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Can public education help us find answers in health care?

I’ve recently been struck by how similar the incentives for performance are between health care and education systems. Using a Newsweek article from 6/6/09 (http://www.newsweek.com/id/200896), I’ve drawn out these rough parallels:

Challenges:

  • “…the Blob, the collection of educatocrats and politicians who claim to support reform but remain fiercely committed to the status quo.” Hmm, let’s see; that would be…the AMA, the insurance industry, pharmaceutical companies, and the entire Republican party?
  • “The widget effect,” in which teachers are “viewed as industinguishable widgets…indifferent to variations in…performance.” Teachers’ unions say it’s “nuts to judge teachers on whether there’s evidence that shows improvement in their classrooms.” As a result, funds tend to get spread eveningly “like peanut butter,” instead of based on innovativeness or outcome. Similarly, the AMA effectively demands payment for merely performing procedures, regardless of whether or not they contribute to the patient’s well-being.
  • Weak congressional leadership and attaching strings that ask merely for “making progress [and] improvement” instead of meeting standards. As we speak, several health care bills are being tossed around on Capitol Hill; options are debated and traded. Will we end up with a bill that is politically pleasing but is so incremental and fragmented that it will only plunge our health care system into further chaos?

Opportunities:

  • “[Obama and his education secretary] understand that the key to fixing education is better teaching, and the key to better teaching is figuring out who can teach and who can’t.” It’s long past due that we apply the concept of pay for performance, which makes so much sense in other contexts (why would we keep paying for a service that we’re not satisfied with?), to health care. We need to stop incentivising large quantities of care, and instead reward quality.
  • Obama and his administration have “leverage over the education industry to impose teacher-effectiveness standards.” In the case of one district, this means “billions in stimulus money and Title I aid for poor schools.” For starters, the HITECH act dangles $19 billion dollars in front of hospitals in exchange for implementing EMR systems that demonstrate “meaningful use.” If the health care bill passes with a public plan, it will bring >$10 trillion dollars into the health care market in the next decade, which can be used to impose quality standards. (Of course, in health care, as in education, a debate would follow about what standards should be used, but that’s a topic for another time.)

So what’s happening in public education?

If we follow the logic of these endeavors to improve public education, it seems that what we need in health care is courageous leadership, monetary leverage, and a system to accurately assess quality outcomes.

This is a very limited comparison, and a lot more innovation is going on in education than I know about. But I’m sure if we looked even deeper, there’s much to borrow from how the education industry is dealing with its quality problem.