Month: May 2017

Do state test results reveal the quality of a school?

Do state test results reveal the quality of a school?

Are state tests, such as the Smarter Balance Assessment an appropriate way to hold schools accountable for quality?  Do these tests truly reveal the quality or effectiveness of a school?  I say, “No,” emphatically, but not for the reasons you might expect.

I agree that the purpose of education is to increase academic skills, even though many in education disagree.  I agree that tests ought to be used to determine what students have learned.  I agree that more learning is better.  I do not agree with folks who say that testing is bad and that schools should not give tests because that stifles teacher creativity.  I do not agree with the proposition that tests can’t measure what is important in education.

Neither do I agree, however, with the use of state-constructed one-size-fits-all tests to attempt to hold schools accountable for quality.  It has taken me several years to come to this position.  I have three main reasons.

First there is the issue of alignment. Let me explain what that means. Imagine you want to buy a sports car.  You look up your favorite sports car to see its rating.  You are shocked find low scores and an “F” grade on the rating system compared to other cars.  Unbeknownst to you the ratings are based largely on the size of the payload the vehicle can carry and the number of passengers that can fit in it.  Your dream two-seater is rated low on that account and there is nothing in there about how fun the car is to drive.  That’s an example of misalignment.

Whatever the state chooses to put on the test becomes, in essence, the required curriculum of all the schools in the state, even if it is irrelevant or actually wrong.  The state tests are wrong both for what they leave out and for what they include.  For example, state tests for elementary age students in reading and math ignore fundamental areas of the curriculum.  I refer to accuracy and fluency in decoding the meanings of words, in the statement (memorization) of mathematical facts, in mathematical calculations, and in spelling.  State tests simply don’t bother to measure these pillars of an elementary education, even though they are critical to future educational success.

An example of schools that do well on these basic academic pillars are the Arthur Academy charter schools.  Due to the use of a trend-bucking curriculum called Direct Instruction (DI), they mostly achieve better test scores than the school districts in which they reside. More importantly, they prepare their students for later success in schooling.  DI is a specific, scripted, sequential elementary curriculum (grades K through 5) that takes much of the guesswork out of teaching.  The lessons are carefully crafted to be easily understood, build only on what has been taught in earlier lessons, and prepare students precisely for what is to come. There are programs for reading, math, spelling, and writing.  All but the very lowest special education students can learn from these programs and emerge from elementary school with average or above average skills.  DI is hated by the progressive educators at universities, but these charters love it, and so do their students and parents.

Curricula, such as DI, that focus on bringing all the fundamental student skills to mastery (including the ones not tested) must do so on top of teaching the things that are measured on the test—while other schools focus all their efforts on the test material.  A majority of American elementary schools no longer teach spelling, for example, simply because it is not measured on the state tests.  While learning how to spell is an essential skill, the state tests have pushed it out of the curriculum.  Not to mention all the other critical content not tested and no longer taught.

Conversely, state tests focus strongly on a number of things that, although they sound good, are not skills to be taught but attributes of intelligence that we desire.  These attributes are such things as the ability of bright elementary students to make inferences from unfamiliar texts, to write interesting imaginative stories, and to find creative solutions to unique word problems in mathematics.

These attributes, and their application, are not an emphasis of the very strong DI elementary curriculum.  But if schools that use DI taught what is in their curriculum (what kids need) and ignored the less relevant, they would get lower state test scores and be branded as poor schools.  Schools ought to be able to use their own tests to measure what their own curriculum plans to teach, and be evaluated on how well the school does what it claims it will do.  Parents, of course, could select schools according to the nature of their claims as well as their performance.

Second, people forget important facts about state tests.  One is that the results have no consequences for the children.  Another is that these are children taking these tests.  Children are subject to wide swings in their performance, often depending on testing circumstances.  Schools routinely find children who have been well taught but who for years have failed the test.  Yet they can reach not only “proficient” but “exceeds proficient” if their teacher sits next to them and makes them read the test aloud and gives them breaks when they get tired.  Essentially we are making certain that they actually do their best on what to them is a very long test.  This is not cheating.  These practices are specifically allowed by the state rules for students who need them; they are called an “accommodation.”  And it is an appropriate accommodation.  It just shows the best that the student can do.  Guess what?  Children don’t always do their best.  Sometimes they just guess their way through the test to get it over with.  If those children go to another school, where no one they know or care about is monitoring their test performance or where they are allowed to do fun stuff when they are “done,” they will probably turn in a failing score the next year. Does that mean the school is bad?  Not at all.  Does it mean the school is good if they carefully accommodate all the children so they get their best scores?  Not at all.

Third is the issue of students’ ability.   This may not be obvious to everyone, but the more able students are, the easier it is for them to learn.  The less able they are, the harder the teacher and the school must work to teach them.   Scores on state tests are as much a measure of how smart the student body is, as they are a measure of how well the teachers teach.  It is ridiculously unfair to ignore this fact and proclaim that high test scores mean a school is good and low test scores mean it is bad.  That would be true only if the student bodies of the schools were evenly matched in IQ—which is never the case.  It is a heavier lift to raise test scores in a school that enrolls many students with low ability, or learning difficulties; and until we begin to measure the weight of the load, we cannot claim to know which school is stronger or more effective.  If we expect teachers and administrators to want to work with populations that are below average in some way, we have to stop proclaiming that those who teach the smarter students are better teachers, just because their students get higher test scores.

We would be far better off if the states stopped giving their tests, instituted more school choice, and left it up to schools to find a way to prove they were doing a good job for the consumers—just as it happens in every other service industry.  Arthur Academy could do it easily in their schools, without a state test. If they gave aligned end-of-year final exams for each of their DI programs and shared the results with parents, they would be blown away by what the children have learned.   Few students outside of their schools could match that performance.  That’s how you prove quality, not with bogus, we’ll-tell-you-what’s-important-to-learn, state tests.

 

Posted by donc1950@gmail.com in Education
Raising the Bar: Why “Standards and Accountability” cannot improve Education

Raising the Bar: Why “Standards and Accountability” cannot improve Education

There is currently a movement underway to reverse the adoption of the Common Core State Standards (CCSS).  Those opposed to the Common Core have a wide variety of reasons, ranging from fear of federal control of curriculum, to privacy concerns about intrusive data collection planned, and controversy about whether the standards are more or less rigorous than the former state standards which are being replaced.  While these details can be debated, the more fundamental question is whether “standards and accountability” can reform or improve education.

The idea of “standards and accountability” begins by attempting to define rigorous standards of what K-12 students at each grade level ought to know and be able to do.  [Missing the important point that some students should be held to higher expectations, shouldn’t they?]  The idea goes that if these standards are good enough, then if students can meet them, we can be happy that our schools are doing a good job.  The accountability part of the equation is to give tests that measure whether or not students can meet the standard expectations.  Supposedly then schools that help nearly all students meet the standards are doing a good job.  Conversely schools in which many students don’t meet the standards must necessarily be doing a poor job.  If the standards are too easy, the schools are getting off with doing a poor job.  If the standards are rigorous enough we can force the schools to do a better job—the threats of accountability will cause the schools to self-reform and improve student scores on the tests and thereby achievement.  That’s the idea.  But, in real life it doesn’t work that way.  Why not?  There are several reasons.

First of all, the standards are too vague to be measured as met or not met in any objective sense.  For example, such standards as, “Understand addition and subtraction of fractions as joining and separating parts referring to the same whole.” is not measurable.  There are an infinite number of ways one could try to measure that and how well a student would have to do on such a test to show they “understood.” And on top of that, there are hundreds of these unmeasurable standards in the Common Core.

Secondly, because the standards themselves aren’t measurable, proficiency is not based on pre-established criteria, standard by standard. Students don’t have to pass all the different standards, or even pass a set number of them.  Instead proficiency is randomly defined by a cut-off score on the entire test.  Unfortunately, because the details of the test are secret, teachers don’t really know exactly which skills are tested, and what students must know or how well they should know them to be considered proficient.  They are trying to hit the target, but they aren’t actually allowed to see it.

Finally, everyone wants to raise the cut-off scores, to expect the lowest students to do more to be considered proficient.  If everyone can do it, then it must not be rigorous enough.

Raising the bar–doesn’t make you a better jumper.

Making the standards more rigorous (which many people want to do) is quite commonly referred to as “raising the bar.”  This metaphor compares academic standards to the bar over which high jumpers sail.  Raising the bar occurs each round in a track meet, as the bar is placed higher, and then the competitors must jump higher each round.  But what is the effect of raising the bar in a track meet?

The effect of raising the bar is to gradually eliminate the less able competitors each round, until only the best is left to win the meet.  Raising the bar does not make everyone equal.  Raising the bar does not make everyone better.  Raising the bar has the effect of sorting out the athletes on the basis of their skill.  No one dreams of using it to rank the coaches, because a large portion of a high jumper’s success has to do with innate ability, rather than just the quality of the coach.  Interestingly, before federal involvement in education and before standards and accountability, standardized academic tests were perceived in exactly the same way.  The results on an academic achievement test told you how accomplished the student was, and were never used to make judgments about the quality of the teacher or the school.

If raising the bar does not make everyone a better jumper, why is it even imagined as a method to reform schools?  Standards would operate, if they work at all, about as well as track meets work to make track coaches better.  In my experience most coaches hope to recruit athletes with more ability—so their performance makes the coach look good.

The same thing happens with schools.  Schools that enroll students with greater ability have high tests scores and are considered good.  Schools that enroll students with more learning challenges and less ability have lower test scores and are considered bad.  Nothing useful is accomplished by this exercise. Absolutely nothing.

I know from first-hand experience that parents can tell whether the school their child is attending is challenging, motivating and effectively teaching their child.  Not all schools are right for all children.  Often siblings need and thrive in very different kinds of schools. The average test scores in the whole school is irrelevant to whether the school is doing a good job for their child.  We don’t need this whole standards and accountability regimen, we need to give parents the freedom to choose schools and give educators a chance to create a variety of new, innovative schools that operate free of the bureaucratic restraints of our current one-size-fits-all system.

Posted by donc1950@gmail.com in Education
The Road to Hell is Paved with Good Intentions

The Road to Hell is Paved with Good Intentions

I fell in love with the left wing of the Democratic Party because they, alone, opposed the Vietnam War.  And of course, because they were the party of compassion for the poor.  Over the years, I fell out of love because they wanted credit for their good intentions rather than for what they actually accomplished.

Although the Democrats started the war in Vietnam and a Republican president ended it, I didn’t blame the Democrats or give credit to Nixon.  I didn’t begin to question my love for the left wing until someone I knew and cared for began to get the “help” and “compassion” that were a trademark of the Democrats since Lyndon Johnson began the “War on Poverty.”

What I discovered, to my shock, was that welfare assistance from the government was not a helping hand, or a hand up.  To the contrary, welfare assistance was a sentence to dependency and poverty without an exit.   The details of how the system ran meant that gradually working one’s way back to self-sufficiency was made harder, not easier, by the so-called “safety net.”  The first step out of dependence is part-time work and jobs that don’t last more than a couple of months.  But all the money you make in such jobs goes against your benefits.  Everything with the government is slow, and so the reckoning takes months.  This means that you have to pay back the benefits you received a couple of months ago, just about the time you’re out of work again. So when you need assistance desperately, you can’t get it, but only because you took a job and tried to better yourself.  If you hadn’t tried to take a job you would still be entitled.  So the lesson is—don’t take a job.

It turns out all of the forms of help and compassion run by government agencies have the same basic structure.  You “qualify” by virtue of having little or no income and you “lose” benefits as soon as you get some income or try to get some.  I have another friend who was unemployed and receiving unemployment benefits because he couldn’t find work in his profession in the local community.  When he went out of town to a trade conference (so he could network with people in his profession from all over the country and hopefully find work) his unemployment benefits were cut off.  He hadn’t stayed in the local community “available for work.” Go figure.

I had learned from personal experience that government assistance, as championed by the left, did not actually help to reduce poverty.  Governmental help does not have the right structure, knowledge, or flexibility needed to really help anyone. It is simply a trap. Not surprisingly, data now show (see the graph to the right) that the poverty rate has stopped falling since we began trapping more and more people in these dependency programs.  They have almost no way out.  That was one nail in the coffin of my love for the left-wing.

