Murder Most Foul

 

The CEO of UnitedHealthcare, Brian Thompson, was shot in the back and killed while walking to a shareholder meeting on December 4. The alleged assassin was apparently enraged by the private health insurance industry—in a note, he called the executives “parasites” who “had it coming.” Insurers too often deny coverage for medical procedures (United denies 17%, the industry’s highest), policy provisions are complicated to navigate, and coverage is both expensive and remarkably profitable.

The murder was shocking and so has been the widespread sympathy for the alleged killer expressed on social media and in opinion surveys. Clearly, many people are so deeply unhappy with American healthcare, especially with private health insurance, that a cold-blooded killer seems to have become something of a folk hero. 

The Organization for Economic Cooperation and Development ranking of 2022 per capita healthcare costs (in U.S. dollars) has the U.S. first at $12,555 followed by Switzerland at $8,049, Germany $8,011, Norway $7,771, Austria $7,275, Netherlands $6,729, France $6,630, Belgium $6,600, Sweden $6,436, our neighbor Canada $6,319, and so on in descending order. The most popular healthcare among its citizens is Finland’s at $5,599. “We’re number 1” in spending is nothing to cheer about, certainly not when that spending buys something widely unpopular.

Health insurance is a profitable business. United, the nation’s largest insurer, made $16 billion in profits in 2023, a 33% increase from 2021, and CEO Thompson was paid $10.2 million in 2023. United’s parent company, UnitedHealth Group, earned 25.9% per shareholder-dollar from 2019-2023, much more than the average 17.9% for all companies in the S&P 500. As one doctor put it, “Today, medicine is awash in the language of economics. Patients are consumers; doctors are providers; health care is a commodity.”

For seniors, United and others offer Medicare Advantage, which often include dental and vision coverages that regular Medicare lacks. Private insurers have learned to game Medicare, which pays a fixed amount according to how many caregiver visits a patient makes. United now encourages doctors to compete: those who diagnose the most conditions in Medicare Advantage patients are eligible for $10,000 bonuses. A nonpartisan Congressional advisory commission estimates private Medicare Advantage plans cost taxpayers $80 billion a year more than regular Medicare. 

Even so, insurance profits are only part of the reason U.S. healthcare is more costly than elsewhere. High prices charged by healthcare providers and high administrative costs are just as important, according to Peterson-KFF (formerly the Kaiser Family Foundation). Private equity firms have bought hundreds of hospitals nationwide and profited from skimping on patient care, staffing, and facility upgrades. 

And increasingly, insurers don’t just insure. UnitedHealth’s Optum is the nation’s biggest employer of physicians, and its OptumRx pharmacy negotiates prices with drug makers (and is being sued by the Federal Trade Commission for anticompetitive practices that artificially raised insulin prices).

How can we fix our healthcare? Shooting executives is never the answer. The answer is to copy the best of what other countries do. There’s a job for Elon Musk’s proposed Department of Government Efficiency (DOGE). The Constitution says the “general Welfare” is one of government’s fundamental jobs, and what is more important to the general welfare than healthy citizens? For all his oddities, Musk has led the global shift to electric vehicles and to commercial reusable rockets. Perhaps he could envision a more efficient and less costly health system serving every American with no loss in quality of care. 

 

       

                            Supreme Court 

             Strikes Out

 

Imagine you’re at Kauffman Stadium to watch the Royals play the New York Yankees. The game is about to start as the umpires walk onto the field, but instead of wearing their usual dark uniforms, they’re in Yankee pinstripes. You suspect that balls and strikes might not be called fairly.

Supreme Court Chief Justice John Roberts has described the Court’s job as “calling balls and strikes,” which should mean not favoring any partisan positions, but for the Roberts Court, this often is not the case. Of the nine Justices, five, often six, heavily favor Republican causes or individuals.

The most recent instance is the June ruling in Trump v. United States conferring on former presidents immunity from prosecution for crimes committed as part of official duties. All six conservative justices—three appointed by Trump—signed on to the ruling (one with reservations), while the other three dissented. Part of Justice Sotomayor’s dissent said, “The court effectively creates a law-free zone around the president, upsetting the status quo that has existed since the founding.” So ends the cherished American tradition that no person is above the law.

