If Education Were Like Healthcare

Medicine and education are both professions funded largely by the government for the public good, but with very different structures for billing and professional compensation. What would schools be like if they operated like medical clinics?

Teachers would be paid not for their time or their performance, but for the number of tests and activities they conducted. Publishers would spend billions of dollars advertising their assessments and instructional materials directly to families, urging them to ask for specific materials to be used in their child’s school.

These two factors – compensation and advertising – would lead to an explosion in the number of exotic and experimental practices and interventions used in schools. Students would often be given redundant assessments in an effort to do everything possible to inform their education (and drive up their bill).

Families could sue teachers if their children failed to meet standards, and teachers would have to take out malpractice insurance. These liabilities would rapidly drive up the cost of education.

Lawyers would appear in TV commercials offering to sue schools for failing to successfully educate students, and huge verdicts against teachers would drive up the cost of malpractice insurance and drive some teachers to leave the profession.

Students would not be guaranteed an education; they’d have to have school insurance. However, students could get emergency tutoring if they’re in a desperate situation, but no day-to-day schooling. If students were unable to pay for the services they receive, the school could sue them to recover its tutoring costs, leading many families to bankruptcy.

Wealthy families would have better insurance which would pay for elite private schools, and would grumble about free handouts to uninsured students.

Teachers would be able to create specialty education clinics, and refer students to expensive educational services provided by branches of their own clinics. For example, if a student failed to learn to read, they could be referred for an expensive evaluation and intervention services, all of which would be paid by the school insurance. Some teachers would become extraordinarily wealthy in private practice, while others would continue to work for paltry salaries in public schools. Demographers would note the shortage of the latter, especially in urban and rural low-income communities.

Instead of two or three secretaries per school, we’d need a dozen or more to handle all the insurance claims – after all, the school-insurance companies would have to pay for all the lessons, tests, tutoring, field trips, lunches, supplies, and other costs associated with schooling.

Teachers would use computerized inventory and service-tracking systems to bill students and their insurance for every pencil, every trip to the bathroom, every sip of water from the water fountain, every handful of Goldfish crackers, every tissue, and every Band-Aid.

Schools would continue to buy supplies in bulk at low prices, but would impose a substantial markup in order to cover the cost of supplies for uninsured students. It wouldn’t be uncommon to bill $3.50 for a Band-Aid or $7 for a pencil. Using a chair and desk would be $150 a day, not including the use of space in the room (another $300).

While students would continue to be taught in groups, they’d be billed individually for the educational services they received. Teachers would continue to assess students’ prior knowledge, build on this knowledge to introduce new concepts, reinforce students’ understanding through guided and independent practice, and assess students’ mastery.

Each stage of this teaching and learning process would be a separate billable professional service, and students who ask questions or ask the teacher to check their work will have this noted in their bills. Each paper graded would incur a flat fee; a skilled teacher could generate thousands of dollars per hour in billable work.

The cries for education reform are frequent and loud, but the current national debate on healthcare reform offers us the rare opportunity to reflect on the strengths of our education system compared to other complex social and professional service systems.

Comments on education, healthcare, and the similarities and differences between them are welcome.

Alvin Toffler on the Future of Education

In this article at Edutopia (also PDF), Alvin Toffler, ever forward-thinking, offers his radical vision for the future of education. He says, not surprisingly, that our system was created to prepare children for employment in the industrial age, an age that has long since passed.

While the Washington Office of the Superintendent of Public Instruction has discussed “personalizing education,” Toffler sees far more structural and systemic imperatives for personalizing education:

Toffler: New technologies make possible customization in a way that the old system — everybody reading the same textbook at the same time — did not offer.

Edutopia: You’re talking about customizing the educational experience.

Toffler: Exactly. Any form of diversity that we can introduce into the schools is a plus. Today, we have a big controversy about all the charter schools that are springing up. The school system people hate them because they’re taking money from them. I say we should radically multiply charter schools, because they begin to provide a degree of diversity in the system that has not been present. Diversify the system. link

Personalizing education, especially at the high school level and beyond, is a great idea. Ever the radical visionary, Toffler says we need to “shut down the public education system” in order to fix it. Logistically, however, Toffler’s proposals would require us to not only rethink public education, but the structure of life and work in our society. His vision of schooling:

  • Open twenty-four hours a day
  • Customized educational experience
  • Kids arrive at different times
  • Students begin their formalized schooling at different ages
  • Curriculum is integrated across disciplines
  • Nonteachers work with teachers
  • Teachers alternate working in schools and in business world
  • Local businesses have offices in the schools
  • Increased number of charter schools

Proposals such as Toffler’s often fail to differentiate between reforms needed at the elementary, middle, and high school levels. For example, personalized paths to college and/or work may be a meaningful goal for high schools to pursue, but how would this benefit elementary students?

While it’s possible that more flexibility and freedom could result in better outcomes for students, it’s also possible that removing any of the standardizing forces (such as fixed arrival times and entry ages) would, in a system with 47.7 million students, lead to more chaos rather than personalization.

