Solution to Problems in Health Care and Higher Education: Change the Incentive Structures


Vernon Smith, one of the 2002 recipients of the Nobel Prize in economics, advocates fundamental institutional reform:

Physicians and medical organizations face escalating administrative costs of complying with ever more detailed regulations. The system is overwhelmed by the administrative cost of attempting to control the cost of medical service delivery. In education, university budget requests are denied by the states who also limit the freedom of universities to raise tuition.
If there is a solution to this problem, it will take the form of changing the incentive structure: empowering the consumer by channeling third-party payment allowances through the patients or students who are choosing and consuming the service. Each pays the difference between the price of the service and the insurance or subsidy allowance. Since he who pays the physician or college calls the tune, we have a better chance of disciplining cost and tailoring services to the customer’s willingness to pay.
Many will say that neither the patients nor the students are competent to make choices. If that is true today, it is mostly due to the fact that they cannot choose and have no reason to become competent! Service providers are oriented to whoever pays: physicians to the insurance companies and the government; universities to their legislatures. Both should pay more heed to their customers — which they will if that is where they collect their fees.



For the full commentary, see:
VERNON L. SMITH. “Trust the Customer!” The Wall Street Journal (Weds., March 8, 2006): A20.

86% Agree that Government Should Ban Dihydrogen Monoxide

A junior high school student in Idaho, Nathan Zohner, demonstrated in a 1997 science fair project how easy it was to hoodwink a scientifically uninformed public. As described in “The Frankenfood Myth,” 86 percent of the 50 students he surveyed thought dihydrogen monoxide should be banned after they were told that prolonged exposure to its solid form caused severe tissue damage, that exposure to its gaseous form caused severe burns and that it had been found in tumors from terminal cancer patients. Only one student recognized the substance as water, H2O.

For the full commentary, see:
JANE E. BRODY. ” PERSONAL HEALTH; Facing Biotech Foods Without the Fear Factor.” The New York Times (Tues., January 11, 2005): D7.

Jefferson Believed: “redemption lay in education, discovery, innovation, and experiment”


Source of book image: http://images-eu.amazon.com/images/P/0060598964.01.LZZZZZZZ.jpg

(p. 43) Jefferson was not a man of the Enlightenment only in the ordinary sense that he believed in reason or perhaps in rationality. He was very specifically one of those who believed that human redemption lay in education, discovery, innovation, and experiment. There were many such in the American Revolution. Thomas Paine spent much of his career designing a new form of iron bridge to aid transportation and communication. Dr. Joseph Priestley, another man who fled royalist and Anglican persecution and who removed himself from England to Philadephia after a “Church and King” mob had smashed his laboratory, was a chemist and physician of great renown. Benjamin Franklin would be remembered for his de- (p. 44) ductions about the practical use of electricity if he had done nothing else. Jefferson, too, considered himself a scientist. He studied botany, fossils, crop cycles, and animals. He made copious notes on what he saw. He designed a new kind of plow, which would cut a deeper furrow in soil exhausted by the false economy of tobacco farming. He was fascinated by the invention of air balloons, which he instantly saw might provide a new form of transport as well as a new form of warfare. He enjoyed surveying and prospecting and, when whaling became an important matter in the negotiation of a commercial treaty, wrote a treatise on the subject himself. He sent horticultural clippings from Virginia to the brilliant French consul Crevecoeur in New York, comparing notes on everything from potatoes to cedars. As president, he did much to further Dr. Edward Jenner’s novel idea of cowpox vaccination as an insurance against the nightmare of smallpox, helping Dr. Benjamin Waterhouse of Boston—the initiator of the scheme in America—to overcome early difficulties in transporting the vaccine by suggesting that it lost its potency when exposed to wamth. Henceforward carried in water-cooled vials, the marvelous new prophylactic was administred to all at Monticello. (Not everything that Jeffrson did on his estate was exploitation.) For a comparison in context, we might note that Dr. Timothy Dwight, then president of Yale and to this day celebrated as an American Divine, was sternly opposed to vaccination as a profane interference with God’s beneficent design.

