This Week with George Stephanopolous was really good this morning. He had on two senators and two representatives, one from each party, to discuss the Senate and House health care reforms. Senator Tom Coburn (R-OK), a practicing doctor himself, seems to make the most sense to me and he had a lot of great arguments about why this bill is not good for patients. The debate started out as the typical back and forth with Democrats saying their bills are awesome and will save health care and Republicans saying they won’t work and will just cost us a trillion dollars, neither party actually citing statistics or facts.

Then something strange happened — the facts came out. Initially, George did a horrible job as a moderator. Facts were brought up that wiped out a Democrat’s argument, the Democrat chalked it up to simply a difference of opinion, and George just left it at that. Hopefully people are smart enough to see through this kind of dishonest debate.

Here’s a great two-fer example of this. When confronted with the fact that the Congressional Budget Office (CBO) said that both bills of the bills would actually increase health insurance premiums, despite the insistence of Democrats that the whole purpose of health care reform is to decrease costs for households, Rep. Debbie Wasserman-Schultz (D-FL) said this: “Well, there are differences of opinion as to whether or not the Congressional budget analysis is correct on the increase in premiums, but the important thing here is that I hope we can all agree that we have to get rid of the profit-driven, insurance company-drive health insurance system that we have, where it’s insurance company bureaucrats, Senator Coburn, that are getting in between patients and their doctors. To suggest that this bill will put government in between patients and their doctors is really disingenuous.”

Did you catch that? Nevermind the facts. Who cares what the CBO says? It’s just an opinion anyway. Now let’s change the issue to those evil insurance companies.

When the CBO scores a Democrat bill in their favor, they tout the CBO as the “gold standard” which must be respected and believed as the gospel truth. But when the CBO says something the Democrats don’t like, they say “well, there are differences of opinion on that.” I call shenanigans.

In response to her, Sen. Coburn goes on to cite the fact  that the percentage of claims denied by government-run Medicare (6.5%) is almost twice the national insurance company average of 3.5%. In response to the Republican concern that government will ration care, the typical Democrat argument is basically that rationing is going to exist under any health care system (100% true, by the way), but rationing already exists and it’s done by those evil insurance companies. Yet Coburn cites the fact that government rations more than insurance companies. I think that’s a pretty important fact to consider. (Note: see the comments on this post for more on the other side of this issue.)

Another great example happened when Rep. Marsha Blackburn (R-TN) actually read from the bill itself. She started by discussing the controversial announcement this week by the Preventive Services Task Force saying that women should not get mammograms until age 50, replacing the current guidelines which say they should start at age 40; and instead of getting them every year, they should get them every two years. Republicans have been skeptical of this, arguing that this is exactly the kind of government rationing they have been worried about.. They argue that not just a coincidence that as the Democrats are looking to expand the government’s role in health care, the federal government is releasing guidelines telling women to not get as much preventive care. The American Cancer Society rejected these new guidelines.

(Note: The PSTF also said that self-examination does more harm than good, as it gets women thinking they might have cancer when they don’t and then we waste money looking for it. You hear that, women? After decades of saying that you should check yourself for lumps because early detection is the key to beating breast cancer, now the government is saying to stop looking for cancer — because, you know, if you find it, you’ll need to be treated for it. And we wouldn’t want that to happen when the government is going to have to pay for it. Democrats always say we have a horrible health care system, but the one thing that they cannot dispute is that our rate of cancer detection and survival is higher than every other country in the world. If we go down this route towards government-run health care, expect those rates to fall in line with the rest of the world; i.e. more people will die from cancer just at the point where cancer rates in the U.S. are falling because we are so successful at beating it. But the government will save money, so yay for that! As Dr. Bernadine Healy, former Director of the National Institutes of Health, said about the new guidelines: “This will increase the number of women dying of breast cancer. Women in their forties have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me and it goes against the bulk of individuals who are actually caring for patients. You may save some money, but you’re not going to save lives.”)

