The MC: The Mackinac Center Blog

How to Ease the Coming Physician Shortage

Changing licensing restrictions and expanding services would help

The U.S. will face a shortage of 46,000 to 90,000 physicians by 2025, according to a report issued by the Association of American Medical Colleges. Meanwhile, the U.S. Department of Health and Human Services notes that the population of Americans age 65 and older will double between 2013 and 2040, swelling to 98 million. Older patients face complex health issues that require more frequent and intensive forms of treatment.

These trends suggest that if nothing is done to lower the high barriers to people seeking medical careers, it will only be a few years until patients will not be able to find the treatment they need.

The cartels that dominate medical professions make it extraordinarily difficult for individuals to enter the field. According to the American Medical Association, most doctors require 11 to 15 years of education and training before they are eligible for a state license to practice. This timespan includes four years of undergraduate study, four years of medical school, and, depending on the specialty, three to seven years of residency. Would-be physicians must then pass a series of exams before they obtain a license.

This process leaves the average new doctor with $169,601 in debt, plus roughly a decade in foregone earnings. And it’s not just the new docs who pick up the tab for their training: U.S taxpayers contribute around $15 billion each year to educating new doctors.

Aside from the extraordinary financial cost and time required for medical training, another factor in the upcoming shortage is a cap on the number of residency slots. A medical residency is something like an apprenticeship, with new doctors prohibited from going into independent practice until they have served several years under the supervision of an already-licensed physician. While more medical schools have opened in recent years to meet the growing demand, there has not been a corresponding rise in residency positions.

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Taxpayers pay for most residency positions through their Medicare and Medicaid dollars, but in 1997, Congress froze the number it funds at 100,000. The Association of American Medical Colleges has lobbied Congress to fund 15,000 more residencies, but in 2014, President Obama proposed to fund fewer, not more, positions. Consequently, medical students will begin to outnumber available residencies as early as next year.

The solution is not to demand that Congress fund more residencies. Instead, state-level policymakers should tear down the protectionist walls erected by professional associations that seek to keep salaries high by suppressing the number of new doctors, nurses, and medical technologists and limiting their abilities to serve patients.

These entrenched special interests use their power in state legislatures to maintain restrictive “scope of practice” regulations that, to cite one example, make it impossible in many places —including Michigan — to open low-cost clinics in Wal-Mart stores staffed by highly trained nurse practitioners. Expanding the scope of practice for midlevel professionals like nurse practitioners and physician assistants would expand the pool of quality health care services available in a state while lowering the cost to receive them.

Special interests also resist the adoption of retail and direct primary medicine. Retail medicine involves a medical professional setting up business in a store front, offering affordable, convenient treatment on an as-needed basis. Direct primary medicine offers a subscription-type model in which a patient pays a fixed monthly rate to a health care provider, encouraging more focus on prevention and maintenance of chronic conditions. States should encourage new models that cater to the needs of different types of patients.

It will take a combination of solutions to resolve the physician shortage, and their unifying theme should be “service.” The criteria for training good health care providers should focus on the needs of the patients — we should not prop up an ineffective model of health care delivery for the benefit of incumbent practitioners. As our population ages and advanced treatments allow patients with chronic illnesses to live longer, policymakers and industry professionals must work together to remove barriers to entry in the health care field, and to free the market to meet changing needs.

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November 7, 2014, MichiganVotes Weekly Vote Report

It's Time for Scope of Practice Reform

Current laws increase health care costs and limit access

Michigan faces a widespread shortage of primary health care providers, and state rules on midlevel health care providers have held up a valuable solution to this problem. Nurse practitioners and physician assistants offer competent care in more locations and at a lower cost than physicians, but these professionals are limited by protectionist restrictions known as “scope of practice” rules. Policymakers should loosen these restrictions to make health care services easier to obtain and afford.

