Catholic schools are closing their doors all across America, leaving future generations with nowhere to turn for the high-quality academics and values-based education so many families are seeking. The number of students attending Catholic schools in the US fell from about 5.2 million in 1965 to around two million in 2008.
Pioneer Institute believes these schools are worth preserving. For over a decade, we have raised our voice in support of these excellent academic options, and tools such as tax credit scholarships that would enable more families to attend.
Pioneer has held public forums, published research on the benefits of Catholic education, on successful models such as Cristo Rey, and on policy changes that would stop the Massachusetts education department from depriving religious school students of special needs services and school nurses. The Institute has also convened key stakeholders, appeared in local and national press, filed amicus briefs, produced a feature a documentary film, and much more.
This week on “The Learning Curve,” co-hosts Gerard Robinson and Cara Candal talk with Ian Rowe, a senior fellow at the American Enterprise Institute, where he focuses on education and upward mobility, family formation, and adoption. Ian shares his background in entrepreneurial school leadership and policy research, and how he became interested in K-12 education reform. They discuss his work to advance quality school options for poor and minority kids as CEO of Public Prep and now cofounder of Vertex Partnership Academies, a character-based network of schools based on International Baccalaureate’s (IB) world-class curriculum. He weighs in on why policymaking around school choice and academic content has become politicized, and the kinds of content K-12 students should be taught, through the 1776 Unites project for example, to prepare for college coursework, meaningful citizenship, and pathways to prosperity.
Stories of the Week: Should the state take over management of the Boston Public Schools? A Boston Globe opinion writer makes the case, noting the disproportionately low-income and minority student population enrolled in the district’s chronically underachieving schools. A US News story highlights the benefits of high school internship programs, to help students get a head start on career preparation before college.
Guest:
Ian Rowe is a senior fellow at the American Enterprise Institute, where he focuses on education and upward mobility, family formation, and adoption. Mr. Rowe is also the co-founder of Vertex Partnership Academies, a new network of character-based International Baccalaureate high schools opening in the Bronx in 2022; the chairman of the board of Spence-Chapin, a nonprofit adoption services organization; and the co-founder of the National Summer School Initiative. Ian is the former CEO of Public Prep, tuition-free Pre-K and single-sex elementary and middle public charter schools, educating more than 2,000 students in New York City. He concurrently serves as a senior visiting fellow at the Woodson Center and a writer for the 1776 Unites Campaign. Mr. Rowe earned an MBA from Harvard Business School, where he was the first Black editor-in-chief of The Harbus, the Harvard Business School newspaper, and a BS in computer science engineering from Cornell University.
The next episode will air on Weds., January 26th, with guest, Andrew Campanella, the president of National School Choice Week.
Tweet of the Week:
The $1 billion budget for the Tech Modernization Fund is a huge investment, but funds are only part of the solution. Tech Talent Project outlines tech fund best practices TMF can use to make gov work for people. #CivicTech https://t.co/KNbhyX29jw
— John Bailey (@John_Bailey) January 17, 2022
News Links:
Boston Public Schools should go into receivership
https://www.bostonglobe.com/2022/01/17/opinion/boston-public-schools-should-go-into-receivership/
The Rise of High School Internships
https://www.usnews.com/education/k12/articles/the-rise-of-high-school-internships
Read a Transcript of This Episode
Please excuse typos.
[00:00:00] Cara: welcome listeners to another week of The Learning Curve. This is Cara Candal here as always with the amazing Gerard Robinson. How you doing this week?
[00:00:32] GR: Doing well. How about you?
[00:00:34] Cara: Yeah, I’m doing okay. I mean, in some sense it was a somber weekend. I was thinking about how, sort of pressuring it was, we just recently had Barry Weiss on the show talking about the rise of anti-Semitism in the U S and then we have this hostage taking at a synagogue Colleyville, Texas this weekend, disturbing that it seems like events like this are happening more and more often in recent years.
[00:00:57] So a little bit of a time of reflection that coupled [00:01:00] with the fact that, of course yesterday, we celebrated Dr. King’s birthday. and we had a guest on last week to talk about Dr. King and his legacy. So, on the whole, restful weekend, but a little bit of unrest in my soul, Gerard thinking about some of this stuff.
[00:01:17] So I, but I hope you’re well, and I hope that our listeners are well. And it also just made me think that I think the content we bring to folks every week is super relevant, as unfortunate as that might be time to time.
[00:01:31] GR: Well, Dr. Carson was on last week. And we know he’s a professor emeritus now at Stanford, and he’s in charge of the MLK papers.
[00:01:40] In fact, we just brought on a new scholar, to, take the project to the next level, but so much of what he discussed in terms of keying and his international influence is really important because yesterday was sharing with the girls, little known fact about MLK is the fact that he was born Michael King.
[00:01:58] his father ended up changing his name to [00:02:00] Martin Luther king. Of course, after he traveled to Germany in 1934 as part of a delegation from the United States Baptist convention to Berlin. And again, this is 1934. We know the year before that, Hitler comes to power. he said he was there. His dad was there the time starting to see.
[00:02:19] Rise of Nazi-ism the Baptist delegation actually put out a statement saying that they were against all forms of racism, antisemitism 1934. And so we’re talking about this and what happened, unfortunately in Texas in 2022. And so it just put into an international context that him going to, Germany, , the home of Martin Luther and coming back and saying, wow, I’m, so moved.
[00:02:43] I’m going to change , my son’s name to Martin Luther king and the rest is history on the anti-Semitism side. We’ve also had J group. On our show. And he’s recently published a really good piece from the heritage foundation, which looked at diversity equity and inclusion [00:03:00] programs at universities.
[00:03:02] But in that report, he also talked about anti-Semitism and, or the lack of focus when we’re talking about diversity or inclusion or equity, and we’re talking about racism. anti-Semitism, isn’t getting a great deal of attention, but here in the Commonwealth, this past weekend, we had the inauguration of governor Youngkin.
