Stephen Brill & Time Expose the Corrupt Cost of Health Care

The real health care questions are or should be: 

Why are the bills so high? What are the reasons, good or bad, that cancer means a half-million or million dollar tab? Why does a trip to the emergency room for chest pains that are only indigestion end up costing as much as a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does routine lab work done at a hospital by a salaried employee cost more than a car? Why do hospitals charge $70 for a box of gauze pads when they’re on Amazon for a couple bucks? And, what is so different about medical systems that cause advances in technology to drive bills up instead of down?

In the longest investigative report Time Magazine has ever published, writer Stephen Brill has exposed the dark side of medical billing and asked the most important question - why are the bills so high?  You won't like the answer, though unless you've navigated the health care and insurance world outside of the protection of group coverage, you likely have no idea what the "costs" of health care are.

School Wide Literacy Makes a Difference

In addressing the idea of school wide literacy - especially amidst the discussion of Common Core's recommendations on informational text - there are few schools more appropriate to spotlight than the success of Brockton High School in Massachusetts.

Watch An integrated approach to literacy on PBS. See more from Need To Know.

"Read Option" & the Common Core's Informational Text Issue

**The following is reprinted from publication in the Denver Post.

Since Tim Tebow's departure, the "read-option" hasn't been at issue in Denver. However, it's set to rise again, this time in Colorado's classrooms.

With recent news about Common Core standards, change is coming to schools, and reading is no longer "an option." Strangely, this isn't without controversy. Common Core's recommendation on informational texts has created a brouhaha. The Washington Post even declared the end of literature in schools after Common Core "mandated" 70 percent of student reading should be informational texts. Teachers now fret about exchanging "The Great Gatsby" for instructional manuals.

But that's simply not true. Most troublesome is that critics can't even "read" the standards. Common Core hasn't mandated that 70 percent of reading in English classes is non-fiction. It recommended teaching non-fiction beginning at the elementary level and increasing until 70 percent of high school reading is non-fiction.

This makes sense because English classes account for one-fifth of high school schedules. Thus, 80 percent of a student's daily load is not literature, but it should include reading. Students in math, science, social studies, health and arts classes should read informational texts. English classes are where literature remains the content. The challenge is for content-area teachers to realize that the "critical thinking" they allegedly teach now means "critical thinking" about "informational text."

Committing to literacy can literally turn around schools. It's not enough to simply focus on proficiency by third grade as Colorado's READ Act stipulates. Literacy needs cultivation at all levels. Tom Fair, an English teacher at Cherry Creek High School, asserts "we have long under-served non-fiction at the high school level."All content teachers assert critical thinking is one of the primary skills they develop. Of course, literacy instruction is simply teaching kids to "think critically" about a text. Thus, if we're going to have education reform, it has to start with reading.

The average low-income child enters kindergarten knowing as many as 5,000 fewer words than middle- and upper-income children. A child who finishes fourth grade not reading at grade level will never catch up with his peers. According to the National Assessment for Educational Progress (NAEP), 44 percent of high school students are "dys-fluent" in reading grade-level, familiar text. They are not illiterate, but they can't truly read. They are "fake readers." Their eyes skim the words, but they don't truly comprehend them.

School reform will never succeed until all reformers and teachers accept literacy as the fundamental skill in accessing information. With Common Core assessing literacy in social studies and science, literacy must finally be unbound from the English classroom. For years, content-area literacy has been part of the ACT, though few paid attention. ACT reading tests have always had sections on social studies and science. Students read dense content-area passages and answers questions in limited time. Without regular literacy instruction in this content, students stand little chance of success. 

Reading is a learning skill, not an English skill. If a student is only getting one hour of literacy instruction, he will never truly become educated.  Teachers from kindergarten to graduate school need to stop assigning reading and start teaching it instead. If the new Common Core standards on literacy promote this, students will benefit.

Problems with Emphasizing College Degrees

"Too many people are going to college," noted Charles Murray in his book Real Education.  Yet, the persistence continues with teachers, counselors, principals, parents, politicians, and billionaire philanthropists promoting a college degree as the path to riches and happiness, as well as the cure to all that ills society.  I wrote about this in an article for the Post a couple years ago after Bill Gates set as a goal "by 2025, 80% of students would earn a four-year bachelor's degree."  What a "brilliant" [sic] idea.  But only if Microsoft is going to hire all these overeducated, over-credentialed people.

