This lesson is designed for health classrooms, grades 9-12.

• Lesson Objectives
  
• Relevant National Health Standards
  
• Estimated Time
  
• Materials Needed
  
• Backgrounder for Teachers
  
• Assumed Student Prior Knowledge
  
• Teaching Strategy
  
• Assessment Recommendations
  
• Extension Ideas
  
• Related Resources
  
• About the Author
  
  

1. Calculate how much of each paycheck is deducted into the Medicare system.
2. Describe the Medicare program.
3. Explain the need for health insurance and Medicare.
4. Analyze and debate presidential candidate proposals for Medicare reform.
5. Develop their own plan to reform Medicare.
6. Work collaboratively with a partner and in small groups.

Standard 2: Students will demonstrate the ability to access valid health information and health-promoting products and services. Performance indicators focus on identification of valid health information, products, and services including advertisements, health insurance and treatment options, and food labels.
Standard 5: Students will demonstrate the ability to use interpersonal communication skills to enhance health. Performance indicators relate to interpersonal communication, refusal and negotiation skills, and conflict resolution.
Standard 6: Students will demonstrate the ability to use goal-setting and decision-making skills to enhance health. Performance indicators focus on setting reasonable and attainable goals and developing positive decision-making skills.
Standard 7: Students will demonstrate the ability to advocate for personal, family, and community health. Performance indicators relate to identifying community resources, accurately communicating health information and ideas, and working cooperatively to promote health.

Estimated Time
Four to six 45-minute class periods.

Materials Needed

• Handout: Paycheck (PDF file)
• Handout: Catching Up With Medicare (PDF file)
• Handout: Challenges Facing Medicare (PDF file)
• Optional Handout: Debate Rubric (PDF file)
• Optional Handout: The Healthcare Crisis in the United States (PDF file)
• Internet access, or copies of relevant pages
• Copy of the 5/17/02 NOW with BILL MOYERS interview with Julie Rovner and TV/VCR (Note: A free transcript of this interview is available on the NOW Web site. Teachers may also tape the broadcast off-air and use it in the classroom for one year. Alternatively, programs are available for purchase from ShopPBS.
• NOW's 4/30/04 broadcast on the new medicare bill and perscription benefit. (Note: A free transcript of this interview is available on the NOW Web site. Teachers may also tape the broadcast off-air and use it in the classroom for one year. Alternatively, programs are available for purchase from ShopPBS.

Backgrounder for Teachers
Medicare is health insurance offered by the federal government to most people who are 65 and older, and to some younger people with disabilities. The program is currently facing significant challenges due to the rising costs of healthcare and the retirement of 77 million "baby boomers" whose healthcare needs will have to be supported by payroll taxes from fewer workers per retiree. To address such crises, the 2004 presidential candidates have proposed strategies for Medicare and healthcare reform.

This lesson provides background on the Medicare program and has students analyze and debate candidate ideas for improvement. For more information on Medicare, its history, and the latest developments on reform efforts, please see the sites listed in the Related Resources section of this lesson.

Assumed Student Prior Knowledge
It is assumed that students understand that Americans pay taxes to the government and that these funds support services such as Social Security, Medicare, etc. It is also assumed that students have some understanding about health insurance.

Teaching Strategy

Part 1: What is Medicare?

1. Introduce this lesson by distributing to each student the handout, "Paycheck." Have students choose an amount for the paycheck between $200.00 - $1000.00 and write it in. Next, have them calculate the standard deduction for Medicare by multiplying the paycheck amount by .145 or 1.45 % of the total amount. Have students look over their paycheck and respond to the following questions:
   • What is Medicare?
   • What do you think the deductions out of each paycheck are used for?
   • What is your reaction to the amount each person pays into Medicare?
   • How much is taken out of someone's paycheck every year? Over one's lifetime?
   Explain to students that everyone employed in the United States pays 1.45% of his or her income to the Medicare system. In addition, employers pay another 1.45% to support Medicare. These contributions will allow students to receive medical benefits when they retire or if they have a long-term disability.
2. Distribute the handout, "Catching Up With Medicare" and copies of the Medicare Fact Sheet provided by the Kaiser Family Foundation. Have students work in pairs to complete the graphic organizer on the Catching Up With Medicare handout using the Medicare Fact Sheet as a reference. Tell students that the Catching Up handout uses a body metaphor to help them remember some of the complex details of Medicare. The body itself represents the Medicare program. They should list the basic definition of Medicare in the head. The "legs" the program stands on will detail the program's financials. The program "gives a hand" to the people eligible for Medicare. The services covered by Medicare are the "heart" of the program. Finally, the program will need to overcome several obstacles, or "hurdles" in the future.
3. Once the graphic organizers are completed, have pairs compare their handouts with other groups and fill in any key points they may have missed.
4. On the back of the graphic organizer have students complete a K-W-L chart: Establish at least 3 things each partnership now knows (K) about Medicare, list at least 3 things they want (W) to learn about Medicare, and then leave the learned (L) column blank to come back to at the end of the lesson.