The immunity case is the latest in a series of controversial rulings with little Constitutional basis or Court precedent: ending women’s right to make reproductive decisions, declaring that “corporations are people” entitled to nearly unlimited political contributions, striking down state and local laws regulating guns in public, limiting the ability of agencies like the FDA and the EPA to regulate in areas of their expertise—all rulings favored by the GOP. It’s no wonder that only 1 in 3 Americans trust the Court, an all-time low.

Bias isn’t the only problem. Justices Alito and Thomas have serious ethical issues. Thomas has been treated to expensive vacations by wealthy conservative Harlan Crow who also paid private school costs for Thomas’s great-nephew, none of which was reported as required. Crow donated large sums to organizations filing briefs before the Court, one of which has Thomas’s wife as a trustee, an obvious conflict of interest, but Thomas has refused to recuse himself from the cases.

Shortly after the deadly Capitol attack on January 6, 2021, Justice Alito’s home flew an upside-down U.S. flag, a symbol of election deniers; later, a flag favored by hard-right extremists appeared at his beach house. Alito blamed his wife, an activist involved in the January 6 episode, and indicated he will not recuse himself from relevant cases. He also failed to report an Alaska fishing trip by private jet with a billionaire GOP donor.

Two of the Court’s conservatives owe their seats to Republican Senate Leader Mitch McConnell who, in 2016, refused to allow a vote on an Obama nominee “because it was an election year” even though the election was nine months away and the Senate had a duty to vote. Trump eventually made the appointment. In 2020, a vacancy occurred six weeks before an election and McConnell changed his own rule and hustled another conservative through a quickie conformation. 

To rebuild confidence in the Court, President Biden has proposed three reforms: a “No One Is Above the Law Amendment” to the Constitution, staggered term limits of 18 years, and an enforceable code of ethics (as in all other federal courts). An amendment is difficult, requiring broad bipartisan support, and term limits might also require an amendment. An ethics code requires only Congressional and presidential approval.

Vice-President Harris has endorsed the Biden reforms. GOP Speaker of the House Mike Johnson has called them “dead on arrival.” 

We the People can save them by electing reform supporters to Congress and the presidency. Court reform is one of many compelling reasons to be informed and vote in the coming election. 

 

Capitalism for All

Imagine you have a pile of money, and you’d like to have a bigger pile. You learn that the Widget Company has invented a better widget, so you buy shares of Widget stock. The company uses the capital you’ve invested to produce the new widgets. They sell like hot cakes, so more workers are hired, profits roll in, and the value of the stock you own rises. You and the company are richer, more people have jobs, and consumers have better widgets. This is capitalism in action, and so far, so good.

Now imagine that because you’re a big investor who knows how to make a buck, you’re elected to the Widget Company board. You now have a voice in decisions including what to do with the company’s growing profits. Raise your workers’ pay? Upgrade your factory with better machinery? Buy out a competitor so your company will have more of the market? Give larger dividends to investors, including yourself? These are tough decisions, but that’s why you and the company executives make the big bucks.

What to do? You’re a capitalist, after all, so you naturally believe that investors who’ve risked their capital on the company are entitled to first dibs on the profits. They, and you, are in it for the money, so stock dividends and high share prices are top priorities. 

To keep investors happy, you think about how to increase company profits by reducing costs and/or increasing productivity. How about automation? Robots are expensive, but they’ll never want raises, never organize a union to get them (except in science fiction when robots finally become smart enough), and can work 24/7 without tiring. Automation is often a no-brainer.

Other ways to reduce costs include avoiding those tiresome government regulations that require your factory to not foul the air and water and to be a safe workplace for employees, and to avoid taxes in every legal way possible. To dodge these obligations, the company pays lobbyists and contributes to politicians who favor deregulation, restrictions on unions, and lower corporate taxes (and, not coincidentally, lower taxes on wealthy people like yourself). 

Now, forget your imaginary pile of money and consider where capitalism has taken us in this tale. It’s no longer “so far, so good.” It’s too far and too bad for workers who get last dibs on company profits and for all taxpayers who have to make up for what corporations and the rich don’t pay (and some pay no income taxes at all).

Perhaps worse in the long run, the conservative Supreme Court ruled, in 2010, that, as Mitt Romney put it, “corporations are people” entitled to make unlimited political contributions. This gives the small corporate class enormous political clout. It’s extreme capitalism—a beautiful system if you’re one of those few but a deck stacked against you if you aren’t. 