Considering only 29% of Americans currently have a bachelor degree, and many are seeking work, and the nation has four million unfilled jobs in skilled labor, the proposal for 80% earning a degree - amassing the spending and debt associated with that - is patently absurd.  For a successful businessman to make such a claim, I truly question his knowledge of society, economics, and the future.  And, herein  is the problem for students and families as they consider options and the logic of pursuing a degree.  With this in mind Jeff Selingo asks in an article for The Chronicle "Are Career-Oriented Majors a Waste of Time?"

Most of the evidence from the workplace seems to imply that the current focus on degrees for all is an incredible waste of time and money.  While Selingo claims not to be in the "don't-go-to-college" crowd of people like Charles Murray, perhaps more of us in education should be.  Certainly, there is nothing wrong with higher education, and in a perfect world the well-paid mechanic could wax philosophic about Socrates and Shakespeare while helping his son with his calculus homework at the same that a neurosurgeon could fix a nice meal as well as teach his daughter how to change the O-ring on the toilet.  However, certain practical questions lead us to avoid shooting for these utopian visions and instead focus on what real progress we can make in the education and employment world.

Too many students are pursuing higher (and expensive) education on the belief that they will "get a better job."  Yet, there is not only no guarantee of that, but far too many will end up working in jobs (saddled with student loan debt) that never required a degree - or at least didn't in the past.  The number of jobs that didn't - or shouldn't - require a degree is shrinking, and that's not good for anyone.  For, there is no reason that the upper levels of high school or career training can't provide adequate skill and knowledge for many jobs - especially clerking and service-oriented work.

Granted, "Saying no to college" is not an admirable solution if the system itself won't change.  Sadly, if employers continue to use the college degree as a screening device - even for jobs such as a bank teller - then America is going to face a serious crisis in its ability to fund all this education.  Meanwhile, electricians can continue to make $50K a year, and millions of jobs in skilled labor go unfilled.

Valuing Work via Technical Schools

With nearly four million jobs in skilled labor unfilled in the United States, the need to re-focus attention on career and technical education (CTE) has never been greater.  With that in mind, it's worth taking a look at the way one technical school district in Connecticut addressed the issue by focusing on school climate.  Because so many kids do not finish their degrees at two-year colleges, Patricia Ciccone sought to address the problem at an earlier point in a student's education by focusing her efforts on improving school climate at the Connecticut Technical High School District.  Ciccone believes technical education is the answer that is lacking in so many discussions about students failing to achieve post high school success and career readiness.  Students may not end up working in the career for which they trained, but they have accomplished post-graduate work, and that credential and experience is going to serve them better in the workplace and in society.  So much of what is happening in high schools - especially those hyper-focused on preparing kids for four-year universities - ends up not serving students well.  In addressing this issue, Ciccone sought to improve overall school climate and student security.  Her work is paying dividends in student achievement, and the results have become a template for school climate discussions statewide.

What's the Big Idea?

"Big Idea, Essential Question, Content vs. Skill, Teachable Moments, Standards-based" - Sometimes the terminology teachers and education personnel use to describe their craft can complicate more than clarify.  None of these concepts is new to me, though I have experienced frustration with all of them at times in my tenure as both a student and a teacher.  The struggle to define exit goals, or standards, for our core classes several years ago elicited much angst and frustration from teachers who fear standardization of content and curriculum like the plague.  

As I recently spoke of standards and the teaching of skills, one veteran teacher I know - a Ph.D - noted that he believes that too often teachers are too enamored of their "Big Ideas" and, in turn, neglect the skill and standards they are tasked with imparting.  From an English literature standpoint, he means teachers can become so focused on their themes and getting kids to simply "love the story" and engage in discussion of prejudice or maturity or love, etc.  In the meantime, they neglect the skills of literacy necessary to pull those themes from the text.  And, writing about it is neglected all the further.  However, in reviewing the concept of "Big Ideas," I like articulating it as the information we really want the kids to walk away with - an understanding rather than a memorization and regurgitation of trivial details and superficial information.  It is the point of education, and it's the what Neil Postman surreptitiously called "the end of education."  In crafting any lesson or educational system, we must ask "what is our endgame?"  What is the goal and outcome?  What is the Big Idea?

