Observed on Marlborough Street, Back Bay, Boston:
Observed on Marlborough Street, Back Bay, Boston:
I’m serious as a heart attack (boldface mine):
In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.
Paging Dr. Campbell! You can probably guess what happened next (boldface mine):
Consider, for instance, a case that would fall into more of a gray area than that of the 60-year-old TV executive. Let’s say, instead, it’s a much older man, one who comes into the hospital with a massive heart attack, and on top of that he’s in cardiogenic shock, meaning that his blood pressure is dangerously low. If you do nothing, there’s perhaps a 95 percent chance he’ll die; if you give him an angioplasty, the chance of death still lingers at 55 percent. As a cardiologist, do you make a hopeless case only slightly less hopeless, put the patient and family through a dangerous and expensive ordeal, and risk ruining your own mortality rate? Or do you walk away?
…The problem with decisions is that not every doctor makes wise ones—and “futility” is a matter of opinion. David Adams, who came from the Brigham and Women’s Hospital at Harvard a few years ago to chair the heart-surgery program at Mount Sinai, remembers a young woman who came to his office late last spring. Her age and her overall health made her seem like a low risk on paper, but before she’d come to see him she’d had an infection in her heart valve that caused a leak that in turn sent her spiraling into gross heart failure. To take on her case, doctors essentially would have had to rebuild the whole top of her heart. Several surgeons turned her down; whether it was because of the risk of public exposure or the practice of good medicine is an open question.
But in Adams’s office, he has a card from the woman. “How grateful I am,” she writes, “that you said yes . . . when other doctors didn’t want to take the risk.”
This could be a problem.
To put this another way, since the mid-70s, when Canada adopted its single payer system, we’ve conducted the largest controlled experiment in the history of the world. We’ve had two political systems spanning the same continent, both nations of immigrants and once part of the British empire, both mainly English-speaking but multicultural, both with Federal systems, and both with a free market system backed by social insurance. And the results of the experiment? The “evidence”? Canadian-style single payer wins hands-down.
On virtually every domestic policy issue, we continue to reinvent a square wheel when we could just copy a functioning round one.
There are a lot of useful idiots and they are hurting us. One wonders just how much ruin there is in a nation.
Sorry, I meant value-added measurement. A while ago, I described how value-added testing of teachers went completely off the rails in Tennessee. Here’s a taste:
Because there are no student test scores with which to evaluate over half of Tennessee’s teachers — kindergarten to third-grade teachers; art, music and vocational teachers — the state has created a bewildering set of assessment rules. Math specialists can be evaluated by their school’s English scores, music teachers by the school’s writing scores.
…For 15 percent of their testing evaluation, teachers without scores are permitted to choose which subject test they want to be judged on. Few pick something related to their expertise; instead, they try to anticipate the subject that their school is likely to score well on in the state exams next spring….
It’s a bit like Vegas, and if you pick the wrong academic subject, you lose and get a bad evaluation. While this may have nothing to do with academic performance, it does measure a teacher’s ability to play the odds…
Half of their assessment is based on their students’ results on state test scores, a serious problem for those who teach subjects with no state test.
To solve that, the state is requiring teachers without test results to be evaluated based on the scores of teachers at their school with test results. So Emily Mitchell, a first-grade teacher at David Youree Elementary, will be evaluated using the school’s fifth-grade writing scores.
But maybe that was a one-off case? Nope (boldface mine):
There are numerous problems with using VAM scores for high-stakes decisions, but in this particular release of data, the most obvious and perhaps the most egregious one is this: Some 70 percent of the Florida teachers received VAM scores based on test results from students they didn’t teach and/or in subjects they don’t teach.
Yes, you read that right: Teachers are being evaluated on students they didn’t teach and/or subjects they don’t teach.
…Kim Cook of Alachua, Fla., who, as this post explained, was evaluated at Irby Elementary, a K-2 school where she works and was named Teacher of the Year last December. Forty percent of her evaluation was based on test scores of students at another elementary school whom she never taught…
If this kind of meaningless exercise doesn’t prove the meaning of meaningless, tell me what does.
What boggles the mind is that people at the Florida Department of Education put serious cognitive activity–I refuse to call it thought)–into this policy. Somewhere, meetings were held, drafts were read, policies were discussed. I doubt this was something an intern whipped up one late night. And they wound up with a policy wherein seventy percent of teachers are ‘evaluated’ using students they have never taught.
To put this in highly technical terms, these people are fucking morons who fell out of the stupid tree and hit every damn branch on the way down.
Education reformers style themselves as hard-headed pragmatists who get things done, but, in reality, they are incompetent ideologues* who shouldn’t be trusted to organize a school picnic, never mind an educational system.
In the real world, the implementation of education reform, even if we credit reformers with honest motivations, is horrific, especially since we have systems that work that could be cloned and implemented.
I blame the teachers unions. Or something.
*Rather than debate stupid versus evil, given the potential harm to the cognitive development of children, I say the default setting should be both until presented with evidence to the contrary.
Wingnut welfare, the career path for professional movement conservatives, seems to be affecting the party’s political fortunes (boldface mine):
But the data and digital divide, while getting most of the attention, is only a symptom of a larger problem that cuts fundamentally to how the Republican Party operates—not just at a tactical level but also a philosophical one. The well-worn pathways of the party’s operatives, in which every low-level staffer commits his or her career to becoming a well-paid TV specialist, must change. The party’s best and brightest need to emulate the career arc of their Democratic counterparts, who devote themselves to data and fieldwork, areas where races are increasingly won or lost….
A December study by the progressive political firm New Organizing Institute found a wide chasm between the number of staffers on Democratic versus Republican campaigns—nationally, the ratio was close to 3-to-1 in favor of Democrats. In swing-state Nevada, where Republicans had hoped the housing bust and vibrant Mormon community would lift Mitt Romney to victory, the totals were even more lopsided: 498 Democrats worked the state, to only 20 Republicans…
Unlike unions, those GOP-leaning groups don’t invest much in the ground game, which, to many GOP operatives who do work in the field, is part of a bigger problem. The GOP’s political class simply doesn’t value that kind of work, even if it’s increasingly important in the 21st century.
Most young Republican operatives view organizing as a mere entry point to a career that will eventually lead to bigger, and better-paying, gigs. “Democrats actually set up and train people to think about those jobs as careers,” said Brian Stobie, a partner at the GOP data-management firm Optimus. “A field-organizing [role] can be a career over there. In our world, it’s a $27,000-a-year job you can’t wait to get out of.”
“All you’re thinking the whole time is, ‘I can’t wait to get out of this and be the political director,’” he added.
I think it’s a little much to claim that the professional incentives are good for Democratic operatives, but they are better than those that exist for Republicans. If your rank-and-file operatives aspire to being the next David Brooks or Mary Matalin (I just threw up in my mouth), you’re going to have difficulty finding people who want to canvass the hoi polloi. There’s a fundamental conflict here, analogous to Democrats who need to raise money from the wealthy, since field operatives don’t make that much money. It might pay better than $27,000 per year, but I can’t see many movement conservatives making, well, teachers’ salaries for life, when the current model of either pundit or well-paid TV specialist is far more lucrative.
Incentives are a bitch, I guess.