16 October 2010

Confusing standards

With reality.

In schools, the principle standards are standardized testing regimens. And from there, we take a measure of academic and career possibilities. What we neglect to relate to people is that these possibilities exist for most everyone else, not simply the top 5% on these tests, and that people should take care to preserve their options, such as by not having children in their teenage years, or not picking up a criminal record, and so on. In other words, we seem to be telling people if you do well on these tests, then there's the fabled American Dream open at your feet, and if not, you're fucked. To be sure, I've encountered hundreds of people in my own academic career who were not cut out to be "educated" in that way. That was not their skill and they had fewer tools sharpened and at the ready to draw on personally in order to advance themselves by the means of an education. But this failing was largely from years of neglect, through a primary system that told them they were not ready and reinforced it by not taking the effort to prepare them anyway. And the reason that many people aren't ready seems to be... that we prepare people to take standardized tests that often have little resemblance to the skills they will need educationally and professionally.

Meanwhile, in health care we seem to have a standard of comparison based on mortality rates. To be sure there are dread diseases that this is a fair comparison for. Presumably if we can cure or even aid with these in treatments, people living longer is a good outcome. But all this emphasis on living longer kind of misses the point. Yes people do not want to die from medical problems "prematurely", but they also want to have lives, not be hooked up to machines to prolong that life but in agony or disuse and despair. And a useful standard for evaluating this sort of thing, Quality adjusted life years, was all but explicitly removed from use during the latest round of health care "reforms". Why?

Because people perceived its use as akin to "death panels". I perceive its use as akin to actually providing health care. The best outcome of delivering care is that the patient lives a longer but happier life, not simply lives longer. It would have been useful if we had some idea whether this is what we were getting for our lost wages and taxes and insurance premiums, because to me, that's what you are ultimately buying.
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