Two recent examples.
1. I was invited to attend the Progressive Policy Institute on Wednesday, but not as a speaker. The topic is introduced by saying
Now that Congress has passed the Every Student Succeeds Act (ESSA), states are revamping their federally required systems to measure school quality and hold schools accountable for performance. But most are doing so using outdated assumptions, holdovers from the Industrial Era, when cookie-cutter public schools followed orders from central headquarters and students were assigned to the closest school.
In today’s world, that is no longer the norm. We are migrating toward systems made up of diverse, fairly autonomous schools of choice, some of them operated by independent organizations, as charter, contract, or innovation schools. Before revising their measurement and accountability systems, states need to rethink their assumptions.
2. And David Cutler must be happy to read this story.
Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians. Compensation for medical professionals will start taking into account the quality of service – not just quantity.
A Nobel Prize in economics was just awarded in part for the insight that it is a bad idea to compensate workers on factors that are heavily influenced by luck. In my view, having someone in Washington evaluate a school or a teacher or a doctor does exactly that.
People who are close to the schooling process, including parents, peers, and principals, can use judgment to evaluate teachers. That’s the way it used to work 50 years ago, before the advent of consolidated, unionized school districts.
For doctors, the prevalence of third-party payments means that their compensation is being determined by remote bureaucrats regardless.
I have a long long list or orthopedic surgeons who I think should be paid (or paid back) based on the fact that they collectively took 20 years to notice that my pectoralis tendon had completely torn and the muscle had retracted 2 inches. Also 9 operations, all using the same scar that was opened up for the operation to finally give me that tendon graft. Among lots of other stupid and scummy things these pricks have done. Including some of the top orthos in L.A.
None of which really counts as support for my opinion on the topic at hand, but I like to vent periodically (I could get into a long digression about why it doesn’t actually disprove my point but that would require an even longer digression).
Look, there are doctor rating sites all over the internet with ratings based on criteria like waiting time and bedside manner, which are important, but not all THAT important.
Also all over the net are sites selling all manner of snake oil, filled with testimonials as to their effectiveness.
The popular press, including major news papers, are filled with crankery on matters of health.
The most popular doctor on T.V. is Dr. frigging Oz.
The vast majority of people absolutely suck at making judgements on medical issues.
How is it, now that “education” is a function of Federal Government, that there has been no action to “regulate” the composition, authorities and actions of local “School Boards” and similar elective facilities; that is, to set “qualifications,” functions and standards?
“For doctors, the prevalence of third-party payments means that their compensation is being determined by remote bureaucrats regardless.”
This is a very important line. I work for a private company in a “competitive marketplace” setting healthcare prices, but I’m still some dude with a spreadsheet in a fundamentally broken system. I know my prices are all over the place and done to maximize my companies bottom line, not provide consumers or providers with some kind of accurate economic guide to value so they can make wise decisions.
Meanwhile, some dude with a spreadsheet in a government office in Singapore is getting way better results then me if we measure it as “delivering quality and affordable healthcare system”.