Goin’ Whole Hog
So, I’m casually reading the New York Times this morning, half-skimming my way through their most recent article responding to the LA Times value-added controversy (or, as I’ve taken to calling it, “The LAT VAM-Sham”). At least, I was half-skimming my way through it, until I got to this part:
In many respects, this movement [to quantitatively evaluate teacher effectiveness] is overdue. Given the stakes, why should districts be allowed to pretend that nearly all their teachers are similarly successful? (The same question, by the way, applies to hospitals and doctors.)
“Hmmm…” I thought to myself. “Maybe I’ve been looking at this whole thing the wrong way. Maybe this new value-added trend is something to be embraced. We really oughta go whole hog on this thing– quantify everything! Shame everyone, in every profession, who doesn’t ‘measure’ up!” So, you heard it here first, folks– I’m on the value-added bandwagon!
Well, not for teachers, though. To really do this thing right, I have to start pushing for change in a field about which I know very little. Since the New York Times already mentioned doctors, and since they are dealing with life and death in their offices, I’m going to start devoting my energy to medical reform. I’ve been going to doctors my whole life, and I’ve read a lot of books about medicine, and I watched an episode of House once. (I can haz federal grant now, plees?)
Now, I hear there’s an obesity crisis in America. I haven’t studied it or anything, but I hear and read about it all the time. The story goes something like this: Americans are big and getting bigger, and bigness causes diseases or something. And those diseases are expensive and uncomfortable and can kill you. So we have to put a stop to that. Doctors are the only ones who can help us.
(Wait. I gotta sneak Data in here somehow. Fatness Data, Fatness Data…OH!)
Ok, here’s how we’re going to crack down on BAD DOCTORS who are keeping Americans dangerously unhealthy and fat! Let’s pass a law requiring group medical practices to tie doctors’ pay and employment to the value they add to their patients’ lives. Let’s use Body Mass Index as our measure.
(I bet I could get this lady to work as the PR rep for this new campaign. She has the courage to say what we all are thinking but don’t dare to speak aloud: “Let’s finally recognize obesity as abuse—abuse of our children, abuse of ourselves—and together take action against it.” Exactly, MeMe. And these bad doctors are abusing us!)
The Body Mass Index was created by a Belgian mathematician. So, already this should have some cachet: This dude wasn’t a doctor, so we can be sure his calculations won’t be at all self-serving or biased by things like “relevant experience” or “practical knowledge of whatever the heck he’s talking about.” Sure, it’s an imperfect measure, and it was created a long time ago, and it wasn’t intended to be used for calculating obesity, and it doesn’t capture everything that we know affects human health. But it’s a number. And numbers, whatever their flaws, are better than human judgment. If we’re going to make any headway here, and stop the CRISIS before we all die of fatness, we have to start somewhere.
Uh oh. Doctors are protesting. They’re saying that they can’t control their patients’ BMIs. Body shape is largely genetic, and they can’t control that or our lifestyle choices. Clearly, these are the whines of lazy, ineffective practitioners. If they were REALLY good at their jobs, they could motivate us to overcome our genes by working out more, and stop us from putting bacon on our cupcakes. No excuses, people! We are in the midst of a CRISIS. If some doctors cannot or will not show progress toward the goal of moving 100% of their patients into the normal BMI range of 18.5 – 24.9, they need to be
eliminated. given additional help.
(But how will I make sure they get that help? Medical practices have had access to each doctor’s patients’ heights and weights for years, and they haven’t acted on that information. I know! I’ll assemble a team and we’ll analyze the data ourselves, and see which doctors are making the most progress. 2/3 of my team has to be named Jason. Then we’ll publish it here,
to boost my readership so everyone can see it. Then people can make truly informed decisions about their care. Mmm… markets. Almost as great as bacon.)
Oh, what now? Ugh, some doctors and their allies are still complaining about unfairness. Apparently, doctors in poor communities are saying it’s unfair to label them as bad doctors because their patients have few safe places to exercise, and have to work all the time, and junk food is cheaper than healthy food and they can’t afford to visit the farmer’s market. (World’s tiniest violin! I’m sure they could spend their free time getting grants to help their patients out if they cared.) And other people are questioning the value of this approach in general, since no one has actually proven that fatness causes disease and people can be healthy at any size. And this one’s saying that extra weight can actually help you live longer…wait, what? And it classifies professional athletes and hot actors as obese? Wha?!?
Stop trying to confuse me with well-reasoned arguments and facts, people! The bottom line here is that we are in a CRISIS. If we have to start thinking about cleaning up the environment, or addressing the subsidies and other things that make junk food artificially cheap, or re-build the suburbs to make them more pedestrian friendly, or make cities safer so people in low-income communities can go jogging, we’ll never get anywhere! We can’t hold everyone accountable for this situation, can we? That’s totally unrealistic
and if that happens, then fewer doctors will prescribe the magic weight loss pill in which I just invested heavily!
Ok, forget it. Clearly, no one here is interested in improving. I’m going to go interview some teachers and parents, since they still care. And maybe eat some bacon.