1. Help students put Medicare in the context of the overall healthcare crises in the United States by watching (or reading Bill Moyers' interview with reporter Julie Rovner from the 5/17/02 broadcast and NOW's 4/30/04 broadcast on the new medicare bill and perscription benefit. As students watch (or read), have them identify answers to the following questions:
   • Why are healthcare costs rising?
   • Hypothesize what will happen to Medicare in the next 20 years?
   • What are some of the consequences of not having health insurance?
   • What is the relationship between income level and type of healthcare?
2. Using the handout, "Challenges Facing Medicare," review the graphs and facts, emphasizing Fact #5 "Fewer Workers Per Retiree to Fund Medicare." Help students understand that due to better healthcare, Americans are living longer; this fact combined with large numbers of "baby boomers" (see Fact #4) creates an imbalance between the number of people in the workforce and the number of retirees needing Medicare benefits.
3. Find out what percentage of the population in your state is above and below age 65 by referencing the NOW Healthcare Resource Map. How much will this percentage likely grow between 1995 and 2025? Discuss what that could mean for retirees in your state.

Break students into small groups and assign them a presidential candidate to research. Students should study their candidate's proposal for Medicare reform and be prepared to debate it. In addition, each group should write a list of related questions that they can ask of other groups during the debate. The following resources will help students in their research:

• The Commonwealth Fund report: Healthcare Reform Returns to the National Agenda: The 2004 Presidential Candidates' Proposals
• CNN: The Presidential Primary Preview
• The White House
  President Bush outlines his goals for Medicare.
• Senator John Kerry
  The probable Democratic candidate outlines his goals for Medicare.

Have each group present their candidate's proposal on Medicare reform. Groups can then debate using the list of questions they created, or by asking some of the questions below from The Commonwealth Fund report, page 18.

1. How many uninsured people does the plan cover?
2. How much will the plan cost the federal government and the healthcare system as a whole, and how might it be financed?
3. Does the plan improve coverage for people who currently have inadequate health coverage, e.g., high costs or limited benefits?
4. Does the plan increase stability of insurance coverage, i.e., make it less likely that people will experience gaps in coverage?
5. Is it likely to improve access to care, the quality of care, or health outcomes?
6. Does it include provisions to reduce costs and improve efficiency in the administration of insurance or delivery of care?
7. Is it easy to administer or does it require a new and untried administrative structure?
8. Could the plan be phased-in over time?

1. After listening to the debate of candidate proposals, have students create their own plan for healthcare reform. The plan can be presented in one of the following formats:
   1. Persuasive speech
   2. Debate
   3. Compare and contrast to the present system
   4. Political cartoon and explanation
   5. Letter format to a government official
   6. As a mock testimony to the Senate
2. Have students revisit their K-W-L charts on the back of the graphic organizer and complete the section, "What I have learned". Share these out with the class.

Assessment Recommendations
Consider assigning points for the following student work:

1. Completion of the "Catching Up With Medicare" handout.
2. Research on a 2004 presidential candidate in preparation for a debate.
3. The debate itself. (See sample debate rubric provided with this lesson.)
4. The quality of presentations for the final activity.

