Health Care v. Education, Part 1

This week’s New Yorker has a great piece on health care costs.  Want to know where the US Gov. spends the MOST money per capita on healthcare?

That would be McAllen, TX in the Rio Grande Valley.  Lat year Medicare spent $15,000 per enrollee there, 2x the national average.

Where the heck did all that money go in a town of about 100,000?  That’s a lot to spend on a few people, after all.

(And, not so by the way, don’t those kinds of numbers remind you of per pupil spending numbers?  Almost $15,000 per pupil in NY, around $8,000 per pupil in CA.  Where, I’m sure you ask yourself, where the heck does all that money go cause I sure don’t see it floating around my school!!!)

So why does McAllen, TX  get so much $$$ from the US Gov.?  Atul Gawande, a doctor and writer, provides  pages of interesting analysis, but the short answer is: because medicine in McAllen is run by businessmen who see patients as ATMs.  The New Yorker has a lovely little picture showing exactly this:

These businesspeople no longer look at patients as human beings with needs and aches and pains but rather as ‘revenue streams’ to be tapped and maximized.

Now medicine should be a relationship between someone who has the knowhow (the doctor) and someone who needs that knowhow (the patient), just like education should be a relationship between someone who has the knowhow (the teacher) and someone who needs the knowhow (the students).  Dr.-Patient.  Teacher-Student.  Pretty simple, right?

Wrong.  What’s happening in McAllen and in medicine generally is that a lot of stuff is getting in between these two endpoints: diagnostic clinics, testing centers, labs, insurance companies, etc.

Not so different from what’s  what’s happening in education.  How many middlemen are there between Teacher-Student?

The horrifying part of the Gawande’s analysis of McAllen is who these middlemen are:  the doctors themselves. Doctors are becoming businesspeople first and care providers a distant second.

One morning, I met with a hospital administrator who had extensive experience managing for-profit hospitals along the border. He offered a different possible explanation: the culture of money.

“In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” he said. But in McAllen, the administrator thought, that percentage would be a lot less.

He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said. They were innovative and aggressive in finding ways to increase revenues from patient care.

It would be as if teachers decided to suck money out of the education system by setting up tutoring clinics, diagnostic labs, testing centers, etc. and charging the government a whole lot of money for them.  If teaching students became a minor part of our days and jobs, and instead tutoring services, catering services, and education products businesses were our main concern and source of income.  (Can we say conflict of interest here?!)

Some teachers are that entrepreneurial, but most aren’t.  In education it’s the Education-Industrial Complex that sucks out the money: consultants, test prep companies, tutoring services funded by No Child Left Behind, George Bush’s brother Neil and his COWs.  There are the construction companies and outsourced cafeterias and the textbook companies and the training companies.  There are all those bureaucrats who double sometimes as consultants.  In short, there’s a vast array of middlemen who do all the ‘business’ of education, raising the cost of education vastly, and inflating per pupil spending numbers that make taxpayers think education really doesn’t need any more funding than it’s already getting.  These are the people who look at students and see ATMs.

For once, it’s better to be a teacher than a doctor.  At least we (mostly) look at kids as kids.

For doctors, according to the article, ATM-vision is spreading.  McAllen is becoming the norm.

And thanks to Allegiant Air, they’re coming our way.

To be continued…

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