[00:03:23] also Lieutenant Governor Sears was the first African-American woman elected statewide and our attorney general, who’s the first Latino elected statewide, , one of the executive orders and one of the executive directives that he signed had to deal with antisemitism, and he also quoted king, I’m not real address.
[00:03:42] So the things you brought up were part of the weekend, and I lived here in.
[00:03:48] Cara: Yeah, lots to think about and you know,, I want to root us firmly back in Boston because as you know, Gerard Dr. King did his doctoral work here in Boston, and I used to love to live really close to Boston [00:04:00] university campus just blocks away and there’s this beautiful, statue dedicated to his memory there.
[00:04:05] And you’ve never seen it, I highly recommended it is right outside of. Main library of the Boston university’s main library, as well as the, student center. It’s a beautiful work of art. So he’s got, a history here and relevant to my story of the week, which, , I asked our producers if I could just get a little Boston today, because we had a story out in the Boston globe this weekend, , an opinion piece highlighting just the absolute failure in many ways.
[00:04:33] I’m just going to name it of the Boston Public Schools. And it got me thinking so much about how disappointed Dr. King would be to know that in a system, where Massachusetts, just so consistently. number one in the nation on so many measures, including NAEP among other things. but we also consistently have some of the widest achievement gaps in the nation.
[00:04:55] Something that is just way too often overlooked, and those gaps are just horrific [00:05:00] in the Boston public school system. So this opinion piece out of the Boston globe, written by Roger Lowenstein talks about the need to consider receivership a controversial word, a controversial term for the Boston public schools.
[00:05:15] And the timing on this is great because my friend with pioneer Institute, I have a paper coming out soon on this very topic. Now I’m going to take just a moment to set the context. And that is that Boston public schools have been consistently persistently failing, , mainly children of color, but the system.
[00:05:33] Also, you know, heavily weighted serves, disproportionate numbers of children of color, because , one of the things that happens in Boston is that if you are in, this is just talking in demographic terms here. If you live in the city of Boston and you are white and. , upper income, you are much more likely not to use it’s public schools.
[00:05:53] so what happens then is that folks are locked into a system where they have what we call intra district choice, [00:06:00] but most times families are choosing among, , just a bunch of low performing schools, unless you can, as we’ve talked about on this show before test into one of the only high performing schools in the Boston public schools, which would be an exam school and admissions based school, some of that’s changing there, they’re revamping, , admissions via exam, , this coming year, , and there’s some changes made post pandemic, but it’s still, these exam schools.
[00:06:23] Have historically been disproportionately populated with higher income children and certainly with white children and many times what families do is they use private education up until the point when kids are eligible to go to the exam schools in middle school. And so where does this leave? The other Boston public schools and the families that are choosing amongst just many, many low performing schools?
[00:06:45] Well, it doesn’t leave them with much choice at all. And this opinion piece in the Boston globe makes the case for the state to essentially take over BPS. Now I’m going to do a little detour here and take our listeners [00:07:00] back to the spring of 2020. And all we’ll remember is the pandemic. But in fact, about a week, a week before schools across the country, shuttered their doors, the commissioner of education, Jeff Riley here in Massachusetts had requested, , had ordered actually study.
[00:07:17] As we do here, we, , , and in many states reviews of districts, but an in-depth review of the Boston public schools, which is one thing that is necessary for receivership. And, , that report was released. Very damning report was released just the week before schools closed due to the pandemic. So.
[00:07:34] Buried. probably not intentionally. I don’t think people really realize the pandemic was coming, but to make a long story short, the report Gerard was damning, absolutely damning. And it unearthed not just pockets of under-performance, but just persistent failure on the part of the system to serve kids persistent failure in terms of getting the right curricula into kids’ classrooms, a disjointed approach to education where schools had a lot of [00:08:00] autonomy and there was just very little accountability.
[00:08:02] We like autonomy generally, but when it’s coupled with accountability and, persistently putting, less skilled teachers in the classrooms where kids most need the high skilled teachers, , not a lot of professional development for teachers, the list goes on and on and on. So one would have thought that once this report was issued, the case for receivership would have been made.
[00:08:21] Unfortunately, that is not what happened. And here we sit years later, with renewed calls, especially as governor banks, , who I think is an ed reform minded person is, , has announced that he’s not going to run anymore. So we’re hearing renewed calls to put Boston public schools into receivership.
[00:08:40] It would require yet another review to confirm what we already know. And that is that the schools are wildly underperforming. And the really important thing here to note is that although receivership is controversial, sometimes it’s called turnaround here in Massachusetts, here in the Commonwealth. We do have a record of some success, some of the only success [00:09:00] stories in the country, and probably the most well-known success story of turnaround from Massachusetts is that of Lawrence, Massachusetts, where our current commissioner was in fact, the receiver.
[00:09:10] So here we have a gentleman who. it has a template for how to do it. Nobody’s suggesting he copy and paste, but receivership is something that we’re hearing renewed calls for, should be on the table. I will preview the pioneer report for folks saying we come to the same conclusion. so the problem is going to be, , will it happen or will it not?
[00:09:30] Because there are a lot of forces against it. It is not a popular idea. Sometimes least popular ideas are, are the best ideas when it comes to serving kids. Because as this, opinion piece in the Boston globe noted, it would be hard to imagine a school system that more poorly serves, especially kids of color, then the Boston public schools.
[00:09:52] So this is one to watch her. I think we’re going to be talking about it in the coming weeks and months, but one that I hope, all of our listeners will look into [00:10:00] controversial but important.
[00:10:01] GR: Wow controversial. And weren’t we here before 1991, if I’m not mistaken. I mean, the,
[00:10:11] Cara: yeah, about that receivership that you’re talking about, the BU Chelsea public schools partnership.
[00:10:17] Yes, very good members. I’m like,
[00:10:18] GR: wait a minute. There was a takeover of Chelsea and there was also, , a takeover. I’ll go guess really a law that abolished the elected school board in Boston.
