A Brighter Tomorrow
With the country facing enormous challenges and few solutions in sight, we convened a Diablo Think Tank to ask some of the brightest minds in the East Bay a not-so-simple question: How do we fix it? Here’s what they said.
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Expert on Health Care
Senior VP, Kaiser Permanente
Jerry Fleming is leading the coordination of health-care reform for Kaiser Permanente, and is the 2011–12 board chair for the California Association of Health Plans.
If you were to design a health-care plan for the 21st century, what steps would you take?
We have these two very difficult trends, one of which is that health-care costs are going up much faster than the rate of inflation. At the same time, the number of people with coverage is dropping. We’re going to have to cover the people that aren’t being covered today, and we have to then have an impact on the trend of health-care costs.
Whether you’re employed or not employed, there has to be a way that you can get coverage. In order for that to happen, there has to be an available level of subsidy for people who are not employed or maybe if they’re self-employed.
There is a mix of actions taken in the Affordable Care Act that, when implemented, does largely accomplish that coverage. It establishes new rules around what health plans can do in terms of their enrollment processes; it then has an individual mandate, which requires people to pick up coverage. And then for those who cannot afford it, it provides subsidies through an exchange, a marketplace where people get to compare plans.
OK, now how do we make coverage more affordable?
The major source of the cost of the health plan premium is the actual cost of health care. You’re going to have to figure out how to lower the cost of care.
Care is a team sport. It’s often complex; it involves lots of different professionals in lots of different kinds of settings. However, if you look at health care, you’ll find that it is often not organized like that. There are lots of individual practitioners out there who don’t have a common information source, so the patient has to glue these things together.
The way, in general, providers are paid for in our country is fee per service. Most of the folks practicing get a fee for each service. And the incentives should really be about getting you healthy: preventative care.
[So,] you change the payment system to be oriented toward episodes of care or fixed payments for somebody’s coverage. And then you save money by keeping people healthy.
The other thing that’s driving costs up is, collectively, our health status is deteriorating because we are becoming a much more sedentary population. … This is about healthy lifestyles, about [our] communities: Do they facilitate being able to get exercise?
So, to sum up ...
It’s not an easy problem to follow, and remember, it’s 18 percent of the economy. But it really does come down to evolving the way that [health-care professionals] work together for our patients, and for the patients themselves to be better informed about their own health and about the providers they go to.
Expert on Education
Professor, saint mary’s college
Phyllis Metcalf-Turner is the dean of the Kalmanovitz School of Education at Saint Mary’s College. She knows the education system inside and out, from teaching special education in Detroit Public Schools to overseeing nationally accredited teacher education programs.
Our economy is struggling, and public education seems to be the place cuts always come from. Can this continue?
If we do want our country to advance and move up from the 26th place that we’re currently rated on the world scale in terms of our students’ achievement in school, then we’re going to have to invest in education as we once did. And it starts with paying teachers what they’re worth.
I think they cannot be as expendable as we’ve treated them in the past—meaning that the minute we have budget woes, we want to slice and dice K-12 education, and nowadays, it’s going all the way up to 13–16. We’re making it almost impossible for people to seek advanced education beyond high school.
The issue of how we evaluate our teachers has been a contentious one. Where do you stand?
We know that America probably has the most diverse educational system in the world, in that we allow all kids to go to school, and our job is to accommodate them. And that means, when you start talking about evaluating a teacher’s effectiveness, taking into account the variables those kids brings to the classroom. I don’t know that there’s a magical pill or a magical test, but I will tell you, it’s more complex than previously imagined.
I think our job ought to be more focused on helping all teachers be effective, rather than trying to identify their limitations or weaknesses, and then excising them. … We already knew that we were hard-pressed to produce the number of teachers needed to meet today’s public school and private school classroom needs. So given that, how can we only look at an approach that talks about getting rid of teachers?
So, who should be in charge of teacher evaluation?
We have to have teachers, administrators, teacher educators—meaning higher ed types—as well as policy people. Definitely parents as well. You’ve got four or five demographics that need to be represented to come up with an instrument or approach to evaluate teachers.
I think ultimately we would want something agreed upon at the national level, as long as you understand that in America, we allow our states to operationalize that according to their unique characteristics.
“How can we only look at an approach that talks about getting rid of teachers?”