Einstein once noted, "Education is what remains after one has forgotten everything he learned in school."  Certainly this idea is what Larry Ainsworth had in mind when he wrote, "Much of what I learned in high school and college I simply memorized for a specific test.  Once the test was over, so was my retention ..." (Unwrapping the Standards 25).  Too much of what is happening in classrooms is trivial and disconnected from a Big Idea or any explanation of making the lesson meaningful to students.  They are often so in the dark about "when they are ever going to use this" or "why we have to know this."  And the default of standards or school board policy or those tough college professors is lost on too many.  Phrasing Big Ideas as what students "need to know" and more importantly what students need to "be able to do" is integral to the success of any lesson or unit or curriculum.  Balancing the Big Ideas between content and skill is a necessary consideration, and I have seen teachers and schools that err too much in one way or the other.  Certainly, much of what we teach could be indicted as "trivial" and not in any way "utilitarian."  But Dickens discredited that approach long ago, didn't he?

As a school administrator faced with these issues in light of the Common Core, I would .... hmmmm.  Punt?  No, just kidding.  Posing questions to teachers in a non-threatening or accusatory is necessary for any administrator.  Too many teachers are on auto-pilot and too few give any consideration to standards and learning outcomes.  And I've noted before, when English teachers are asked what they teach, they often simply say, "I teach To Kill a Mockingbird."  Yes, of course.  But what do you do with it?  What's the point?  What's the goal?  What's the learning outcome?  What's the Big Idea?  Why this book and not another?  What do you want students to know and be able to do when they have finished this sublime piece of literature?  Other than to acknowledge that it is, truly, a sublime piece of literature.  Questions, questions, and more questions.  Always seeking "the point."  That is the Big Idea.

Dr. Ben Carson's Disappointingly Cliched and Divisive National Prayer Breakfast Speech

If you haven't heard the news yet, Dr. Ben Carson spoke at the National Prayer Breakfast, and has set the GOP punditry afire with their drooling over his amazing speech.  The image of a successful African -American man who came "from poverty" and a "single mother" and rose to the job of neurosurgeon is certainly impressive and worthy of commendation.  However, my instinct is that Carson's veiled comments on tax policy and health care are what are really the "amazing" part of the speech.

To be perfectly honest, I don't find anything particularly impressive or powerful about his speech or message.  While Carson's success is impressive, and I do appreciate the work his non-profit has done, the message of this speech is nothing but a regurgitation of cliched ideas that have become mantra in the GOP but are rather stale as part of any real policies.   His own success is admirable, and he correctly attributes it to a very strict mother who demanded a focus on education.  How fortunate for him that his mother was so committed.  And the message that parents should be the same is important.  However, unless he has  ideas about how to achieve similar results with kids whose parents don't care or push them, then his own story is simply that.  I am glad that Dr. Carson started a educational foundation that builds reading rooms and offers $1000 scholarships to kids who achieve.  Hopefully, he will inspire more successful people to use their wealth and influence in such positive ways.  Beyond that, his words were divisive despite his implications of unity.

Despite the forum of the National Prayer Breakfast being about great messages and role models for the country, Dr. Carson chose to veer off into commentary on tax policy with no credibility whatsoever, and no great ideas to offer.  For example, his veiled argument in favor of a flat tax - potentially a 10% one at that - is rather weak, especially as it hints that the rich are "over-taxed."  They aren't.  Undoubtedly, Dr. Carson is in the upper ranks of earners and probably a millionaire.  Interestingly, according to the IRS, the average millionaire pays a tax burden of 21%.  Certainly, not burdensome - and nowhere near the 63% that Phil Mickelson foolishly ranted about last week.  While lamenting the tax burden on the wealthy is popular among GOP pundits, it's not even supported by original free market conservatives.  Adam Smith promoted the idea of a progressive income tax as correct and necessary because the rich already had an unfair advantage in the free market.

And, Carson is absolutely incorrect that people want the taxes to "hurt" the rich.  That's not the point.  Carson goes to the Bible for his inspiration on taxation and "tithing," but his "hurt the rich" comment ignores the Bible.  As Christ noted in Mark 12:41-44 with the women who gave her only "two coins," her contribution was meaningful precisely because it was all she had - it did hurt her.  When the poor and middle class pay taxes, it takes away from their money for basic necessities and living expenses.  When the rich pay, it comes out of luxury.  So, it's not that it has to "hurt" people, it's that wealthier people can literally afford to pay more.  That basic idea is that with greater benefit comes greater responsibility.  That's also a Bible lesson Carson ignores - Luke 12:48 - "To whom much is given, much will be required."  And I guess Carson isn't worried that it will be harder for a rich man to pass into Heaven.  Now, I am not necessarily a believer that the Bible should guide our laws - but Carson appears to be.  So, the problem is that he's selective about just which verses to apply.

Additionally, Carson offers the flat tax as a solution and then sort of flippantly defers that "of course, you have to get rid of loopholes."  As if that is some sort of minor issue.  In fact, that's the entire issue.  He notes that "people who make $10 billion will put in a billion."  Yet, that's not close to being true when we speak of corporate income taxes.  Companies like GE who make billions of profits often skirt their entire tax bill.  Yet, Carson grossly oversimplifies his "flat tax" platform by casually noting we'll just "close the loopholes."  Good luck.  If he had any ideas on how to do that, or perhaps started a Carson Tax Foundation to make that happen, he might have a truly powerful message and impact.  Instead, he simply notes we have to close loopholes.  No great wisdom there, and actually a rather naive belief that "we'll just close" them.

Speaking as a doctor, Carson also proposes a plan to "fix" the health care situation, yet his comments are not only nothing new, but also rather naive and removed from the realities of the health care market.  In discussing health care costs, he identifies health saving accounts as some sort of panacea for lowering costs.  Sadly, this is neither a unique or revolutionary idea, nor a powerful message, and he provides no evidence that it would do anything to improve health care or lower costs.  In fact, I would bet he doesn't have one, and I would bet he is a member of a large group plan for which he pays no out-of-pocket costs.  As a consumer of health care on the open market, I'd love to talk to him about the HSA that I have had for my family for years.  It's no panacea for controlling health care costs or spending.  While the HSA model might be marginally effective fifty years from now for people born today, it does nothing for immediate concerns and it will do nothing to cover costs for many middle and lower class people.  I'd imagine there were quite a few Medicare users and people with great group health care through their employers in that crowd, and it's rather insulting for them to cheer such a plan that will never affect them.

Dr. Carson may be a successful man and a great doctor, but he's not very impressive in terms of public policy.  While political correctness may be a bad word in his world, it often means simply respecting others whose culture and views are different.  Clearly, his desire to not be politically correct - especially in his comment about "Merry Christmas" as simply a gesture of goodwill - is simply his desire to have no respect for others with views and beliefs different than his.  I don't find that to be a powerful message about issues facing our country.  While that message seems to resonate among the GOP pundits who are writing about him - notably Hannity who interviewed him and the WSJ whose editorial claims he should be president - I don't find him to be anything special as a public speaker.  This was certainly not an "amazing speech."

The "Oscars of Teaching" & the Milken Foundation

Great things are happening in America's classrooms.

Despite a preponderance of criticism of public schools, educational success is on the rise in America, and some true education leaders are honoring it and spreading the word.  For nearly thirty years, the Milken Family Foundation has been committed to supporting and improving public education.  Through a myriad of philanthropic endeavors Lowell Milken has promoted effective educational practices, often spotlighting and honoring students and teachers who are making a difference.  One of the foundation's most well-known programs is its Milken Educator Awards.  The program was named the "Oscars of Teaching" by Teacher Magazine years ago.  It was founded in 1985 with the intention to "celebrate, elevate, and activate excellence in the teaching profession," and it has given away $63 million to educators who are making a difference.  That degree of support is extraordinary in the education world, and, like the educators it honors, it deserves some recognition.

