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Lesson Plan

What Role Should Government Play in Paying for Health Care?

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FILM: This lesson plan is designed to be used with the film Life. Support. Music., which documents the recovery of guitarist Jason Crigler after he suffered a brain hemorrhage while onstage at a show. Classrooms can use Crigler's powerful story to raise issues about U.S. health care reform, especially topics related to long-term care.

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OBJECTIVES

During this lesson, students will:

  • Use viewing skills to understand and interpret video clips.
  • Conduct Internet research to respond to a series of questions on Medicaid
  • Discuss to what degree, if any, a government should help its citizens with medical expenses.
  • Write a one-page position paper that explains which health care reform strategy is best and why.

GRADE LEVELS: 6-12

SUBJECT AREAS: Civics, Current Events, Health

 

MATERIALS

ESTIMATED TIME NEEDED: Two 50-minute classes

 

SUGGESTED VIDEO CLIPS:
Clip 1: Jason's Crisis Begins (length 7:36)
The clip starts at the beginning of the film and ends at 7:32 when Monica says, "I cannot go on without Jason." (Note: This clip includes the word "pissed.")

Clip 2: "It Did Not Look Good" (length 4:27)
The clip begins at 14:55 with Monica describing the early days of Jason's recovery and ends at 19:22 with Dr. Carter saying, "...that he'd make a really remarkable recovery."

Clip 3: "I've Proved Them All Wrong" (length 2:55)
The clip begins at 1:05:23 with the sun setting over New York City and ends at 1:08:18 with a crowd at a club clapping for Jason.

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BACKGROUND

In August 2004, guitarist Jason Crigler suffered a brain hemorrhage while onstage at a club in New York City. Jason's hemorrhage was caused by an arteriovenous malformation (AVM), which is an irregular blood vessel whose arteries and veins lack pressure-diffusing capillaries, often causing the blood vessel to spring a leak. Doctors believed that Jason would either die as a result of the hemorrhage or he would require constant care for the remainder of his life due to serious brain damage. But after an intense period of rehabilitation, Crigler was able to recover and once again leads an active life.

During his recovery period, Crigler needed long-term medical care. The Medicare website describes long-term care as a variety of services that, including medical and non-medical care for people with chronic illnesses and disabilities. Most long-term care is meant to assist people with daily living activities, such as dressing, bathing and using the bathroom. Long-term care can be provided at home, in the community, in assisted living facilities or in nursing homes. Most funding for home care is provided by Medicare, which offers insurance for those 65 or older and for younger people with certain conditions. Medicaid funds about 20 percent of home care costs and is the primary source of funds for long-term care in the United States. In 2000, 45 percent of funds spent on long-term care came from Medicaid; individuals paid out-of-pocket for approximately one third of such care.

As the American population ages, the need for long-term care is projected to grow sharply. In 2009, about nine million men and women over the age of 65 will need long-term care. By 2020, 12 million older Americans will need long-term care. Most will receive care at home; family and friends are the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services says that people who reach age 65 will likely have a 40 percent chance of entering a nursing home. About 10 percent of the people who enter a nursing home stay there five years or longer.

One factor complicating the funding of long-term care is the fact that there is no single agency to oversee such care; a report from the National Council on Disability says more than 20 different agencies and nearly 200 programs are involved at the federal level. The involvement of state and local programs makes the situation even more complex. Thus, those who wish to provide at-home care face a daunting set of bureaucracies in seeking support.

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ACTIVITY

1. Explain to the class that many Americans struggle to pay for health care. These challenges are even greater when someone requires long-term care due to age, accident or serious illness.

2. Tell students that you are going to share with them the true story of Jason Crigler, a 34-year-old guitarist in New York City who experienced a medical emergency in 2004 that caused him to need long-term care. Then, play Clip 1 for the class. (Note: This clip includes the word "pissed" and the medical term "ventriculostomy," which is a procedure where a tube is inserted through the skull into the brain to drain fluid and release pressure.)

3. After the clip, explain that though Jason survived the bleeding in his skull, he was non-responsive and partially paralyzed. Over the next six months in the hospital, he made some progress and was able to say a few words and interact a little with those around him. However, it was very expensive for him to stay in the hospital. He reached the one million dollar lifetime cap placed on his health insurance coverage. Like 90 percent of Americans, the Criglers did not have long-term care insurance. To make matters worse, getting a new health insurance plan would have been very difficult, because Jason's brain bleed would have been considered a pre-existing condition. Play Clip 2 and ask students to listen to how the Criglers were able to help pay for Jason's care after they transferred him to the Spaulding Rehabilitation Center in Boston.

4. When the clip ends, explain that the Criglers were able to get help for their medical bills from Medicaid. Distribute the handout and have students use the Internet resources listed in the "Resources" section below to find the answer to each question. Based on the level of Internet access at your school, you may need to have students work in groups at each computer or complete the handout outside of class for homework.

5. Discuss to what degree, if any, the government should help its citizens with medical care expenses. Have students justify their positions. Keeping in mind that Jason's pre-existing condition will make it difficult to get health insurance in the future, how should his future medical expenses be covered?