OK, back to the show. Blackburn read verbatim from the bill. Citing titles, sections and pages, she explained how the bill renames the Preventive Services Task Force to the Clinical Preventive Services Task Force. Then she explained how the bill assigns the CPSTF the task of rating all preventive services with a grade of A, B, C, D, or I. At this point, Stephanopolous seemed shocked (shocked!) that the representative had actually read the bill, even perhaps a little annoyed by it. But Blackburn pressed on, explaining that the bill says that only services rated A or B actually must be paid for by health insurance. And the preventive cancer treatments between ages 40 and 50, which the PSTF just announced are unnecessary, were given a rating of C. So the fact is that if women want to continue to get screenings at age 40, they will not be paid for by insurance or the government. You can still argue that we might find more breast cancer in one respect: women over 50 without health insurance will now get free mammograms under their health insurance or government option. But you can’t deny the fact that women 40-50 will either get fewer mammograms or have to pay for them out of pocket. Or can you?

Wasserman-Schultz, who suffered from breast cancer herself just a while back, then accused Republians of playing politics with breast cancer. She flat out denied what Blackburn had just said. Her response to the assertion that the CPSTF’s guidelines would essentially become law: ”No, they would not be.”

At this point I give Stephanopolous some credit. He actually put the language of the bill right up on the screen so we could all see that what Blackburn had said was 100% true. Wasserman-Schultz’s answer: “This task force’s recommendations are simply recommendations. They aren’t controlling, they aren’t going to be binding.” Again, shenanigans. Sure, nobody is saying that a 40-year old woman can’t get a mammogram, but she’s going to have to pay for it herself because no insurance company, especially the government option, will pay for it. I don’t know how this woman can lie to the American public with a straight face, but she did. And to his credit, Stephanopolous called her out on it.

Health care reform (a.k.a. health insurance reform, because it sounds less controversial) is a difficult thing to do, no question about it. There are going to have to be some sacrifices made no matter what we do – if you want to cut costs, you have to improve efficiency or reduce services; it’s that simple. When politicians, of either side of the aisle, exaggerate claims, dismiss facts, or flat-out lie about what is in the bill, they need to be called out. I’m glad that George Stephanopolous finally did that today, and I hope he’ll continue to do it in the future.

The Senate bill was released today and I have a few thoughts about how politicians on both sides are being dishonest about the bill.

Let’s start with the Republicans. The CBO’s estimate of the effects of the bill are that the cost for the government option health insurance plan will likely be higher than private plans. On Fox News, Carl Cameron reported that this confirmed what Republicans have been saying for months — that government-run health care will be more expensive. Really? That’s not how I remember it at all. I remember Lindsay Graham (R-SC) saying that the government option would be cheaper than private plans. And because it is cheaper, companies will ditch their private health insurance plans. Private health insurance companies won’t be able to compete and they’ll be driven from the market. the government option was supposed to destroy private health insurance. Now we discover that it won’t, and that’s somehow bad too? Republicans are trying to take both sides of this issue. If the government option is less expensive, it will ruin private industry. If it’s more expensive, it’s a sign that the government is inefficient and can’t do anything right. You can’t have it both ways, guys.

Speaking of having it both ways, let’s move on to the Democrats. In trying to keep this bill deficit-neutral, they are forced to raise about a half trillion dollars in taxes. $28 billion of this is taxes is expected to come from employers that do not provide government-approved health insurance plans for their employees, so they get fined. So what happens if these companies shape up and put their employees on the government option? The government now has to pay for the health care of these individuals, and the government does not collect the tax revenue. Seems to me the Democrats are counting on money that, if their bill is successful, they won’t get. It’s just like the SCHIP bill passed a few years ago. In order to help pay for an expansion in the State Childrens Health Insurance Program, the Democrats in Congress increased cigarette taxes. If people stop smoking (as we want them to do), the government doesn’t get its money and the kids don’t get health care. As I tell my students, next time you’re smoking, just tell yourself, “I’m doing it for the kids.”

The Democrats say the bill costs $848 billion and will reduce the deficit by $130 billion. That means they’re increasing revenues by 848+130 = $978 billion. Some of this is assuming new efficiencies in Medicare that the CBO says are questionable. And the rest of it is on taxes. The goal wasn’t to reduce the deficit by increasing taxes (especially in a recession) — it was to provide affordable health care for all. If you only need $848 billion, why not increase taxes enough so that you get $848 billion in revenue. If you ask me, this extra $130 billion is because they know those Medicare cuts won’t happen.

And last but not least is the difference in timeline between costs and revenues. The Democrats start collecting taxes next year, so the $978 billion in revenues comes over 10 years. But the benefits people get in the health care bill don’t start for 5 years. So they’re actually saying that we’ll collect money for 10 years and only pay it out for 5, and somehow this is a deficit reduction. That’s like me saying that I’m only going to pay half of my bills this year and then, at the end of the year being proud of all of the cash that I have in my checking account. It’s ridiculous. And the CBO says that in the second 10-year period of the bill (2019-2029), health care costs will TRIPLE.

And politians wonder why we’re sick of their games and want to throw them out of office. They can’t be honest about the numbers. They play a shell game with our money. And they talk out of both sides of their mouths. My suggestion for 2010: vote out every single incumbent. Maybe they’ll get the message.

I like to consider myself a relatively tech-savvy person.

When my colleagues have a question about D2L (our course management system, similar to WebCT or Blackboard), they ask me. When a colleague gets a new iPhone, he asks me how to set up his mail. When I visit my parents every year, they have a list of things I need to show them how to do (and write instructions they can refer to after I’m gone) — how do I rip a CD into iTunes and then burn a copy of it? How do I format something in Excel. How do I set up the wireless network? Usually I feel like I have a good idea of what’s going on, know what questions to ask and know where to find the answers.

Then I started working on my online courses. The goal originally was to have everything in D2L. Each week’s material (a “module”) would be a folder in the Content area and students would click on their different assignments. A Word document with an introduction to the chapter and a set of learning objectives. A link to a lecture presentation or two on video. All of these things would be housed on a media server at SCSU (since taking up space on D2L is, shall we say, frowned upon).

At first I just used PowerPoint and recorded audio. That file would be sent to the tech people on campus and they would convert it using Adobe Presenter into a flash video that students could watch in a web browser. It looked great and worked well. The problem was that it was just me reading a slide. It couldn’t do screen capture. I have colleagues at other schools that have used a software called Camtasia. It captures what’s on your screen so that when you’re talking through your presentation, students can see your cursor. You can highlight things and draw graphs on the screen in real time. And you can open up a web browser to show them an article, or where to go to get a piece of data. It looked cool. Of course, it costs money — $180 or so for educational purposes.

I then learned about Camstudio — a free version that has most of the same features. The only problem is that the flash conversion done by Camstudio has an interface that does not include FF or RW buttons on it. The whole upside to video is that students can rewind a section if they don’t understand it and watch it again.

So I learned about something called Flowplayer, which has a nicer interface — basically, you watch videos in much the same way you would watch a YouTube clip someone put on a blog. You can rewind, fast forward, go to specific points in the video using the slider bar, and expand to full screen. But then I need another software to convert the Camtasia AVI output file into FLV format. Okay, I got that. I also got a video editing program so I can clip out the beginning and ending parts of a presentation if they’re rocky, and I can split up a long video or splice together short ones. And now I don’t have to send every video (which is too big to send in e-mail of course) to the tech people to have them converted to a Flash file.

The question is then: how the heck do I get my students to watch this? I spend hours playing around with some HTML code that would enable Flowplayer but it wouldn’t work. The tech people gave me a workaround but the flash video they created did not include the ability to make the video full-screen, which will be crucial for my students to look at all the graphs.

Then yesterday I finally realized the best solution to my problem. I decided to put the online courses up as two new blogs hosted on my own personal web site. (You’ll see them as the top two links on the right side of the page.) I don’t know how anybody would do what I’m doing using the school’s resources. It’s just too complicated — too many moving parts going on and what ends up getting sacrificed is the experience for students. So instead I’ll have a blog and each post will be a module. I’ll add all the text I need, include video clips they can watch full-screen, and include links to other articles. All in all, I think it’s a great solution. I can password-protect each post and give students the password each week, and other people can’t steal my content. It also means I can give the password to colleagues from other universities who want to see what I’ve done — something I can’t do if the course is all on D2L. In the end, I found a great solution that meets all of my needs and will hopefully provide a quality educational experience to my students.

But I think it’s a little sad that the only way to have an online course set up the way I need it to be set up, so my students can learn what I need them to learn in the way that I think is most effective — and in a way that is not that technologically fancy at all — is to completely bypass the university technology system that is supposed to make everything happen for us. I honestly don’t blame the tech people — I think they’re doing the best they can. They were extremely helpful in helping me realize what exactly it was that I wanted to be able to do in the online course, providing a headset and microphone so I could make my recordings, and answering all my questions in a way that was understandable. I know they’re dealing with restrictions imposed on them by others, security issues, licensing issues, etc. I post this not to complain about the work they have done (because, frankly, without them I would have been even more lost), but to point out that right now we have a system where technology dictates pedagogy. You are told what is possible and you try to mold your course around that — and if you don’t like it, you have to find a way to work around the system. That’s not right. Pedagogy should drive technology, not the other way around

An interesting story about a middle school in North Carolina that was allowing parents to purchase extra credit for their children. As it turns out, that was a controversial thing to do. (Duh.) $20 would purchase 20 test points, 10 points each on two tests. The tests were normalized to be out of 100 points, so you were basically buying your kid a one grade bump on two tests. Here’s the part of the story that made me laugh:

Susie Shepherd, the principal, said a parent advisory council came up with the idea, and she endorsed it. She said the council was looking for a new way to raise money.

“Last year they did chocolates, and it didn’t generate anything,” Shepherd said.

Shepherd rejected the suggestion that the school is selling grades. Extra points on two tests won’t make a difference in a student’s final grade, she said.

What Ms. Shepherd is saying is two things: a) Parents should spend $20 to buy their kids extra credit so that the school can raise money, and b) it will not have any impact on their grade. I don’t know how many tests there are every semester, but a 10% increase on two tests has to have some impact on a student’s grade, doesn’t it? And if there are so many tests that it doesn’t matter, than the PAC is basically stealing the parents’ money, selling them something that is worthless. Either Ms. Shepherd thinks the parents of the children in her school are stupid or she thinks people reading the story are stupid. I’m not sure which.

I’ve flirted with some controversial things with grades in the past, and I’ve often had to ask my colleagues what they thought of it, and have backed away from a few proposals. In my Industrial Organization class at Northern Michigan University, I ran a simulation game based on Severin Borenstein’s Competitive Strategy Game. I’ve used the game, or a variation thereof, all three times I have taught I.O. in my career and the students love it. It applies principles from throughout the course, forces them to use Excel to run simulations and calculate different scenarios, and helps them visualize what they are learning. I can’t get Dr. Borenstein’s software to work any more for some reason so I use an Excel file to run the simulations and that allows me to tweak things and create new markets. It’s more work for me but the result is better and I’m much more in tune with the decisions students are making.

The game accounts for about a quarter of each student’s final grade. It’s a semester-long project with an assignment every week or two (it varies by semester). It can be a lot of work or students can half-ass it and hope to get lucky.  The first time I taught the course, I was not sure how motivated students would be. So to encourage them to really take it seriously, I stated in the syllabus that members of the team that finished in first place would each received one grade shade bump on their final grade; if they had an A-, I would bump them up to an A. But I realized something: the good students are probably going to take the game more seriously, and they’re probably going to get an A anyway. NMU did not allow me to give out A+’s, so a grade bump for these students was worthless. So I decided to give it to them as a property right — they could give it away to a friend or even sell it to another student if they wanted. I would set up an auction for them.

I loved the idea at first, and so did they. Students often consider their grades as their property, but they do not have the right to sell or trade that right. I thought I would experiment with that. But at the end of the semester, I started hearing complaints from some of the other students. They thought it was unfair that someone who did poorly all semester could buy a grade bump from another student. I mentioned that there would be an auction for the grade bumps (two of the three students in the winning group already had an A and therefore did not need theirs) and everybody had an equal opportunity to put in a sealed bid on one of them. Naturally, some complained that this meant the wealthier students would get the grade bump — the same thing complained about in the story linked above.

I did not want to cause a controversy with this, so I did not collect any money from the students who put in the highest bids, and I did not give them the grade bump. I took the two highest bids, averaged them, and gave the two students that owned the grade bumps cash from my own pocket. I thought that was the fairest thing to do — why should they suffer a loss of income because I changed the rules on them? If I remember correctly, it was only $25 or so each. Nobody bought a grade, and the students that earned the grade bump and did not need it received the cash equivalent value.

But there have been other times when I have thought of doing something similar. As it turns out, I’m not the only one considering it. In fact, Michael Baye, the author of the book I use in Managerial Economics, gave an online web conference a few months ago where he talked about something he does in his classes that could easily be construed as grade-selling. He includes class participation in his grades. He also auctions off a few shirts at the beginning of the semester and any student wearing one of the shirts when his or her name is called is automatically immune from questioning and gets 100% that day. Some students keep the shirt in their backpack and put it on before every class. These students have essentially bought a percentage of their grade. He does it so that when he asks students how much they are willing to pay for a good at the beginning of the semester, it’s not just a thought experiment; it’s something tangible, something that has real value to them. He uses the numbers he gets from this experiment to create a demand curve. He uses the numbers to run regressions, to calculate consumer surplus, the profit-maximizing price for a monopolist, and a variety of other things. It’s a running theme throughout the whole course based on an actual tangible good. But still…is he selling grades? Does the fact that he’s selling a shirt make it not so straight-forward?

I have thought of doing something similar in my Managerial Economics class in the future. I don’t grade attendance so the magic shirt idea wouldn’t work. Instead, I thought that students would bid on one of several homework passes. Each homework assignment is usually worth between 5-7% of their final grade and there are 3-4 of them. It’s not hard to get a good grade on homework assignments and most students get at least 80% on them. But if they bought one of these passes, a student would have one freebie and receive 100%. In my mind, I justify it by saying that if a student decides to just not learn the material and use the homework pass, their grade will likely suffer on the next exam, which usually takes place the following week. And I can do the same analysis on the data that Baye does — I’ve seen the Excel sheets he has created with it and he applies the data to almost every concept students learn the entire semester.  It really is a valuable teaching tool. But is it buying a grade? And if it is, is it worth any potential controversy if it has pedagogical value? If I sold magic homework shirts instead, would it be any different?

I’m interested in comments from students and educators.

I’m usually one to have a strong opinion on something one way or another, once I figure out what the facts are. But after reading a story today about a proposed new law, I’m not sure whether I like it or not. I think I could be in favor of it but, well, I need more facts. Selling me on public policy changes based purely on theory is not easy to do.

The proposed law would require that when an employer tells a sick employee to stay home, they pay the employee for up to 5 days of sick leave. Currently there is no law forcing employers to offer any paid sick leave. But with H1N1 waking people up to the possibility of a pandemic, lawmakers are starting to reconsider this. The Center for Disease Control (CDC) has been advising employers to encourage their sick employees to stay home. My school did the same thing for faculty, staff and student. But faculty have paid sick leave and, worst case scenario, students get the day off. We don’t usually hear complaints from them about that.

For millions of people, especially hourly workers, staying home for the good of the firm means less money in their pockets, a difficult decision for people to make, especially in a soft economy. They don’t want to infect their co-workers, but they can hardly afford to stay home. The CDC is spinning this as a good thing for employers: if your sick employee stays home, she won’t infect her co-workers and the amount of sick time taken overall will decrease. Paying for sick leave encourages her to make a decision that is in the best interest of the firm. Overall productivity will stay high and the few days of paid sick leave the firm has to pay is small relative to the potential loss in profits from a firm-wide outbreak.

(A quick market-based analysis: if the CDC is correct, profit-maximizing firms would have been voluntarily doing this all along — especially evil corporations who only care about profits. If the CDC is correct, you don’t need to force firms to pay for sick leave. So if they’re not choosing to do this, they must have concluded that they would rather have less-than-full productivity out of a more sick work force than have some people stay home sick and have to pay them for it.)

One problem I have with the article: no mention of any statistics. The CDC seems to just assume that when an employee goes to work sick, she will infect other people and they will infect others. While that’s certainly possible in theory, there is also the other side of the argument: many employees work while sick and maintain their productivity and don’t infect anyone. It depends on individual behavior, how communicable the disease is, and how long it lasts. I’m not sure how you would gather statistics on this to do a cost-benefit analysis here, but it seems that nothing like this has been attempted. But Congress can’t afford to worry about that — they’ll pass a law anyway.

Next thing you know, we’ll be passing mandated flu shots. Actually, that would no doubt be stricken down as unconstitutional. (Actually, I’m not sure that word means anything any more.) Instead, the government will just impose fines or taxes on firms that do not offer free flu shots to their employees. And they’ll tell firms: it’s for your own good. And it might be. It very well may end up costing less for the firm to pay for all its employees’ flu shots than endure a loss of productivity as people take sick leave. But without any data or analysis behind it, I’m skeptical.