid--teachable-moment-lesson.html.twig x field--node--uid.html.twig * field--node--teachable-moment-lesson.html.twig * field--uid.html.twig * field--entity-reference.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'username' --> <!-- BEGIN OUTPUT from 'core/modules/user/templates/username.html.twig' --> <span>fionta</span> <!-- END OUTPUT from 'core/modules/user/templates/username.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--uid.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'field' --> <!-- FILE NAME SUGGESTIONS: * field--node--created--teachable-moment-lesson.html.twig x field--node--created.html.twig * field--node--teachable-moment-lesson.html.twig * field--created.html.twig * field.html.twig --> <!-- BEGIN OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <span> <!-- THEME DEBUG --> <!-- THEME HOOK: 'time' --> <!-- BEGIN OUTPUT from 'core/modules/system/templates/time.html.twig' --> <time datetime="2009-07-21T14:39:12-04:00" title="Tuesday, July 21, 2009 - 14:39">July 21, 2009</time> <!-- END OUTPUT from 'core/modules/system/templates/time.html.twig' --> </span> <!-- END OUTPUT from 'core/modules/node/templates/field--node--created.html.twig' --> <!-- THEME DEBUG --> <!-- THEME HOOK: 'links__node' --> <!-- FILE NAME SUGGESTIONS: * links--node.html.twig x links.html.twig --> <!-- BEGIN OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> <!-- END OUTPUT from 'themes/contrib/bootstrap/templates/system/links.html.twig' --> Tue, 21 Jul 2009 18:39:12 +0000 fionta 888 at https://www.morningsidecenter.org