Capitalism is a great engine of prosperity, but without strict regulation and a progressive tax structure, it’s an engine with no train. People who help make the everyday economy work—nurses, truckers, teachers, builders—are left at the station. A healthy economy is a balancing act between private profits and the public good. Today, our economy is unbalanced and unhealthy.

Here’s the cure: We want wealth to flow to the many, not just to the few, so channel excessive wealth to essential public services like education, healthcare, and infrastructure. That’s how we created Social Security, public schools, Medicare, and the original G.I. Bill. It’s how we can provide affordable college/tech schools and universal healthcare. Also, ensure workers have a level playing field by protecting their right to organize and to have significant representation on corporate boards as many other rich capitalist countries do. 

The greedy will no doubt call this cure—or any cure—“socialism.” I call it having a social conscience. It’s capitalism that works for We the People.

When Schools Went Wrong

Sherlock Holmes called public schools “Lighthouses, my boy! Beacons of the future! Capsules, with hundreds of bright little seeds in each, out of which will spring the wiser, better England of the future.” Americans have cherished similar hopes but have too often been disappointed, leading over the past century to a series of school reforms that shaped today’s schools—for better and for worse.

Historians trace much of the “worse” to a small red pamphlet published in 1918, Cardinal Principles of Secondary Education, that called for replacing, for most students, the traditional European liberal arts and sciences curriculum with seven student goals: health, command of fundamental processes, worthy home membership, vocation, citizenship, worthy use of leisure, and ethical character.

The reform’s purpose was to keep more youngsters in school by making it easier and more immediately practical. Academic subjects like history, biology, and algebra would remain as a parallel track for the fewer than one in ten who were college-bound. For the majority, social studies replaced history, geography, economics, and government; general science replaced biology, chemistry, and physics; and practical math and language arts covered “fundamental processes.”

The Cardinal Principles was composed by a committee of the National Education Association chaired by a manual training teacher and including administrators and a professor of education. The authors were driven by the need to assimilate millions of immigrant children, many knowing no English and with little experience of democracy, by the demand for industrial workers, by severe health and social problems including the deadliest influenza epidemic of modern times, and by fear of political unrest in the wake of the Great War. The business community applauded the emphasis on vocational training and lobbied states to adopt the new goals. Over the next decade, they became the norm in much of the country.

The shift from mastery of academic subjects to what reformers saw as meeting children’s “needs” was politically popular. Teaching kids hygiene, marketable skills, and citizenship was hard to criticize, especially when it made success in school easier. Parents liked their children succeeding, and politicians and business leaders liked that such studies made it easier—and cheaper—to train and hire teachers.

The academic community opposed the Cardinal Principles, so much so that schools of education became intellectually divorced from the universities of which they were a part. Teachers became increasingly isolated from scholarship in arts and sciences disciplines. Thousands of experienced teachers resisted the reform, and many were fired.

Making matters worse, the trauma of the Great War led America to adopt an isolationist attitude through the 1920s and 30s. Why bother with the rest of the world and its troubles when the U.S. could withdraw behind its moat of oceans and rely on its own plentiful resources? This further distanced schools from fertile centers of serious thought in Europe and elsewhere. One result that troubles us still was that many fewer students learned foreign languages.

While other countries were improving schools with added rigor and sharper focus on academic disciplines, America chose to ask less of its students and teachers. This continued through the 1950s when complaints about semi-literate graduates and the shock of Sputnik prompted a new round of reforms with increased academic content.

Cardinal Principles had some positive results, recognizing the importance of motivation and of children’s developmental stages among them. But its low expectations and short-term goals in place of deep knowledge and disciplined thinking poisoned American schools for decades. To some degree, it still does. The Sputnik reforms of the 1960s, the Nation at Risk reforms of the 80s and 90s, No Child Left Behind, and now the Common Core have all been attempts to right the wrong course our schools took after 1918. History matters.

Schools Travel a Bumpy Road

As described in the previous column, American schools were harmed for decades by low student expectations and shallow curriculum prompted by the 1918 booklet Cardinal Principles of Secondary Education. Recovery began in the 1950s, thanks partly to World War II veterans who had noticed a higher level of education common in Europe and whose own expectations had been raised by G.I. Bill college study. Too, a best-selling book, Why Johnny Can’t Read, helped focus the nation’s attention on the troubled schools.