As a Colorado teacher I was recently pleased to learn of the honoring of a Denver Public Schools teacher by the Milken Foundation.  Barth Quenzer, a devoted art teacher at the Brown International Academy was awarded an "Oscar of Teaching" last October, and the story of the Milken Foundation's presentation was covered in a great feature on 9News.  Quenzer was visibly surprised and overwhelmed by the ceremony where the school's entire student body and staff had assembled.  Colorado has been making great strides in education reform, and it is nice to know organizations like the Milken Foundation are recognizing it.  As foundation senior vice president Dr. Jane Foley said, "At the Milken Family Foundation, we don't think educators get enough recognition.  We just don't say thank you enough."  Barth Quenzer has just received one heck of a "thank you."  He is, by all accounts, an inspiring teacher who is a devoted member of their school community.  In the words of his principal Lynn Heintzman, Barth Quenzer simply "inspires our children to be artists."  That ability to inspire is at the heart of educational achievement, and it's great to see it honored.

The Milken Educator Awards are important simply for their acknowledgment of the difference an effective and inspiring teacher can make in the lives of young people.  As Lowell Milken has said, "Each of us can recall those teachers who had a profound impact on our lives."  For the most part, these actions go unheralded - they are just part of the job.  And teachers don't encourage and inspire with the goal of being rewarded.  The learning and success of the child is its own reward.  Thus, the Milken Foundation seeks to discover and honor them.  As noted in the news story, "no one is allowed to apply." Instead, the foundation uses a committee which seeks nominations from a state's department of education.   Recipients of the Milken Educator Award are then honored for their achievement with a public ceremony - often to the complete surprise of the winner - and a monetary award of $25,000 to be used in any way the teacher wants to use it.  

Check out the following video of the ceremony:

Living Healthy Is Good For the Country

Worried about the national debt?  Fretting about our deficit?  Want to see a cut in government spending?  Hoping for lower tax revenues?  If these issues are on your mind, the best thing you can do is to start living healthy.  Cut out the soda and most processed foods, walk thirty minutes a day, and save the country.

It seems like every single day reveals an article or presentation about "how to live healthier."  Just today in the USA Weekend supplement found in most Sunday papers, an article offers advice on how to Keep Going Strong: 7 Fresh and Easy Lab-tested Ways We Can All Steer Toward Vitality as We Age.  Not surprising to anyone who pays attention, "We may be living longer than ever, thanks to medical advances, but we're not living healthier."  Americans regularly put their health - both physical and economic - at risk by remaining sedentary and eating large amounts of processed foods that everybody knows are unhealthy.  Nothing in the news has reversed these trends in the past three decades.  However, perhaps a new angle regarding the pressure our weight and poor health are putting on the national pocketbook could re-direct the discussion.  Dr. Ezekiel Immanuel - yeah, that famous brother - poses the interesting assertion in the Opinionator blog that We Can Be Healthy and Rich.  Without doubt the greatest economic risk to the American budget is the unfettered growth in health care spending via Medicare.  Thus, if we simply consumed less health care - and demand went down - we could be shaving hundreds of billions of dollars off the federal budget.  Instead, retired Americans - who are virtually uninsurable in the private market - are in need of increasingly costly health care.

Alas, it doesn't have to be that way.  The federal budget is straining under the burden of health care costs precisely because Americans are entering their elderly years in need of such extensive care.  With the Baby Boom generation retiring, it was no mystery that Medicare budgets were going to be strained. And, there is little cost to the recipients with Medicare premiums intentionally low, despite the cost.  The problem is that so many health care problems are easily treatable with lifestyle - notably diet and exercise.  Countless Americans are on blood pressure, insulin control, and cholesterol medication while making no changes to their lifestyle.  These are lifestyle conditions - and much of the cost could be eliminated with healthy living.  And, it's not just Medicare and retirees.  The private health care/insurance system spreads costs across risk pools.  Thus, one person's habits affect another's costs.  I consume little to no health care, but that doesn't prevent my premiums from rising because overall costs and payouts still go up.  The problem is that so many of the payouts are for preventable conditions.  The best way to save money via health care spending is to simply not need to spend money on health care.  Or more importantly, spend the money on health - and not sickness.  Yes, cliche as it is, "an apple a day can keep the doctor away."

Public - and personal - health is a national security issue.  Anyone who seeks to save money - both at a personal and federal level - should be doing everything possible to decrease consumption of health care.  And that starts with decreasing consumption of empty carbohydrates and poor food quality via processed foods.

Our health - and the health of the nation - depends on it.