School Choice Dies in Illinois

If you read my last post, Real School Choice, you know how important school choice is to the future of many children, especially those from low-income families. School choice is the key for the children of these families to escape poverty and lead productive lives. But not everyone agrees.

The State of Illinois has just declared that teachers unions are more important than children. That’s the message they sent to 9,600 low-income children when they killed their scholarships to private schools. The Wall Street Journal editorial board says, “Sometimes the worst political scandals occur in plain sight, even if most of the press corps chooses not to notice. That’s what happened last week in Illinois, where the Democratic-union machine killed scholarships for 9,600 low-income children.”

The state and national teachers union made a priority of blocking an extension of the Invest in Kids program that provided a 75% state tax credit for donations to help families afford private schools. The unions claim the credit drained money from public schools, but public funding has increased nearly $2 billion since Invest in Kids began under former Gov. Bruce Rauner. Only 35% of Illinois children read at grade level, according to Wirepoints, so no wonder there are more than 20,000 children on the Invest in Kids waiting list.

Current Gov. J.B. Pritzker refused to help save the program, even for children currently benefiting from it. Those families will now have to find some other way to pay tuition. Empower Illinois, the state’s largest scholarship-granting organization, says it will seek private donors to cover tuition. But the most common donation was $1,000, and many of those smaller donors may disappear without the tax credit.

Gov. Pritzker is a billionaire, and his Pritzker Family Foundation could help. According to Crain’s Chicago Business Journal, the foundation has donated $8.3 million to Milton Academy, the Massachusetts boarding school Mr. Pritzker attended. It has donated $2.5 million to Duke University, according to Carolina Journal, and $100 million to Northwestern Law School, which has renamed itself in his honor. Invest in Kids is a bargain by comparison, requiring about $71 million for the coming year.

The WSJ says, “Illinois is now the first state to kill a major school-choice program. The scandal reflects the bloody-mindedness of the unions that want to snuff out even minor competition to retain their monopoly. And it reveals how little most Democrats care about the children they imprison in these failure factories.”

While most states are increasing the scope of their school choice programs, Illinois is killing theirs. This is not surprising since Illinois is a deep blue state controlled by the Democrats and Democrats are the strongest supporters of teachers unions. Don’t look to the White House for any help, however, since First Lady Jill is also a member of the teachers unions. President Biden has made it clear he will always be a friend of the teachers unions.

The only solution to this problem for residents of Illinois is to vote for Republicans, or vote with their feet by moving to red states that value school choice. Many Illinois residents have already made this decision as the following graphic shows. Illinois leads the nation, along with New York, in losing the most residents in the last census.

Urgent Care or See Your Doctor?

Urgent care centers or “walk-in clinics” are popping up all over the place. Some people refer to them as a “doc in the box.” They offer convenience and same-day service without an appointment. So, when should you use them instead of your doctor?

The name should give you a hint – “urgent care.” They’re good for urgent problems that don’t quite fit into the “emergency” category. They became a popular place to be seen when the Covid pandemic hit and people needed to find out if they were Covid positive. Going to an emergency room didn’t seem right and they’re usually associated with long wait times. Going to an urgent care center got you a quick answer to the question of whether or not you had Covid. Primary care physicians generally discouraged Covid visits anyway.

But what about when your blood pressure is high? The urgent care center will probably give you a temporary fix for that problem, but won’t do the necessary testing and follow-up that is really needed. They also won’t keep up with your vaccinations and do needed health screening exams.

Sumathi Reddy, writing in The Wall Street Journal, says the ubiquity of walk-in and urgent-care clinics has changed the way many of us seek treatment for what we think are minor ailments such as the flu, pinkeye or a pulled muscle. Instead of trying to make an appointment with our primary care doctor, who might not be able to see you the same day, we often just go to the walk-in clinic.

“The urgent care center is going to focus on the problem at hand and move on, but their primary care is going to try to think more comprehensively,” says Dr. Ateev Mehrotra, a professor of healthcare policy at Harvard Medical School who has researched urgent care clinics.

The number of urgent care centers has grown by about 14% every year since 2016, says Lou Ellen Horwitz, CEO of the Urgent Care Association, a trade group. Mehrotra’s research found that the number of urgent care center visits per person more than doubled between 2008 and 2015.

When to see urgent care

Urgent care is a great place to go to address immediate medical concerns when you can’t get an appointment with your doctor or it’s a weekend or evening and the office is closed. (If it’s potentially life-threatening, though, you should go to the ER.) Urgent care centers can be better suited to treat certain injuries than your doctor’s office. Sprains, strains, cuts and burns are all things that urgent care centers are good at treating, says Dr. Rupal Bhingradia, a family physician who works at an urgent care clinic in New York.

Many urgent care centers have equipment that allows them to do more than your average primary care practice. “They’ll often have X-ray equipment, CT scans, ability to do sutures, IV and so forth,” says Mehrotra. “In general most primary care practices cannot provide those kinds of services.”