But just when a drive to enhance academic offerings was gathering steam, schools were overwhelmed by the postwar baby boom. Thousands of new schools were hurriedly built and new teachers hurriedly trained. States and school districts had all they could handle coping with expansion; academic quality took a back seat and fewer than two-thirds of students finished high school.

The 1957 launch of the Soviet Sputnik I satellite shocked America. The Eisenhower administration and Congress pumped millions into upgrading curricula, classroom equipment, and teacher training, especially in math and the sciences. New textbooks were written, including a biology text so good that updated versions are still used today. History and other subjects were emphasized as part of what came to be called “Sputnik reforms.”

With The Sixties came two of the schools’ greatest successes: supporting national efforts to ensure minority rights and women’s rights. Schools came to be judged by their “holding power” and graduation rates improved significantly. As desirable careers beyond teaching, nursing, and secretarial work opened to educated women, schools did their part. When I graduated in 1961, able girls interested in healthcare were counseled into nursing; when I returned as a teacher eight years later, many were aiming to become physicians.

Ironically, these successes hurt schools. A well-intentioned desire to keep kids in school led to fragmented curriculum in the name of “relevance” and to “social promotion” regardless of learning, both of which discredited schools in the eyes of the public and especially of employers. Financially attractive career opportunities meant the loss to teaching of many of America’s brightest women who had long formed the backbone of school faculties.

Soon, falling test scores (partly due to students from deeper in the talent pool taking ACT and SAT tests) and the post-Watergate suspicion of all things government led to another wave of school criticism. A 1983 blue-ribbon commission report, A Nation at Risk, asserted "If an unfriendly foreign power had attempted to impose on America the mediocre educational performance that exists today, we might well have viewed it as an act of war."

The authors called for a longer school year on a par with other developed nations, more academic course requirements, higher student expectations, making teaching a more attractive career, and much else. A Nation at Risk became the most influential call for reform since 1918 and led to needed improvements, though mostly the least expensive.

The No Child Left Behind law of 2001 wasn’t a “reform” as much as an effort to make schools accountable by publicizing test scores in basic skills. Funding was inadequate and one lasting effect was to focus attention on math and language skills at the expense of other learning. Relentless testing soon made it unpopular.

Now comes Common Core, a promising effort begun by nearly all state governors to raise achievement nationwide to global standards. It’s a complex project criticized by many educators for having too much input from for-profit corporations, but promising nonetheless.

Sadly, the Kansas Senate recently voted to not fund Common Core implementation. Any hint of nationwide standards offends conservative ideology, for many senators a higher priority than student learning. I suspect that if Eisenhower’s Interstates were proposed today, Kansas conservatives would object: roads, like schools, convey outside ideas and tie the state to the larger world. Risky business, no? No.

Spying on Schools

Searching for the secrets of high-achieving schools, and aware that inside information is hard to come by, journalist Amanda Ripley (Time, The Atlantic) recruited spies—American exchange students from schools in Oklahoma, Minnesota, and Pennsylvania—who attended ordinary high schools in Finland, South Korea, and Poland, countries where students do exceptionally well on international measures of learning. The result is Ripley’s recent book The Smartest Kids in the World and How They Got That Way (Simon and Schuster, 2013).

Much writing about schooling has adult political agendas that detract from achievement issues. Ripley’s book is an exception: a secret agent story where the spies—Kim, Eric, and Tom—are normal teenagers alert to the attitudes and behaviors of their overseas classmates and refreshingly open to comparing their exchange experiences with those of their hometown schools.

Kim’s story is especially compelling. A bright girl from Oklahoma, she yearned for a bigger, more promising world. Her local school had limited curricula, low expectations, a vague focus on academics, and little encouragement from the state legislature. Three times, legislators mandated student achievement standards and tests—routine in high-achieving countries—and three times, legislators backed off at the last minute fearing criticism of poor test scores.

Kim’s school district was one of 530 in Oklahoma and, with only four schools, had ten district administrators and directors as well as principals. Ripley calls this “hyperlocal control, hardwired for inefficiency.” Costly, too.

Kim’s modern high school was not hardwired for scholarship. Its “jewel” was the basketball court, not the library or science labs. Parents were involved in booster clubs and the PTA, but in little related to academic achievement. The principal told Ripley his biggest problem was “expectations.” He said they were “too high.” Really? Half the graduates went on to Oklahoma’s public colleges, but more than half of those were placed in remedial classes.

