Would it be shameful not to reform health care?

It would be shameful if we do nothing to fix the health care system in the USA, so says Dr. Joseph W. Stubbs who is president of the American College of Physicians and an internist in Albany.  You can read his editorial which was published in the Atlanta-Journal Constitution yesterday.  He argues from his position as President of this prestigious organization and from his context as a practicing physician.  

He says this about the current health care legislation in Congress:

To be perfectly clear, the proposed health care legislation is not about rationing care, socialized medicine or death panels. To the contrary, instead of leading to “rationing,” Congress would fund research to provide my patients and me with objective clinical information, based on the best science available, to choose the most effective treatment among the many available ones. And, instead of promoting “death panels,” the bill empowers patients to decide how they want to be treated at the end of life. Patients would make these decisions in consultation with their doctors — not government employees.

He supports the effort in Congress because health care reform will:

  • provide coverage for all Americans,
  • provide scholarships for those interested in pursuing careers in primary care, 
  • create a more efficient system of administering health care by controlling costs while promoting best possible health outcomes.

Finally, he writes:

Within our grasp is the achievement of health reform legislation that makes coverage affordable by building upon and improving our current employer-based system, providing incentives for young doctors to go into primary care, reforming and improving Medicare physician payments, and reducing the costs associated with our broken medical liability system. Let’s not let the opportunity slip away.

Has the rancor and shouting ended, and the real discussion just beginning?  How does an article such as Dr. Stubbs’ inform us about health care, and health care reform?  What do you think?

Using Case Studies to Help Students Investigate Health Care Issues

There were two articles that I read today that contribute to how science teachers might use case studies (sometimes based on articles in the press or magazines, or actual cases written for students and teachers). The cases and/or artices could to create a context relevant to student dialogue, discussion & inquiry. The first article was about about the effect the lack of health insurance has on working-age Americans, and the second article was on the effect of Mexico’s Universal Health Insurance on household expenses and health.

In an article published in the American Journal of Public Health and reported on Harvard Science website, researcher’s from Harvard Medical School found that nearly 45,000 annual deaths are associated with lack of health insurance. As one of the author’s said “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

In another article reported on Medical News Today and published in an upcoming issue of The Lancet, the authors explore findings of Mexico’s pilot universal health insurance system (Seguro Popular). They report that Seguro Popular, designed to extend health insurance and regular and preventive medical care, pharmaceuticals, and health facilities to 50 million uninsured Mexicans, has reduced catastrophic health expenses for poor families, and appears to be a successful program in the communities in which the study was based. As one of the researchers said, “That Mexico may now have a validated architecture for delivering health services to the poor seems to be the most surprising and encouraging result from this experiment. We found that the stewardship of Seguro Popular has been successful in reducing overall catastrophic and out-of-pocket expenditures for inpatient and outpatient medical procedures, especially in the poorest individuals.”

Each of these articles could be used as starting points for an exploration of health care, not only in the US, but in other countries as well. To what extent can it propsed that care should be a universal expectation?

One strategy that many science teachers have used over the years to explore issues in science teaching is the case study method. A valuable resource for an inventory of cases is The National Center for Case Study Teaching in Science. You will find cases in many categories, including those related to health science including Medical Ethics, Medicine/Health, Pharmacy, and Molecular Biology/Genetics. For each case, you will a link to the case study, including a set of questions for inquiry discussion, and teaching notes which includes background, context for the case, objectives, teaching methods, and references. One case you might find relevant today is A Case Study Involving Influenza and the Influenza Vaccine.

What are some examples of cases or articles that you would like to share?

Health Care in the US: An S-T-S Issue for the Science Classroom?

Health care has emerged as one of the most contentious issues of the day in the USA. The contention is not new. This PBS time line covering the past 100 years identifies points of contention and progress in the government’s attempt to deal with health care on a national level. A more informative time line of health care in America can be viewed at this New York Times website. The issue is explored in the timeline from the campaign of Theodore Roosevelt (he promised national health insurance) to the current effort by President Obama to reform health care.

