ACA Repeal — the Backdoor Method

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Apparently, the bill to keep the government operating excludes payments to insurance companies that subsidize healthcare for those buying insurance through the Marketplace. The tactic is to force insurers out of the market, thus closing the door on the Affordable Care Act.

In theory, that would cost anyone with a subsidy their healthcare.

We’ll see what happens next.

Equality of Education; Inequality of Teacher Pay

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In theory, the quality of teacher impacts the quality of education students receive. In the Brown v. Board of Education of Topeka decision in 1954, the USSC rejected the argument that students in unequal schools could receive equal education. However, if teachers are important, then how do we reconcile the Court’s decision with these findings:

  • There’s a huge disparity in teacher pay between school systems. Affluent districts pay much higher salaries than others.
  • Charter schools, which are supposed to be the road to improve education, pay much lower salaries than most public school districts.

New Jersey treats teachers as public employees, and their salaries are public information. Without going into detail on all 650 public school districts and charter schools in the state (available at reference 1 below), here’s the outlines of the situation:

  • The median salary in 2016 for a school teacher in NJ was $66,117 per year.
  • Northern Valley Regional district in affluent Bergen County paid the most, with a median salary of $105,650.
  • Teachers in the Edison Township school district in Middlesex County had a median salary of $95,432.
  • At the other end, Milford Township in Hunterdon County had a median salary of $48,007.

New Jersey just isn’t that large geographically. The cost of living is relatively uniform across the state.

Many/most of the charter schools are worse: for example the Jersey City Global and Red Bank charter schools both have median salaries of $42,000. Of course, the charter schools haven’t been around as long. We could expect salaries to increase with teacher seniority. However, the need to generate profits at many of these schools may restrict what goes into the classroom.

If you were a capable teacher, where would you want to teach? Where would you expect the best teachers to go? How does this reconcile with equality of educational opportunity?

By comparison, NJ is one of the best-paying states for teachers in the US. The only states that pay as much or more are Alaska, California, Connecticut, District of Columbia, Massachusetts and New York. Maryland pay is lower than NJ, but close. (2) Conversely, South Dakota and Mississippi are at the low end of teacher pay, paying less than 65% of what New Jersey pays.

Again, where would the best go?


Sources:

  1. Tom Davis, “NJ Median Teacher Salaries, Highest To Lowest: How Much Does Your District Pay?” NJ Patch, 24 April 2017. https://patch.com/new-jersey/princeton/s/g3o6z/n-j-median-teacher-salaries-highest-to-lowest-how-much-does-your-district-pay?utm_source=alert-breakingnews&utm_medium=email&utm_term=weather&utm_campaign=alert
  2. National Center for Education Statistics, 2013. https://nces.ed.gov/programs/digest/d13/tables/dt13_211.60.asp

Two Places by Han Wo (translation)

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This is elegant.

Life is But This 命

Han Wo 韓偓 was a child prodigy whose uncle, the famous Tang Dynasty poet Li Shang Yin 李商隱 wrote two poems about his brilliance.

Two Places by Han Wo (842 – 923)

Above us the calm mountain stretches

In front of here the clear creek runs

Think of the mountain and the water

Found in two place but always bound

(c) Mary Tang 鄧許文蘭 2017

兩處。韓偓

樓上澹山橫,樓前溝水清。

憐山又憐水,兩處總牽情。

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Continuing Education for Doctors: What Your State Requires

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Medicine is highly dynamic. By one report, there are 4,500 pages of new findings produced every day — that’s a huge amount of material. A conscientious practitioner is going to spend hours each day on homework. Some doctors do, some don’t.

What do states require? There are requirements for continuing education in most (but not all) states in the US. That’s simple recognition of the fact that what one learns in medical school will become obsolete over time.

The states vary from no requirement for continuing education to a requirement of an average of 50 hours per year.  Here are the tiers. (1)

  • No requirement:
    • Colorado
    • Indiana
    • Montana
    • New York
    • South Dakota
  • 15 hours per year (average):
    • Vermont
    • Wisconsin
  • 20 hours per year (average):
    • Arizona
    • Arkansas
    • Delaware
    • Florida
    • Georgia
    • Idaho
    • Iowa
    • Kentucky
    • Louisiana
    • Mississippi
    • Nevada
    • North Carolina
    • North Dakota
    • Oklahoma
    • Oregon
    • Rhode Island
    • South Carolina
    • Tennessee
    • Utah
    • Wyoming
  • 24 hours per year (average):
    • Texas
  • 25 hours per year (average):
    • Alabama
    • Alaska
    • California
    • Connecticut
    • District of Columbia
    • Maryland
    • Minnesota
    • Missouri
    • Nebraska
    • New Mexico
    • West Virginia
  • 30 hours per year (average):
    • Virginia
  • 33 hours per year (average):
    • Kansas
  • 50 hours per year (average):
    • Hawaii
    • Illinois
    • Maine
    • Massachusetts
    • Michigan
    • New Hampshire
    • New Jersey
    • Ohio
    • Pennsylvania
    • Washington

How much is enough? None is probably not good. Even 3 days per year seems light.

The problem is that doctors can’t be counted upon to sign up for training when it isn’t required. In one example, in 2015, to counter the current epidemic of painkiller abuse, the FDA required drug makers to offer opioid training classes for physicians. Unfortunately, only 38,000 of the roughly 320,000 physicians who prescribe these drugs signed up for the classes. (2)

What training has your doctor taken recently?


Sources:

  1. Medscape, “State CME Requirements,” last updated April 2016. http://www.medscape.org/public/staterequirements
  2. Bloomberg, “Undertrained Doctors, Overprescribed Drugs,” 4 May 2016. https://www.bloomberg.com/view/articles/2016-05-04/undertrained-doctors-overprescribed-drugs

Early surgery for hip fractures can save lives

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This is something that any senior or anyone caring for a senior should see.

Researchers at Southmead Hospital (UK) report that surgery within 24 hours of injury save lives among elderly patients with hip fractures.

They analyzed data from 241,446 British patients, measuring the death rate in the 30 days after admission. They found that if surgery were delayed past 24 hours, the death rate increased by 8%. The death rate increased by 20% if surgery were delayed 48 hours.

The concern with elderly patients is whether they need time to stabilize after an injury. It turns out that taking that time can add to their risk.

Has your doctor seen that report?


Sources:

  1. BBC News, “Early Hip Fracture Surgery Will Save Hundreds of Lives,” 20 April 2017. http://www.bbc.com/news/uk-england-bristol-39655669

 

The Rising Need for Poetry

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Lyn has written something terrific here; please read.

lyncrain

As a poet I cannot go gently, I must write.  We are living in a new literary era which I feel is now the poetry of social connections. There has always been a long tradition of political activism in poetry. But with the internet, it has become the new Avante Garde.

“I see protest poetry as a genuine means of encouraging someone to feel the inconsistencies, the horror of the lives we are living. Social protest is saying that we do not have to live this way. If we feel deeply, and we encourage ourselves and others to feel deeply, we will find the germ of our answers to bring about change. Because once we recognize what it is, we are feeling, once we recognize we can feel deeply, love deeply, can feel joy, then we will demand that all parts of our lives produce that kind of joy. And when…

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