Ah it's that time of year again. Get the kids on the yellow bus, sit in traffic and think about stuff that bugs you.
Right now, one thing is bugging me (at least more than anything else) - healthcare reform.
Yes, it's controversial and yes, it's annoying but the reality is something is going to happen this year regarding healthcare and insurance whether you like it or not. Apparently to have an opinion differing from those in elected positions makes one 'Un-American' or an extremist.
However, I am going to propose something different with this blog today. I am going to suggest that people can actually have a civil conversation and debate about creative ways to help solve this problem. Here are the rules:
1. No berating an opposing view.
2. Your argument must be supported by facts
3. Please refrain from salty language (that's only allowed by me, the host. It's the only priviledge I get to enjoy.)
4. Have fun and no solution is off limits. (That's called brain storming - something politicians in DC are incapable of doing because it involves having a brain to storm with.)
So here's my idea (yes, my bullet-proof vest is zipped up and I have my big boy pants on.)
Require surgeons to post their performance, or track record, showing how many operations they've performed, the number of medical related issues that resulted from these operations and the years of experience their staff has. Basically a surgeon would be required to give a three year history on patients after the surgery. (Think of it like the label on the back of a breakfast cereal, only something that's easily written on an 8.5 x 11 piece of paper.)
Next, after reading the 'prospectus,' allow the patient the chance to either pay A) a price that includes the ability to sue the the doctor for malpractice or B) a price that does not allow the patient to sue for pain and suffering, but only lost wages.
In the auto industry they call this 'tort' or 'no tort.'
Now before you go berzerk on me, consider the following:
According to statistics from Stanford University, in 2005 about 20 million people underwent surgery with anesthesia. 12,000 of those patients died from a surgery that was unnecessary (i.e - plastic surgery, elective surgery, etc.) 106,000 died from medication errors associated with the surgery, 20,000 from hospital errors and 80,000 from infections resulting from the surgery (National Ledger, 8/21/2009.)
Let me do the math for you. That means that .1% of all surgeries resulted in death due to hospital errors during surgery. Other patients that died were a result of surgery that was not elective and required immediacy, such as heart attacks, cancer treatment, horrific accidents, etc. Let's call these things 'unpreventable' and outside of a hospitals ability to 'fix.'
Consider some of these facts, also from the National Ledger and confirmed from other sources such as National Institute on Health.
A study conducted by the AMA revealed that despite spending $3000 more per person on healthcare here in the US compared to Great Britain, twice as many American have diabetes and we also have a higher rate of heart attacks, strokes, lung disease and cancer than our friends across the pond.
What gives?
We're overmedicated folks. A forty-year study conducted by Dartmouth confirmed that as certain areas of the country spent more on healthcare, those folks died a faster pace than areas that spent less on health care. Is less really more?
The World Health Organization in 2008 found that the US has the worst track record compared to other industrialized nations when it came to preventable deaths due to treatable conditions such as bacterial infections and and complications from surgeries (both of which occur in hospitals, I might add.)
Next, cap the number/type of prescriptions one doctor can write. Do we really need auto-refills from an answering machine at the local pharmacy? Shouldn't SOMEONE monitor how the prescriptions are working PRIOR to reordering?
From personal experience, I literally stopped taking medication because I felt better and have eliminated my acid reflux problem. I still have 97 pills left from a 100 pill order, but the auto dialer at the pharmacy called to remind me that my prescription can be refilled and to place my order soon.
I am not an automobile needing an oil change.
Instead, through preventive maintenance NOT induced by drugs (you know, running, eating better and going to bed at a reasonable time) I helped my body heal. Old fashioned approach, but something that works quite well; not just for me but for all of us. We're not unique, folks, despite what people tell us.
So there it is.
We spend twice as much as Britain for care that is worse, so the solution before you and the rest of America is to do what? Spend more money?
Money is not the answer. In fact, money is what got us into this mess. Money for the drug companies, money for the lawyers, money for victims.
No. Remove the monetary element and begin letting people choose.
I anticipate many comments, discussions and ideas. That's what this is all about.
Saturday, August 22, 2009
Monday, August 3, 2009
Improving Education
If you don't mind I'm going to pull away from healthcare reform and the stock market this week and discuss something that is near and dear to my heart - education. As a proud member of the Mars Area School Board I am a huge proponent of educating our young adults; not just so that they can get a better job and create a higher standard of living, but also so they can appreciate the gifts our world and our neighbors have to offer. Call it "education for the sake of education," I guess.