Extension Ideas

1. Have students create a survey on Medicare to gather information from a local senior citizen group.
2. Invite a physician to be a guest speaker to discuss health insurance and how it affects the profession.
3. Invite someone in who uses Medicare to describe how the system has either benefited them or made care more difficult.
4. Have students write letters to state senators and congressman about their position on healthcare reform.
5. Have students compare and contrast two of the candidate proposals for healthcare reform.
6. Compare the United States healthcare system to the universal healthcare systems in other countries.
7. Have students calculate the cost of care for a chronic illness over a period of time.
8. Have students estimate what healthcare will cost their family over the next 5 - 10 - 20 years.
9. Have students predict what the healthcare system will be like when they retire.
10. Ask students if they know someone or if they themselves have had their tonsils removed. Show students the cost for a common surgery such as a tonsillectomy. According to the Minnesota Council of Health Plans, a tonsillectomy would cost $5,914.00. A helpful summary has been compiled by the Minnesota Council of Health Plans, 2550 University Ave. W., Suite 255 S., St. Paul, MN 55114. For information call 651-645-0099, e-mail info@mnhealthplans.org or visit http://www.mnhealthplans.org. Using this common surgery as an example, have students discuss what they think such a surgery would cost a family who has health insurance, a family who has no health insurance, and a retired person.
11. Students can deepen their understanding and background on why U.S. healthcare is in crisis by watching the video, HEALTH CARE CRISIS, or by reading the transcript. Have students work in pairs to answer the questions on the related handout, The Healthcare Crisis in the United States.
12. Create a campaign poster depicting how the candidate will improve healthcare in the United States.
13. After listening to the debates, students can write a brief statement on which candidate they would support for Medicare reform. The statement should include at least three critical components that support their decision.

Related Resources
Below are some sites that provide useful information related to this lesson's topic. These resources are provided in addition to the helpful Web sites listed in the Teaching Strategy section of this lesson plan.

NOW's Medicare Overview
Information on the 2003 Medicare reform and perscription drug benefit, including a Q & A with a medicare expert from the Kaiser Family Foundation.

AARP: Health Insurance and Medicare
AARP is a nonprofit membership organization advocating for persons 50 and older. This site offers user-friendly information related to the Medicare system.

The Century Foundation Medicare Watch
This site offers detailed information about Medicare and many related resources and links. It covers the basics of Medicare, news, research and development, a list of experts and more.

Families USA: The Voice for Healthcare Consumers
This national nonprofit, non-partisan organization offers a multitude of resources related to Medicare and healthcare.

Free Advice: How It's Financed
This site explains in simple terms how Social Security and Medicare are funded.

Health Insurance
The U.S. Department of Health and Human Services provides numerous resources related to Medicare and Medicaid.

History of Medicare
The Centers for Medicare and Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Among the resources at this site is a timeline showing how and when the program was established.

Kaiser Family Foundation
The Kaiser Family Foundation provides non-partisan information on national health issues to policymakers, the media, and the general public.

The League of Women Voters
This Web site features a report by the LWVEF and the Kaiser Family Foundation that clarifies how Americans feel about Medicare reform.

The National Bipartisan Commission on the Future of Medicare
This commission was in put in place in 1998 to find real solutions for the Medicare crisis. Its Web site includes four factual charts and graphs related to the future of Medicare, as well as other resources.

The Official U.S. Government Site for People with Medicare Coverage
A service of the The Centers for Medicare & Medicaid Services (CMS), a Federal agency within the U.S. Department of Health and Human Services administers this service. The site offers information and assistance to Medicare users. It also contains a user-friendly glossary of terms related to Medicare and health insurance.

The White House
President Bush outlines his goals for Medicare. Listen to the President's radio address or view a multimedia video of President Bush discussing how he will improve the current Medicare system.

About the Author
Donna DeTommaso-Kleinert is an elementary physical education teacher at Hatfield Elementary School in the North Penn School District Lansdale, Pa. She has participated on the writing team for the Pennsylvania State Health and Physical Education Standards and coordinates and presents the new teacher induction program. She has been in the teaching profession for 20 years with experiences in elementary and secondary health and physical education and also as a learning coordinator of all the special area curricula. Presently she is enrolled in a curriculum and instruction program in the Department of Kineseology at Temple University. Her proudest accomplishments have come from motherhood and marriage.