[00:10:27] Cara: That’s right. in Chelsea. Yes, no. Yes. Boston as well. So we have mayoral control as many cities do. Yes.
[00:10:33] GR: It’s amazing.
[00:10:34] I mean, as you’re talking to our listeners, just think about it 1991, governor Wells says, you know what, we’re going to take over the school system and put it under what we call mayoral control. Now let’s put this in context. Boston had had an elected board since 18 22, 1 of the first urban systems in the country of its type to be open, to be free, and to really try to [00:11:00] push the ideas of a new Republic, trying to make sense of a changing economy.
[00:11:06] And I remember reading that back in the nineties because my graduate work at the time was on state marrow takeovers of schools. But to think that that was 1991, mayor Flynn, , supported it. City council supported it. A number of black leaders and community groups were opposed to it. But what are the reasons they took it over was because of what was then called academic bankruptcy.
[00:11:29] Todd Ziebarth, who was then working for education commissioner of the states, , last year, talked to Todd. He was working with, Nina at the national Alliance for public charter schools. he really laid out why it happened and things will forward. And then there were more changes. But the fact that we can even mention the term receivership in 2022 for the millions and millions of dollars invested in the school system, which is in a city with the largest university reach in the country.
[00:11:59] And we [00:12:00] turned to the number of colleges in the greater Boston area, almost 250,000 students there, you have some of the best minds there. And yet this is a challenge, but that I was shocked to
[00:12:10] Cara: see thousand dollars per year. $23,000 people in Boston public schools. And I’m proud to say well-paid teachers on average, more than a hundred thousand dollars in teacher salary per, teacher.
[00:12:24] So, I mean, this is a system that, the adults are doing well, there’s money going into the system. The outcomes are absolutely not there. Most kids in BPS still cannot read on grade level. So anyway, like I said, Gerard, thank you for your long memory. , but it’s, unfortunately it’s the same old story here.
[00:12:40] And so hopefully these calls for reform will have.
[00:12:45] GR: Well, maybe my story will be helpful for if in fact the school system is in receivership and you bring in a trustee or whatever term you want to use, maybe he or she could think about this idea. And so my story is from us news and world report is from [00:13:00] Heidi Borst and it’s titled the rise of high school internships.
[00:13:04] so let’s put it in perspective. In 2021, we had 15.1 million public high school students, and 1.5 million private school students. And according to Heidi, We know that a lot of students in college participated in internships. I was an intern for three years, at a corporation when I was at Howard university, a ton of my friends were, but she said, that’s great for you, but let’s try to get drawings started in high school.
[00:13:31] And I think she’s right. And so one person who also thinks she’s right is Lori cop Weingarten. She is a certified educational planner and president of one stop college constantly in New Jersey. And she said working and interacting with various employers and employees. It’s really about bringing exposure of the basics of what a future career could look like in an industry.
[00:13:55] And she said, it’s one thing just to say, you should get a job, but it’s really about learning the [00:14:00] skills, both verbal nonverbal, social, emotional learning skills, all the dynamics that you need in order to mature, because when students find an internship opportunity, it often provides them an opportunity to mature.
[00:14:12] So that’s what Lori’s saying. Well, there’s a guy named Kevin Davis. He’s the founder and chair of first workings, which is a non-profit organization that pairs low-income students with paid internships. that students who work for nonprofits or for-profit corporations are getting really good exposure before they get to college into the importance of creating a work-based culture.
[00:14:35] Because as you and I have talked about on the show, everyone’s not going to go to college. It shouldn’t be because they don’t have the academic, skillset to do so it’s because they do and decide to go directly into the workforce. Or become an entrepreneur, but creating high school internships, according to both Kevin and Lori, makes a lot of sense.
[00:14:54] In fact, Kevin said, quote, through the internship experience, high schoolers gained the confidence to [00:15:00] succeed in their chosen path. We also know that students who are involved in this work are going to likely do better academically. So what about the higher education level? Since that’s what we know a lot about according to a 2019 survey of internship programs sponsored by the national association of colleges and employers, they found that 70% of the college students who were interns received a job offer.
[00:15:25] If we were back in 1991, when I graduated, I would be one of the people in the 70%, but that’s at the college level, not so great at. High school level. So according to a 2020 study by the American student assistance, it’s a nonprofit that helps students obtain college degrees. It identify through its survey.
[00:15:45] Only 2% of high school students had completed an internship. So if we’re looking for examples, let’s look at Washington DC, my former hometown, the Madeira school, which is outside of Washington, DC is a private high school for girls. [00:16:00] They emphasize experimental learning and they’d had an internship program that has been a part of the school’s curriculum for more than 50 years today.
[00:16:09] At school in turn at community-based organizations as sophomores, they also internal capitol hill as juniors, and then into career oriented positions as seniors, we can also look to the Midwest, although not your state, a nearby state of Ohio, , Trinity high school has an internship program that has placed students in internships at the Cleveland museum of art and the Cleveland botanical garden, along with healthcare and municipal services.
[00:16:38] So there’s one professor who said, you know what I can tell when a student who walks in my class has been involved in an internship, and this is from Joseph Danini director of clinical experience and assessment at the college of education and human development at the university of Nevada Reno.
[00:16:54] Here’s what he says. Quote, through most prepared a student is when they enter [00:17:00] college, the easiest. time, he or she will have when adjusting to the rigors of college level academics, as well as social pressures in higher education, we try to do everything we can to support students in their press appearance toward degree and completion.
[00:17:14] And so what he basically said, okay, I have an idea. When students walk into my classroom, who’s been involved within an internship. So on my side of the fence, I am proud to say that when I was president of the black Alliance for educational options, we actually use some of our high school students in internships.
[00:17:31] Some were supported locally, some nationally, some paid, some volunteer, but the main goal was twofold. One to give them an opportunity in high school, to be involved with planning a conference, a planning and agenda to go to Capitol hill or doing something in the community. Number two, for some, it was paid cash for others.
[00:17:52] It was actually credit they can earn. So I’m a big believer in the idea of internships. I like this article because it’s reminded me that I [00:18:00] need to do more for those students in high school. What are your. I
[00:18:03] Cara: think it’s huge. I mean, I would point simply to the Cristo Rey network of Catholic schools where, students pay for their education because they only serve kids who can’t afford the cost of private school education.
[00:18:14] So they pay for their education through internships. I’ve done research on these schools and it shows exactly what you’re talking about. That is through internal. The kids cultivate the life skills, soft skills, so to speak that they need for success. So I think you are right on. I couldn’t agree with you more.
[00:18:30] I am shocked that nationally only 2% of kids participate in internships. And I’d also like to say that, like, I would hope that in conjunction with thinking about internships, we can think about pathways to college and career as well as, making students and parents aware of internship opportunities, pathways opportunities, and also like to really give a quick shout out.
[00:18:51] And this is more about apprenticeships that the Tennessee department of education just became the first state to get approval from the department of labor to [00:19:00] have. High school students, engage in apprenticeships to become teachers. So you can start learning as early as high school, whether or not you want to pursue a teaching career, they will pay for a bachelor’s degree.
[00:19:09] They will pay for current teaching assistants to do the same. So I think this is great theme and I hope we keep hitting on it. Gerard, we’ve got to get to our guests because we’ve got a fabulous guest today. Dread friend of yours, your colleague at AEI. We are going to be speaking with Ian Rowe.
[00:19:26] He is a senior fellow at the American enterprise Institute, focusing on education and upward mobility, family formation and adoption. So we’re going to take a quick musical break. We’ll be ready.[00:20:00]
[00:20:38] GR: Hello listeners. Welcome back to The Learning Curve. As you know, every week, we bring you an exciting guest to talk about something in the field of education. Public policy entrepreneurship, where we’re lucky today to have Ian Rowe who actually has a footprint in those three areas and many others. Ian Rowe is a senior fellow at [00:21:00] the American Enterprise Institute where he focuses on education and upward mobility, family formation.
[00:21:06] Adoption. Mr. Rowe is also the co-founder of Vertex Partnership Academies, a new network of charter base international baccalaureate high schools opening in the Bronx in 2022. He’s also the chairman of the board of the spent Chapman. it is a nonprofit adoption service organization and he’s the co-founder of the national summer school initiative.
[00:21:28] Ian is a former CEO of public prep, a tuition free pre-K and single-sex elementary and middle public charter school network educating more than 2000 students in New York city. He currently serves as a senior visiting fellow at the wisdom center and a writer for the 1776 Unites campaign and earned an MBA from Harvard business school, where he was the first black editor in chief of the harvest, which is Harvard universities, , school of business newspaper, and he [00:22:00] has a BS in computer science engineering.
[00:22:02] From Cornell, Ian, welcome to The Learning Curve. Hello,
[00:22:06] Ian: Gerard. Gosh, exhausted.
[00:22:12] Just listening to all of that. Oh my gosh. I better live up to expectations that bio set, but it’s good to hear your voice.
[00:22:19] GR: Doing well, listeners may not know this, but, , Ian and I, both fellows at the American enterprise Institute. And even though we’re in the same shop with COVID and everything else , we haven’t had a chance to see each other in person walking the halls of AEI.
[00:22:32] But, , you continue the good work. I read what you write. I’ve seen you on television a couple of times and you do really good things. And in fact, as you were talking about your background, all the things you’ve done, this is just a great way to open up our conversation. We’ve given people a brief overview of some of your accomplishments and your academic background.
[00:22:53] Would you share with our listeners a little bit more about your biography that I didn’t cover? And what was your aha [00:23:00] moment that made you become interested in K-12 education reform?
[00:23:04] Ian: Well, first of all, jars, great to speak with you. Thank you for having me on. in terms of why I’m interested in K to 12 education, principally is because I, , myself am a great beneficiary of a great K-12, public education, in New York city.
[00:23:23] My parents came to this country from Jamaica, west Indies, via England. when we first came to the U S we lived in Brooklyn and, enrolled in the public schools. And, we ultimately moved to Queens. And then actually for high school, I went to Brooklyn tech high school. I had a great, great education, so I’m very aware of what it means to have access to a tuition free K to 12 education, you know, and then from there for my K to 12, I was able to then get into Cornell, which, another great platform and went to engineering school.
[00:23:58] I can’t underscore enough. Of [00:24:00] course, the role my parents played in valuing education and providing a stable home. so my early days were, I would go to school. I would come home, I’d do my homework, we’d have dinner and I’d go to bed. And I wake up, I go to school, come home, do my homework, go to bed, you so they created a routine, And instead of predictable, , experiences, growing up for me and my brother. So it is the combination certainly of a strong stable household with my parents who, you know, who stayed together for 48 years before my dad passed away. And, my dad always saw public education as great equalizer.
[00:24:40] no matter where you come from, as long as , the state provides a solid, , public education or, if you take education in your own hands, but one way or the other that young people get inculcated into a system where they, learn the knowledge, skills, habits to be successful, they understand the ways of [00:25:00] being within a given society.
[00:25:01] So even, even as immigrants, as we came over from Jamaica, we have our own, food and likes and ways of being there was also, an American college. To become part of and to be, , inculcated in and that’s important. as I’ve gone through my journey in life, I have now seen what it means to have access to a great education and also what it means to not have access to a great education.
[00:25:27] So when I graduated from Cornell, I went to work for what was then Arthur Anderson became Anderson consulting, which then became Accenture. I was doing all sorts of. Strategic planning for these big consumer products firms and, and did a few big projects. And, but I wasn’t really feeling that inspired, frankly.
[00:25:47] I started mentoring and public schools in New York city, and I just saw all these great kids, who by virtue of zip code or the family structure that they were born into had a really hard time. in school [00:26:00] and it just didn’t seem fair, that they either didn’t have access, to really great schools or because they were, , in challenging home environments, it just made it really tough for them to Excel.
[00:26:12] So that just put me on a whole different journey. I decided to leave Anderson, you know, get off the partner track there. I was fortunate enough to get into Harvard business school. and then I started this really weird journey. I met this young lady whose name is Wendy cup. Who’s the founder of teach for America.
[00:26:29] So I started talking to her in the , early days when they were recruiting outstanding people that teach in urban and rural public schools. did the crazy thing. after business school, I went to work for teach for America, with Wendy. , and then, through various activities, I worked at the white house.
[00:26:45] The bill and Melinda gates foundation, even MTV, but all throughout all of these, there was an education component that I was connected to and ultimately wanted the opportunity to run my own network of schools. So I ran public prep, as you [00:27:00] mentioned, which is a network of single-sex, , public charter schools, , in the heart of the south Bronx and lower east side of Manhattan.
[00:27:06] So ran that for 10 years and amazing. Again, we can talk more about it, but, pre-K through eighth grade, more than 2000, primarily low income kids, primarily black and Hispanic kids. And the whole idea was to build a sense of agency and self-sufficiency, and, ensure that they had. that they had a real shot to compete.
[00:27:26] And now I’m launching a new network of, as you said, character-based international baccalaureate high schools in the Bronx because, , there’s just, aren’t enough great high schools in the city. And I like to be a think tanker, and a doer, , and to demonstrate institutions that live up to the values of, you know, equality of opportunity, individual dignity, common humanity.
[00:27:52] Cause I think those are the kinds of things that young people should be exposed to. and there aren’t enough institutions , that stand,[00:28:00] , for these things, especially in the current environment, there’s a lot of woke ideology, telling young people that they’re either an oppressor or an oppressed, based on their skin color.
[00:28:10] And we want young people to understand that they have the ability to achieve at the highest levels, but we need our institutions to be focused on. Rigorous curriculum, high expectations, and this whole idea of viewpoint diversity as well. So that’s a long winded story that, I myself, , had a great K to 12 education, and I want to make that opportunity available for other kids.
[00:28:32] GR: I had no idea that you worked for MTV. We can talk offline about that. We’re talking about shaping character , , and just doing some of the math you were there, , at a point when it had a really big imprint upon like high school thought and what people were thinking about sociology, culture and life, let’s go back to your immigrant parents.
[00:28:53] You know, we think about black people in the United States. we overlooked the fact that according to research from pew, that [00:29:00] approximately 9% of the people we call black in fact are immigrants. And if you look at the immigrant families who are black, who come to the United States, a disproportionate number of them compared to African-Americans have gone on to major success.
[00:29:14] You’re one example we think of vice-president Kamala her father from Jamaica. We think of Colin Powell, his parents from the island, And a lot of them actually ended up in New York, other places as well, but a lot in New York. What about the immigrant story? Is a part of not only your narrative, but also the broader narrative about the whole idea of social agency.
[00:29:36] What is it about that? Immigrant dynamic that sometimes we overlook when we’re having the black conversation?
[00:29:43] Ian: Yeah. You know, this, is a tough conversation because sometimes people don’t want to admit, , that if you actually look within the black community and in particular recent immigrants from the Caribbean, , parts of, , African countries, , Nigeria [00:30:00] Ghanaians, incredibly high levels of success.
[00:30:03] and yet if you listen to the dominant narrative, as it relates to. , the black community. if you get a, you listen to a Nicole Hannah Jones of, New York times, 16, 19 project, she wrote an 8,000 word essay. basically saying if you’re black, it doesn’t matter what you do.
[00:30:24] Doesn’t matter if you buy a home. Does it matter if you save doesn’t matter, if you get educated, doesn’t matter. Uh, essentially none of that, none of those activities quote, make up for 400 years of racialized plundering unquote, period. And it just leaves you with has this idea that, gosh, if you’re black, I mean, you’re, going to get shot on the street or you have no shot in the end, her and her whole reason for saying these things was that was her rationale for a thing of $14 trillion reparations program.
[00:30:56] Because if you’re black, , you just don’t have the agency [00:31:00] to move forward. And yet, , if you look at certain communities and by the way, not only immigrant black communities, but. African-American families who’ve been here, who do the things that, by the way, Nicole, Hannah Jones has done in her own life.
[00:31:13] So Nicole, Hannah Jones has gotten married, gotten educated, bought a home, , done those things and, you know, cause her accountant would be very surprised to hear her say these things. And so what it indicates is that perhaps there are factors that transcend race that really are the driving factors behind the economic and other forms of prosperity.
[00:31:37] And it’s just the case, that, you know, and this is now back to some data, which I often sites often refer to as the success sequence. But if a kid has the opportunity to get a good, good, basic education, even just a high school degree than a full-time job of any kind, just so we learned the dignity and discipline of work.
[00:31:57] And then if they have children and they [00:32:00] had been married for. 97% of the time amongst millennials, you avoid poverty, and that just so happens to be the kind of behaviors that most immigrants, certainly recent immigrants practice. You know, there’s a huge value placed on education and educational choice, huge value placed on family, and huge value placed on staying together and reinvesting across generation.
[00:32:28] , and so that’s the story, in Jamaica, like my, and my parents came here, it was not only my parents, but you know, their brothers and sisters and, , we all got together every Sunday night and It was a cocoon of safety and education and love.
[00:32:43] And by the way, expectations like expectations , and not just expectations to get by, but expectations to be an engineer, to be a lawyer, to be a doctor like , to, succeed, but succeed superbly. [00:33:00] so sometimes we have this conversation. some people resent like, oh, you’re saying that, black Americans who are in this country are lazy.
[00:33:07] No, it’s just recognizing that, , if there’s a white supremacist on every corner, that’s oppressing every black person. Well, for some reason, there are certain black people that like, oh, I see you’re from Nigeria, then you’re good. You know what I mean? Like that there actually must be some other factors that are driving success and you start to see that these are the habits.
[00:33:29] These are the decisions, either behaviors that right now seem to be more entrenched in communities that, , come into the United States who have an immigrant ethos who come to this country with more of the, I’m going to make sure I take advantage of the opportunities. And so if we’re able to divorce those, behaviors and attitudes, From skin color and say that you’re not inherently oppressed because of skin color.
[00:33:58] that if you adopt [00:34:00] these certain behaviors, then you can be successful too. To me, it’s liberating. Final point is that when we think about empowering and liberating messages for young people, especially young black kids, it’s important that they know that simply because they’ve been born, , in the hood or, wherever that they’re not inherently oppressed or inherently powerless or inherently dependent upon the government in order to solve their problem.
[00:34:27] As Nicole, Hannah Jones likes to articulate that there are people that look just like them. People who may have come from another country recently, or people who have been in, in the country for generations, but for both sets of people. Agency is within their grasp self-sufficiency is within their grasp.
[00:34:46] And it’s not a mystery that their actual behaviors, their actual decisions around family formation, getting your education, full-time work. All those things in a particular order can lead you [00:35:00] on a pathway. And by the way, let’s not forget having a faith commitment to cause we don’t often talk about the power of religion, but that these things are within your grasp to be successful regardless of skin color.
[00:35:11] GR: As I hear you talk. And I know you’re from New York. I also think about another person with the immigrant background, Shirley Chisholm, , who ran for president, , in the early 1970s, wrote a book on boughten on boss. And she’s saying,, something. She said, then some of the things things are saying now.
[00:35:26] So also think there’s something in the water in New York and new Yorkers to do these kinds of things. and speaking of immigrants, who’ve done well. Also want to, give them granulations to Lieutenant governor, , winsome series here in Virginia. I had a chance to go to her Naugle events, earlier this week.
[00:35:42] And that’s, another example of someone with Jamaican roots, who is now changing tide here in Virginia.
[00:35:49] Ian: I was waiting to hear the announcement that you were going to be the secretary of education.
[00:35:53] GR: All know I was so excited to hear the announcement about, , Amy Gudera
[00:35:58] Ian: secretary. I know Amy [00:36:00] knows great stuff, but When Younkin Sears one, I thought, oh my God, going to be populating their candidate, who were some amazing people who are already in Virginia, who, uh, so I thought of you. but it’s all good.
[00:36:11] GR: It’s all good. No, I appreciate the kind of thought you talking about New York and you’ve got to end printing in a few of the burls and you made a really good point about IB.
[00:36:20] , talk to our listeners about why international baccalaureate, and also talk about why character, because we hear the word, we just celebrated, King’s holiday. And I think about an article that king wrote, get this at age 18, he wrote an article called the purpose of education, and it appeared in the January, February, 1947 edition of the maroon tiger.
[00:36:44] And in it, he said, quote, we must remember that intelligence is not enough intelligence plus character. That is the goal of a true education. So why a network of character schools and why IB?
[00:36:58] Ian: Yeah, it’s such an [00:37:00] essential question. I’ve just written a book called agency. and the whole thrust of the book is, to empower the rising generation, to overcome the victimhood narrative to determine how to, create their own pathway to power.
[00:37:16] I put a lot of thought into this word called agency, , which I define as the force of your free will guided by moral discernment. think of velocity, it’s a vector. Think of velocity, velocity. Isn’t just speed, but it’s speed and directly. Right. So we, as human beings, we have free, will we have the ability to make decisions?
[00:37:41] We’ve got the ability to move our life in one direction or the other, the question is what does that direction come from? where do you get a sense of what the likely rewards or consequences are of decisions that you make? And so, for me, that’s where the [00:38:00] power of mediating institutions come from, because, first and foremost, there’s your family, that’s the first place. And in fact, I’ve even created a framework called free family religion. Education entrepreneurship. Those are the pillars that if a young person really thinks about their life, those are the character forming institutions, the character shaping institutions that help young people understand how do I navigate this force of free will that I have.
[00:38:35] And so that’s why I’m launching a network of character based international baccalaureate schools. You know, this new network of vertex partnership academies, the anchored in the four Cardinal virtues of courage, justice. Wisdom temperance, those are virtues that are .
[00:38:54] Every other virtue is derivative of those four. then I think young people need a [00:39:00] grounding. And what does it mean to have courage? What does it mean to stand in the face of fear to understand the risks and yet to have the power. To do something to still move forward , in that moment where you’re, the most scared, you’re the most terrified, but like, for example, having a great family is, a place where, you know, you always have a safe place to come back to.
[00:39:21] I remember when my parents, , shared stories about, , coming, first they moved to England. My mom moved to, my dad wrote for her hand in marriage for her to travel from Jamaica to England. This is in the mid 1950s. so they could be together and get married. And she, had a ton of support for her family and that we will always be here for you.
[00:39:41] And, and so you start to realize got there that these institutions, they have my back. Right. So, and that’s where a faith commitment also is really important that there are a set of morals and, , structures that help you make decisions. So why a character based school is [00:40:00] it, first of all, what’s interesting is every school is a character based school, right?
[00:40:04] The question is, are you explicit about what you’re teaching or not? If you’re a school that doesn’t have expectations, for example, around timeliness or high expectations, or being diligent about doing your homework every night, or building study habits, then you’re actually a character-based school too, but you’re actually building the wrong.
[00:40:27] , character-based traits. So it’s really just owning the fact that kids are in our school building, for a significant portion of their life. And hopefully us working alongside with parents help to build those character-based strengths that young people will need throughout their lives to make good decisions.
[00:40:48] And so agencies, this building’s idea of the force of your free will guided by moral discernment. And that moral discernment has to come from somewhere that the ability to [00:41:00] discern decisions from a moral perspective has to come from somewhere. And I put forth that family, religion, education entrepreneurship, if you embrace those four pillars that you’ll have a much greater likelihood of leading a life of freedom, the life that you choose, the life that you want.
[00:41:20] And that’s what I want for our young people in our schools.
[00:41:23] GR: I’ve already, pre-ordered a copy of your book. , at least on Amazon, it says it’s scheduled to come on March.
