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Peter Berger: The fault in ourselves

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Editor’s note: This commentary is by Peter Berger, an English teacher at Weathersfield School, who writes “Poor Elijah’s Almanack.” The column appears in several publications, including the Times Argus, the Rutland Herald and the Stowe Reporter.

I teach analogies to my students. Solving analogies involves statements like “hot is to cold as up is to …” where you have to come up with a word that completes the thought. Arriving at the correct answer requires knowing what all the words mean and recognizing their relationship to each other, which in this case is they’re opposites, which is why the correct answer is “down.”

Analogies commonly involve less familiar words and more complicated connections. Analogies are valuable because they reflect the way people think, in that they require students and the rest of us to identify ideas and articulate their relation to one another. If more of us could better solve analogies, our personal and national thinking wouldn’t be nearly as muddled as it often is.

I include my own thinking.

Anyone who applied for college admission before 2005 knows what analogies are. That’s the year the College Board eliminated them from the SAT verbal exam. The experts felt analogies were too vocabulary-based, an odd complaint to register when you’re talking about a test of verbal ability. This focus on vocabulary purportedly required too many students, especially low socioeconomic status students, to guess too many of their analogies answers.

That, of course, is simply another way of saying that too many students didn’t know enough words. American education’s reflex remedy was to stop expecting them to know as many words.

This plan worked perfectly. Today’s students know even fewer words.

I mention analogies because I’ve several times relied on analogous thinking to point out the flaw in expecting teachers to deliver success for every student. This, in case you’ve missed the last 30-odd years of inservice meetings I’ve been blessed to attend, is precisely what teachers like me are expected to provide – “success for all students, no exceptions, no excuses,” an objective known today in our standards-based world as universal proficiency.

I cleverly compared holding me responsible for a student’s success, regardless of his home life, ability or effort, to holding my physician responsible for my health, regardless of my reckless consumption of booze, tobacco and chocolate eclairs, and my decision to take up permanent residency on my couch.

Case closed. Drop the mic. Perfect analogy.

Unfortunately I was right. It was a perfect analogy. In fact, it was so perfect that the officials who oversee health care in my state, following a nationwide trend, have coincidentally adopted it to guide how physicians will be paid for taking care of their patients. No longer will my doctor be compensated on a “fee for services” basis, meaning he won’t be paid anymore for what he does. Instead, under the new “pay for performance” model, his income will depend on “the quality of his patient’s care” and “the health of the people he treats.” Essentially in practice he’ll be allowed a certain dollar amount to care for me, and any expenses exceeding that amount will come out of his pocket.

In short, pay-for-performance means he’ll be paid based on my performance.

By the way, in another innovation borrowed from the education world, the five-member board overseeing our health care reform consists of a business owner, a lawyer, two finance specialists and an economics professor. If you’re looking for a doctor on the board, you can stop looking. Apparently, including doctors when you’re reforming health care makes as little sense to experts as including teachers when you’re deciding how to run a school.

A first blush, there’s a certain businesslike appeal in paying someone based on results. The problem is not everything operates along business lines. The premise on which health care finance reform rests is that paying physicians based on how much they do induces them to do more so they’re paid more, whether or not the procedures they perform and the tests they order make any sense or do any good.

This fundamental assumption is doubly flawed. First, prescribing physicians, especially primary care physicians, don’t profit from most of the tests they order or from the expensive procedures performed in hospitals. Even more significantly, if you assume that some physicians are unduly motivated by financial incentives so they currently prescribe unnecessary procedures in order to maximize their earnings, you must also concede that under the new system, the same unduly motivated physicians will be incentivized to not prescribe procedures, even if they’re advisable, in order to maximize their earnings. The result will be worse care for people like you and me.

Meanwhile, most physicians, in their efforts to heal and first do no harm, will continue to exercise their best judgment and heed their consciences.

It’s the same for teachers. Most of us are already doing the best we can. Threatening to dock our pay based on our students’ test scores or incentivize us with “merit pay” based on our students’ test scores won’t change how I teach. It also won’t change the critical factors that impede student achievement and that lie outside my control – students’ home lives, ability and effort.

Yes, health care is expensive. Education is expensive. I’m sure there’s waste in health care my physician could detail, just as I could bend your ear with the details of the waste I see every day in education. There’s nothing wrong with prudently working to reduce the cost of either enterprise.

What is wrong, however, is holding anyone responsible for someone else’s performance, whether you’re talking about my physician and me, or me and my students. He should be held responsible for deficiencies in his practice, as I should be called to account for deficiencies in mine.

No one should be or can be accountable for someone else’s irresponsibility. The convenient tendency to confound the two is a reflection of our inflated sense of entitlement, where everything is due me, and our national narcissism, where nothing is my fault or my obligation, and everything can be blamed on someone else.

Clearly, we each can and do suffer valid grievances, some of us more than others. But until we each can recognize when the fault is in ourselves – in our daily lives, at our doctor’s office, at our children’s school, and in our politics – the fault will fester and its remedy will elude us.

Read the story on VTDigger here: Peter Berger: The fault in ourselves.


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