Sometimes an opinion piece asks a question for rhetorical purposes, as a device to introduce a topic. Other times, however, the question is a legitimate one for which the author has no answer.
Below are a few of the latter.
First question. Would teacher education be better served by following the trades model of earning one’s way from apprenticeship to master, emphasizing hands-on instruction more than classroom learning?
Many who see the trades education model as “beneath” a professional will have a strong and angry knee-jerk reaction, but it would be worthwhile to give the notion a chance.
Have aspiring teachers start with 60 hours of learning the basics of the content they wish to teach, plus courses required by the college or university to ensure that they have a general base of knowledge.
The apprentice level would start by requiring the educator to spend one semester as a teacher aide and at least one other semester as a substitute teacher. Frankly, every teacher should spend time as a substitute before taking on a classroom because this reveals the classroom management skills of the teacher. It also lets the educator know whether or not this job is truly for them.
At the journeyman level, a teacher would receive their own class to teach and could remain at this level through his or her career.
A master teacher would have acquired and demonstrated skills beyond that of the journeyman. They would make more money, but also be expected to serve in leadership positions and do more for the school and community than run a class. This would also serve as a track for those who would make a career of administration.
The difference lies in emphasizing hands-on training and experience over acquiring the same knowledge and skills from a university or college classroom.
Journalism and a number of other fields would also benefit from adopting the trades system over that of a college major in the subject.
Question Number Two. Why do the federal and state governments collect taxes as they do, rather than simply billing and providing payment plans as a business would?
Income taxes were never collected prior to 1913 because the United States Supreme Court ruled them unconstitutional. Until the digital age, the Internal Revenue Service had significant challenges in ascertaining a taxpayer’s income and this led to the bizarre, backwards, and just plain bad system states and the federal government use for collection.
Consider how strange it is that the federal government knows how much each taxpayer makes, outside of under the table cash payments, but that it insists that the taxpayer figure up their income and whatever other taxable assets they received. If the taxpayer comes up with the wrong figure, he or she pays the consequences.
With the digital age well entrenched, why can’t the federal and state government send a tax bill at the end of each January. That bill would automatically come with a monthly payment plan to dispatch the bill by December 31. Taxpayers would have until April 15 to issue a counteroffer with their deductions or evidence that the government assessed them wrongly. They must also, legally at least, report revenues received in cash even if the federal government is unaware. Whatever difference comes to the taxpayer’s benefit would be deducted from their December payment.
The government might actually find that if they bill like a private sector company, they will achieve better collection results and find fewer taxpayers inadvertently getting in trouble. They could adapt a billing system already in use by major private sector companies to enhance efficiencies. Adapting this process should also reduce the overhead of the IRS itself, saving taxpayer money.
Final question. In an age of health care empires with massive geographical reach, is there a reason why people can’t pay a retainer directly to their preferred health care system instead of also supporting the insurance industrial complex at the same time?
This here is the big question. Obamacare was written – in large part – for, by, and of the health insurance industry. They included a number of innovations, such as a large-scale expansion of billing coding, that has driven up the cost of health care to be much less affordable to anyone in a position of having to pay while the profits of the companies themselves keep rising.
It is right and good for private sector companies to earn profits, but when times change and new techniques are possible, no one should be immune to the drive to save costs and increase efficiencies.
One of the consequences, unintended or not, to the expansion of administrative costs, has been consolidation. Health care providers have centralized to a great degree in response to the massive overhead that came from the Obamacare laws.
Prior to the 21st century, doctors hung up their own shingle and tended to practice independently. Hospitals were generally more independent operations or clustered their facilities tightly within a region.
Health insurance originated from a patchwork quilt of sickness funds, workman’s compensation programs, and other initiatives. During the Great Depression, Baylor University Hospital devised an insurance plan that would cover patients patronizing their system, but not others. A hospital in Sacramento built on that, allowing their plan to cover medical services throughout the city, whether part of their system or not. This evolved into Blue Cross, which later combined with a similar program called Blue Shield, both serving as not for profit organizations.
As the population grew more mobile, it needed a broader scope of coverage as patrons sought medical care from a number of different providers.
Economic, social, and regulatory conditions evolved quickly in the 20th century, which shaped health insurance coverage. Government fixes only spawned more problems for both the industry and consumers, a dynamic repeated with the West Virginia Public Employees Insurance Agency in the past few years.
Health care systems in the past decade have expanded with voracious appetites. Even Federally Qualified Health Clinics, created for low income consumers, have engaged in expansion when possible.
Most of those who patronize the larger systems, such as WVU Medicine, will only rarely be too far from the system’s facilities to receive care. Their primary care physicians, specialists, medical services, and even emergency care will all lie within reasonable traveling distance for their consumers.
One must ask, given that fact, what is the point of health insurance for these consumers at all?
The health insurance industry itself is worth nearly $5 trillion. It employs nearly one million nationwide, a jump from about 765,000 in 2005. Add to that the cost of brick and mortar facilities, computer hardware and software, and everything else, right down to the swag it passes out at events and conferences.
Health insurance premiums pay for all of that on top of health care for the consumer.
Many argue for a government run single payer system while ignoring the fact that governments are terrible administrators of almost anything. The two largest single payer health care systems in the world are Britain’s National Health Service and the United States Veterans’ Administration system. No one who relies on either will vouch for their efficiency or effectiveness. Each has dedicated practitioners, but the systems themselves fail on a consistent basis to provide timely care because they are government entities with different priorities.
Old times will remember that the State of West Virginia once had a monopoly on selling hard liquor in its own chain of stores back when that was a product much more in demand than today. The State couldn’t earn a profit on that because governments are poor stewards of business operations due to the same dynamic.
What would seem to make the most common sense would be to pay a monthly retainer to a health care system. These systems would compete with each other to offer the best deals while eliminating the massive costs imposed on everyone by the health insurance industry, primarily because consumers would no longer have to support two major industries with their premiums.
Health care systems could make their own decisions on what and how to cover and leave behind the headaches of dealing with insurance companies. Those using Medicaid, Medicare, and veterans’ benefits could simply have all or part of their retainers covered by those agencies, depending on their level of personal economic challenges.
This method could enhance the free market aspect of the health care economy by increasing healthy competition. It could also at the same time reduce what consumers pay while increasing system revenues simultaneously.
