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What level of medical care should the federal government provide for the elderly, and what trade-offs are we willing to make to provide that care?
Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink?
—Barry Goldwater, 1964 (Nichols, 2011, p. 16)
Don’t ever argue with me [about health]. I’ll go a hundred million or billion on health or education. I don’t argue about that any more than I argue about Lady Bird [Mrs. Johnson] buying flour. You got to have flour and coffee in your house. Education and health. I’ll spend the goddamn money. I may cut back some tanks. But not on health.
—Lyndon B. Johnson, 1965 (New York Times, 2009)
In 1966, with the active leadership and support of President Lyndon B. Johnson, Congress passed the act establishing Medicare, a program of government-sponsored health insurance for those age 65 years or older. In 1972 it was amended to include the disabled. Although beneficiaries pay premiums for voluntary parts of the program, the basic benefit of Medicare, the benefit covering hospital care, is financed by a dedicated payroll tax. In 2016, that tax totaled 2.9% of an employee’s salary, half of which was paid by the employee and half by his or her employer. Medicare faces dramatic shortfalls in the future as the population ages and the average per-person cost of American medical care continues to rise from an average of $356 per person in 19701 to an average of $10,021 in 20151 (Centers for Medicare and Medicaid Services, 2015)
Today, as in the 1960s, there are many opinions about the level of medical care the federal government should provide to the elderly. Some believe this is not the proper role for the federal government, and that individuals should acquire their own medical insurance from private companies. Others believe that the federal government has a duty to provide the elderly with medical care to better ensure their basic level of health.
The debate about Medicare is about more than taxes and government spending. Ultimately, this debate gets to core questions about the kind of country we are and the kind of country we want to be. Are we a country of individuals who value free choice, comfortable with the fact that not everyone will be best served by such a system? Or are we a country that values community and shared responsibility, comfortable that some individual choices may be sacrificed?
BE ABLE TO:
Day 1 of 2
Begin by presenting students with the graph “Poverty Rates by Age: 1959 to 2014” from the U.S. Census Bureau (Resource 1). Ask students to work in small groups to analyze the graph and explain its data in their own words. If students have trouble understanding the graph, use the following questions and comments to guide their analysis:
Tell students that in 1966 Congress passed the act establishing Medicare, a program of governmentsponsored health insurance for those age 65 years and older, then ask:
Ask students what they know about Medicare. Use the material in the introduction to this lesson and in the “Overview of Medicare” included with this packet to help student understanding. Probe for understanding with questions such as:
After the mini-lesson, ask students what more they can now say about the graph in Resource 1. Ask students to consider the implications of Medicare spending growing faster than our economy. Help students recognize that the source of this money is not unlimited, and money spent on Medicare cannot be spent on other areas like education or defense. Explain to students that this represents a difficult decision that we face as a nation concerning how to allocate our funds. Tell students that they will be investigating this dilemma throughout the course of this lesson.
As students learned in the introductory discussion, the rising cost of medical care presents an important dilemma that we must address as a country. What trade-offs are we willing to make to provide that care?
Present students with the cartoon “Threats” (Resource 2) and ask them to consider its meaning. After students have studied the cartoon for several minutes, ask what they notice, drawing them out on the detail of what they see. If students jump to an interpretation of the cartoon, ask them for the basis of the interpretation and ask other students if they agree or disagree.
If students are having difficulty getting into the cartoon, ask them more directed questions, such as:
Ask students if they believe the public would generally agree or disagree with the artist’s opinion. Ask them what more they would need to know before deciding if they agree or disagree with either interpretation of the artist’s opinion. Although an investigation is beyond the scope of this lesson, discuss with students what more they would want to know (1) about the sources of the current budget deficit, and (2) about the relative risk the federal debt represents to our security. Tell students that they will revisit this cartoon at the end of the lesson to see if their understandings have changed.
Ask students to provide hypotheses as to why the cost of health care has increased so much in the last 40 years, even accounting for inflation. Through discussion and, if time allows, reference to news stories analyzing the subject, encourage students to focus on the most likely possibilities, such as increases in administrative costs in health care (single-payer systems have much easier administrative and claims systems); increases in medical malpractice suits, which often lead to overtesting (so-called “defensive medicine”); and the rising costs of new pharmaceuticals and procedures and tests requiring expensive equipment and significant research. Conclude by asking students what more they would need to know in order to test their hypotheses.
Presidential Viewpoints on Medicare
Divide students into groups and distribute “Presidential Viewpoints on Medicare” (Resource 3). Explain to students that the information they just received should be thought of as possible answers to the essential dilemma of this unit.
Inform students that they will use these statements to summarize different beliefs about Medicare. Students should reference these statements as they work with their group to respond to the handout “Individual Responsibility, Social Responsibility, and Medicare” (Resource 4). As the students work, move from group to group, answering questions and clarifying points of confusion. Resource 4 includes a Teacher’s Guide to potential student answers.
Day 2 of 2
Reports from Discussion Groups
Ask students to review the handout “Individual Responsibility, Social Responsibility, and Medicare” that they examined yesterday and clarify any points of confusion within each group. When each group is comfortable with their answers, ask for volunteers to share an answer with the class. Write students’ answers on the board as they respond, and ask other groups to add to their classmates’ answers as you proceed through the handout. After each question, clarify any misconceptions and reinforce the recurring themes from the students’ explanations.