The next nail in the coffin came as a result of what I learned as a teacher.  At one point as a special education teacher I had a caseload of 28 third grade children with dyslexia—none of whom could read.  I found and used a curriculum called Direct Instruction (DI) that taught every one of them to read.  My school district was uninterested in my success.  DI used phonics and was labeled “harmful.”  DI was removed from the district, without regard to data.  When I realized that the public school system was unresponsive to important outcomes (like whether or not children learned to read!), I began to learn about school choice—in which parents, who do care about outcomes, get to choose a school.

Charter schools, which are public schools freed from the constraints of the administrative bureaucracy of districts and sometimes from the teacher’s union as well, have to attract all their clients.  I went to work for charter schools, and of course, the charter schools in which I was involved used DI. In our schools we taught every one of our students how to read, and we filled our schools, located in poor neighborhoods, with students.  Parents, especially poor parents, were finally able to choose a school that would teach their children to read.  But our schools were not allowed to grow because of deliberate political obstacles.

When I realized that left wing Democrats were the primary obstacle to increased school choice, I was done.  The left wing says it cares about children and the poor.  The left wants to be judged by its good intentions.  But the policies the left supports do not help, and actually hurt children and the poor.  I think results speak louder than words.  I do think the road to hell is paved with good intentions.

Posted by donc1950@gmail.com in Political philosophy
Differentiation and the problem of missing skills

Differentiation and the problem of missing skills

As people are being trained to be teachers in our schools of education they are taught that justice and fairness require that they teach all students together in a classroom with their peers.  Furthermore, they are taught that all the students should be taught the same material that is appropriate for their grade level.  When they go out into schools, the administration of most district schools promotes the same philosophy—that all students should be taught the “core curriculum” that is appropriate for their grade level.  The Common Core now specifies what should be taught at each level and school districts monitor closely to see that teachers are teaching exactly what is supposed to be taught at each grade level—without regard for the skill level of the students.

The student pictured is counting on her fingers to do math when she should be well beyond that problem.  So what about the problem of students who are lacking skills that were presumed to be taught in prior grades?  What are teachers supposed to do with students who have difficulty spelling, or decoding, or doing simple math?  How about students who can’t write with reasonable grammar and punctuation or who fail to add or multiply correctly when they try?  As anyone who has spent time in public school classrooms, this is a huge and glaring problem.  What is the expected solution?

The current buzz-word that is supposed to solve this problem is called differentiation.  Anyone who wants to sell materials to schools now includes information about how to “differentiate” lessons so as to accommodate the wide variety of skills levels in every classroom.  The theory is that lessons can be presented about a concept or idea and then students will be allowed to respond or complete assignments about the lesson at a variety of skill levels.  So some students who cannot write are allowed to draw pictures to express their answers, while others will write with invented spelling, and still others will complete essays with correct spelling and punctuation.  A differentiated assignment in math might include students who use calculators, others who do computation, and still others who write a long-hand explanation of how to find the answer—without having to do it.

Unfortunately, as in much of educational rhetoric these days, the emperor has no clothes.  Differentiation is a method of coping with the problem of missing skills.  Differentiation does not provide the instruction needed by students who are missing those skills.  When students don’t know basic skills, they failed to benefit from (or receive) instruction on those skills.  The fact that the student didn’t learn it the “first time” tells you something about how difficult it will be for this student to learn that skill.  Not learning it the “first time” means these students will need more intensive, focused and effective instruction than is typically provided at the grade level where that skill is normally taught.  The student will need more explanation, more examples, and more practice to master the skill than was even in the textbook the first time the skill was taught.  Because it didn’t take the first time, more is needed.

But here’s the rub.  Now that the student has moved past the grade level where this skill is supposed to be taught, there is no time allotted for instruction on this skill.  Don’t learn how to decode in first grade?  Well once you’re in second grade, good luck getting that really basic instruction you missed in first grade.  The teacher has to be teaching the skills of second grade and really has no time to teach those prior skills.  This is a problem in second grade.  Imagine how crazy it is in the typical sixth grade, where students are missing skills from the past six years!

A previous buzz-word was “mini-lessons.”  Teachers were supposed to teach missing skills on an ad-hoc basis, when they came up, in little mini-lessons that only took a couple of minutes.  Not surprisingly, mini-lessons don’t work, because students who hadn’t learned those skills in prior years needed longer, more carefully designed lessons, with more examples and more practice in order to learn the skills that have eluded them for years.

