If life were grade school, girls would rule the world

This was a fantastic piece in the Atlantic about how girls confidence, relative to boys, seems to drop so precipitously in the middle school years.  I loved the quote, I took for the title of this post:

“If life were one long grade school,” Carol Dweck, the Stanford University psychologist who wrote The Growth Mindset, explained to us in an interview for our first book, women “would be the undisputed rulers of the world. But life isn’t one long grade school.”

So, what’s the story?  Great Atlantic piece on research by Katty Kay, Claire Shipman, and Jillellyn Riley:

In our research, we worked with Ypulse, a polling firm that focuses on tweens and teens, to survey more than 1,300 girls from the ages of 8 to 18 and their parents. (The sample was broadly representative of the country’s teen population in terms of race and geographic distribution.) The data is more dramatic than we’d imagined: The girls surveyed were asked to rate their confidence on a scale of 0 to 10, and from the ages of 8 to 14, the average of girls’ responses fell from approximately 8.5 to 6—a drop-off of 30 percent.

Until the age of 12, there was virtually no difference in confidence between boys and girls. But, because of the drop-off girls experienced during puberty, by the age of 14 the average girl was far less confident than the average boy. [emphases mine] Many boys, the survey suggested, do experience some hits to their confidence entering their teens, but nothing like what girls experience. (The Ypulse survey did not break down its findings at a granular enough level to discern if there was any correlation between kids’ race or income level and their self-described confidence.)…

As boys and girls (and men and women) take risks and see the payoffs, they gain the courage to take more risks in the future. Conversely, confidence’s absence can inhibit the very sorts of behaviors—risk taking, failure, and perseverance—that build it back up. So the cratering of confidence in girls is especially troubling because of long-term implications. It can mean that risks are avoided again and again, and confidence isn’t being stockpiled for the future. And indeed, the confidence gender gap that opens at puberty often remains throughout adulthood.

What makes confidence building so much more elusive for so many tween and teen girls? A few things stand out. The habit of what psychologists call rumination—essentially, dwelling extensively on negative feelings—is more prevalent in women than in men, and often starts at puberty. This can make girls more cautious, and less inclined toward risk taking. Additionally, at an early age, parents and teachers frequently encourage and reward girls’ people-pleasing, perfectionistic behavior, without understanding the consequences. Often, this is because it just makes parents’ and teachers’ lives easier: In a busy household or noisy classroom, who doesn’t want kids who color within the lines, follow directions, and don’t cause problems? But perfectionism, of course, inhibits risk taking, a willingness to fail, and valuable psychological growth. “If life were one long grade school,” Carol Dweck, the Stanford University psychologist who wrote The Growth Mindset, explained to us in an interview for our first book, women “would be the undisputed rulers of the world. But life isn’t one long grade school.”

In fact, later in life, the goalposts shift considerably. “It rewards people who take risks and rebound,” Dweck added. And the boys in our survey seemed to have a greater appetite for risk taking: Our poll shows that from ages 8 to 14 boys are more likely than girls to describe themselves as confident, strong, adventurous, and fearless.

Wow– that’s all disturbing and distressing.  The solution?  Girls soccer.  Okay, not exactly, but:

There’s evidence that tweaking the status quo, and acclimating girls at this critical age to more risk taking and failure, makes a difference. Some of the most compelling data links participation in sports to professional success.

Okay, obviously not just sports (though, I sure hope Sarah wants to stick with soccer as long as possible):

It’s not only through athletics that young girls can gain confidence; sport is simply an organized and easily available opportunity to experience loss, failure, and resilience. But the same skills can be acquired by participating on a debate team, learning to cook, or speaking up on behalf of a cause like animal welfare—as long as there is a move outside of her comfort zone, and a process of struggle and mastery, confidence will usually be the result…

It’s essential to close the gap, and to do so early, because the long-term effects of these dynamics hurt not only girls, but the women they become, many of whom, within a few years of entering the workforce, experience another confidence drop, and a drop in aspirations. Their rule-following, good-girl methods have been celebrated, rewarded by a structured educational and societal system. It’s a shock to arrive in the adult world and discover a dramatically new playing field: Failure is okay. Risk is worth it. No wonder they struggle: Their whole life, to date, they’ve internalized just the opposite, a societal bait and switch that should be recognized. Girls are adept at learning—they just need the right study guide.

Of course, is this all just society?  Is there some nature vs nurture going on here (obviously, there’s some pretty dramatic biological changes– and yes, the brain is biological– for both genders that kick in at puberty).  Would love to see more of this across different countries and cultures.  Of course, even if there is a genuine biological component, that doesn’t mean we we should respond any less to trying to overcome this gap, but I’m pretty curious.  Anyway, for know, all of us need to do our part to turn confident, kick-ass, grade school girls into confident, kick-ass, young women.