Scope of practice restrictions are defended as an attempt to raise standards of care by limiting the range of procedures a medical professional is licensed to perform. They also impose extensive training requirements, limit a professional’s ability to write prescriptions, and require costly annual license fees. A growing body of scholarship shows that the restrictions do more harm than good for patients and consumers.

New research is discovering that scope of practice restrictions result in higher costs by artificially increasing the income of providers through a rationing scheme that does nothing to improve the quality of care. The research indicates that access to care is improved when nurse practitioners and physician assistants can offer more procedures and operate more independently than current laws allow.

A working paper from the Mercatus Center at George Mason University in Virginia shows how restrictions on nurse practitioners and physician assistants raise health care costs. Expanding the scope of their practices reduces the cost of Medicaid outpatient claims by 11 percent, and improves patients’ access to health care with little effect on quality.

Access to affordable care will improve when we streamline regulations that allow physicians to delegate patient care to physician assistants. Michigan expanded the scope of practice for physician assistants in 2011. That reform enjoyed broad support within the health care industry, which lauded it as an important step toward greater efficiency and effectiveness in delivering care, but policymakers should not stop there.

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In Michigan, a majority of counties are designated as Primary Medical Care Health Professional Shortage Areas by the U.S. Department of Health and Human Services, which compiled a list of counties with a higher-than-average ratio of residents per physician. The demand for nurse practitioners and physician assistants has grown tremendously in recent decades because, without these midlevel providers, many patients in underserved areas would get no care at all. Lawmakers should rely on the professional judgment of active practitioners and craft policies that enable nurse practitioners and physician assistants to help meet the needs of Michigan patients.

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Detroit Children Need Choice, Not Bureaucracy

DeGrow responds to DPS reform in the Detroit News

Children in Detroit desperately need more choices when it comes to their education, but bills currently making their way through Lansing would do just the opposite, as Mackinac Center Director of Education Policy Ben DeGrow wrote in a recent Letter to the Editor.

In the letter, published by The Detroit News, DeGrow explains that a set of bills approved last month by the Senate would create the Detroit Education Commission, adding another layer of bureaucracy and limiting school options for families.

Rather than double down on more centralized authority, let a thousand flowers bloom. There really are only two options: either have a politically appointed board determine what’s best for Detroit schoolchildren (something that’s clearly failed in the past), or empower families to decide for themselves. A free market of educational providers — one where good schools are rewarded with more students and funding and bad schools are closed — can work in Detroit, if given a chance.

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Read the letter in its entirety at The Detroit News.

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Why Michigan Needs Electioneering Reform

MLive publishes Mackinac Center policy analyst’s take

There is a need to prohibit local governments and school districts from campaigning with taxpayer money, Mackinac Center policy analyst Jarrett Skorup writes in an op-ed recently published by MLive.

In the piece, Skorup weighs in on efforts to change state advocacy laws. Earlier this year, Gov. Snyder signed Public Act 269, preventing public officials from advertising ballot issues within 60 days of an election in an attempt to stop localities and school districts from advocating for tax increases on the public dime.

The need for this bill is easy to see. Even though it is technically illegal for local officials to use taxpayer resources to advocate for a yes vote on a proposal, local governments routinely fund messages that appear to be advocacy, and there's little recourse for taxpayers when they do cross the line.

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In response to backlash from school districts and local governments and an injunction on the new law, the Legislature is now considering a bill that Skorup says “goes too far in the other direction” and “reestablish(es) the fuzzy line between informing the public and persuading the public” that necessitated a policy change in the first place.

A middle ground is needed to prevent advocacy while still allowing local governments to provide information. The Legislature should clarify that government officials, if asked, still could provide citizens with the date of an election and the exact language of the proposal. But that's it. The standard should be that if it's not a message a government official could provide to a voter while at the polls, it shouldn't be allowed.

Read the op-ed in its entirety at MLive.

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April 1 Michigan Legislature Weekly Roll Call Report

Constitutional amendments on same sex marriage, legalized pot, “referendum-proofing” bills and more

The House and Senate are on a two-week spring break, so rather than votes this report contains some recently proposed constitutional amendments of interest. To become law these require a two-thirds vote in the House and Senate and approval by voters.

Senate Joint Resolution H: Ban welfare for illegal aliens
Introduced by Sen. Joe Hune (R), to place before voters in the next general election a constitutional amendment to prohibit the state from giving any kind of public assistance to illegal aliens. Referred to committee, no further action at this time.

Senate Joint Resolution I: Repeal same sex marriage ban
Introduced by Sen. Rebekah Warren (D), to place before voters in the next general election an amendment to repeal Section 25 of the Michigan constitution, which currently states, “To secure and preserve the benefits of marriage for our society and for future generations of children, the union of one man and one woman in marriage shall be the only agreement recognized as a marriage or similar union for any purpose.” Referred to committee, no further action at this time.

Senate Joint Resolution M: Replace gas tax increase with 1% sales tax increase
Introduced by Sen. Kenneth Horn (R), to place before voters a constitutional amendment that would increase the state sales tax from 6 percent to 7 percent and use the money for roads, while repealing the gas tax and vehicle registration tax increases enacted by the Legislature in 2015. Referred to committee, no further action at this time.

Senate Joint Resolution O: Legalize marijuana
Introduced by Sen. Coleman Young II (D), to place before voters in the next general election a constitutional amendment to prohibit the Legislature from adopting a law that makes adult possession or use of marijuana a criminal or civil offense. Laws regulating production and sales could be enacted, and also laws regulating the time, place and manner of use for public health and safety purposes. Referred to committee, no further action at this time.

House Joint Resolution BB: Call for “Article V” U.S. constitutional amendment convention
Introduced by Rep. Lee Chatfield (R), to submit an application to Congress calling for a "convention to propose amendments to the U.S. Constitution," limited to the issues of fiscal restraints, federal powers and congressional term limits. Referred to committee, no further action at this time.

House Joint Resolution DD: Lower minimum age for lawmakers
Introduced by Rep. Aaron Miller (R), to place before voters in the next general election a constitutional amendment to lower the minimum age requirement for legislators from 21 to 18 and for governors from 30 to 21. Referred to committee, no further action at this time.

House Joint Resolution FF, Senate Joint Resolutions H and N: Limit referendum on appropriations ban
Introduced by Rep. Jim Townsend (D), Sen. Rebekah Warren (D) and Sen. Curtis Hertel (D), respectively, plus many cosponsors, to place before voters in the next general election a constitutional amendment to revise the current prohibition on citizen referendums challenging bills that contain an appropriation.

The measure would establish that the ban only applies to bills that substantially fund one or more state departments, or which are needed to close current state budget shortfalls. A 2001 Supreme Court ruling interpreted the provision as prohibiting referendums on any bill containing an appropriation, even a small or incidental one. In several instances the Legislature has deliberately added modest appropriations to controversial bills that would likely have been challenged by a referendum. Referred to committee, no further action at this time.

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A Mackinac Center video profiling California teacher Rebecca Friedrichs and her fight to free herself from forced unionism was featured this week by The Washington Post in its coverage of the Supreme Court’s 4-4 decision on the case.

Because her state does not provide right-to-work protections, Friedrichs must pay dues to the California Teachers Association as a condition of her employment. In the video, posted under the headline “California teachers explain their Supreme Court case,” Friedrichs explains why being forced to pay dues to a union violates her First Amendment rights:

People like myself, who are agency fee payers, pay 100 percent of the collective bargaining fees. However, we do not get to vote within collective bargaining. Collective bargaining is just as political as anything else the union does because when you go to elected officials and you bargain for the use of taxpayer funds, that’s political.