Kim, Eric, and Tom studied overseas in 2011-2012. Through thousands of emails and phone calls as well as on-site visits, Ripley picked the brains of her spies and their friends and met with school officials and testing experts here and abroad. She found some things much the same here and there, including electronic youth culture. Schools, though, were dramatically different.

The most obvious difference, in every country, was a total focus on academic learning. Schools had no other purpose. Sports and other activities were mostly outside school, sponsored by community organizations.

The spies found less testing overseas, particularly in Finland, but the major nationwide tests were serious business. Students studied for months, and scores could determine their future learning and career opportunities. In South Korea, airports rescheduled flights to avoid jet noise near schools on test days.

Teachers in host countries were drawn from the top of the talent pool, rigorously trained (often at public expense) and influential. Teaching was a prestigious profession.

In no subject were differences as clear as in math. Math is critical as a system of logic that trains young minds to think straight, not to mention as the key to the sciences and to desirable careers. As early as third grade, American kids have easier math assignments then lose time every fall reviewing what they’ve lost over their long summer breaks. More than other subjects, math builds on what is learned before, so early weakness compounds with time.

The overseas students overwhelmingly attributed success to hard work, not to inbred talent as  Americans tend to believe.

Host schools used little technology compared to schools here. No interactive white boards, no “clickers,” often no calculators.  

The New York Times calls Ripley’s a “masterly book,” but wonders if it “can also generate the will to make changes.” It can only if concerned citizens read it and act on it.

Teachers: Glamour Everlasting

Describing Our Miss Brooks, the popular 1950s TV program starring Eve Arden as a witty, sarcastic English teacher beloved by her students, The Kansas City Star recently noted that Arden portrayed “an intelligent woman in an unglamorous profession.” I suppose glamour, like beauty, is in the eye of the beholder. What could be more glamorous than passing on the wonders of nature and civilization to the next generation while helping them learn to think rigorously and live well, thereby strengthening our country and helping ensure a better future?

I mention this because of the importance of improving our schools. Recent studies of successful school systems around the world confirm what we’ve known all along but haven’t acted on: that teaching in those places is viewed as a glamorous profession or, if not glamorous, certainly prestigious. In the high-achieving countries of East Asia and Europe, teachers enjoy a status similar to that of physicians and judges here. The contrast with the American tradition is sharp, and the negative impact on our children clear.

In How the World’s Best-Performing School Systems Come Out on Top, a two-year study of twenty-five systems including ten of the best, McKinsey & Company, the gold standard of global management consultants, concluded that most attempts to improve low-performing systems—restructuring, reducing class sizes, charter schools, and the like—make little or no difference. What makes a difference is teachers: “The quality of an education system cannot exceed the quality of its teachers.”

All the best-performing systems select teachers from the top third or higher of college students: the top 5 percent in South Korea, 10 percent in Finland, 30 percent in Singapore and others. Most do this by limiting the number of teacher-training slots and admitting only those who score well on tests of literacy, numeracy, and problem solving, and who demonstrate outstanding communications and interpersonal skills. (In Finland, only one in ten applicants is admitted.) Once selected, students receive intensive training under master teachers, often at public expense including paid internships.

Such careful selection and early rewards elevates respect for teaching and helps attract the best applicants. Top countries also sweeten the pot by paying beginning teachers roughly equal to the average of other demanding fields. In addition, top-performing systems typically have strong teacher unions with a major voice in school standards and operations.

In America, prospective teachers tend to come from the lowest third of college students. Admission standards to teacher-training programs are generally low, tuition is high, internships are short and unpaid, and beginning salaries below average. The inevitable result is the Star’s “unglamorous profession” where thousands who train to teach never do and nearly half of those who do teach leave within five years. Aside from the waste of public resources and of these graduates’ investments, the public perception—and children’s perception—is that teaching—and, therefore, learning—isn’t important; it’s seen as a job for those with few other options.

Compounding the error, politicians in some states have been cutting school resources, attacking teacher unions, and insisting that teachers be accountable for better results while paying no attention to the compelling evidence for how to get those results. We need good teachers, and we need good politicians to create a system to attract more of them.

February 3, 2012