Leaving Non-Native Speakers Behind?

No Child Left Behind has undoubtedly brought well-deserved attention to the importance of data and human capital in the policy debate, but a great deal still needs to be done to advance issues surrounding accountability, measuring improvement and teaching as a profession.  Since many teachers are entering the discipline from different fields, it is essential that new reforms closely scrutinize the nature and metric used to determine highly-qualified teachers, who, in fact, should be encouraged to enter the neediest schools.    As noted in “Really Leaving No Child Left Behind” (NY Times, 9/7/07), a provision being considered that would allow schools to test English language learners in their native languages for as long as seven years would have detrimental effects on students’ incentives to learn English, integrate, and partake in social and economic activity that broadens opportunity during a crucial stage of the lifecycle.  Instead, reforms could achieve more by focusing on measuring progress with more concrete benchmarks, both for educators and students across the board.  – Arian Hassani | Program Associate   

Reflections on “Vista” Care

Health care has found legs in the current electoral season.  In anticipation of big health care plan rollouts, Phillip Longman’s “Best Care Everywhere” (Washington Monthly, 9/11/07)  makes a stab at a compelling new health care program, based on the VA.  While the VA has a reputation for mediocrity, Longman points out,

The VA has the highest rate of patient satisfaction of any health care delivery system in the United States, by far—higher even than fee-for-service Medicare, with its limitless choice of doctors…. [T]he VA also comes out on top of virtually every study ranking the quality, safety, efficiency, and cost-effectiveness of U.S. health care providers.  

It is clear that the cost of the uninsured, both in terms of human costs and money, is continuing to mount.  At the same time, our nation gets relatively little for the health care dollars spent on both the insured and the uninsured. As cited in Longman’s article, the $1,629 per uninsured person is a higher per capita health care expenditure than Europe and results in higher premiums and lower reimbursements for the insured, employers, the government, and providers.   Longman’s main thesis is strong: any effective health care reform to come to fruition in the next presidential term must combine measures to improve access and make major gains in value, while ensuring a lower cost for higher quality care.  The plan depends on requiring everyone to purchase health insurance, with those unable to afford insurance receiving reimbursements at tax time.  The plan is pitched as a safety net for near-failing hospitals, by raising reimbursement rates for providers, particularly those who currently serve large populations with Medicaid or the uninsured.  In addition, it requires an updated medical database system in place at all facilities operating as a Vista provider.  Most compelling about the VA-based Vista model that Longman introduces is the goal to realign incentives by investing in health care for patients across their lifetimes:  

Uniquely among U.S. health care providers, the VA has a near-lifetime relationship with its patients.  This, in turn, gives it an institutional interest in preventing its patients from getting sick and in managing their long-term chronic illnesses effectively.  If the VA doesn’t get its pre-diabetic patients to eat right, exercise, and control their blood sugar, for example, it’s on the hook down the road for the cost of their dialysis, amputations, blindness, and even possible long-term nursing home costs.  Unlike the vast majority of American health care providers, the VA also has no incentive to perform unnecessary surgery or redundant tests.  Where other health care providers make money by treating patients, the VA makes money by keeping them well. 

However, several pivotal questions remain that Longman has not addressed. 

Is health insurance the same as auto insurance?  While Vista depends on compelling all Americans to purchase health care in a manner similar to auto insurance, some would argue that access to health care and access to a private motor vehicle are not comparable.  Health care is a basic human right, while driving is a luxury or privilege at best.  Certainly those who choose to purchase a car can factor in the costs of insuring their vehicle against damage.  Unfortunately, the same is not true for the 28.5 million children currently living in poverty or for the 47 million Americans who currently find themselves uninsured.    

Is the same access appropriate, or affordable, for every American?  The Vista model makes central questions of competition and variety.  Although it would be attractive to believe that a truly comprehensive, limitless benefits package should be accessible to every American, it is also unrealistic.  How can the Vista model for universal coverage be tailored to still provide the variety necessary to make it universally appealing? 

What role will employers play?   Currently, the majority of individuals receive their health care through employers.  Although this contributes to the rates of those who are uninsured – since the majority of those without coverage are only uninsured while looking for a new job – employers have a vested interest in the health of their employees and should therefore shoulder some of these costs.  If Vista proves an attractive plan, employers may stop offering private insurance, leaving taxpayers to shoulder more of the costs of providing health care, in the form of government entitlements. 

Can Vista be solvent in an initial rollout?  As proposed, Vista would start by providing insurance just for the uninsured.  In this scenario, its risk pool could be its downfall.  The uninsured are often higher-cost patients than the insured.  If Vista starts by enrolling the sickest patients, it will struggle to break even. The VA system provides high-quality care to a large proportion of our nation and has spearheaded major innovations in health care IT and quality improvement.  Ultimately, there may remain significant benefits to widely disseminating the skills and experience gleaned through the VA.  However, before such a model can be implemented, Longman has a lot of questions left to answer. – Marie-Adele Sorel, Program Associate & Lonny Stern, Communications Director