PrintDeclaring that access to healthcare is a right, not a privilege, the AFT has pledged to support a national single-payer system as a possible way to prevent cost shifting and to pare down administrative expenses. Other endorsed solutions include employer mandates, wider eligibility for Medicare and Medicaid, and responsible state initiatives.
The resolution also warns that free-market approaches to healthcare, such as health savings accounts, “would lead to even greater fragmentation of a ‘system’ that is already dysfunctional due to its lack of coordination.”
So, what is single-payer national health insurance? According to John Abraham, deputy director of the AFT research and information services department, it’s a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.
One reason for interest in the single-payer model is that the United States now has a crazy quilt of financing and payment for healthcare that relies on public (Medicare, Medicaid and Veterans Administration) and private insurers alike. The current yearly cost for healthcare in the United States is nearly $2 trillion, or about 15.5 percent of the gross domestic product.
Private, for-profit insurers spend lots of money on overhead, sales and marketing—things that have nothing to do with patient care. Doctors and hospitals are forced to hire large administrative staffs to deal with different procedures from each insurer. What’s more, profit-taking by vendors also removes money from the current healthcare system.
According to Physicians for National Health Insurance, about $350 billion per year could be saved by rolling the administrative functions provided by insurance companies into one administrative agent.
A single-payer system would:
■ Be financed in part by eliminating private insurers and recapturing their administrative costs.
■ Ensure that all Americans are covered for medically necessary services, including physicians, hospitals, prescription drugs and medical supplies.
■ Pay physicians a “fee for service,” according to a negotiated schedule, or pay doctors a salary through a health maintenance organization (HMO). Hospitals would negotiate an annual global budget for operating expenses. Expansion and medical equipment purchases also would be managed by regional health planning boards, eliminating the “medical arms race.”
■ Replace premiums and out-of-pocket costs with taxes. Overall costs would be controlled by a combination of negotiated fees, global budgeting and bulk purchasing.
Other options for achieving systemic healthcare reform include:
■ A national law requiring that employers either provide a legislated set of benefits for all employees or pay the cost of an equivalent plan into a state or regional fund that provides the benefits for workers.
■ An expansion of Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP) to cover all Americans.
To see the AFT’s resolution on single-payer healthcare, go to www.aft.org/about/resolutions/2006/
healthcare_system.htm
Thousands of Miami members rally for salary improvements
AFT members in Miami-Dade, Fla., sent a message to school officials in October when thousands of teachers and support personnel attended rallies throughout the county to demand salary improvements to match those offered in nearby counties. Teachers and school employees represented by the United Teachers of Dade have been working without a contract since June 3, and the district has not put sufficient dollars on the table to match Monroe County, which offers a starting teacher salary of $40,000, or Broward County, which offers a starting salary of $37,000. Members also are pressing the school board to ensure that all steps on the salary schedule receive adequate compensation. Many Dade County educators are leaving to work in Broward or Monroe, UTD president Karen Aronowitz told school board members.
NCLB’s accountability measure for schools, known as adequate yearly progress (AYP), was a featured topic in the inaugural session, held Oct. 10 at AFT headquarters in Washington, D.C. Congressional staffers joined representatives of education and civic groups for a panel discussion of “‘Failing’ or ‘Succeeding’ Schools: How Can We Tell?”—a new paper written by Paul E. Barton, a leading testing researcher, and published by the AFT.
The current AYP system is a weak, patchwork approach, Barton argued. It cobbles together old and new state exam systems and different notions of student proficiency. And when it comes to gauging adequate yearly progress in schools, the current AYP system blurs the distinction between measuring students and measuring schools. “There was never a time when this accountability shirt was cut out of the whole cloth. It was pieced together from old shirts,” said Barton, an education writer and consultant who is former director of the Educational Testing Service Policy Information Center.
Barton said policymakers need to ask hard questions about the appropriate use of tests. The law requires that tests be aligned to content standards and instruction—and “test results are not valid until the alignment occurs,” he stressed.
The author also said that school accountability can’t be achieved under the current system, which compares one group of students’ end-of-year knowledge with a different group’s end-of-year knowledge. “There is no measure of change in knowledge” under this approach, Barton said. A better way, he proposed, would be testing in the fall and spring, with tests aligned to the curricula. This approach also provides teachers with useful information at the beginning of the year, rather than a simple “grade” at year’s end. And to protect against overtesting, Barton argued that assessments may not need to be used every year for every student.
This new approach still poses a fundamental question that policymakers will have to grapple with: How much gain is enough? The answer must be based on “informed judgment of what are acceptable” student gains.
Also participating in the discussion was Raul Gonzalez, legislative director at the National Council of La Raza. Gonzalez acknowledged the value of student achievement growth in any new or modified AYP formula. But from a “civil rights perspective,” Gonzalez emphasized that NCLB must not abandon the concept of helping all students reach academic achievement levels that signal proficiency. Former AFT educational issues department director Joan Baratz Snowden also joined the panel. She echoed Barton’s concerns about an accountability system that doesn’t distinguish between student and school performance. And, given the depth and scope of social problems in many communities, “resources are needed in any serious accountability system,” she maintained.
Panelist Andrew Rotherham, co-founder and co-director of Education Sector, a national education policy think tank, said it’s also important that changes to NCLB accommodate the political landscape as well as the best thinking among education researchers. There is strong appeal among parents for a system that reports how their own children are doing in school, he said. And there is also a practical sentiment among some individuals in Congress and in the Bush administration who will resist major changes in the law.
The session was moderated by AFT executive vice president Antonia Cortese, who stressed that any version of AYP won’t succeed “if the system isn’t grounded in a rich curriculum that challenges all children.”
