Photo of the day

So many times I’ve been to zoos and the like and if they had wolves, they were always lying, sleeping at the far end of their enclosure.  Never had a good look at a wolf.  This past weekend, the wolves were up and about at the Western North Carolina Nature Center and it was amazing.  Came right up to the glass and looked right at us.  So, so cool.

Steven Greene

Getting health care 180 degrees wrong

I guess it doesn’t really surprise me anymore how completely, amazingly wrong-headed the Trump administration can be on policy matters, but still…

If there’s one thing I like to get through to my students on health care policy (okay, maybe 10 things) , it’s how the perverse incentives of fee-for-service medicine drive up our medical costs.  Among the less well-known, but important aspects of ACA is programs that try and move away from this.  Of course, Trump and his minions are trying to undo that so doctors can get richer and we can all waste more money.  NYT:

or several decades, a consensus has grown that reining in the United States’ $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care.

The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment. Now, the Trump administration is siding with doctors — making a series of regulatory changes that slow or shrink some of these initiatives and let many doctors delay adopting the new system…

The efforts to chip away at mandatory payment programs have attracted far less attention than attempts by President Trump and congressional Republicans to dismantle the Affordable Care Act, but they have the potential to affect far more people, because private insurers tend to follow what Medicare does. That in turn affects the country’s ability to deal with soaring health care costs that have pushed up insurance premiums and deductibles.

The administration has proposed canceling or shrinking Medicare initiatives that required doctors to accept lump sums for cardiac care and joint replacements, two of Medicare’s biggest cost drivers.

Ugh.  And all the storm and bluster aside, this is about doctors (and hospitals) getting rich (er).

This news came out the same week as the death of noted health care economist, Uwe Reinhardt.  Sarah Kliff’s excellent appreciation features this pertinent explanation of health care costs:

I wanted to take today’s VoxCare to tell you about a Reinhardt paper I think anyone interested in health policy ought to read. It fundamentally shaped how I think about the biggest problems in American health care — and the right solutions to fix them.

The paper is called “It’s the prices, stupid!” It is co-authored with Gerald Anderson, Peter Hussey, and Varduhi Petrosyan.

The thrust of the argument is this: America does not have an overuse problem when it comes to medicine. We do not go to the doctor more than people in other countries — we actually go to the doctor a little bit less.

The reason that American health care is so expensive is that, each time Americans do go to the doctor, we pay outlandishly high prices. We’re not consuming lots and lots of health care. We’re just paying higher price tags.

This is a fundamental fact about American health care that often gets lost in our debate. We have a lot of discussions about “waste” in American health care or “overuse” in our fee-for-service system…

What Uwe Reinhardt taught me about American health care is exactly the title of his paper: It’s the prices, stupid. And that has shaped what I decide to report on. It is why I tackle projects that try to bring more transparency to American health care pricing, and the reason I think it’s important to tell the stories of the medical bills my readers send me.

These aren’t one-off, sad stories. These are, as Reinhardt rightfully spent his career arguing, small windows into the systematic way the American health system charges sky-high prices

There’s so much wrong with our health care system, but we actually know what the right steps to take are.  The ACA was a few baby steps in the right direction.  Alas, Trump’s minions (I’m 100% sure Trump himself is beyond clueless on the policy details) want to lead us in precisely the wrong direction.

Put the laptop down

From my perspective, the evidence for the negative impact of laptops in the classroom has already been sufficiently compelling that I banned them years ago (though, I make sure to explain to my students why).  A recent piece in NYT summarizes the latest research on the matter, and the case is only more compelling.  In fact, a colleague whose class I recently reviewed (and suggested he needed to ban laptops), is now convinced.  There’s a lot of solid research on the matter now:

But a growing body of evidence shows that over all, college students learn less when they use computers or tablets during lectures. They also tend to earn worse grades. The research is unequivocal: Laptops distract from learning, both for users and for those around them…

In a series of experiments at Princeton University and the University of California, Los Angeles, students were randomly assigned either laptops or pen and paper for note-taking at a lecture. Those who had used laptops had substantially worse understanding of the lecture, as measured by a standardized test, than those who did not…

The strongest argument against allowing that choice is that one student’s use of a laptop harms the learning of students around them. In a series of lab experiments, researchers at York University and McMaster University in Canada tested the effect of laptops on students who weren’t using them. Some students were told to perform small tasks on their laptops unrelated to the lecture, like looking up movie times. As expected, these students retained less of the lecture material. But what is really interesting is that the learning of students seated near the laptop users was also negatively affected.

I think there are probably narrow, specific, uses where laptops can enhance a classroom.  But as for a general purpose tool for note-taking, they clearly need to go.

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