Seeing the fault in ourselves

I teach analogies to my students. Solving analogies involves completing statements like “hot is to cold as up is to ….”

Arriving at the correct answer requires knowing what all the words mean and recognizing their relationship. Since in this case they’re opposites, 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 each other.

If more of us could better solve analogies, our personal and national thinking wouldn’t be 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 lodge against 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 answers.

I mention analogies because I’ve several times relied on analogous thinking to point out the flaw in expecting teachers to deliver “success for all students, no exceptions, no excuses,” known in our standardsbased 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, it was so perfect that officials who oversee health care in my state, following a nationwide trend, have coincidentally adopted it to guide how physicians will be paid.

No longer will my doctor be compensated for what he does on a “fee for services” basis. 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, 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 health care reform board consists of a business owner, a lawyer, two finance specialists and an economics professor.

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 or expensive hospital procedures they order.

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 conscientious efforts to heal and first do no harm, will continue to exercise their best judgment.

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 impediments to student achievement that lie outside my control – students’ home lives, ability, and effort.

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

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.