For example, in 1945 President Harry Truman argued in a message to Congress that the federal government should play a role in health care, saying “The health of American children, like their education, should be recognized as a definite public responsibility.” One controversial part of his plan was the creation of a national health insurance fund. This optional fund would be open to any citizen, who would pay a monthly fee into the plan. Doctors and hospitals would be paid directly from the fund. Truman’s plan was denounced by the American Medical Association (AMA) , and was called a Communist plot by a House subcommittee. The AMA fought vigorously against the bill, and characterized the bill by coining the phrase “socialized medicine.”

I am not going to explore the history of health care, but instead I want to consider how the health care reform issue could be explored in science classes as a science-related social issue (S-T-S). For many years, science educators have advocated a variety of S-T-S themes for inclusion in the science curriculum. These themes such as population growth, air quality, energy, water resources, have also included health, and health related topics such as world hunger, quality and availability of medical care, and the cost of medical care.

In a study of students’ views of science, researchers at the University of Norway (The Relevance of Science Education Project) found that health, genetics, disease, first aid, epidemics, harmful technologies, and related issues were high on the list of topics that teenagers in more than 40 countries views as important to study in science.

In a recently published book by T. R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care makes the case that health care in the US can be reformed by examining other countries’ models of health care, and then using ideas from these models to reform health in the US. As he explores in his book, and as has been documented in reports in the literature, the USA is the only industrialized nation that does not provide health care to all of its citizens. He explores four different models of health care. As he points out, the US health care system has elements of all four. Here they are, as portrayed in his book:

  • The Bismark Model (found in German, Japan, France, Belgium, Switzerland, Japan). Named after Otto von Bismarck, it is familiar in the US in that health care providers and payers are private entities, and the model uses private health insurance plans financed by employers and employees . However, in these countries, everyone is covered. In the US, about 65% of its citizens are covered by this model.
  • The Beveridge Model (Britain, Italy, Spain, most Scandinavian Countries). Inspired by William Beveridge, a British social reformer, health care in this model is provided and financed by the government through taxes. In this model medical treatment is a public service, such as education. In this model many of the hospitals and clinics are owned by the government, and many doctors work for the government. There are, however, private doctors in this model, as well. As Reid points out, its this model that is coined by some Americans as “socialized medicine.” Yet, for Native Americans, military personnel, and veterans, health care is provided in a Bereridge-style-model.
  • The National Health Insurance Model (Canada, Taiwan, South Korea, Medicare in the USA) In this model the providers of health care are private, but the payer is a government run insurance program. Monthly premiums are collected by the government, and medical bills are paid directly by the government to the private providers. In the USA, for example, each medicare receipient pays $95 per month for health care from private entities. In Canada, a family of four would pay about $120 Canadian for basic health care. As said, for all of us over 65, where in the Canadian model, and indeed, President Johnson modeled Medicare after the Canadian model.
  • The Out-of-Pocket Model (Most of the countries of the world) In this model health care is provided as a pay-as-you-go approach, and in countries, for example Cambodia, India, Egypt, 45 million citizens in the USA, health care is fundamentally absent, or available if you can pay.

Students in science classes, especially at the middle and high school level should be involved in the discussion of health care, not only as it pertains to them as individuals, but them as part of a community and a larger society. There are many ways to enter into a dialogue with students, and help them carry out science-related health projects. Some entry topics could include: tobacco, alcohol and other drugs, diseases (H1N1 flu), violence, sex education, pediatrics, addictions.

When I listen to politicians talk about why health care should not be reformed, or that they simply disagree with whatever plan is proposed, I realize that they seem to be functioning in a void, and appear unaware of the issues that impact children and teens, especially those who have little or no access to the medical care system in the US.

How would you craft lessons and activities for students to engage in the health care reform issue? What topics would you use to help students explore the science and social aspects of the issues at hand?

International Colleagues: I would very much appreciate your comments on this issue. I clearly have not explored health care in many nations, and your story would be important to other readers of this blog. Please inform us about health care in your country. For readers whose country I’ve mentioned in this post, tell us what you think.

Images from NASA for Science Teaching

I received note from Jake Johnson, outreach coordinator, the Internet Archive Outreach, NASA images asking to mention a resource for teaching at the NASA Images website.

I think you will find this site a powerful aid for teaching.
Here are some examples: