Aug 01 2012

Med Reform

Imagine a day when a group of politicians and philanthropists read in the newspaper that the United States does not have the highest life expectancy in the world.  Not only that, we are actually ranked 38th in the world at 78.2, a full four and a half years below the number one country Japan.  Outraged, they decide to ‘do something’ about this crisis.  Despite knowing little about health and medicine, they become ‘medical reformers.’

They start a campaign educating the public about the problem.  They say that we should not be content with people in this country living shorter lives than people in other countries.  This is, after all, life and death.

Another report comes out and points out that we have in this country over 15% of all people (and over 22% of all children) live in poverty, and the life expectancy of poorer people is less than the life expectancy of richer people so our position on the life expectancy list is a bit misleading since the countries above us on the list have much lower percentages of poor people.

The med reformers say that anyone who uses this argument as an excuse is not valuing the lives of the poor.  There is no reason why we can’t get the life expectancy of the poor up to the life expectancy of the rich, thus increasing our countries position on the life expectancy list to the top.

Every person has had ‘good’ doctors and ‘bad’ doctors.  The med reformers say that research shows that doctors have the greatest in-hospital impact of any other component.  They decide that to get the life expectancy up for the poor, and for the rich too, we need to identify who the best doctors are and reward them and identify the worst doctors and fire them.  They develop a complicated formula where we measure the amount of  years-added to a person’s life as a result of having one doctor or another.

When professional doctors complain that they are not miracle workers and are unable to overcome all the out of hospital experiences that can shorten someone’s life, the med reformers tell them to stop making excuses.  The med reformers are convinced that doctors can overcome every out of hospital experience because they have seen the miraculous results of charter hospitals and their young doctors who trained for just five weeks, but have managed to accomplish an amazing amount of years-added.

Doctors who know that this is too good to be true start investigating the claims of these charter hospitals.  They find that these hospitals are refusing to treat patients who require too much time and effort and can make them less able to keep up their years-added statistics.  Other hospitals with miraculous results resort to other gimmicks to artificially boost their years-added scores.  Some cryogenically freeze their patients just before they die.  Some keep their dying patients alive on life-support systems.  Some even redefine ‘year’ to mean just 200 days.

Despite all this evidence, med reformers insist that the results of the miracle hospitals are genuine.  The President of the United States allys himself with a group called DFMR (Democrats For Medical Reform) and they encourage him to appoint as surgeon general a man who has never studied medicine.  That surgeon general imposes a new program Race To The Top (of the life expectancy list) based on evaluating doctors by the years-added metric, firing doctors who score low, and shutting down hospitals that have low years-added scores.

As a result of these programs, ironically, the life expectancy in the U.S. actually goes down.  Though about less than 1% of people  (5% of hospitals are charter hospitals, but only 1 in 6 of them have better years-added than public hospitals) do live longer lives, artificially or not, the other 99% of people suffer as resources are poured into the charter hospitals and doctors at the public hospitals get fed up and leave the profession.

Eventually the public begins to realize that the original premise, that we ‘should’ be at the top of the life expectancy list was not the right goal.  Getting to that goal by blaming and firing doctors and shutting down ‘failing’ hospitals is doomed to fail.  Instead the reformers should not have been looking for a short cut.  They should have deeply examined why our countries life expectancy was low and invested resources into preventative treatments, like pre-natal care for pregnant mothers, and dedicating more resources to the ‘poverty’ even though that is a scary problem to face.

15 Responses

  1. Dave W

    Brilliant! I mean this in a non sarcastic way.

  2. Steve M

    Very apt analogy.

  3. anonymous

    I agree that this whole scenario sounds ludicrous. But it is important to understand that a whole separate crew of equally incompetent health policy consultants/think tanks and economists are actually pitching strategies quite similar to what you describe above.

    Their knowledge of actual health care practice is no greater than their knowledge of what goes on in a classroom. Yet their arrogance in proposing their solutions is comparable, while the quality of the solutions is comparably absurd.

    They are pitching pay for performance strategies, hospital and individual physician rating systems based on data that are no better (often even worse) than education measures for parsing actual effectiveness. They are creating the same perverse incentives through these ill-designed policies and metrics (such as creating the incentive for cardiologists to under-serve higher risk less compliant, disproportionately minority patients – because compromising their outcome statistics might put their reimbursements at risk).

    It’s all disturbingly similar to what’s going on in public education. It would appear that in both cases the primary objective is to hold down the wages of those who actually do the work, be that teachers, or doctors and nurses… indeed doctors do earn much more than either of the other two – but the gap in pay between physicians vs hospital administrators and insurance execs is widening substantially. The end goal is to retain (hoard) more resources for those who… well… don’t actually do the work… and don’t possess the technical skill, relevant knowledge, compassion or work ethic to really make any valid contribution to either field (or arguably to society as a whole at this point).

    Yep, that’s whose in charge here – defining the policies from inside the beltway (and in statehouses). These are the folks who believe they are entitled to everything, believe they are too good to teach and were both academically unqualified and too lazy to go through medical school and residency. Yet, in their own warped value systems, they are clearly worthy of a wage and wealth accumulation far greater than either of these groups of suckers who spend their time trying to serve actual…ugh… people…even poor people… and their children no less.

    I only wish more teachers, physicians and other health care workers (and all those on the front lines of public service) had more opportunity to share their experiences with these policy movements in order to understand the parallels and potentially start working together to turn this craziness around!

    • Joanne

      YES very well put anonymous !!

  4. TeacherEd

    Great analogy! There is a lot more going on that places the entire medical field at-risk.

    Rather than address poverty, including assuring a livable wage for the working poor, those non-medical med reformers would be getting billions of tax dollars and private funds poured into keeping their medical failure hoax alive, including bloating the pockets of medical testing companies. They would be entrenched in the business of creating armies of quack doctors, snake oil hospital superintendants, pseudo medical education schools and faith healing hospitals, while condemning traditional doctors and the medical schools where they were trained. These non-medical reformers would collaborate with billionaires and politicians so that regulations are increased for traditional doctors working in traditional hospitals and so there are no regulations for quack doctors working in pseudo hospitals, where science may be subservient to religious and ideological dogma.

    To completely destroy traditional doctors, hospitals and medical schools, non-medical reformers would dictate how traditional doctors, hospitals and medical schools must do their jobs. They would institute polices where the death rates of doctor’s patients are tied to doctors, hospitals and the doctors’ teachers. Stack raning would result in Title IV federal student aid being denied to anyone who wanted to study at a lower ranked traditional medical school, leaving doctors, hospitals and medical schools with the choice of either following the pseudo medical model or shutting down.

    Why this would not be a more “scary problem to face” than addresssing poverty is beyond me.

    • Steve M

      Several of the hypothetical practices that you detail are actually being done to curtail legalized abortion in states such as Kansas and Missouri.

  5. Ken Mortland

    Very illuminating. There is also a verseion, called “No Dentist Left Behind” or “No Cavities Left Behind” that lampoons the oral hygiene industry.

  6. Dave

    Anonymous, I couldn’t agree with you more.

    Be forewarned, I’m about to make sweeping generalizations in my post below. Unfortunately I don’t think enough people are paying attention to the unintended consequences of the ed reform movement, so I will have to write a somewhat over simplified and preachy post. I think more people need to see the big picture, because those who can’t see the “forest through the trees” will continue to blindly follow the zealots who are the loudest and so adamant about this cause.

    Teachers, doctors, nurses, engineers, blue-collar people, and others on the front-lines who do the actual work in this country do not have time to confront or challenge the opportunists and snake oil salespeople that run self-serving non-profits, consulting groups, and think tanks. After-all, what time do they have when they are the one’s doing the hard work on a daily basis?

    Thankfully, Gary has stepped up to the plate and is working on putting out the ed-reform fire that is getting larger and larger. No cause or movement should have unchecked power. We need dissent, and the pendulum has tipped too far to the side of the ed-reformers. I started seeing this 4-5 years ago when all the education articles I saw in the mainstream media were articles about how great TFA and No Excuse Charters were and that pay-for-performance and value-added measurements were going to elevate our students at the bottom to the levels of their middle-class peers, or even, get this, outperform their SUBURBAN COUNTERPARTS and get 100% of all STUDENTS ACCEPTED INTO A 4 YEAR UNIVERSITY! Some No excuse charters had demonstrated this after comparing their state exams to schools in the suburban demographic, but anyone with knowledge from the inside knows how numbers get manipulated to advance an agenda. Of course, leave it to those who align with Wall Street donors and elite consulting groups that all our answers can be solved by making our schools run like test prep factories. After all their kids aren’t attending these schools.

    How many industries that align with the ed reform movement such as high finance and management consulting do we have to watch screw up before the ed reformers realize their approach to raising achievement is flawed?

    Personally, I think the tipping point for me came after attending a screening of “Waiting for Superman.” I think I can speak from my experience working at a No Excuses charter that this film was misleading and actually does more harm than good.

    I don’t think I’ve seen such blatant propaganda reach mainstream movie theaters since Michael Moore’s films. Nevertheless, I’m still a fan of charter schools, even though I am skeptical of large charter networks or districts.

    I’ve recently noticed that the most influential and powerful force perpetuating and fanning the flames of the ed reform movement, is the elite media. Let’s be honest, (another broad sweeping generalization), those who control the elite press are friends and probably former classmates, or at least share the same alma maters of people currently in positions of power advocating ed reform. If you attended a highly selective university or belonged to an elite organization like TFA, you probably were more ambitious than your peers and cared more about self-promotion and the real or big problems that you were destined to solve. Most of the former corps members I know, who only taught a couple of years, and then exited for bigger and better opportunities continue to subscribe to the same ill-informed ideology of the ed-reform hardliners.

    Unfortunately many people with limited school experience, who have stayed in education as advocates and champions of reform outside the inner walls of a school, have had trouble grasping the damage that is being done to our schools. Of course, they have never taken the time to really understand or learn what it takes to get “good” or “excellent” at a real profession, but if you left the classroom after a couple of years and stayed in education in some capacity outside of schools, you were most likely not an effective teacher.

    There seems to be too many TFA alums today concerned about padding the resume and rising up as fast as possible in education, whether it’s running a school after 3 years of teaching, getting elected to school board, or working for an elite educational non-profit or consulting/policy group than building real competence in the field of education. We all know these jobs are more acceptable to discuss with friends or family but think about the children who are affected when you champion policies that encourage a slash and burn approach to getting results. We all know how successful Investment Banking has been under this short-cut model :)

    Here’s some advice, if you plan on staying in the education field, you need to build credibility working in schools. Whether this is administration or teaching, I don’t care. If you stayed a few years past your commitment to actually get competent at teaching or administrating a school building, you might actually be a better educational leader in the long run.

    (I’m getting preachy) Chasing the prize of power, fame, money, etc.. will never get you the respect or credibility from those who excel in their professional domains. Do people like Michelle Rhee actually realize or care that anyone with an ounce of understanding about what it takes to a run a great school or teach kids well do not respect her extreme views? I’m no psychologist, but I think it would take someone who is delusional or has an inferiority complex or narcissistic personality disorder to stand before the American public and champion the widget and efficiency approach to solving the educational crisis in America.

    I highly doubt there are very many people who agree with Rhee’s educational philosophy who have taught more than 5 years in a low-performing school. The unintended consequences of the ed reformers policies have yet to fully play out, but I am seeing more and more of the best and most stable teachers leave the worst schools because of the evaluation madness. This is the greatest tragedy in this whole ordeal. They are turning more and more districts into a revolving door of 1st and 2nd year teachers who have no ties to the community they are serving. Sadly, the ones who get hurt the most in this process are the kids.

    I guess the biggest challenge of stopping this craziness is to either sell-out and work as hard as possible to block the madness from inside the walls of where these decisions are being made, or become a voice of reason like Gary and continue to write and speak to media outlets. I guess I will leave the policy debate up to Diane Ravitch, even though she does need some help from mid-career TFA alums who are still working in schools.

  7. Patrick Walsh

    Great work, Gary. As usual.

  8. What Patrick said.

  9. Johnny

    “Reform” isn’t about education or what is best for out country or kids. It is all about money and power and how to direct it all to a few players. You aren’t one of them.

  10. S

    This is more of a comment on style than content but I always think extended analogies sound painfully self-righteous.

    That said – yes, yes, I agree that there is no quick and easy formula for success in any field that is affected by a long history and affects a huge amount of people

    • Gary Rubinstein

      What, me, self-righteous? I can’t believe it.

    • TeacherEd

      I don’t think it’s self-righteous to use analogies to help people recognize what’s going on in the world around them. Analogies such as this are necessary because there are many who can’t see the big picture, since it’s been clouded by so much propaganda. If the left-right alliance does anything well, it’s hijacking language as a method of using smoke and mirrors to conceal their true purpose and promote their agenda.

      I know many average folks, including some teachers initially, who took the language at face value, such as No Child Left Behind, TeachForAmerica, StudentsFirst, Stand for Children, Race to the Top, the Common Core State Sandards, etc., and I think that was the intent of using euphemisms. Organizations and their promoters probably wouldn’t have gotten as very far as they have if their names were more truthful. How many folks would have supported No Child Left Untested, Teach for Your Resume, Corporations First, Pretend to Stand for Children, Race to More Testing and the Common Core National Standards?

      Too many people still don’t realize what’s been happening across the country, since they bought the book based on it’s cover and haven’t delved into the fine print, so it’s time to reveal the truth. If analogies are required to produce enlightenment, so be it.

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