There are certain times where you should skip urgent care and head straight to the emergency department, says Friedman. This includes if you have any symptoms that might be a heart attack or stroke, such as chest pain or face numbness. If you’re struggling to breathe or have severe abdominal pain, it makes more sense to head to the ER rather than wasting time at an urgent care clinic that may end up sending you there, he says.

When to see your primary care doctor

The number one challenge with urgent care centers is that they generally don’t have access to your electronic health record, which details your medical history and other important medical information, says Mehrotra. An urgent care doctor isn’t tracking your health over the long term or looking for patterns that may require new treatments. So especially if you have a complicated health history or chronic illnesses, relying too much on urgent care for treatment may mean you miss bigger problems.

Cost can also be a factor when deciding whether to go to your doctor’s office or urgent center, says Mehrotra. It typically will cost more to go to an urgent care clinic than your primary care doctor’s office because they typically have more overhead expenses with longer hours and extra equipment. But it will be less than going to the emergency room.

You shouldn’t use an urgent care clinic as a replacement for a family physician or primary care doctor, says Bhingradia. Primary care doctors will manage your overall care rather than simply treating a one-off complaint, and should be your first point of contact for routine healthcare needs such as vaccinations, screenings and treatment of chronic conditions, she says.

In general, if the problem can’t wait for your doctor’s availability, but isn’t a true emergency, go to the urgent care center. If it can wait, see your primary care doctor.

Real School Choice

As an orthopedic surgeon, you wouldn’t expect me to write about school choice. But some things “light my fire” and one of them is school choice. As someone who has benefited greatly from higher education (I’ve had 31 years of education including my orthopedic training), I understand the importance of getting a good education.

I grew up in the era of good public-school education when teachers unions didn’t exist. Today, the public schools have declined significantly as teachers unions have prevented school districts from firing bad teachers. The result is many students suffer from a poor education. This can be the difference between prosperity and poverty for many low-income students.

The Covid pandemic focused the nation on public school education as many children suffered from closed schools. The private and parochial schools re-opened long before the public schools, which were kept closed by demands of the teachers unions. This disparity between public and private schools highlighted the school choice movement and now it is gaining great momentum. The school choice issue has become a significant determinant in many elections as more and more low-income Democratic parents realize that school choice is the key to their children escaping poverty.

But there are limitations to the progress made thus far by school choice. Roland Fryer, writing in The Wall Street Journal, thinks he knows the reason. He says, “School choice is sweeping the nation. But school choice as we know it won’t fix the American education system. The movement must return to Milton Friedman’s vision of unfettered competition, which no existing school-choice program achieves. Friedman wanted parents to have the autonomy to select the optimal educational environment for their children, unbounded by geography or income brackets, and to take their full allotment of education funds with them.”

Fryer believes school choice advocates must be bolder and refuse to settle for half a loaf. The underlying problems in U.S. education demand it. Despite being the world’s most prosperous nation, the U.S. ranks 36th in math and 13th in reading on the 2018 Program for International Student Assessment, a poor showing driven in part by racial achievement gaps. Despite decades of initiatives to close those gaps, black and Hispanic students lag behind their white peers in academics, graduation rates and college enrollment. The structure of American education is the culprit. We ask a system designed for standardization and conformity to innovate, personalize the educational experience, and address longstanding societal failures.

There is no doubt the existing school-choice system has helped thousands of families. But millions are waiting, and current choice programs operate within the same inadequate framework. Increasing choice on the margin through partial vouchers, magnet school or other measures has yielded disappointing results because of an imperfectly competitive market. Real competition doesn’t mean entering a lottery to attend a charter school or providing vouchers worth only a fraction of public-school funding.

This has led to mixed results in school-choice programs. While some charter schools have dramatically outperformed public schools, such as the Success Academy of New York City, others have done no better than public schools. A 2018 Wall Street Journal analysis of Milwaukee’s voucher system found that “voucher students, on average, have performed about the same as their peers in public schools on state exams,” and that vouchers seemed most effective at the schools that accepted the fewest of them. The District of Columbia’s voucher program, according to a 2013 study, improved high-school graduation rates but had uncertain effects on reading achievement and no clear effect on achievement in math.

The transformation of American education is bringing a more competitive and diverse array of schooling options for students. The most important development is the rapid expansion of education savings accounts, which 11 states offer. These accounts allow parents to channel public funds to a variety of educational services, from private-school tuition and microschools to tutoring and online courses, but they typically don’t match the funding provided to public schools. Even so, they are helping turn Friedman’s vision into reality.

In the interplay between ESAs and entrepreneurial zeal lies the revitalization of Friedman’s free-market vision for education. With more choices, parents are becoming informed consumers, prompting schools to refine their offerings. Fryer says, If we can fully commit to free-market principles in education, we can create an education system that unlocks the talents of every student in our lifetimes. I dream of the day when the inadequacies in American education are consigned to history.”

I dream of that day, too.