On Tuesday, the U.S. Supreme Court issued a split decision in the case that would have protected public employees in non-right-to-work states from being fired for not paying union dues. Mackinac Center’s F. Vincent Vernuccio explained the impact of decision in a recent blog, noting that the fight for employee freedom is far from over:

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Still, attorneys for the plaintiffs are undaunted. Center for Individual Rights President Terry Pell released a statement after the decision, saying, "We believe this case is too significant to let a split decision stand and we will file a petition for rehearing with the Supreme Court." Rebecca Friedrichs echoed this sentiment, telling reporters, "All of us plaintiffs have been in the classroom for a very long time, so we’re very patient people, and we are definitely in this for the long haul. Today’s decision isn’t the end of the case, and in our view, it simply just delays the final outcome."

Watch the entire Friedrichs video at The Washington Post and read Vernuccio’s full analysis on the case here.

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The Times Herald published an op-ed this week by Michael LaFaive, director of the Morey Fiscal Policy Initiative at the Mackinac Center, calling into question the state’s no-bid contract with a company that produces reports on the Pure Michigan advertising campaign.

In the op-ed, LaFaive discusses a recent report by Longwoods International that shows high returns on the Pure Michigan ads but fail to disclose any calculations to taxpayers who paid for the report. Because this report and others produced by Longwoods serve as justification for the $33 million Pure Michigan ad campaign and make extraordinary claims about the supposed return on investment of this spending, LaFaive said there should be transparency in the process. He writes:

Such claims should come with a high burden of proof, yet the company refuses to disclose the calculations behind this extraordinary claim, and the agency that purchased the report appears unconcerned. Longwoods asserts that its methods are proprietary, or secret. But Michigan taxpayers, who paid almost $150,000 for this report, should not have to take the government’s word that such a claim is valid, much less the word of the private company that made it.

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That’s especially true given the apparently cozy relationship between the company and the agency: Longwoods’ current chairman is the former MEDC (Michigan Economic Development Corporation) official in charge of the state’s tourism promotion programs. Moreover, Longwoods’ MEDC business is the result of no-bid contracts.

LaFaive, who has authored a soon-to-be-released study on the questionable practices used to justify the Pure Michigan campaign, encouraged lawmakers to press the hold button on such spending until they make the review process transparent.

Given the MEDC’s incentive to justify its budget with unsupported claims, lawmakers should place an embargo on any further contracts evaluating Pure Michigan or other economic development programs. The embargo should remain in place until all such contracts are open to independent examination and review.

Read LaFaive’s op-ed in its entirety at The Times Herald.

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Hung Supreme Court Delays Freedom for Public Employees

Supporters of workers' first amendment rights still optimistic

On March 29, the U.S. Supreme Court issued a one-line ruling on a case that would have brought right-to-work protections for public employees across the country. The court said that a lower court decision would stand, meaning government unions in non-right-to-work states can still get public employees fired for not paying them.

However, because the decision was the result of a 4-4 tie rather than a majority ruling, it does not affect the entire country — only the Ninth Circuit, where the case was decided earlier. The case, Friedrichs v. California Teachers Association, was brought by the Center for Individual Rights on behalf of Rebecca Friedrichs and several other California teachers. Friedrichs and her fellow plaintiffs argued that everything done by a government union is “inherently political” and that they have a First Amendment right not to fund politics they disagree with.

Supporters of worker freedom were initially optimistic that the court would affirm the First Amendment rights of public employees through Friedrichs. With the death of Justice Antonin Scalia in February, however, a positive outcome seemed unlikely as Scalia was widely thought to be the swing vote in the case. For the time being, Scalia’s passing likely saved unions’ ability to force public employees in about half the states to pay them dues or fees.

Until a ninth justice is appointed, not much of anything deemed controversial will get through the court, meaning freedom may be delayed for Rebecca Friedrichs and other public employees across the country wishing to exercise their rights.

But, if the Senate continues to block the nomination of Merrick Garland, President Obama’s nominee to the Supreme Court, and a president is elected in November who would appoint a justice like Scalia, there is a good chance the issue of forced unionism could be reheard by a new court and decided in favor of worker freedom. On the other hand, if Merrick Garland or a similar nominee is appointed to the court, chances are very slim for a decision favoring public employees’ First Amendment rights. As the Washington Times recently noted, “Garland rulings consistently side with labor unions.”

Still, attorneys for the plaintiffs are undaunted. Center for Individual Rights President Terry Pell released a statement after the decision, saying, “We believe this case is too significant to let a split decision stand and we will file a petition for rehearing with the Supreme Court.” Rebecca Friedrichs echoed this sentiment, telling reporters, “All of us plaintiffs have been in the classroom for a very long time, so we’re very patient people, and we are definitely in this for the long haul. Today’s decision isn’t the end of the case, and in our view, it simply just delays the final outcome.”

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Cases using similar reasoning to Friedrichs, such as Janus vs. AFSCME brought by the Liberty Justice Center in Illinois, are working their way through lower courts and could be heard by a full Supreme Court if they do not rehear Friedrichs.

No matter what happens at the Supreme Court, labor reform will continue to come from the states. With West Virginia becoming the 26th right-to-work state this year, there are now a majority of states in the country where unions cannot get workers fired for not paying them. That number will continue to grow.

Three things to remember about the Friedrichs case are:

  1. The Supreme Court did not set any precedent with their decision. The only place the decision stands is in the Ninth Circuit, which covers California and several other western states.
  2. A full court with a new justice may rule in favor of the First Amendment rights of government workers. The Friedrichs attorneys are petitioning for the case to be reheard when there are nine justices. Other cases could also be brought before a new court.
  3. The country is moving swiftly in the direction of worker freedom. When West Virginia became a right-to-work state earlier this year, it became the fifth state to become right-to-work since 2000, and the fourth to do so since 2012.

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The gas and vehicle registration tax hikes lawmakers agreed to last fall could essentially be used to pay for the state’s Medicaid expansion, Mackinac Center’s James Hohman argues in an op-ed published by the Lansing State Journal today.

Because the tax hikes — projected to bring in more than $533 million in their first year — will not take effect until 2017, legislators dedicated $400 million in general fund money to roads. Once the increased tax revenue rolls in that $400 million general fund allocation will pay for Michigan’s Medicaid expansion and increases in the Department of Health and Human Services and K-12 education budgets, according to the executive budget.

Hohman explains the problem with transferring one-time expenditures:

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The $400 million the Legislature directed to transportation was marked as a one-time expenditure, and thus should be considered nontransferable. But unless the revenues used for that one-time expense dries up the following year – a dubious claim to make about a growing general fund – then labeling it as a “one-time” decision meant that the money would be available to use elsewhere next year.

Read the full op-ed in the Lansing State Journal.

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(Editor's Note: The following is the written testimony Education Policy Director Ben Degrow offered to the House Appropriations Committee on March 7, 2016.)

Thank you for the opportunity to share my thoughts concerning the challenging state of education in Detroit. Since its inception the Mackinac Center for Public Policy has advocated policy solutions that expand freedom to help improve the quality of life for all Michigan residents.

In this case, the residents are thousands of Detroit Public Schools students, who are receiving an inferior education that will not prepare them adequately for life and career. Many are crying out for something better. They need to see hope.

There are challenges and constraints within the political process, not to mention the other obstacles that stand in the way of needed change. Included among them are restrictive union contract provisions, limited access to transportation and school performance information for many parents, and a state constitution that rules out public support for educational options that might help rescue a significant number of Detroit students.

I don’t have to remind you of the looming fiscal breaking point that faces Detroit Public Schools. The prospect of having to bail out DPS legitimately frustrates many state taxpayers. If the Legislature is to approve a fiscal package to pay off the district’s debt, taxpayers need the assurance that the state will not have to return down this road again any time soon. And for the sake of students present and future, any bailout must be accompanied by dramatic changes, not business as usual.

The recent track record of DPS under state emergency management cannot be defended. Academic achievement is at the bottom of the nation, deficits continue to grow. And frustrating mismanagement most recently has evidenced itself in the terrible working conditions and facilities that fueled weeks of teacher sickouts and attracted national media attention.

