Marieke van Woerkom uses an engaging game with M&Ms to help students see how insurance works and to touch off discussion on the current reform debate.


Students will:

  • share what they know about the healthcare debate
  • look at the notion of healthcare versus health insurance
  • engage in an activity about health insurance
  • think critically about and compare different health insurance options

Social and Emotional Skills:

  • empathy and concern for others
  • making choices and learning about consequences
  • critical thinking

Materials needed:

  • M&Ms or some other "currency" like pennies or pieces of paper
  • Agenda on chart paper
  • Yellow paper or card stock to make insurance cards
  • A hat, box or other container in which to put students' names
  • A bowl in which to collect the currency (M&Ms)

Information about the healthcare debate for the teacher:


Gathering (5 minutes)

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.

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.


Check Agenda (2 minutes)

Explain that in today's lesson students will explore aspects of the healthcare debate that have been all over the news in recent months.

Setting the Stage (10 minutes)

  • To start out, get a sense of what your students already know by asking some or all of the following questions:
  • What have they heard about the healthcare debate?
  • Do they know what the debate is about?
  • What do they think healthcare is?
  • What do they think health insurance is?
  • Is there a difference?

Explain to your students that you'll be doing an activity in which they will get to experience how insurance works.


The M&M Health Insurance Game

(30 minutes)

Create the Community

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.

Distribute the Currency

Next provide your students with "currency" - 15 M&Ms each. Instruct students not to eat the M&Ms because they will need them for more important things. (If students do end up eating M&Ms use it later on as a teachable moment. Sometimes when we go for instant gratification, we regret it later!)

Let students know that the 15 M&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.

The Cost of Health Insurance

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&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&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."

To Insure or Not to Insure?

Ask everyone to put aside the 10 M&Ms for monthly costs like rent, transportation and food. That money can't be spent on anything else. Students each have 5 M&Ms left for everything else they want (and need) to buy.

Ask your students who would like to buy health insurance for 3 M&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&Ms on a medicine, medical procedures and doctor's check ups to illustrate.

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.

Pool the Insurance Money

Collect M&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&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.

Case Study 1: Broken Leg

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&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&Ms.

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&Ms to pay for his costs for the month. If he did not take out insurance, ask him for 6 M&Ms to cover the costs (which he won't have).

Use this moment to reflect on whether it makes sense to take this kind of risk with our health. Have a short class discussion.

Case Study 2: Fever

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&Ms.

Again, find out if the student took out insurance. If she did, take 3 M&Ms from the insurance fund. If not, ask her for 3 of her M&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?

Case Study 3: Injuries from a Car Accident

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&Ms this month alone. There will be follow up costs in the months to come which will add up to much, much more.

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?

Have a short discussion.

Case Study 4: Appendicitis

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&Ms, but some complications require further hospitalization that will cost another 20 M&Ms over the next two weeks.

Check if the student has insurance.


Discussion of the Case Studies

Now, open up the discussion using some or all of the following questions:

  • What did students think of the activity?
  • Ask students who took out insurance and didn't get sick or hurt: How do they feel about having taken out insurance?
  • Ask students who took out insurance and did get sick or hurt: How do they feel about having taken out insurance?
  • 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?
  • 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.
  • Does it make sense to gamble with your health in this way?

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&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.

Ask students: Was there enough money in the insurance fund to cover those who got sick or hurt?

Talk about what happens if everyone takes out insurance. When everyone is insured, there are more M&Ms available in case someone gets sick. This is called "spreading the risk."

But what if not everyone can afford to pay for health insurance?

Do your students think that the M&Ms collected from everyone else should cover their healthcare costs? Why? Why not?

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.

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.

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.

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.

To wrap up the lesson ask students:

  • Reconsider: What is the different between health insurance and healthcare?
  • Do they think everybody should have healthcare, no matter how much money they have?
  • Is healthcare a human right?


Closing (3 minutes)

Ask a few volunteers to share what they learned today.

Possible Follow-up Discussion

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:

  • What word is contained within insurance?
  • What does the word sure mean?
  • Can anyone ever be sure about whether they'll get sick or hurt?

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?"

Main Entry: in·sur·ance
Pronunciation: \in- shur-?n(t)s also in-\
Function: noun
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
2 : a means of guaranteeing protection or safety

Main Entry: sure
Pronunciation: \shur, especially Southern shr\
Function: adjective
Etymology: Middle English seur, sure, from Anglo-French seur, from Latin securus secure
6 a : bound to happen : inevitable b : bound, destined



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: