Helicopter parent thread at the Atlantic

The possibly-inevitable helicopter parent thread has erupted at the Atlantic, so if any of you has the time or inclination to leave a comment, I hope you will.

I've just left this one:

I'm Catherine, a 'character' in the book (for the record, I tutored my own son for SAT math & took the test myself, once.)

Reading this passage I see that a fairly important section of the chapter has been omitted, and that is Debbie's attitude toward her son's grades.

The problem wasn't the Bs.

The problem was that her son was sliding by. He was underachieving, as his math teacher says.

Actually, I have a copy of the manuscript - here's the section that appears in the book but not in the excerpt:

"For me–and this was where I parted ways with the school–the issue wasn’t grades. I would have been proud of Ethan’s B’s if the math teacher had bounced in and said, “Ethan’s a hard worker.” But that’s not what he said, and it wasn’t what I was seeing. Ethan was taking the easy path, and the school was in his camp. The administrators thought Ethan, a happy-go-lucky, disorganized middle school boy with ADHD, should determine his own academic goals."

The boy whose parents were told they should be happy with Cs (in high school) is a friend of my family; I contributed his story to the book. That boy also has ADHD and his case was one of very significant underachievement.

With both boys, the school's approach to an underachieving student with ADHD and a 504 plan was to push back against the parents instead of providing the "accommodations" the boys needed to function as well as their peers (and which the school is obligated to provide).

And in both cases, too, the boys ended up transferring to Catholic schools where they did much better without any SPED 'services' at all. (Neither family is Catholic.)

Judging by some of the emails Debbie's been receiving, parents of kids with ADHD seem pretty often to be the target of 'helicopter parent' judgments made by school administrators.

I'm love to know how many parents have this experience.

Debbie has now had several emails from parents with the same story: an underachieving child with ADHD, a school administrator conveying the message that a) parents shouldn't "push" and b) they're the only parents who are pushing.

I'm now wondering how many people with kids on 504 plans are explicitly told, by school personnel, that "letting" their child "fail" is a good motivator for children with ADHD.

Meet the new boss

Our new $240K $250K superintendent, the one who was to bring accountability, college prep, and every-child-every-dayness to my district, is leading the annual fall effort to set goals.

(Fall is for goals; winter and spring are for threatening to cut Latin and Greek if we don't override the tax cap.)

Thus far, he is in charge of framing the discussion, and since the board no longer allows comments at the beginning of meetings, he may remain in charge. We will see.

Irvington parents aren't meek. A couple of weeks ago, the super attempted to push through, with just two days' community notice and on a consensus vote,  two "speech policies," the purpose of which was to sharply curtail (if not eliminate altogether) student First Amendment rights. That effort was crushed by a hardy group of parents and high school kids who shredded both the policies and the impetus behind them. It was a debacle and, judging by the look on the super's face the night everyone turned out, it may have been the first real parent uprising of his career.

In any event, the district is now the recipient of two letters from Adam Goldstein, the second of which a high school student read out loud during the board meeting. He did a fabulous job. Very witty.

But back to the goals of fall. The superintendent believes we should ask "challenging questions" (challenging questions constructed by him, not us). Last year the challenging question was: What does success look like?

A close reading of the above slide reveals a pattern in the use of evaluative adjectives:

Without the adjectives, we have:

Or, alternatively, adding evaluative adjectives to the first option, we get:

Et voilà:

So that was last year's challenging question.

This year's challenging question for parents and taxpayers to ponder is:

• [Should our district goal be admission to] Ivy League vs. schools with top programs for the areas our students are interested in[?]

e.g.: So-and-so knows a student who is super-smart and could definitely get into a top college but he wants to be "X" when he grows up, so he's going to attend a lesser-ranked college because it has the top program in his desired field of "X."

That's what we want!

We shouldn't obsess over Ivy League schools!

Fine, I won't, but I know brainy kids with very high SAT scores who are not getting into Big-10 schools. That's a problem.

The super also reports that the district has put 'technology' on the back burner (wrong), so now technology is going to be on the front burner. I bet if we play our cards right, we can be the first kids on the block to invest in Smart Tables! (The sturdy pedestal prevents tipping by even the most enthusiastic learners....)

The board asked him if he could come up with a couple of "deliverables." Last year's goals, they said, were too broad; this year they'd like a deliverable. Or two.

That is a fabulous word, deliverable. I wish I'd thought of it.

scratch Columbia off the list

From The Fundamentals of College and University Teaching
by Steven Mintz, Director, Graduate School of Arts & Sciences Teaching Center Columbia University:

In recent years, a model of higher education that emphasized the transmission of knowledge and skills has given way to a new paradigm, which shifts the focus from the instructor and toward the student. This is a shift from transactional to transformative teaching.

In transactional teaching, an instructor conveys information and students are expected to assimilate and synthesize new knowledge on their own.

Transformational teaching, in contrast, is much more self-conscious about its objectives and methods. It adopts a learner-centered rather than an instructor-centered approach...It gives students assignments that they find meaningful, involving case studies, real-world data and problems, research and inquiry, and encourages them to public display their findings.

[snip]

Teaching can be didactic, emphasizing the transfer of information. It can be philetic, in which the teacher serves as role model and mentor. It can be evocative, assisting students in discovering the personal meaning of a topic or text, rather than seeking some larger truth. Then there is heuristic teaching, which engages students in a process of inquiry and discovery to help them develop the habits of a particular discipline.

Didactic, philetic, evocative, heuristic --- killer list!

But...is that it?

Only four kinds of "teaching"?

Aren't there others?

Other kinds of teaching, like .... off the top of my head ... irresponsible.

Irresponsible teaching. That's one, definitely.

Or unaccountable. That's another.

Irresponsible .... unaccountable .... ineffective ..... oppressive .... depressive ..... unsound .... unhinged .... harebrained....

I could go on.

mom of 4 fills out a survey

A classic school story from mom of 4------

the edworld (among others) doesn't give up its stranglehold easily. Our old district was apparently required to send out parent surveys to find out if the HS cluster wished to continue the 7-8 JHS format or move to the MCPS-proposed 6-7-8 MS format. The vote was something over 90% wishing to keep the JHS format, but we got the MS anyway. Apparently, there was no requirement that anyone read the results or follow the parent wishes. All of the best things (academics) about the JHS while my older kids were there had been lost and all of the worst things (artsy-crafty, touchy-feely, non-academic) came from ES to the MS. My younger kids hated it. Sigh

I'm laughing!

Not one hour ago, I finally worked up the energy to track down this year's "Student Performance Review"...which I find has, once again, failed to disaggregate the 3s from the 4s!

Surprise!

I spent six years of my life trying to get my district to disaggregate the 3s from the 4s. Before that a parent who works at CUNY and was involved in the standards movement here in New York state spent a lot of time and energy doing the same.

Now it's 2013, C. is in college, and the 3s and the 4s are still one.

update 1/18/2013: No! I'm going blind! The 3s and the 4s are disaggregated! (I thought I remembered LJ - the CUNY dad - having finally prevailed on that one ---- )

[pause]

I've just searched the Irvington Parents Forum for the word "disaggregate." I find a post dated 10/10/2007 that notes the 3s-and-4s issue but points out that a combined 3s-and-4s category is an improvement on what came before.

You should all take a look at that post if you have a moment. It includes a note from the then-principal of the middle school refusing to tell Ed and me how the black and Hispanic students are doing on the state tests. The year before, I think it was, not one black or Hispanic 8th grade student had passed. So we were asking for data.

No Child Left Behind was supposed to spark that kind of behavior, and in our case it did.

Reading that old post, I think we did make a bit of progress. There was a time, not too long after, when the administration-slash-board required people to FOIL everything. (Which we did.) The only documents you could get from the school without a FOIL request were a school calendar and your child's report card. Things were so bad that my friend Robyne, who had been elected to the board in a landslide vote, had to FOIL district documents.

Today we have disaggregated 3s and 4s!

money-back guarantee at Morningside Academy

Morningside Academy offers a money-back guarantee for progressing two years in one in the skill of greatest deficit. Summed across its 23 years, Morningside Academy has returned less than one percent of school-year tuition. (p. 7)

[snip]

The summer school program offers a money-back guarantee for progressing 1 year in the skill of greatest deficit. Summed over 23 years, Morningside Academy has returned less than two percent of summer school tuition. (p. 10)

The Morningside Model of Generative Instruction: What It Means to Leave No Child Behind by Kent Johnson & Elizabeth M. Street

money back

from my notes taken during the Summer School Institute at Morningside Academy:

We put our money where our mouth is. [In special education] every year you gain [just] 6 months & get farther and farther behind. Instead of gaining 6 months, we want you to gain 2 years for 1 year in the chair [i.e., one year in Morningside].

The kids gain two years. [They are] not lifers in special ed. We want them to gain a lot and grow a lot.

People say it’s impossible.

If we don’t [produce 2 years gain in 1 year], we give the parents the money back.

There are a couple of riders: students have to attend [school], and parents have to support the program. Parents have to be involved in daily report card.

········

Parents are required to attend one class a year on how to read and understand the daily support card. The parent has to interact with the Support Card or they lose the guarantee – [and] the parent can’t just give kids money for lots of [As]

[At Morningside, an equal sign on the Daily Support Card is the equivalent of an A.]

The parents do give tangible rewards: you pick dessert, you pick the video. Parents tie rewards to positive interactions in the family.

Or the family could just have a discussion with the child [if grades on the Daily Support Card are not what they should be].

The Support Card is a jumping-off point for parents. The parent can talk about each category, and the categories are very specific.

QUESTION: How do you know the parent has interacted with the Support Card?

If you see the child hasn’t been taking the Support Cards home – if that pattern shows up – or if the kid doesn’t care if he gets a point; that means the parent doesn’t care. Then [we] call the parent in for a conference, & at every conference we talk about 'How are you interacting with the Support Card?'

in the leafy suburbs

Eighteen months into my job as the first woman director of policy planning at the State Department, a foreign-policy dream job that traces its origins back to George Kennan, I found myself in New York, at the United Nations’ annual assemblage of every foreign minister and head of state in the world. On a Wednesday evening, President and Mrs. Obama hosted a glamorous reception at the American Museum of Natural History. I sipped champagne, greeted foreign dignitaries, and mingled. But I could not stop thinking about my 14-year-old son, who had started eighth grade three weeks earlier and was already resuming what had become his pattern of skipping homework, disrupting classes, failing math, and tuning out any adult who tried to reach him. Over the summer, we had barely spoken to each other—or, more accurately, he had barely spoken to me. And the previous spring I had received several urgent phone calls—invariably on the day of an important meeting—that required me to take the first train from Washington, D.C., where I worked, back to Princeton, New Jersey, where he lived. My husband, who has always done everything possible to support my career, took care of him and his 12-year-old brother during the week; outside of those midweek emergencies, I came home only on weekends.

Last spring, I flew to Oxford to give a public lecture. At the request of a young Rhodes Scholar I know, I’d agreed to talk to the Rhodes community about “work-family balance.” ... What poured out of me was a set of very frank reflections on how unexpectedly hard it was to do the kind of job I wanted to do as a high government official and be the kind of parent I wanted to be, at a demanding time for my children (even though my husband, an academic, was willing to take on the lion’s share of parenting for the two years I was in Washington). I concluded by saying that my time in office had convinced me that further government service would be very unlikely while my sons were still at home.
Why Women Still Can't Have It All
by Anne-Marie SlaughterAtlantic Monthy | July-August 2012

Anne-Marie Slaughter is talking about a phenomenon I never see addressed in popular articles about "balancing work and family": the teen years are the hard ones. Or can be. When I was young the feminist model was: stay home for 3 or 4 months while you're nursing, then go back to work. The demanding years were assumed to be a child's pre-school years; once the child reached school age, you were 'done,' in a sense. It made sense to work outside the home at that point.

That always struck me as wrong, even before I had kids. My question was always: so when your child turns 13 and goes sprong, where are you? Not that all children go sprong at age 13. C. didn't, and thank God for that. Nevertheless, plenty of kids do go sprong, and if you have more than one child, that would seem to raise the odds of your someday being the parent of a teenage kid who has come unglued.

So I like the fact that this high profile woman has actually spoken, out loud, about what happens to a high profile career when a teenager is in distress.

That said, I was struck by the list of problems Ms. Slaughter's son is having:

• skipping homework
• disrupting classes
• failing math
• tuning out adults who try to reach him

With the possible exception of the fourth item, all of these issues are school problems, requiring school solutions.

You can see this easily if you imagine a 14-year old student who has no parents, or, alternatively, has parents who are dysfunctional. When that student skips homework, disrupts classes, fails math, and tunes out helpful adults, who deals with it?

The school. At least, it's the school that is going to have to deal with the problems if they're to be dealt with at all. There's no one else. And, over the past ten years, some schools have come to see things just this way.

But word hasn't reached the leafy suburbs (Slaughter teaches at Princeton and presumably sends her boys to Princeton public schools.) Nominally high-performing schools believe it is up to parents to solve school problems. More accurately, nominally high-performing schools believe students don't actually have school problems. Students have student problems, which stem from the student's upbringing and genes and have nothing to do with the school one way or another. ^*

The problem with this philosophy is that parents can't solve school problems from home, no matter how engaged and well educated and emotionally stable they are themselves. Most obviously, parents can't fix disruptive classroom behavior from home. And while in theory a parent can make sure homework gets done, in practice it's not easy and in some cases it's not possible. (I've seen the not possible scenario firsthand.) Typically, parents have no idea what the homework assignments are or when they're due (echalk notwithstanding), and a parent who has no expertise in a subject can't tell whether her child actually did his or her homework property, or just wrote something down on paper.

As to math, teaching math has got to be the school's job, period. It doesn't matter what emotional problems a student is having; the school has to teach math to struggling students, too.

Affluent schools won't be good schools until they ask themselves Richard DuFour's question: "What will we do when students aren't learning?"Ask, and answer.

the leafy suburbs: School Reform Moves to the Suburbs by Mike Petrilli

^* True of the bullying issue, too. Bullying is something kids do, and parents are responsible for kids, so parents need to stop their kids being bullies. Not sure what this means for parents of the child being bullied, of course. 

David Brooks has a really good idea

David Brooks has a really bad idea
David Brooks has a really bad idea, part 2
All is forgiven.

"bad teacher" - bad parent?

I AM a special education teacher. My students have learning disabilities ranging from autism and attention-deficit disorder to cerebral palsy and emotional disturbances. I love these kids, but they can be a handful. Almost without exception, they struggle on standardized tests, frustrate their teachers and find it hard to connect with their peers. What’s more, these are high school students, so their disabilities are compounded by raging hormones and social pressure.

As you might imagine, my job can be extremely difficult. Beyond the challenges posed by my students, budget cuts and changes to special-education policy have increased my workload drastically even over just the past 18 months. While my class sizes have grown, support staff members have been laid off. Students with increasingly severe disabilities are being pushed into more mainstream classrooms like mine, where they receive less individual attention and struggle to adapt to a curriculum driven by state-designed high-stakes tests.

On top of all that, I’m a bad teacher. That’s not my opinion; it’s how I’m labeled by the city’s Education Department. Last June, my principal at the time rated my teaching “unsatisfactory,” checking off a few boxes on an evaluation sheet that placed my career in limbo. That same year, my school received an “A” rating. I was a bad teacher at a good school. It was pretty humiliating.

[snip]

When the assistant principal walked in, one of these students, a freshman girl classified with an emotional disturbance, began cursing. When the assistant principal ignored her, she started cursing at me. Then she began lobbing pencils across the room. Was this because I was a bad teacher? I don’t know.

I know that after she began throwing things, I sent her to the dean’s office. I know that a few days later, I received notice that my lesson had been rated unsatisfactory because, among other things, I had sent this student to the dean instead of following our school’s “guided discipline” procedure.

I was confused. Earlier last year, this same assistant principal observed me and instructed me to prioritize improving my “assertive voice” in the classroom. But about a month later, my principal observed me and told me to focus entirely on lesson planning, since she had no concerns about my classroom management. A few weeks earlier, she had written on my behalf for a citywide award for “classroom excellence.” Was I really a bad teacher?

In my three years with the city schools, I’ve seen a teacher with 10 years of experience become convinced, after just a few observations, that he was a terrible teacher. A few months later, he quit teaching altogether. I collaborated with another teacher who sought psychiatric care for insomnia after a particularly intense round of observations. I myself transferred to a new school after being rated “unsatisfactory.”

Behind all of this is the reality that teachers care a great deal about our work. At the school where I work today, my “bad” teaching has mostly been very successful. Even so, I leave work most days replaying lessons in my mind, wishing I’d done something differently. This isn’t because my lessons are bad, but because I want to get better at my job.

In fact, I don’t just want to get better; like most teachers I know, I’m a bit of a perfectionist. I have to be. Dozens and dozens of teenagers scrutinize my language, clothing and posture all day long, all week long. If I’m off my game, the students tell me. They comment on my taste in neckties, my facial hair, the quality of my lessons. All of us teachers are evaluated all day long, already. It’s one of the most exhausting aspects of our job.

Teaching was a high-pressure job long before No Child Left Behind and the current debates about teacher evaluation. These debates seem to rest on the assumption that, left to our own devices, we teachers would be happy to coast through the school year, let our skills atrophy and collect our pensions.

The truth is, teachers don’t need elected officials to motivate us. If our students are not learning, they let us know. They put their heads down or they pass notes. They raise their hands and ask for clarification. Sometimes, they just stare at us like zombies. Few things are more excruciating for a teacher than leading a class that’s not learning. Good administrators use the evaluation processes to support teachers and help them avoid those painful classroom moments — not to weed out the teachers who don’t produce good test scores or adhere to their pedagogical beliefs.

Worst of all, the more intense the pressure gets, the worse we teach. When I had administrators breathing down my neck, the students became a secondary concern. I simply did whatever my assistant principal asked me to do, even when I thought his ideas were crazy. In all honesty, my teaching probably became close to incoherent. One week, my assistant principal wanted me to focus on arranging the students’ desks to fit with class activities, so I moved the desks around every day, just to show that I was a good soldier. I was scared of losing my job, and my students suffered for it.
Confessions of a Bad Teacher
By WILLIAM JOHNSON
Published: March 3, 2012

As far as I can tell, there are two approaches to accountability: roughly, top-down and bottom-up.

Top down means state tests, substantially reduced teacher autonomy, and lots and lots of principal observations.

Bottom up means professional learning communities.

At least, that's the way it looks to me.

I gather from some of palisadesk's comments that top-down can work. At the same time, I've spent the past 6 years of my life trying to function as a parent inside a tiny district headed by a top-down superintendent, and those were six long years. I never want to hear the words "work up the chain of command" again ever. Or "Thank you for your ongoing cooperation and support." I don't like being thanked for my ongoing cooperation and support. I feel that if there must be ongoing cooperation and support, I would like to be the person receiving the said cooperation and support at least occasionally.

Anyway, blood over the dam, but my point is: I don't think top-down makes for happy teachers, and I know for a fact that top-down in my district produced a very large cohort of unhappy parents.

I'm reading that in Finland teachers function as professionals, and it looks like maybe that's going to happen in my district.

I vote for teachers as professionals.

And I vote for Richard DuFour's "professional learning communities" as the best way to get there.

school boards

With the contemporary focus on college and workforce readiness, many may be surprised that 14.1 percent of board members rank preparing students for college as sixth in importance out of six education goals, and 16.4 percent give the same ranking to preparing students for the workforce. When asked what they consider the most important objectives for schooling, the most popular board member responses are to “prepare students for a satisfying and productive life” and to “help students fulfill their potential.”

School Boards in the Age of Accountability
Frederick M. Hess
Olivia Meeks

Here in Irvington, a number of us have been asking the administration to hold itself accountable for student achievement. One parent has been pressing the case for well over a decade.

At this point, two of five board members are also asking the administration to measure the effectiveness of its programs and teaching philosophy.

At last week's board meeting, the interim director of curriculum put up a slide listing 20 "Indicators of Success," and said, "[This] is a new one for us. What indicators do we use to determine if we are being successful?"

testing

ok, I'm writing a blog post about a book sold on Amazon: Driven by Data: A Practical Guide to Improve Instruction by Paul Bambrick-Santoyo.

hmmm

Interesting.

my thoughts exactly

You Haven't Taught Until They Have Learned: John Wooden's Teaching Principles and Practices
by Swen Nater, Ronald Gallimore, Bill Walton (Foreword), Jim Sinegal (Foreword)

running with the big dogs

from Work Hard. Be Nice. by Jay Mathews:

One popular slogan irritated [Harriet Ball]: “All children can learn.” That was not the right message, she thought. It ought to be “All children will learn.” The word “can” was too passive. It meant the child was capable. That was not enough. There was a big difference between capability and achievement. Many educators thought it was up to their students and their parents to summon the motivation to use their God-given talents. Ball took her responsibilities more seriously. She brought this up every time she saw the slogan: “Uh-uh, I don’t want no ‘can,’” she said. “All of us will learn. I will learn from the kids. They will learn from me. Ain’t no ‘can.’ We will all learn.”
p.37

worse than you think

Klein said he believed staff at Public School 38 in Brooklyn answered school surveys honestly, even though the Daily News reported that Principal Yolanda Ramirez berated them for 40 minutes for slamming her in their responses.

"First of all, my own experience is it's pretty hard to pressure anyone in the system," Klein said. "I'm convinced - these are anonymous surveys - I'm convinced people play them overwhelmingly straight. "

Ramirez was caught on tape telling teachers that they shouldn't publicly slam her because, "if I were to begin putting out some of your dirty laundry a lot of you wouldn't be here."

Chancellor Joel Klein says teachers answer survey questions honestly because they are anonymous
by Erin Einhorn and Rachel Monahan
April 16th 2010

KIPP for high-SES kids

in the comments thread

Michelle Rhee in the Journal

HOW TO LEAD: I often get in trouble for saying this, but I actually think it's true—that collaboration and consensus-building and all those things are, quite frankly, overrated. None of you CEOs run your companies by committee. So why should we run a school district by committee? The bottom line is that in order to run an effective organization, you need one leader who has a very clear vision for what needs to happen and the authority to make that happen.

FIRING EMPLOYEES: We had to conduct a reduction in force of about 500 employees in the district. And that included about 250 or so teachers. We made the decision that we were going to conduct the [layoffs] by quality, not by seniority. It caused this firestorm.

From a managerial standpoint, it would make no sense to do a layoff by seniority only. In a school district that is struggling as hard as ours is, we have to be able to look at the quality and the value that different employees are adding.

MONEY FOR NOTHING: We spend more money per child in this city than almost any other urban jurisdiction in the country, and our results are at the absolute bottom. So it goes against the idea that you have to put more money into education and that's how you're going to fix it.

It comes down to two basic things about why we spend so much money and the results aren't as good. First is a complete and utter lack of accountability in this system. And the second is a lack of political courage on the part of most of the people who are running cities and school districts.