With that said, much has been said about finding ways to improve our educational system. One such proposal involves merit pay for teachers. On the surface this appears to be a great idea, and I'd challenge anyone to oppose methods for improving student performance.
However, when you look behind the numbers, it's very important to discover what the carrot tied to the stick is before implementing policies that reward teachers for improvements by their students. Additionally, it's important to evaluate administrators and their effectiveness.
Current proposals for merit pay seem to focus on improving test scores, which seems like a very real indicator of whether teaching methods are working and students are improving. After all, improved exit exams are clearly a sign that teachers are doing a better job teaching the things we deem to be important, right?
Not so fast.
Many economists have begun to analyze merit pay based upon improved scores and are discovering that teaching effectiveness actually decreases when financial incentive is tied to standardized tests such as the ones being proposed by congress. In fact, while scores certainly improve, student performance in areas goes down.
How can this be?
In order to analyze this, one needs to look behind the numbers and look at motivators. What motivates someone to teach?
First and foremost, it's pretty safe to assume that one enters the teaching profession to impact others first and make money second. In fact, the same holds true for police officers, social workers, nurses and healthcare workers and other community related type of professions. Motivators for this group would be things that impact the world socially first. Economists call these "social motivators (we're not much for creativity when it comes to naming things. Sorry.)
As a result, improving big societal topics like reducing childhood obesity, reducing violent crimes, reducing illiteracy, etc. are things that these groups would find quite endearing and they'd be happy to be a part of the solution. The evaluation process is cumbersome, time-consuming and difficult to measure; particularly over a short period.
However, when the "carrot" becomes something easily measurable, such as improved test scores, increased attendance or reduced drop out rates, the workers can and do modify their behavior so that they achieve the desired results.
Think about it for a minute. If you were given the opportunity to earn a 10% bonus based upon your product (children) improving their test scores, would you modify your teaching plans to include everything on the test? Absolutely. However, you might be overlooking true learning that occurs day to day; what everyone, including our President, is calling 'teachable moments.' Should we sacrifice teachable moments for the sake of a 1%, 2% or 5% improvement in test scores?
Study after study is beginning to reveal that merit pay for teachers might not be a fundamentally sound idea for this very reason. Imagine a police officer that worked on commission, earning $10 for every speeding ticket he or she generated. How about a firefighter that earned a commission on every fire they put out? (Would this lead to an increase in fires as well?) Maybe a doctor should earn commission on the number of surgeries he or she performs (aren't we going down this road already? How's that working out?)
Additionally, studies are showing that the amount of money spent per pupil does not actually equate to improved student scores. This flies in the face of everything we're being told by legislators, yet we continue to believe that spending more money per pupil is the only solution. After all, money fixes everything here in the US. In fact, we spend more per pupil in the US than any other country in the Western Hemisphere. The return our investment is less than stellar if measured in economic terms.
Perhaps an overhaul of our education system is needed. Let's start with reptition. How can we expect students to learn and retain anything when they only need to go 1/2 of a year?
No. There needs to be merit based performance incentives, but the carrot needs to be something other than test scores. It needs to directly tied to things that the instructor can control, such as his or her daily attendance, improving communications with parents or guardians (both positive and negative communications) and representing the employer (in this case the school district) in a favorable light through community involvement, fundraisers, etc. - things that occur outside of normal school hours so that they can continue to do what they do best, which is teach.
Perhaps congress and the current administration could dangle a carrot tied to going year-round or districts that offer longer school days. Imagine how much your personal performance at work would improve if you were required to work 45 hours per week. Currently students in Pennsylvania high schools have to have 5.5 hours per day, five days per week, of instruction time. That's 27.5 hours per week, 180 days per year. If you want to stretch this over the entire year, it would be the equivalent of working a part-time job 13 hours per week, or a day and a half per week, all year. You can't learn anything of substance in this timeframe.
And we want to tie teachers down with more standardized tests? It's counter-intuitive, but it tugs at our emotional reasoning.
This is called Behavioral Economics, by the way.
I know that my ideas are not popular right now, and most likely, society is going to put merit pay in place based upon test scores. Additionally, I don't see any politician suggesting full-time, 8 hours per day for students aged 12 and older. Don't look for it anytime soon, either.
Let me be one of many others to verbally come out and say this is a bad idea and will ultimately lead us to a decrease in efficiency as a society. If you have any doubts, look at the runway of failed education reforms like No Child Left Behind, Standardized Exit exams, etc.
We're not solving the bigger problems which is teaching students to embrace learning for learning's sake. That's too hard.
With that said, much has been said about finding ways to improve our educational system. One such proposal involves merit pay for teachers. On the surface this appears to be a great idea, and I'd challenge anyone to oppose methods for improving student performance.
However, when you look behind the numbers, it's very important to discover what the carrot tied to the stick is before implementing policies that reward teachers for improvements by their students. Additionally, it's important to evaluate administrators and their effectiveness.
Current proposals for merit pay seem to focus on improving test scores, which seems like a very real indicator of whether teaching methods are working and students are improving. After all, improved exit exams are clearly a sign that teachers are doing a better job teaching the things we deem to be important, right?
Not so fast.
Many economists have begun to analyze merit pay based upon improved scores and are discovering that teaching effectiveness actually decreases when financial incentive is tied to standardized tests such as the ones being proposed by congress. In fact, while scores certainly improve, student performance in areas goes down.
How can this be?
In order to analyze this, one needs to look behind the numbers and look at motivators. What motivates someone to teach?
First and foremost, it's pretty safe to assume that one enters the teaching profession to impact others first and make money second. In fact, the same holds true for police officers, social workers, nurses and healthcare workers and other community related type of professions. Motivators for this group would be things that impact the world socially first. Economists call these "social motivators (we're not much for creativity when it comes to naming things. Sorry.)
As a result, improving big societal topics like reducing childhood obesity, reducing violent crimes, reducing illiteracy, etc. are things that these groups would find quite endearing and they'd be happy to be a part of the solution. The evaluation process is cumbersome, time-consuming and difficult to measure; particularly over a short period.
However, when the "carrot" becomes something easily measurable, such as improved test scores, increased attendance or reduced drop out rates, the workers can and do modify their behavior so that they achieve the desired results.
Think about it for a minute. If you were given the opportunity to earn a 10% bonus based upon your product (children) improving their test scores, would you modify your teaching plans to include everything on the test? Absolutely. However, you might be overlooking true learning that occurs day to day; what everyone, including our President, is calling 'teachable moments.' Should we sacrifice teachable moments for the sake of a 1%, 2% or 5% improvement in test scores?
Study after study is beginning to reveal that merit pay for teachers might not be a fundamentally sound idea for this very reason. Imagine a police officer that worked on commission, earning $10 for every speeding ticket he or she generated. How about a firefighter that earned a commission on every fire they put out? (Would this lead to an increase in fires as well?) Maybe a doctor should earn commission on the number of surgeries he or she performs (aren't we going down this road already? How's that working out?)
Additionally, studies are showing that the amount of money spent per pupil does not actually equate to improved student scores. This flies in the face of everything we're being told by legislators, yet we continue to believe that spending more money per pupil is the only solution. After all, money fixes everything here in the US. In fact, we spend more per pupil in the US than any other country in the Western Hemisphere. The return our investment is less than stellar if measured in economic terms.
Perhaps an overhaul of our education system is needed. Let's start with reptition. How can we expect students to learn and retain anything when they only need to go 1/2 of a year?
No. There needs to be merit based performance incentives, but the carrot needs to be something other than test scores. It needs to directly tied to things that the instructor can control, such as his or her daily attendance, improving communications with parents or guardians (both positive and negative communications) and representing the employer (in this case the school district) in a favorable light through community involvement, fundraisers, etc. - things that occur outside of normal school hours so that they can continue to do what they do best, which is teach.
Perhaps congress and the current administration could dangle a carrot tied to going year-round or districts that offer longer school days. Imagine how much your personal performance at work would improve if you were required to work 45 hours per week. Currently students in Pennsylvania high schools have to have 5.5 hours per day, five days per week, of instruction time. That's 27.5 hours per week, 180 days per year. If you want to stretch this over the entire year, it would be the equivalent of working a part-time job 13 hours per week, or a day and a half per week, all year. You can't learn anything of substance in this timeframe.
And we want to tie teachers down with more standardized tests? It's counter-intuitive, but it tugs at our emotional reasoning.
This is called Behavioral Economics, by the way.
I know that my ideas are not popular right now, and most likely, society is going to put merit pay in place based upon test scores. Additionally, I don't see any politician suggesting full-time, 8 hours per day for students aged 12 and older. Don't look for it anytime soon, either.
Let me be one of many others to verbally come out and say this is a bad idea and will ultimately lead us to a decrease in efficiency as a society. If you have any doubts, look at the runway of failed education reforms like No Child Left Behind, Standardized Exit exams, etc.
We're not solving the bigger problems which is teaching students to embrace learning for learning's sake. That's too hard.
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