6. Explain that one way the government controls Medicaid costs is by placing limits on services. For example, rehabilitation services are limited to those that will lead to a measurable restoration of function. At one point, the doctors at Spaulding determined that Jason's recovery was not likely to progress much further. Once that conclusion had been reached, Medicaid refused to provide further rehabilitation benefits. Jason's family did not want to put him in a nursing home, so they took on his extensive care personally. They worked diligently with Jason to continue his rehabilitation, and in time he was able to recover, care for himself and play guitar again. He finished an album of songs and performed live in New York City with a number of his friends in the music industry. Show the class Clip 3 so that students can see Jason's stage of recovery approximately two years after his brain hemorrhage. Also, show the video update with the Criglers to see how they are faring in 2009.

7. Discuss what Jason's quality of life might have been like if his family had been unable or unwilling to continue his rehabilitation after his Medicaid benefits were cut. How might the progress of his recovery have been affected? What impact could that scenario have had on his wife and child?

8. Divide the class into groups of three and ask each student to teach the other members of the group about one of the strategies for health care reform outlined on the Public Agenda for Citizens website. (See the "Consider the Choices" section under the bar graph.) Tell each group to discuss how each strategy could potentially help or harm families in the Criglers' situation. Also, how would these strategies address the long-term care issues that students listed on their handouts?

9. Conclude the activity by having each student write a one-page position paper that explains which reform strategy he or she thinks is best and why. 

 

ASSESSMENT SUGGESTIONS
Students can be assessed on:

  • Completion of the handout
  • Participation in class discussion and group work.
  • Clarity of ideas and supporting detail expressed in the position paper.

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EXTENSIONS & ADAPTATIONS

  • Delve deeper into the economics of health care with POV resources for the film Critical Condition. Read basic facts about the uninsured. Use the provided lesson plan to help students develop public service announcements to disseminate this information.
  • Analyze the lyrics to Jason Crigler's song, "The Books on the Shelf," which he wrote about his recovery. Ask students to write their own songs that either contain biographical themes or express their political views about health care in the United States.
  • Explore the benefits of keeping a journal. Introduce the topic by watching the film, Life. Support. Music. in its entirety. Then, discuss the journal entries Marjorie wrote while her brother Jason was in the hospital following his brain hemorrhage. (She reads some of these entries aloud about 10 minutes into the film.) Why did she begin to keep a journal? What types of ideas did she record? How did it help her cope with the adversity she was experiencing in her life? How might her journal keeping have affected the care she gave to Jason? Challenge students to keep a journal for a set period of time and then reflect as a class on the benefits that they experience.

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RESOURCES

Fact Sheet: Medicaid and Long-term Care Services and Supports — The Kaiser Family Foundation provides a regularly updated fact sheet that describes what long-term care services are provided and to whom, details on how these services are funded and the future outlook for this program.

Fact Sheet: Medicaid's Rehabilitation Services Option — This issue brief from the Kaiser Family Foundation provides an overview of current policy issues related to rehabilitation services funded by Medicaid.

Glossary of Medicare and Health Insurance Terms — The American Association of Retired Persons (AARP) provides definitions for commonly used health insurance terms.

Public Agenda for Citizens: Health Care — This non-partisan site provides an overview of the problems with the U.S. health care system and briefly outlines arguments for and against the three main strategies for addressing these problems.

State Health Facts: Medicaid and CHIP — The Kaiser Family Foundation provides bar graphs, tables and color-coded maps that present a wealth of statistics on Medicaid and health issues, broken down by state.

The State of 21st Century Long-term Services and Supports — This report from the National Council on Disability outlines issues related to long-term care and makes policy recommendations for addressing them.

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STANDARDS

These standards are drawn from "Content Knowledge," a compilation of content standards and benchmarks for K-12 curriculum by McRel (Mid-continent Research for Education and Learning) at http://www.mcrel.org/standards-benchmarks/.

Civics
Standard 16: Understands the major responsibilities of the national government regarding domestic and foreign policy and understands how government is financed through taxation.

Standard 21: Understands the formation and implementation of public policy.

Health
Standard 1: Is familiar with the availability and effective use of health services, products and information.

Language Arts
Standard 4: Gathers and uses information for research purposes.

Standard 7: Uses reading skills and strategies to understand and interpret a variety of informational texts.

Standard 9: Uses viewing skills and strategies to understand and interpret visual media.

ABOUT THE AUTHOR
Cari Ladd, M.Ed., is an educational writer with a background in secondary education and media development. Previously, she served as PBS Interactive's Director of Education, overseeing the development of curricular resources tied to PBS programs, the PBS TeacherSource Web site (now PBS Teachers) and online teacher professional development services. She has also taught in Maryland and northern Virginia.

Background Sources:
» "Medicaid and Long-term Care Services and Supports." Kaiser Family Foundation
» "Medicare: Long-term Care."
» "The State 21st Century Long-Term Services and Supports: Financing and Systems Reform for Americans with Disabilities." National Council on Disbility. December 15, 2005

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[W]hen the Criglers asked if I would consider making a documentary about the whole saga, I knew their beautiful optimism amid the heaps of suffering would be the story. Of course, I underestimated the entire thing.”

— Eric Daniel Metzgar, Filmmaker