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.