The only solution to the problem of missing skills is to explicitly address them.  Identify students who need to learn the skills regardless of grade level, get them together with a teacher, design strong lessons with clear rules, lots of examples, and plenty of practice.  It can be done.  It is the job of teachers and schools.  But in this era of Common Core dictated curriculum there’s no time and no freedom in the schools to do the job.  We need educators in the trenches to have both the freedom and the responsibility to devise solutions to this basic and fundamental problem.  Parents need the ability to hold schools accountable for solving this problem, by having the ability to move their child to a school that knows how to solve this problem.  (I know it is a soluble problem because I have worked in charter schools that have solved it.)  Right now parents have no choice.  They are forced to patronize schools that fail to education their children. Until we change this, all the hoopla in the world isn’t going to improve outcomes in our schools.

Posted by donc1950@gmail.com in Education
Let’s end dependence rather than poverty

Let’s end dependence rather than poverty

 

Recently, I heard a school administrator promoting the importance of making all of the parents at our schools aware of the existence of government programs for the homeless.   “Lots of people don’t even know that they qualify for these programs.” she enthused.  “If they are living with family members and not paying rent, they can qualify as homeless!”

What would that do for them, I wondered?

According to the website of the Oregon Homelessness Prevention and Rapid Re-housing Program (HPRP), its “re-housing program” can provide these kinds of services to the “homeless”:

Re-housing programs work with people who are already homeless to help them quickly move into rental housing.  Re-housing programs can provide housing location, financial assistance including security deposits, rent assistance and payment of arrearages and case management.  Both homeless prevention and rapid re-housing programs coordinate with other community resources to ensure that participants are linked to ongoing assistance, such as housing vouchers, intensive case management, or assertive community treatment.

So if a family (in this community often a new immigrant family) is managing their finances by living with relatives until they can get on their feet, government agencies can arrange to give them financial assistance in the form of security deposits to rent a place they otherwise couldn’t afford to rent, and participate in a program of government “rent assistance” or “housing vouchers.”   The person recommending this seems to think it would be a good thing to move someone into a situation where he was dependent on government for a place to live.  Implied, but not stated, is the assumption that it is kind of stupid to prefer to take care of yourself when you can get something for free instead.

Connected to that assumption is the proposition that any well-meaning person, such as a teacher or school administrator, has an obligation to convince stiff-necked individuals that their pride is hurting their children, and they really should accept the government’s largesse.   This assumes, however, that one’s quality of life is measured simply by the dollar amount of the things one receives, without regard to how one obtained them.

Some time back, the Cato Institute released a report entitled, “The American Welfare State: How We Spend Nearly $1 Trillion a Year Fighting Poverty—and Fail.”     http://www.cato.org/pubs/pas/PA694.pdf  Their estimate is that we spend about $15,000 per person below the poverty line on anti-poverty programs without eliminating poverty.  Michael Tanner noted that most of our efforts are designed not so much to fight poverty, but to make it more comfortable to be poor.  I’d like to suggest that we fight a war to eliminate dependence, rather than to fight poverty.

Not so many decades ago it was commonly understood that there was something demeaning about being on “the dole.”   People did not want to accept charity if they could make their own way in life.  There were the pejorative terms “kept woman” and  worse still, “kept man,” meaning a person who did not have a job but was supported by a sex partner.   Many of the social programs we have today were sold with difficulty to an American public for whom public assistance and dependency carried a stigma.

According to Andrew Biggs of the American Enterprise Institute, Social Security was presented not as a needs-based program of charity in which today’s workers pay for the benefits of today’s elderly, but as “a system of social insurance under which workers (and their employers) contribute a part of their earnings in order to provide protection for themselves and their families if certain events occur.  As a result of this ‘earned benefit’ status, collection of Social Security benefits has never carried the stigma associated with food stamps, Supplemental Security Income, or other welfare programs.” http://www.american.com/archive/2009/february-2009/obama-vs-fdr

That has been the pattern with a number of “entitlement” programs.  Instead of being needs-based charities, which show one’s dependence, programs such as Medicare and Social Security are made for everyone.  Therefore there is no stigma and everyone should be happy to receive benefits from the government.  Of course, the effect is that these programs have ballooned in size and are currently unsustainable.  (Odd that sustainable houses and buildings are all the rage, but sustainable social programs, not so much.)   We have a huge financial burden looming ahead of us as these entitlement programs become ever more costly as more of us baby-boomers retire and expect to collect benefits.  Because there is no stigma associated with these programs, we all intend to capitalize on them.

