To the Teacher
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.
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.
Student Reading:
The president's health insurance plan
"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.
"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."
"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."
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."
Highlights (*most controversial items)
For those who have health insurance:
- Allows people who have health insurance they like to keep it
- Makes it illegal for insurance companies to deny coverage
- Ends premium discrimination based on gender; limits it based on age
- Prevents insurance companies from dropping coverage if medical condition was not listed on application, except in cases of fraud
- Prohibits insurance companies from placing annual or lifetime caps on benefit payments
- Eliminates extra charges for preventive care like a colonoscopy
- Eliminates gradually a gap in Medicare drug benefit that can now cost a senior $4,080
For those who don't have insurance:
- Creates a marketplace that allows people without insurance and small businesses to compare plans and buy one they prefer at a competitive price
- Provides tax credits to help lower-income people and small businesses buy insurance
- *Offers a public health insurance option designed to promote competition and provide more choice
- 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
For all Americans:
- *Is supposed to save money, not add to the deficit, and is to be paid for upfront
- Requires additional budget cuts if savings are not realized
- 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
- Requires large employers—those with more than 50 workers—to cover their employees
- Requires independent workers who can afford it to purchase coverage but provides a "hardship exemption" for those who cannot
*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.
*There are many questions about whether the Obama plan will in fact reduce healthcare costs and avoid deficit spending.
(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
For discussion
1. What questions do students have about the reading? How might they be answered?
2. Why do you understand to be the main reasons why many people think that health insurance reform is essential and why others oppose reform?
3. 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?
4. Why is the "public option" controversial? If you don't know, how might you find out?
5. 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?
Student Reading 2:
Critics and commentators
Republicans
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."
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."
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."
For details on Republican healthcare ideas see www.gop.gov/issue/health-care.)
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." (New York Times, 9/11/09)
Health insurance industry
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)
Physicians for a National Health Program (PNHP)
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 Annals of Internal Medicine 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.
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.
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.
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."
Dr. Andrew Weil, Arizona Center for Integrative Medicine
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." (www.huffingtonpost.com, 9/10/09) Some of that "more" would include the following:
1. Ban direct-to-consumer marketing and advertising by big pharmaceutical companies, which make people believe that "there's a pill for every health problem."
2. Create a "national institute of health and healing" to research less invasive and expensive therapies.
3. 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."
4. 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.)
5. Require insurers to cover health promotion and integrative care.
6. Establish an office of "health education" that would "make nutrition, diet, and exercise an integrated part of every child's education."
("A Healthcare Call to Action," www.drweil.com, 9/11/09).
Michael Pollan, author of In Defense of Food: An Eater's Manifesto.
"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," New York Times, 9/2009)
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.
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."
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."
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."
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."
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."
For discussion
1. What questions do students have about the reading? How might they be answered?
2. 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?
3. On what health insurance issues do Republicans agree with Democrats? Is each one clear to you? If not, how might you find out more?
4. What is a single-payer plan? Why do you think most doctors support it? Why is the insurance industry opposed?
5. Why would Dr. Weil ban pharmaceutical company advertising?
6. 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?
7. 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?
8. 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?
9. What does he mean by "one of the leading products of the American food industry has become patients for the American healthcare industry"?
For inquiry and discussion
The health insurance debate offers an opportunity for family discussions this fall.
Invite students to take the readings home and ask parents to read and discuss with them major questions:
- What are their reactions to Obama's plan and why?
- 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?
- What do they know about the "single-payer" proposal? What opinions do they have about it?
- What do they think about Weil's emphasis on "integrative medicine" and "integrative care"?
- 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?
Students might then report to the class parent responses to such questions for further class discussion.
This lesson was written for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email them to: lmcclure@morningsidecenter.org