Mr. Toffler is correct that our education system was designed to serve an industrial-age society. As such, it is highly efficient, with relatively high student-to-teacher ratios. While affordable, these ratios do not correspond to norms in the world of work. Consider, for example, that a manager in corporate America would never be expected to have 150 people reporting directly to her – yet millions of middle and high school teachers have this many or more students for whom they are directly responsible each day.

Mr. Toffler is also correct that our schools are not working for a large number of students. However, it’s easy to lose sight of the fact that they are working for many more. While we need many more alternative schools to help meet the needs of all students, we don’t need to remove the benefits of traditional schools from students who are thriving in our system.

Any radical restructuring of public education must take two mandates into consideration:

  • The need to educate all children
  • The need to operate on a realistic budget that society can sustainably provide

Making secondary schools more like colleges could help some students, while it would surely allow others to slip through the cracks. Making schools more like company offices could better prepare students for the world of work, but it would also be orders of magnitude more expensive.

Perhaps the question of funding will eventually resolve itself, if society comes to see the payoff of quality education.

Edutopia: You’re advocating for fundamental radical changes. Are you an optimist when it comes to public education?

Toffler: I just feel it’s inevitable that there will have to be change. The only question is whether we’re going to do it starting now, or whether we’re going to wait for catastrophe.

Read the full article at Edutopia

Educating the Whole Child in a Standards-Based World

There is no question that standards matter. After high school, students will be expected to know and be able to do certain things as responsible members of a democratic society. Every state has standards, and NCLB mandates regular testing to determine how many students are meeting those standards.

In our high-stakes era, test scores matter a great deal, probably far more than they should. If the tests are good predictors of future success, we can safely assume that higher test scores are good, and lower test scores are bad. But we want to develop many desirable traits in our students, only a handful of which are measurable.

Schools in Texas have taken a rather blunt approach to raising test scores: preparing students directly for the test through drills and direct exam-preparation activities. Texas has drawn a great deal of criticism for its narrow focus on tests, though some schools have also been hailed as successes for raising their scores.

But what if there were a better way to raise test scores (which matter), in a way that also develops other traits that matter (but can’t be measured by standardized tests)? Montessori schools are doing just that, according to a recent study:

Montessori education is characterized by multi-age classrooms, a special set of educational materials, student-chosen work in long time blocks, a collaborative environment with student mentors, no grades and tests, and individual and small group instruction in academic and social skills. More than 5,000 schools in the United States, including 300 public schools, use the Montessori method, according to background material for the study.

A Montessori education creates solid citizens who perform at least as well academically — and sometimes better — as their public school counterparts.

…Montessori children also responded much more positively to questions like “people at my school care about each other.” And they felt more positive about school and their peers, and about their school as a community.

In addition, all the Montessori children responded to social problems in a positive, assertive way, Lillard said. Take the example of a child cutting in front of another child in line. The Montessori-trained children were “more willing to confront positively compared with the public school children who were more likely to ignore it or engage in retaliatory behavior,” she said.

When tested on academics, the Montessori 5-year-olds scored better on early reading and math than did their counterparts, and the 12-year-olds did as well as the traditional school children. link

Pressure to improve performance can be a good thing. Principals and teachers can be motivated, to some extent, by accountability requirements like those in NCLB. But too much pressure can result in a shifting-the-burden dymanic, in which test scores are improved at the expense of other, more desirable student characteristics, such as enjoyment of literature and divergent critical thinking.

We need to see standardized tests as diagnostic tools that tell us what to work on, and look for broader measures of school performance. We need to develop tests that predict more than a student’s socioeconomic status – tests that are valid indicators of what a student knows and can do. Only when we have this kind of assessment and accountability system will we create the positive pressure that will drive the kind of education system we want our children to have.

Previously: “Bubble Kids” and Dilemmas of Accountability

Gates Foundation Small Schools: Success, Failure, and Lessons Learned

BusinessWeek describes the first six years of the $29 billion Bill & Melinda Gates Foundations’ efforts to reform troubled high schools:

After gathering a team of experts, they decided to focus on high school dropouts, the 20% to 30% of teens who fail to get a degree in four years. The foundation embraced what many social scientists had concluded was the prime solution: Instead of losing kids in large schools like Manual, the new thinking was to divide them into smaller programs with 200 to 600 students each. Doing so, numerous studies showed, would help prevent even hard-to-reach students from falling through the cracks. The foundation didn’t set out to design schools or run them. Its goal was to back some creative experiments and replicate them nationally. “I thought, if you get enough of these going across the country, people will realize they’re good, and more and more will pop up,” says Melinda Gates, who devotes several hours a week to education philanthropy.

Six years and a steep learning curve later, the Gateses see just how intractable are the many ills plaguing America’s worst schools. It has been a difficult, even humbling experience. Melinda Gates says she and Bill didn’t realize at first how much cooperation it would take from school districts and states to break up traditional big schools. “If you want to equate being naive with being inexperienced, then we were definitely naive when we first started,” she says. “There are a lot of places where many people have given up, or decided that ‘bad schools are not my problem.’ There are also a lot of entrenched interests.” read more

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