But just restoring school board control over the traditional district model offers no real consolation. The past track record of local fiscal mismanagement prompted the need for emergency managers in the first place. Even so, proponents of “local control” may be onto something. But the form and function of that local control is still a really important question that needs to be answered. In short, we need to take local control even further.

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Replacing or supplementing a locally elected school board with a politically appointed commission or board with unilateral control over what schools students may attend or which schools will be allowed serve students would be doubling down on the centralized, command-and-control system that has failed, and failed. And then failed some more. Such a move would represent a step backward for many Detroit families, because although they don’t make perfect decisions about which school is best for their children, they know a lot more than a bureaucratic board does from its perch on high.

People of good will disagree about the right policy solutions to fix education in Detroit. No simple answers are apparent. But the goal of providing all Detroit students with the opportunity to receive an effective education remains at the forefront. Too much of the debate has been focused on preserving an ineffective institution, with the hope that tweaks to this institution will make a significant difference.

Some proposals offer limited hope of making a positive impact, but mostly work around the edges. State-imposed merit pay systems and caps on administrative expenses, alternative teacher certification, and more flexibility to operative on year-round calendars. All promise to do more good than harm, but none of them will truly succeed if the current bloated bureaucracy and strict union rules remain in place.

The time has come to imagine something dramatically different for the students and families of Detroit. This alternate vision, a hopeful vision, is one that follows the most promising path of urban education recovery, one that places greater trust and responsibility in parents, school principals, teachers, and community leaders.

The state should open the doors to more quality educational options, and put them within reach of more families. We should eliminate the old model of address-based school assignment – let a thousand flowers bloom and trust parents to find the school that fits their needs. In a way, they’ve already been doing this for years: DPS’ enrollment has plummeted because over time many parents have voted against DPS with their feet. Dissatisfied, thousands have found ways to enroll their kids across district lines or in one of the many area charter schools.

My colleagues at the Mackinac Center have documented some of these stories on our website, ChoosingCharters.com. Stories told in parents’ own words. Stories of LaTanya Dorsey, Janine McKinney, Cory Hughes, and Lisa Cobb, to name a few. Detroit mom Toya Putnam, who enrolled her two sons in a charter school, explained it best: “I wouldn’t want anyone else to pick & choose for my kids’ future.”

Her view is shared by many Detroit parents. In a recent public opinion poll, nearly three out of four Detroit voters said they want more educational choices.

Not every charter school is great. There is no reason to rest satisfied and say that the charter school sector has raised the bar enough.

But the best available research shows that, on average, they’re improving education in Detroit. The Center for Research on Educational Outcomes at Stanford University, known as CREDO, recently studied 41 urban centers and identified Detroit’s public charter sector as one of four “essential examples of school-level and system-level commitments to quality that can serve as models to other communities.”

Their research found the average Detroit charter student gains an extra 2 to 3 months learning every single year. That means if a student enrolls in a charter school in kindergarten, by 5th grade, they’d have mastered an entire year’s worth of extra learning compared to if they had stayed enrolled in the school assigned to them based on their address.

Notably, Detroit’s charter schools are achieving these results with thousands of dollars less revenue per student. With total 2014-15 per-pupil revenues of $8,900, Martin Luther King Jr. Education Center Academy earned the top spot on the Mackinac Center’s most recent Context and Performance Report Card, which takes into consideration the impact that poverty has on average test scores. Close behind, in 2nd place out of over 2,200 schools, Ross-Hill Academy, brought in $8,800 per student. These two homegrown DPS-authorized charters provide hopeful evidence of a better path. And clearly, based on the CREDO research, they are not alone. The growing system of University Prep schools, for example, is raising the bar as well—with philanthropic and operational support that comes from outside the dominant interests of the education establishment.

The protection of existing educational options ought to be the floor, and not the ceiling, of the discussion. It’s time to let 1,000 educational flowers bloom across Detroit, to grow and attract more quality school models, and to expand students’ access to them.