[00:41:30] Ian: I think it’s more going to be April just because of, , supply chain issues. But, ah,
[00:41:35] GR: that is true. Well, listeners, you can go to Amazon or you can go , to his Templeton, press your publishing.
[00:41:41] Yes, yes, yes. Yeah. Yeah. And they are at the Templeton foundation and the current family foundation are two of the, major funders of character education across the country. They fund the organization where I work as well. So I want to give them a shout out, someone who. With this someone I know. Well, and, , Bob Woodson, he’s been on our [00:42:00] show.
[00:42:00] I first met Bob in September of 1987 when I was a freshman at Howard and he spoke about race and about getting young black men in Detroit, , to marry women that they had impregnated. And I walked up to him afterwards, shook his hand, and no idea that years later, our paths would cross different ways.
[00:42:23] Including his granddaughter, who went to the university of Richmond school of law and my wife at the time about wife at the time she worked at university of Richmond law school was her mentor. Bob and I have been in conversation and I know you were working with him with 1776 unites. Talk to us about your work there and how you guys are influencing conversations about America’s founding documents about Supreme court cases, slavery.
[00:42:47] Those, yeah. Yeah.
[00:42:48] Ian: It’s such, such a great question. , So you met Bob Woodson back in 1987. I honestly had never heard of him her’s work until, I think it was about [00:43:00] February of 2020. Just to give you a sense. I mean, here’s this incredible icon to think about the work that he has done in the United States of America as a man period, and as a black man in particular, and for someone like me, who’s worked in education at MTV at the gates foundation.
[00:43:20] I’ve never really known his work. Gives you a sense diminishes. The work of someone like a Bob Woodson and yet elevates the work of, , Al Sharpton or a ton of FC codes or Nicole Hannah Jones like this. These are the people who are viewed by the larger society of those who speak for the black community.
[00:43:40] so even that is, of a Testament. So I got to know Bob, , because he had, , again, after 40 years of running the Woodson center, uplifting people from, , in thousands of communities across the country to become agents of their own uplift. He saw that the New York times [00:44:00] had just published the 16, 19 project, which, , , as many of your viewers are probably familiar with was initially just the magazine issue was a series of essays that had a pretty robust, , and provocative view of American history.
[00:44:14] And in fact, , it clearly intended to quote unquote re-imagine history and say that maybe the country’s founding was not 1776. And in fact it was 16, 19, and maybe, , this country is not all that, you know, maybe the founding ideals were quote unquote false when they were written that the America was, was founded as a slave ocracy and not at the mock.
[00:44:36] and that country has anti-black racism running in its very DNA. I mean, you think about in your DNA, it means it’s a permanent malignancy. And Bob said, wait a minute, you don’t speak for all black people. And we have to stand up country doesn’t just, run on autopilot and [00:45:00] that it will be threatened.
[00:45:01] I mean, democracy requires an informed, electorate to continue to move it forward and uphold its principles. So he got together a group of people, , myself, Glen Lowery, John McWhorter, Coleman Hughes. I mean just an amazing group of, quote unquote elders as well as newbies who wrote just trying to.
[00:45:19] Create greater opportunity for not just black kids, but all kids across the country to understand that we do live in a country that has an incredibly, , in some ways flawed history and yet incredible stories of resiliency and progress and the whole idea of slavery, the fact that it existed in the United States.
[00:45:38] Yes, but it existed all over the world. And the United States was one of the pioneers for how slavery was not only overturned, but the people who had been once oppressed haves thrive and can continue to thrive if we unlock the secrets that at least some of our community has had access to. and so joined Bob and the 1776 [00:46:00] unites and team.
[00:46:01] And , when we also heard that the 16, 19 project partnered with the Pulitzer center to actually create a corrective. And we’re like, what? Wait a minute. Like they, they don’t just want a magazine issue. they want to indoctrinate kids into this view of America as this permanently oppressed society that if you’re black, I mean, you are screwed according to Nicole, Hannah Jones pen, her team and her ilk.
[00:46:26] And so, you know, maybe that’s another idea. Maybe there’s an alternative point of view and it wasn’t to demonize or to cancel, but to stand strong and say, we decided. We disagree. And here’s our proof. Here’s our evidence. Here’s people throughout American history who have fought against this idea of America being a country with a permanent malignancy.
[00:46:49] And so we said, you know what, if she’s going to create a curriculum, , let’s create one, not just in response, but to highlight the incredible stories of the African-American experience in United States, warts and [00:47:00] all, not just cherry picking. So if you’re going to tell the story, for example, about the Tulsa massacre, then tell the whole story, tell stories of black wealth and entrepreneurship that create that led up to the Tulsa massacre.
[00:47:16] And then tell the story of what happened afterwards, the recovery, the resilience, tell the whole story so that people can see that. Yes, I mean, America has parts of it is a wretched. Unfortunately like many other countries in the world. And yet there seems to be this through-line where the very values and principles that the country was founded upon were the values and principles and informed laws like the civil rights act and the voting rights act and everything else that has created the opportunity that yes, exists today for low-income Americans, black Americans, for people, billions of people around the world, that’s still yearn to come to this country.
[00:47:58] so Bob and [00:48:00] I, and the team, that curriculum that we created has now been downloaded more than 25,000 times. By teachers in all 50 states, it’s been downloaded in public schools, private schools, charter schools, homeschools after-schools prison ministries, anywhere where character formation is happening for kids.
[00:48:25] And we’re very proud of that because you know, again. We’re not looking to, call people bad names or, cancel, but to show that there is an empowering alternative. If we want to look at American history, bring it up. This country has a lot to be proud of there parts of the country, like many others, unfortunately that it’s a very negative past learn from it.
[00:48:45] Be honest, but tell the whole story. Don’t sanitize American history so that you cleanse it of all the bad things nor cherry picks. You only focus on the most increase jus atrocious events is I think most of the 1619 [00:49:00] project does. And so that’s what we’re trying to do to show that there was a compelling alternative.
