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Thompson: Learning from Others II

Atulgawandeb Atul Gawande wants health care reformers to learn from the "battery of small scale experiments" that eventually improved American agriculture, and he correctly concludes that incremental progress is possible without a master plan. Gawande rejects the search for a "grand solution."  The health care reform bill is a hodgepodge of pilot programs - and "that is how it should be." And by the way, he ends with the modest words "we'll also need data, if we're going to know what is succeeding."

Larry Cuban wants educators to learn from the failure of Electronic Health Records to reduce medical costs, citing the $100 million Cleveland Clinic effort. Cuban says it is "no surprise that research follows changes in practice rather than the reverse. Giving too much credit to new technologies for organizational outcomes and well before studies support the claims is not peculiar to EHR and medical care. It applies to public schooling as well."

Cuban’s second point is that "boosters continue the tainted practice of falsely attributing gains in quality health care and cost containment or district test scores to technological innovations without having data in hand. Moreover, when that data comes up short, then ... blame is distributed

—not to the policymakers who make flawed, data-free decisions nor vendors who shamelessly boost every new gadget–but to the practitioners who work in hospitals and schools."

Getting back to Gawande borrowing insight from agricultural policy, he would be less sanguine in the effects of governmental efforts if he came from the Dust Bowl state of Oklahoma rather than Ohio, but that would just provide more proof for his and Cuban’s calls for modesty. The irrationality of our uncoordinated health care and education systems is nothing compared to the destructive way that the public trust was misused to build our railroads and to perpetuate the rape of our land, Progressives of the day blithely blamed the ignorance of poor farmers, not the complex dynamics of political and economic oppression.  Progressive reforms were helpful, but the real problem was not the backwardness of farmers but the brutality of the system that "farmed the farmers."  And the sorry tale further reinforces the reminder that we’ve survived worst.

"Reformers," who see education as the civil rights issue that it is, remind me of my mentors who saw top down land reform as the answer. If America had taken other courses and if we had a century of industrial policy and national agricultural policy, we might now be adept in meeting Five Year Plans, and maybe data-driven accountability along the lines of NCLB would work today.  I'm hoping that the RttT, however, will prompt a hodgepodge of pilots as well as a reminder of why a NCLB II regime would be just as alien to America's history of incrementalism from the bottom up. 

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