Some of that may come by attracting more high-quality charter operators willing to compete on a level playing field. Easier access to existing unused or under-capacity school facilities certainly would help. Incentives to attract more quality instructional talent also could be explored. Then there’s the need for more equitable funding.

While DPS per se doesn’t need more money, Detroit students themselves may. Currently, significant shares of funds that enter district coffers are diverted to MPSERS pension contributions, union contract obligations, required debt payments, and central administrative costs. And it is well documented that those administrative costs are disproportionately high at $2,000 per student, considerably more than state averages. Quite an accomplishment for the state’s largest district.

Rather than pour dollars down from the state into a district apparatus that takes away its shares first, why not “backpack” dollars directly to individual schools based on enrolled students? Each individual student would bring to his or her chosen school a specified amount of state funds. The amount of funds could be based on significantly defined student characteristics — including economically disadvantaged or English Language Learner, or grade level. Regardless, enact a funding system that ensures more key educational decisions are made from the bottom up, not from the top down. State funding will go farther and have more of an impact if it goes directly to the schools and classrooms that needs it.

Making that model work means empowering and attracting great school leaders – a critical element of student academic success. Building-level leaders have greater opportunity to shape the destiny of school communities where they better know students, and are directly accountable to them and to their families. How does Detroit mold and attract more top-notch principals like Dr. Clara Smith of Thirkell Elementary, which rated as the state’s top elementary school on the 2013 Mackinac report card? Or Juan Martinez, principal of Cesar Chavez Academy in southwest Detroit? His high school topped our report card in 2014 by beating the odds with a high-poverty student population.

Of course, along with autonomy must come accountability for results. That starts with a reasonable and transparent school grading system, as some have proposed. Ideally, such a system would operate statewide, recognizing that many families in Detroit and elsewhere navigate their choices across district lines. An A to F grading system can be a beneficial tool, if done correctly. Florida’s success in this area offers some guidance to Michigan: Their report card measures a mix of student achievement levels and student growth metrics and does a good job of keeping a high bar, while not penalizing schools for simply serving relatively low-performing students.

Accountability means progressively raising the standards and expectations for the year-to-year academic growth Detroit students can achieve. But it does not mean dictating specific facets of school design and staffing.

This type of decentralized educational model entails rethinking the district’s role as a service provider rather than a command and control agent. While providing the core instructional services, school leadership should be empowered to purchase other services—student support, professional development, custodial, IT, human resources—from the district or an outside provider on a competitive basis.

It also envisions the school board or other elected agent as a contract or portfolio manager. Rather than focusing on enacting and enforcing district-wide policies, the governing body would negotiate performance standards, monitor results, and make quality services available.

Here’s the kicker. The idea isn’t new or radical, not even to Detroit. Former emergency manager Robert Bobb floated a similar plan back in 2011, a plan supported by then-school board president Anthony Adams. Bobb’s “bold step” was to convert up to 45 district schools into independent, charter-managed entities. But it never came to fruition.

The experience of other districts that have gone this direction tells us that some degree of school-level control may need to be phased in, and that some principals need additional support outside areas of traditional instructional leadership—like financial management. The good news is that a wide array of helpful resources and tools stand available to draw upon.

Making such drastic changes essentially would require pushing the Reset button on Detroit Public Schools, not simply changing the name over the door. It would mean getting Detroit out of MPSERS, terminating union contracts, and restaffing the entire district. It would allow for a fresh start and a new trajectory, one that offers real promise of a brighter future and not a return down the same troubling path.

In December 2013, the California-based Reason Foundation published a study evaluating 15 districts across the nation that provide some level of portable student funding and decentralized budgeting systems. The study examined how well districts raised achievement levels and closed achievement gaps between rich and poor students. Both correlation and regression data strongly suggest that greater degrees of school-level budget autonomy are connected with better performance. A district that allocated half of its budget through student choice at the school level had almost 10 times greater chance of closing achievement gaps than a district that allocated 20 percent of its budget through a student-based formula.

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