Christopher Hitchens. Thomas Jefferson: Author of America (Eminent Lives). New York: HarperCollins Publishers, 2005. ISBN: 0060598964

Vouchers Enable Choice, Competition, and Learning

TierneyJohn.jpg
John Tierney. Source of image: online version of NYT article cited below.
The New York Times Op-Ed education columnist offers a provocative evaluation of how Milton Friedman’s educational voucher proposal is working in Milwuakee:

The Journal Sentinel, which endorsed John Kerry in 2004, has parted company with the Democratic Party on the voucher issue. It backed Republican efforts this year to expand the program, which has led to the creation of dozens of new private schools in Milwaukee.
“We’ve seen what school choice can do,” said Gregory Stanford, an editorial writer and a columnist at the paper. “It’s impressive to go around to the voucher schools and see kids learning. Their parents are much more satisfied with these schools. And the fears that the public schools would be hurt have turned out to be wrong.”
In fact, the students in public schools have benefited from the competition. Two studies by Harvard researchers, one by Caroline Hoxby and another by Rajashri Chakrabarti, have shown that as the voucher program expanded in Milwaukee, there was a marked improvement in test scores at the public schools most threatened by the program (the ones with large numbers of low-income students eligible for the vouchers).
The competition spurred the public system to shift power from the central administration to individual schools, allowing councils of parents and teachers to decide who should teach there, instead of forcing the schools to accept incompetent teachers just because they had seniority.
“Poor teachers used to shuffle from one school on to another in what we called the dance of the lemons,” says Ken Johnson, the head of the school board. “But we couldn’t let that continue once our students had the option to go somewhere else. We had to react to students’ needs. We had to start seeing them as customers, not just seat-fillers.”
Some of the new voucher schools have flopped — but the advantage of a voucher program is that a bad private school can be shut down a lot faster than a bad public school. And while critics complain that there still isn’t definitive evidence that voucher students are doing better over all in their new schools, the results so far in Milwaukee and other cities are more than enough to declare vouchers a success.
“All the good research, including the voucher opponents’ work, shows that kids who accept vouchers are doing at least as well as their public school peers,” says Joseph Viteritti of Hunter College. “That’s remarkable, considering how much less money is being spent on the voucher students.”
In Milwaukee, where the public system spends more than $10,000 per student, private schools get less than $6,400 for each voucher student. But when you see what can be done for that money, you realize what’s wrong with Democrats’ favorite solution for education: more money for the public-school monopoly.
. . .
The school principal, Denise Pitchford, worked in the public schools, but she took a pay cut in exchange for less red tape. “I wanted the flexibility to give immediate personal attention to every student,” she said. “To me, it represented less money but a better opportunity.” Just like the whole voucher program.

For the full story, see:
JOHN TIERNEY. “City Schools That Work.” The New York Times (Tues., March 7, 2006): A25.
Note: This article was reprinted under the title “Vouchers Offer Many Positives.” in: Omaha World-Herald (Weds., March 8, 2006): 7B.

Mary K. Fox

Jenny’s fourth and fifth grade teacher, Mary K. Fox, ended a long battle with cancer on January 30, 2006. Here are our “Guest Book” entries:
February 1, 2006
You were a great teacher. I will miss you very much. I remember the first day you met Willy (my dog). You liked him very much. Willy will always remember you, and think of you as Jenny’s teacher.
Love, Jenny (and Willy)
Jenny Diamond (Omaha, NE )
February 1, 2006
We admired Mary’s strength and determination; her patience and good will.
Art & Jeanette Diamond (Omaha, NE )

“If you’re giving while you’re living, you’re knowing where it’s going”

The American Council of Trustees and Alumni has published a short book, “The Intelligent Donor’s Guide to College Giving,” that lays out some basic ground rules for donating to higher education. These include placing clear restrictions on gifts, working with a particular professor (and, if possible, bypassing the development office) and avoiding endowments in perpetuity. As Sir John Templeton wisely said: “If you’re giving while you’re living, you’re knowing where it’s going.”
Obviously, this sort of due diligence does require time and effort on the part of the donor, But if even a few more philanthropists were watching where their funds ended up, college officials would surely monitor their programs more carefully. There have been a few celebrated cases in recent years in which donors have asked for their funds to be returned after discovering that they were misused, and these cases have sent a shudder through the academic community.

For the full commentary, see:
JAMES PIERESON. “Only Encouraging Them.” The Wall Street Journal (Fri., November 18, 2005): W13.

Thomas Sowell on Ben Rogge as Teacher

The classic small liberal arts college is more than a pleasant place where other people know you, though that is not a small consideration for a student living away from home for the first time—especially a shy student.  Academically, the learning process can be far more manageable where professors are teachers first and foremost.  One of the best taught introductory economics classes I ever saw was taught by the late Ben Rogge at Wabash College in Indiana.  Few students at Harvard would ever get such a good foundation in the subject.  Ben, rest his soul, had obviously thought through all the pitfalls of the subject and led the student safely around them.

Source: online version of Thomas Sowell. Choosing a College: A Guide for Students & Parents. 1989.
http://www.amatecon.com/etext/cac/cac-ch03.html

Free to Choose in Education

Here is the text of my brief letter-to-the-editor that was published several months ago. “OPS” stands for Omaha Public Schools.

Competing school districts within the Omaha area permit parents some freedom of choice in the education of their children.
If OPS succeeds in ending that freedom, the Legislature should restore freedom of choice by adopting Milton Friedman’s proposal to issue vouchers to parents, to be spent at the public or private school of their choice.

Art Diamond. “Try Vouchers.” Omaha World-Herald (Thurs., June 16, 2005): 6B.

Never Say Die: Milton Friedman on Vouchers, Again

From an opinion-piece by Milton Friedman, at age 93, in today’s Wall Street Journal:

Whatever the promise of vouchers for the education of New Orleans children, the reform will be opposed by the teachers unions and the educational administrators. They now control a monopoly school system. They are determined to preserve that control, and will go to almost any lengths to do so.
Unions to the contrary, the reform would achieve the purposes of Louisiana far better than the present system. The state’s objective is the education of its children, not the construction of buildings or the running of schools. Those are means not ends. The state’s objective would be better served by a competitive educational market than by a government monopoly. Producers of educational services would compete to attract students. Parents, empowered by the voucher, would have a wide range to choose from. As in other industries, such a competitive free market would lead to improvements in quality and reductions in cost.
If, by a political miracle, Louisiana could overcome the opposition of the unions and enact universal vouchers, it would not only serve itself, it would also render a service to the rest of the country by providing a large scale example of what the market can do for education when permitted to operate.

MILTON FRIEDMAN. “The Promise of Vouchers.” The Wall Street Journal (Mon., December 5, 2005): A20.

Drucker Predicted “Universities Won’t Survive”

Mr. Drucker also told us to expect enormous changes that will come in higher education, thanks to the rise of satellites and the Internet. “Thirty years from now big universities will be relics. Universities won’t survive. It is as large a change as when we first got the printed book.” He believed “High school graduates should work for at least five years before going on to college.” It will be news to most college presidents and a lot of alumni that “higher education is in deep crisis. Colleges won’t survive as residential institutions. Today’s buildings are hopelessly unsuited and totally unneeded.” All this from a life-long academic.
. . .
How higher education is managed did not impress Mr. Drucker; but what did is our continuing education system, whether in community colleges or by computers. Also: “Our most important education system is in the employees’ own organization.” That is where most Americans learn the most.

STEVE FORBES. “A Tribute to Peter Drucker.” The Wall Street Journal (Tues., November 15, 2005): A22.

In Millard, Parents Can Choose Montessori; In OPS, They Cannot

[p. 1B] The district contends that taking over dozens of suburban schools and thousands of students would minimize the impact of the option program and give OPS a better chance at integration.
But if OPS succeeds, it also could undermine the ability parents now have to choose the school that fits best for their children.
That’s important to Art Diamond, who lives within the OPS district but sends his 11-year-old daughter, Jenny, to Millard’s Montclair Elementary [p. 3B] because of its Montessori program.
“It seems to me the main issue is who is offering the best educational program,” Diamond said. “If they (OPS) had offered a Montessori program, we would have stayed in OPS.”
. . .
As Mackiel sees it, that departure causes problems for the Omaha district by altering its racial and economic makeup. But parents of option students don’t view their decisions through the same lens.
“It frustrates me when I hear OPS saying people live in Millard to get away from diversity,” said Diamond, the OPS resident whose daughter attends a Montessori program in Millard.
“I believe strongly in diversity, but I also believe strongly in Montessori.”

MICHAELA SAUNDERS and PAUL GOODSELL. “OPS Has No Option But to Let Whites Go.” The Omaha
World-Herald
(Sunday, November 13, 2005): 1B & 3B.
Jenny is actually currently a sixth grader in Millard’s Montessori program at Central Middle School. But Ms. Saunders was mainly asking me questions about our original decision to option into the Montclair Elementary Montessori program. So maybe I was unclear that Jenny had moved on to the next stage of the Millard Montessori program. In any event, the story was essentially accurate in capturing the main point of my comments: we chose Millard because, unlike OPS, MIllard has the entrepreneurial initiative to offer the Montessori educational program.