Affordable Care Act of 2010
Ask students what they know or have heard about the Affordable Care Act (often called “Obamacare” in the media). Encourage multiple answers and examples, including what they may have heard on the media or from their parents. Gather student responses and ask them to try to pinpoint one answer to the question “What are the basic points of the Affordable Care Act?”. It’s very likely they will be unable to answer that without media hype or rhetoric.
Provide students with the information that the Affordable Care Act (ACA) was signed into law in 2010, creating a firestorm of epic proportions between the two main political parties in the United States. The law has three main parts: improving the quality and lowering the costs of health care with prescription discounts for different parts of the populace and small business tax credits, increasing access to health care through the insurance marketplace, and providing new consumer protections such as required access to medical care through insurance for pre-existing conditions (U.S. Department of Health and Human Services, n.d.).
Have students work with a partner to discuss the following questions, then come back for a brief group discussion.
Responding to the Essential Dilemma
To help students begin to develop their own opinions on this subject, ask them to do a “5-minute write” in response to the essential dilemma of this lesson: What level of medical care should the federal government provide for the elderly, and what trade-offs are we willing to make to provide that care? When students have finished writing, divide them into small groups and ask them to share what they wrote with their classmates. Explain to students that this is not a debate; rather, it is a way for students to learn about the opinions of their fellow classmates and further develop their own opinions on this topic. After each student has shared her or his opinion, the groups should discuss the ideas presented, guided by the following questions:
After each group has discussed their ideas, ask for volunteers to summarize their deliberation for the rest of the class. Ask other groups if their experiences were similar or different, and discuss their responses with the class. Conclude this part of the activity by asking students to share what additional information they would need to make a more informed decision about the essential dilemma of this lesson. (Note: Students’ answers to this question could point to opportunities for future lessons on this topic.)
When students have completed their discussion of the options, turn their attention back to the cartoon they examined at the beginning of the lesson and ask them to revisit their comments. Lead students in a brief discussion guided by the following questions:
Assign students a 250-word essay addressing the essential dilemma: What level of medical care should the federal government provide the elderly, and what trade-offs are we willing to make to provide that care? The assignment can build on their 5-minute write, or subsequent discussion may have changed their mind. In either case, this is a more elaborated piece, and student work should make use of the statements they read in the handouts and incorporate the ideas developed in discussion with classmates.
Common Core State Standards (CCSS) Initiative
CCSS.ELA-Literacy.RI.11-12.6. Determine an author’s point of view or purpose in a text in which the rhetoric is particularly effective, analyzing how style and content contribute to the power, persuasiveness or beauty of the text.
CCSS.ELA-Literacy.RI.11-12.7. Integrate and evaluate multiple sources of information presented in different media or formats (e.g., visually, quantitatively) as well as in words in order to address a question or solve a problem.
CCSS.ELA-Literacy.RH.9-10.6. Compare the point of view of two or more authors for how they treat the same or similar topics, including which details they include and emphasize in their respective accounts.
The College, Career, and Civic Life (C3) Framework for Social Studies State Standards
D2.Civ.5.9-12. Evaluate citizens' and institutions' effectiveness in addressing social and political problems at the local, state, tribal, national, and/or international level.
D2.Civ.13.9-12. Evaluate public policies in terms of intended and unintended outcomes, and related consequences.
NCSS National Curriculum Standards for Social Studies
6.Power, Authority, and Governance. Social studies programs should include experiences that provide for the study of how people create, interact with, and change structures of power, authority, and governance.
Center for Civic Education's National Standards for Civics and Government
I.A.What Are Civic Life, Politics, and Government? Why are government and politics necessary? What purposes should government serve?
II.B. and D.What Are the Foundations of the American Political System? What are the distinctive characteristics of American society? What values and principles are basic to American constitutional democracy?
III.B. and E.How Does the Government Established by the Constitution Embody the Purposes, Values, and Principles of American Democracy? How is the national government organized and what does it do? How does the American political system provide for choice and opportunities for participation?
V.B.What Are the Roles of the Citizen in American Democracy? What are the rights of citizens?
American Presidency Project. (n.d.). Retrieved from https://www.presidency.ucsb.edu/
Cardow, C. (2011, August 3). Threats. Cagle Cartoons. Retrieved from http://www.politicalcartoons.com/ cartoon/76827563-85b2-4edd-ad11-63201937c851.html
Centers for Medicare and Medicaid Services. (2015). Projected. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html
Committee on Education and the Workforce, Democrats. (2009, July 31). House Democrats expose campaign of misinformation on health insurance reform. Retrieved from http://democrats.edworkforce.house.gov/press-release/house-democrats-expose-campaign-misinformation-health-insurance-reform
DeNavas-Walt, C., & Proctor, B. D. (2015). Income and poverty in the United States: 2014. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-252.pdf
DollarTimes. (2016). Inflation calculator: The changing value of a dollar. Retrieved from https://www.dollartimes.com/inflation/
New York Times. (2009, September 19). Don’t let dead cats stand on your porch: A tutorial from Lyndon B. Johnson. Retrieved from https://www.nytimes.com/2009/09/20/weekinreview/20word.html
Nichols, J. (2011). The “S” word: A short history of an American tradition . . . socialism. New York: Verso Press. Social Security Administration. (2011). Special collection: Presidential statements. Retrieved from https://www.ssa.gov/history/presstmts.html
U.S. Department of Health and Human Services. (n.d.). Key features of the Affordable Care Act. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html
Grades 6-8, 9-12