Single payer reality

We interrupt you from all Brett Kavanaugh all the time to highlight Jon Cohn’s excellent piece on Taiwan’s single-payer health care system.  There’s a lot we could learn from Taiwan.  They are relatively new to single-payer, actually.  Back in the 1990’s they realized they needed to create a high-quality, national health care plan and studied countries around the world to see what made the most sense.  Their conclusion: single-payer.  The results: not perfect, but really, really good:

More than 99 percent of people living in Taiwan now have insurance through the NHI. They pay premiums based on a sliding scale, with employers contributing additional premiums, and they have to pay modest out-of-pocket costs for everything from prescriptions to hospitalization.

That last part might surprise people who think that single payer necessarily means “free” health care. It doesn’t, though the NHI waives copayments and deductibles for several key populations: the poor, pregnant women, children younger than three and people with serious, long-term conditions like diabetes or cancer.

“It protects the disadvantaged, it protects the sick, really well,” Cheng said. “When they set up the program, they said, ‘We should feel sorry for those who are sick ― on top of that pain and suffering, it’s an awesome financial burden. We should take care of that.’”

It’s easy to see how such a system could get expensive. But the Taiwanese government establishes a hard limit on overall health care spending, then negotiates fees for every medical service and supply. It’s cost control by brute force, and it works. In 2016, the overall budget worked out to less than 7 percent of Taiwan’s gross domestic product, compared to 16 percent in the United States. [emphases mine]

Some of the difference shows up in superficial ways, like Taiwan’s conspicuously spartan and utilitarian facilities. A popular pediatric clinic in northwest Taipei that I visited had curtains, not doors, on some room entrances, plus a waiting area that consisted of a bench crammed into a hallway. The large, cartoonish sign bearing the clinic’s name looked like it belonged on a fast-food restaurant or gas station.

But patients in Taiwan have the kind of access to medical care most Americans would envy. They can see any doctor or visit any hospital anytime they want, and pay just a small additional fee for specialty care without a referral.

And, hey, because Cohn (and me) are fair and balanced, there’s some definite downsides:

Every health care system has its trade-offs, and in Taiwan one of those is the effect of low fees on physicians, who have basically tried to make up in volume what they can’t get in price. The Taiwanese end up seeing the doctor more frequently than people in most other countries but spend less time in the office when they do. Doctor burnout is becoming a problem and a small but growing group are making regular trips to clinics in mainland China, where they can make more money because the People’s Republic, desperate to meet their fast-growing population’s need for care, now offers better pay.

Another place Taiwan has saved money is on cutting-edge treatment ― in particular, the latest cancer drugs. Taiwan’s government negotiates pharmaceutical prices directly with manufacturers, as pretty much every country except the U.S. does. But it typically waits a year or two after the release of a new drug before approving it, and then bases its payment on a mix of what other, larger countries are already paying. That has the effect of steering more people to older, cheaper therapies, even when newer ones are available.

Also, the politics in the US for something like this are really, really hard:

Proposals like the one Bernie Sanders has outlined envision wiping out private insurance, which would mean getting rid of the employer benefits through which the majority of working-age Americans now get coverage. It might be a change for the better, providing more comprehensive coverage, with no networks, and for lower cost overall. But making that case to the tens of millions who currently have employer benefits they like is difficult, and some people would inevitably feel, justly or not, like the transition left them worse off.

Yep.  That said, well short of single-payer, there’s some really good steps we could and should take in this direction:

A good place to start might be taking the critical step that Taiwan did. Policymakers could make sure that people with cancer, diabetes and other chronic, economically-crippling conditions don’t face out-of-pocket costs ― protecting those people from financial duress and reducing the likelihood they postpone necessary care because of cost. Introducing fixed fees and global budgets slowly, as Maryland is already doing on its own and California is contemplating, might also work. That could also help ensure that cuts were done in a way that didn’t deter important innovation.

Neither of those features is unique to Taiwan or even, as it turns out, to single payer. Many of the public-private hybrid systems in Europe have them too. One very real possibility is that a push for single payer could leave the U.S. with a system that looks more like what those other countries have, simply because the politics and policy of dislodging the current system would prove too difficult. It’d still be cheaper, and a lot more humane, than what exists now.

There’s lots of ways to go.  A couple things are for sure– currently, sadly, Republicans have absolutely zero answers to solving the real health care problems we face as a country and as individuals, and, we really could learn a lot from places like Taiwan.

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