We have a system in which you can have been teaching for 25, 30 years. Every year, you could actually take your children backward—not just not improve their learning as much as you should, but your kids can move backward in your classroom every year—and you will continue to have a job. You will continue to get your step raise. You will continue to get your negotiated union increases. Where else can that happen, except in public education? So that lack of accountability is a significant problem.

And then on the courage part, I think that when you're talking about making the difficult decisions that are necessary in this climate—closing schools, firing teachers, removing principals, et cetera—those are the things that make most politicians run for the hills because it makes your phone ring off the hook and people are saying oh, don't close this school, don't fire this person.

OUT-OF-CONTROL SPENDING: When I came on board, people told me to find out where the money is going, and so I sent people out. One of my assistants came back to me and said, "Did you know that we spend $80 million a year in this city transporting a few thousand kids to special-education placements across the city?" And I did the quick back-of-the-envelope math and it turned out to be $18,000 per kid, per year.

And I thought, that's crazy. I said, well, I don't know anything about running bus routes, but I'm pretty sure I can do it for cheaper than $18,000. With $18,000 a year, you could buy the kid a Saturn the first year and a driver for the Saturn every year after that!

So I said, this is going to be a good one. We save the money; we're more efficient; we push the money down to the classroom. And what people said was, no, you can't do that because for decades, the district had done such a poor job of transporting these kids to their placements that now it's under a court order.

There's a court-appointed special master who now runs the bus system, and he's allowed to spend as much money as he wants to as long as he gets the kids to school on time. All we can do is pay the bill. We have no ability to control costs. It's an insane system that's been set up over time because of the dysfunction of the school district.

VOUCHERS AND CHARTER SCHOOLS: We have a very strong choice dynamic in this city. About a third of the school-age children go to charter schools. We have the traditional public schools, and then we also have about 2,000 kids who attend private schools through the use of vouchers. We call it the tri-sector approach. I think it works extraordinarily well.

Laying the Groundwork
November 23, 2009
WSJ

Gabriela has a problem

If you've time to comment on this Flypaper post, you should.

more is less

What a Texas town can teach us about health care: Costlier care is often worse care.

McAllen [Texas] has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

[snip]

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

“Oh, she’s definitely getting a cath,” the internist said, laughing grimly.

[snip]

Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents.

[snip]

Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be.

[snip]

That’s because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens.

[snip]

I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

“I’ll be there,” the cardiologist said.

Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay.

The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.

“When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing,” Cortese told me.

[snip]

The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

The Cost Conundrum
by Atul Gawande
June 1, 2009
The New Yorker

When the needs of the patient come first, medical care costs less.

Judging by the amount of money charter & parochial schools spend to educate children, compared to the amount public schools spend to not educate children, I'd say that principle will turn out to be true of schools, too.

help desk - How to Measure Anything

Does anyone know anything about this book?

How to Measure Anything: Finding the Value of Intangibles in Business by Douglas W. Hubbard

due process for parents of general education kids

from Barry G:

As people think about lobbying their Congressman/Senator, it might be good to have some outlines in hand for legislation that offers parents due process for general education. One thing that SPED [special ed] laws allow is, for example, testing. If a parent requests their child be tested to determine possible LD or other problems and to determine the need for an IEP, the school must comply. If they do not, the parent has the right to have the child tested by a firm of their choosing, and if the results show the child has problems, the school then has to reimburse the parents for the cost of the testing. And in fact, upon initial request, the school has 60 days to make a determination of whether the child qualifies for an IEP.

We need laws that allow parents to be recognized. Parents should have the right to have their child tested in math, English etc using say ITBS. If the results show the child is doing poorly, the parents can be reimbursed for the cost of testing and also reimbursed for tutoring, or using Sylvan, etc. Rough idea, I know, but you get the gist. Any thoughts?


SPED: special education
LD: learning disabilities
IEP: Individualized Education Plan (for SPED kids only)
ITBS: Iowa Test of Basic Skills [parents of general education kids can order the test & give it to their children themselves, which I did one year - around $40 - ask me if you want details: cijohn@verizon.net]