Online Simulation of Health Care Reform: Helping Health Educators Learn and Participate

Introduction When compared to other nations with similar economic and political systems, health care in the United States in 2007 offered less access, required higher costs, and was not achieving the best health outcomes {Secretary General of the OECD, 2009 #9}. These circumstances provoked public debate before and after the 2008 elections and that debate lead to landmark legislative reform of health care in the United States. The online simulation described here challenged health education students to apply their understanding of health care concepts, to explore their use of digital technology as a means for political action, and to fulfill their professional responsibility {National Commission for Health Education Credentialing Inc., 2010 #21} to communicate and advocate for health. This teaching strategy used digital technology to simulate political reform in a college course on U.S. health care while Congress, the President, and many other Americans actually shaped and passed major health care legislation. The online simulation was used twice: first in a hybrid course during the spring semester coinciding with the inauguration of President Obama, and then in two sections of the course during the following spring semester when on March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act 2010. President Obama's campaign for health care reform was accomplished in less than 15 months, but it was only the latest of many incremental reforms dating back to health care proposals by Teddy Roosevelt in 1912. (1) Opponents of the President's reforms were planning further efforts to change health care (2) thereby telling Americans that the organization of health care was likely to be the result of an ongoing political process. In this time of change it was hard to ignore how citizens were increasingly going online to participate in elections and many things political. According to The Internet's Role in Campaign 2008, a report from the Pew Internet and American Life Project, the 2008 campaign was the first where more than half of the voting-age population went online to connect to the political process; online participation included social networking sites, websites, blogs, and other forms of online discussion. Young adults (18-24) were most likely to use online resources with 74% reporting that this was one of the ways they participated in the campaign. (3) A second report from the project described Post-Election Voter Engagement in political activity; 46% of Obama voters and 33% of McCain voters were expecting online communication from their leaders after Election Day. Of Obama supporters who were active online during the campaign, 25% were expecting to go online to seek support from others for the new President's agenda. (4) Online digital technology was familiar to young adults and going online was an important part of how they learned about health care and how they participated in the political deliberations that were defining the form and function of the health care system. The teaching strategy described in this paper incorporated familiar digital technology to help students learn about health care and about how to participate in health care reform. The following sections were used to explain why it was important for heath educators to understand health care and health care reform, to describe the emerging use of online technology in the politics of health care reform, to provide an overview of a course on U.S. Health Care, to detail an online simulation of health care reform, and to suggest how experience informs future use of this type of online simulation. Rationale for a Required Course on Health Care Health care and health care reform represented relevant areas of study for the professional preparation of health educators. The National Commission on Health Education Credentialing identified seven areas of responsibility that are applicable to health education practice in health care settings. …