Here lies the problem–and also the solution to the problem.  Instead of a War on Poverty, we should have a War on Dependence.  All our social programs should have as their goal helping people become independent of government assistance.  They would still require considerable effort and would still employ many social workers for years to come, but the war could be won!  We could get to the point where everyone had a way to support himself.

How would that look different from today’s social programs?

For one thing, we’d begin by applauding all those who already take care of themselves.  We would hold them up and give them recognition.  We would put them on talk shows and news programs to tell their story of how they manage in life without government assistance.  They would become our role models.  We would applaud and appreciate the fact that they do not need to collect on the various social programs to which they are “entitled.”

For example, people over 65 who were working at a job or who could afford their own medical insurance would be honored for their ability to be independent of Medicare.   Right now of course, you virtually have to take it, because no one will insure you at age 65 unless you collect all the Medicare benefits you can.  So right now we are forcing dependency—but the War on Dependence would change that.

We should encourage everyone to avoid having to depend on Social Security as well.  Anyone over 65 who doesn’t need to collect “benefits” from the payroll tax in order to survive in old age would be a hero in everyone’s eyes.  If people keep working, that would be super, because they can be independent thereby.  If people save enough to retire with dignity, that would be even better, because they would be permanently independent.   What’s more, their children would be well on their way to permanent financial independence, when they inherited the principal of their parents’ retirement fund.  As part of the War on Dependence, social workers would help younger people set up various retirement savings plans.  Each person who had a workable retirement savings plan could stand tall in the knowledge that he would not become dependent on Social Security.

One of the sad by-products of the endless and hopeless War on Poverty is that self-sufficiency is no longer valued as it once was.  Someone is considered a fool to turn down government benefits if he can “qualify” for them.  What’s more, someone who gets a first-rung-on-the-career-ladder-job at a low wage still feels bad about himself.  Instead of being proud of being independent, he sees that he is still in relative poverty, and that is what’s bad.  People who are supporting themselves, no matter how meager their circumstances, should be encourage to take pride in not being dependent.  We should make self-sufficiency the goal, the prize, the honor.

Social workers could help farmers who accept government subsidies find ways to become self-sufficient so they can be respected for making an “honest living” without help.    Businesses that sold products abroad without help from the government would be recognized and patronized.  Similarly, industries that did not ask for protectionist tariffs imposed by the government, but could stand on their own, would be new American heroes.  Students who found a college they could afford without government help would be seen as more resourceful and valuable future employees.   Colleges that keep themselves in business without whining for more government money would be seen as more competent than those that couldn’t manage on their own.  This turn of events might even drive down the cost of college.  Primary and secondary schools that focus on helping their graduates prepare for the real world would also be recognized and respected; the ability of their graduates to avoid dependence would be the final measure of the schools’ own worth.

Success would no longer be a nebulous and ill-defined chimera, but would be identified as the ability to support oneself and one’s family.  Families that took care of their own (whether the young or the elderly) without government assistance would be honored.  People with disabilities would be helped to develop as much independence as possible, and honored for every bit they could obtain—instead of scorned for their efforts to contribute to their own support.

Oddly, poverty could, in a sense, be eliminated overnight by simply writing checks of the proper amount to all the poor.  It would help if all our programs of assistance were rolled into one program, so we could keep track of how much we were giving to each person.  We might find that we had already eliminated poverty–that the cash value of all the various forms of assistance we provide to the needy would total enough to give them an income over the poverty line.   But few people really believe, deep in their hearts, that mere dollars will eliminate the problems of the poor.

Independence is the solution–and we need to return to the habit of valuing it.  There is still truth in the old proverb, “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.”  That means focusing our efforts on reducing dependence instead of fostering it.  A War on Dependence would be infinitely better than the old, unwinnable War on Poverty.

 

 

 

 

Posted by donc1950@gmail.com in Social problems
Pre-existing conditions: My house is on fire!

Pre-existing conditions: My house is on fire!

