Let me preface this blog post by saying I believe we need healthcare reform in this country and I do not believe ObamaCare to be a sure sign of the Apocalypse. After stumbling upon an editorial by Daniel Henninger, “ObamaCare’s Lost Tribe: Doctors” that ran in the Wall Street Journal on July 5, 2012 (http://online.wsj.com/article/SB10001424052702304708604577505210356532588.html) I noticed some striking and disturbing parallels between the Affordable Care Act and Race to the Top.
I have stayed out of the fray of the ObamaCare debate since I am not in the medical profession, I don’t have time to read the actual law, and I avoid doctors and hospitals at all costs unless I am giving birth. My knowledge of ObamaCare is the same as any American who has just been watching the nightly news. Hmmm…letting kids stay covered until they’re 26, not denying coverage to people with preexisting conditions? Sounds pretty good. Requiring people to buy insurance to pay for these changes? Makes sense. So I found it a little disturbing when I read more of the details about how the law was created and the implications for doctor patient relationships which struck me as eerily similar to the implications for teacher student relationships imposed by Race to the Top.
The first moment of realization came after reading this line in Daniel Henninger’s editorial, “Have you noticed what got lost in this historic rumble? Doctors. Remember them?” Oh, no! You mean they didn’t consult any actual doctors when they devised the Affordable Care Act? Sounds just like Secretary Arne Duncan’s decision to ignore teacher voices in the creation of Race to the Top.
Next uh-oh moment came after reading these lines, “ObamaCare has been a war over the processing of insurance claims. It has been fought by institutional interests representing insurance, hospital and pharmaceutical firms. The doctor-patient relationship, or what used to be called “the practice of medicine,” has sunk beneath these waves.” Oh, no! It sounds like Arne Duncan listening to Bill Gates, Pearson and the American Institutes for Research promoting value added models without any thought of how teachers’ relationships with their peers and students might be adversely impacting by ranking teachers against each other based on test scores.
Henninger goes on to lament the omission of the words “doctors” and “nurse” yet the inclusion of CEO voices “The piece, however, did cite the view of one CEO who runs a chain of hospitals, explaining how they’d deal with the law’s expected $155 billion in compensation cuts. “We will make it up in volume,” he said.
Volume? Would that be another word for human beings? It is now. At Obama Memorial, docs won’t be treating patients. They’ll be processing “volume.” And then, with what time and energy remains in the day, they’ll be inputting medical data to comply with the law’s new Physician Quality Reporting System (PQRS), lodged in the Centers for Medicare and Medicaid.”
Ugh….”volume” for teachers can be translated into larger class sizes which has been advocated by Bill Gates, Mayor Bloomberg, and even Arne Duncan (despite what Obama might say to the contrary). Then my eyes zeroed in on the most dreaded word for teachers in today’s educational context “data.” You mean doctors are going to have to waste hours of time, their energy, and money inputting data to meet government demands instead of treating actual patients? OH, NO! TRIPLE OH, NO! As a teacher, I have been forced to dig and dive into data and then let it drive my instruction but it hasn’t improved learning in the least. It has just robbed me of time to plan lessons, grade papers and contact parents.Then the second most dreaded word appeared in Henniger’s editorial, “measure.”
“Here’s the Centers’ own description of what PQRS does: “The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS).”
We’re all pressed for thinking time these days, but the one group we should make sure has time to focus on what’s in front of them is doctors treating patients. Instead, they’ll also be doing mandated data dumps for far-off panels of experts.”
OH, NO! They are going to measure the results of doctors as well! They’re proposing merit pay for doctors!
“Doubts, even among believers, have begun to emerge about what ObamaCare could do to the practice of medicine. A remarkable and important piece by Drs. Christine K. Cassel and Sachin H. Jain in the June 27 Journal of the American Medical Association directly asks: “Does Measurement Suppress Motivation?”
The question raised by the article is whether imposing pay-for-performance measurements on individual physicians does more harm than good: “[C]lose attention must be given to whether and how these initiatives motivate physicians and not turn physicians into pawns working only toward specific measurable outcomes, losing the complex problem-solving and diagnostic capabilities essential to their role in quality of patient care, and diminish their sense of professional responsibility by making it a market commodity.”
Sounds a lot like teachers teaching to the test and ignoring the whole child. As a teacher, I know pay for performance is not good for education and I imagine a similar system for doctors could also prove disastrous. The teaching and medical professions are not like selling cars. We are dealing with human beings. The value of our work cannot always be measured and boiled down to an excel spread sheet. Teachers must help all students and doctors must help all patients, regardless of whether we believe they will result in the desired measurable outcome. To not do so, would be a violation of the oath of both professions.
I went on to read some of the readers comments and the arguments also seemed eerily similar to arguments for education reform.
“It seems that the consensus among the author of this article and most commenters here is that the ACA is not the solution. So what do you, the people opposed to ACA, propose we do? We obviously cannot continue with the status quo. I’m not trying to be snarky here, rather I’m wondering what others might propose.” Yikes! There’s the favorite phrase of education reformers “we cannot continue with the status quo.” Just like in education, any voices of opposition are shot down as proponents of the “status quo.” Just because I have been a critic of Race to the Top does not make me a lover of the current education system and completely resistant of change. I just don’t believe change for the sake of change (even if it is untested and likely will do more harm) is a good thing.
Then I read another comment about the democrats and professional medical associations throwing physicians under the bus, “We were not lost in the healthcare debate. The Dems threw us out of the 5th floor window. Then they cut a backdoor deal with the AMA that granted them continued possession and use of their proprietary diagnostic and treatment coding system. The AMA took the bait and with only 17% physician support, endorsed ObamaTaxCare. The AMA and the pols sold us out. Then they locked us out.” Yikes! Sounds like teachers complaining about democratic politicians, the NEA and the AFT. You mean people don’t listen to doctors either?
There are even doctor haters out there, “If they all quit – who cares. There’s plenty of younger, well trained, foreign doctors who’ll come here to take their places. Since when – in capitalist America – do we owe Doctors a living?” OMG! This sounds just like the argument of Queen bee teacher hater Michelle Rhee who actually worked to petition the governor of Tennessee to veto a bill from the Tennessee Legislature that limited the amount of foreign workers charter schools could employ and advocates the superiority of younger inexperienced barely trained TFA teaching recruits.
After reading Danlel Henniger’s editorial and noticing the striking parallels between the Affordable Care Act and Race to the Top, I began to get an uneasy feeling about the future of medicine in this country. The same queasy feeling I’ve had all year about the future of education in this country after experiencing the implications of Race to the Top. Hopefully the next time the government decides to reform the two most important institutions in most Americans’ lives, public education and health care, they’ll consult the experts and include some actual practitioners and not just the corporate interests that stand to profit from reform.