Congress and the national media are discussing the Republican attempts to repeal and replace Obamacare.  One of the thorniest issues is how to care for people with pre-existing conditions.  The media portray this as clearly a humanitarian crisis brought on by the heartless conservatives.  They put on camera a woman with cancer who begins to cry talking about what will happen to her entire family if she cannot get health insurance now that she has been diagnosed with cancer.  Cancer treatments are so expensive that a family faces financial ruin if they don’t have medical insurance.  Taking away coverage for pre-existing conditions is so mean spirited, even President Trump can’t stomach it.  There’s a huge problem with it, however.

Requiring that health insurance companies sell insurance to cover a catastrophic event, such as cancer, after it has occurred is the same as asking insurance companies to sell you fire insurance after your house is on fire!  It defeats the whole purpose and intent of insurance.  The idea of insurance is that all sensible people buy it, most of whom won’t need it.  Lots of people pay for it for years and years and all of those pooled premiums are enough to cover the cost of the catastrophic event, for the unlucky person it happens to.   No one likes paying premiums year after year for something that only might happen, but prudence says it’s better to be covered for those catastrophes than to be facing them without insurance.  If you could wait to buy “insurance” until after your house is on fire, or after you’ve had a car accident, or after you’ve been diagnosed with cancer, then everybody would.  But then everyone who took out a policy would be getting a huge payout, and the premiums would have to reflect that.  Eventually, homeowners insurance would be as expensive as a house, car insurance would be as expensive as a car, and so on.  Not everyone is waiting to buy health insurance until after they are diagnosed with a pre-existing condition, but many people have pre-existing conditions and so under the wonderfully generous Obamacare system premiums are going through the roof, and insurance companies are dropping out of the business.

Interestingly enough, in a single-payer, socialist system of health care everyone has to pay in taxes for the healthcare so the costs are distributed evenly over the healthy and unhealthy evenly.  So that system is more economically viable than Obamacare.   The question is, can a free market take care of people, of everybody, as well as socialism?  Getting back to a free market from where we are now would be difficult and tricky, even if we were behaving in a smart way and understanding economics correctly–which our congressmen apparently do not.

In a free economy, health insurance, like life insurance, is something everyone should buy early in life so it is affordable and to be prudent about protecting yourself and your family from financial ruin should you get cancer (or some other expensive medical condition) later in life.  The deal between you and the insurance company should be that you carry the policy your whole life and maybe they have to pay out if you have a catastrophe.  That means you have one policy your whole life and the fact that you’ve kept it in force means the insurance company has to pay if something terrible happens to you.  That’s a fair bet and lots of insurance companies would be willing to cover you.

Health insurance should not be provided by your employer, because you need to keep the policy if you change jobs or your employer goes out of business.  You might end up looking for coverage after you have an expensive health condition and now you’d have to pay excessively high premiums.  It should not be provided by the government as a benefit for being poor because if you get a job you’ll lose that benefit and that insurance and you might end up having to get coverage when you can’t.  It really shouldn’t be provided by the government when you’re old, because you were paying into a policy all your life and the insurance company should be on the hook as you age, not taxpayers.

But that is not the world we live in.  We have ruined the health care insurance market in many ways.  So what do we do now, particularly about the people with pre-existing conditions?  We should look at ways to 1) pare that problem down as much as possible and 2) incentivize everyone else to prudently acquire health insurance before they get pre-existing conditions.

Allow insurance companies to cover everything but the pre-existing condition, so everyone can afford the rest of their insurance.  Maybe have the government and/or charities pay for the care (not the insurance, but the actual care) for people with pre-existing conditions.  Make it like Medicare, which isn’t that generous, so everyone could see that they would be better off if they buy coverage for themselves early before pre-existing conditions.  End the employer and government provided health coverage and have everyone buy private insurance.  Give vouchers or cash assistance to those who can’t afford insurance, but get them out into the same private market as everyone else.  More people in the pool, the lower the premiums will be.  The earlier you buy health coverage, the cheaper it will be.  The healthier you are, the cheaper it will be.  We will have to take care of the people for whom it is too late to be prudent–the people whose houses caught fire before they bought insurance.  However, we should work to decrease the number of those people, not set up the rules to reward people who wait to buy coverage with pre-existing conditions.  That’s a recipe to bankrupt the entire private health insurance system.  Maybe that’s what Obama really wanted?

 

 

 

Posted by donc1950@gmail.com in Medicine