[00:49:05] And, the nice thing is I think many people are responding to say, , we appreciate it that you’re not running away from the America’s past or, our experience with slavery or Jim Crow, or even present day racism. but the key is recognizing that what once may have been literally structural racism in trined into law is now.
[00:49:28] Surmountable racism, um, by people who, again, based on some of the things we talked about before are thriving in our country and 1776 unites stands to make that story known to millions of black and other kids across the country.
[00:49:47] GR: No, that’s a powerful story on so many fronts. As we get ready to close.
[00:49:52] What are two things you think, for example, we are going to have over 30 gubernatorial elections of this [00:50:00] year. What are two things that, , sitting governors or people who are seeking to unseat a governor or have a seat is going to be open because of term limits? What a couple of ideas that those candidates should be thinking about for their campaign, not just for education, but the whole part of just understanding human development.
[00:50:19] Ian: Yeah. Well, I think they should look to your state of Virginia and look,, at what, governor Yuncken made a point of, during his campaign. And it was pretty straightforward. parents have a voice families matter, education matters, choice, educational choice matters. And parents would have a say in development of their kids.
[00:50:42] sometimes we make things a lot more complex than they need to be. And I thought in his campaign, things were pretty simple. I think over the last few years, you know, since the tragic, murder of George Floyd, which was a heinous event, and yet reaction to it unleashed the awoke [00:51:00] ideology that again, paints the country as this permanently racist, all of our institutions are infiltrated with racist.
[00:51:08] and yet there are a number of people who were tiring of that ideology, which seems to, just place people in boxes. Regardless and says that the only factors that matter are your skin color or your gender. And based on that, you’re either going to be oppressed, or you’re an oppressor full stop and ignoring the more developmental aspects of what makes a human, being a human being, your family, the family that raises you religious or faith commitment that you’re part of the quality of education that you have in school choice.
[00:51:47] And then ultimately, so idea of entrepreneurship, your ability to generate wealth in all of its forms, social wealth, financial wealth, free family, religion, education, entrepreneurship. [00:52:00] If I were someone running for governor or running for political office, those would be the things I would, run on.
[00:52:05] you know, , I would trying to revitalize the institutions that make us all free family. Education entrepreneurship. That’s what we need to come together on as a country, across race, across class, across gender. That’s what I would run on because that’s the future of our country.
[00:52:27] GR: Well, Ian, thank you for the work that you do, both at a think tank.
[00:52:31] And in your role as an entrepreneur, who’s creating do tanks, known as schools. our listeners are here to support you, let us know what we can do in the future, , look forward to seeing you soon. Thank
[00:52:43] Ian: you so much. It was a very inspiring conversation.[00:53:00]
[00:53:24] Cara: Gerard, we are going to close it out as always with the tweet of the week. This one from John Bailey. So at John underscore Bailey the $1 billion budget for the tech modernization fund, known to those who know about it as the TMF is a huge investment, but funds are only part of the solution. Tech talent, project outlines tech fund, best practices.
[00:53:46] So the tech modernization fund, this is tons of money tech infrastructure, but we need an outline for how to get it done because as he points out, money is not enough. I encourage everybody to look up John Bailey on Twitter. [00:54:00] This will take you to a nice link that has a great policy brief with the best practices and steps that folks need to take in order to make the best use.
[00:54:09] As John says, to make government work for people. What do you think about that? That’s something hunter next week, Gerard, you know, it is national school choice week. So we’re going to be back with our friend, Andrew Campanella, and, I hope you bring your yellow.
[00:54:22] GR: I will.
[00:54:23] Cara: I bet you, I bet you got a lot of them at this point.
[00:54:26] I’ve got a few, they’re hanging out somewhere with purses that I only use once a year. So Gerard until next week you take care of yourself. You stay warm and I hope we can open the show next week with some cheerful news. [00:55:00]
Recent Episodes:
Hubwonk host Joe Selvaggi talks with Pioneer Senior Fellow in Healthcare Josh Archambault about his newest research paper, produced with the Cicero Institute and the Reason Foundation, on states’ success in implementing telehealth to improve healthcare outcomes. They discuss how Massachusetts has used remote medicine to better reach patients and serve their needs.
Guest:
Josh Archambault is President and Founder of Presidents Lane Consulting. He is a Senior Fellow at both Pioneer Institute and the Cicero Institute. His work experience has ranged from work as a Senior Legislative Aide to a governor, Legislative Director for a state senator, to years working for think tanks operating in thirty-five states, and in D.C. He is a regular contributor to the influential Forbes.com blog, The Apothecary. Josh holds a master’s in public policy from Harvard University’s Kennedy School of Government and a B.A. in political studies and economics from Gordon College.
WATCH:
Read a Transcript of This Episode
Please excuse typos.
Joe Selvaggi:
This is Hubwonk. I’m Joe Selvaggi.
Joe Selvaggi:
Welcome to Hubwonk a podcast of Pioneer Institute, a think tank in Boston. The strain to our healthcare system created by the COVID 19 pandemic has given rise to innovations that will forever change the face of medicine, perhaps chief among these is the embrace of telehealth. The ability to access healthcare remotely telehealth smokes, obvious benefit is that it can facilitate a connection between patient and provider in a convenient and less costly setting, but an overlooked if perhaps is the promise of improving patient care itself, by offering more targeted and coordinated expertise while providing health data from tests performed at home. Imagine the benefit to a diabetic patient with mobility issues of having remote access to a diabetes specialist and nutritionist, and being able to provide real time medical data to those providers from home for populations like these telehealth can be a lifesaver. How well has Massachusetts done to ensure this technology is integrated into our system and how can we improve in the future?
Joe Selvaggi:
My guest today is Pioneer Institute’s senior fellow in healthcare. Josh Archambault. In a new paper produced by Pioneer Institute in coordination with the Cicero Institute and the Reason Foundation entitled “Rating the states on telehealth practices, a toolkit for pro patient and provider landscape.” The researchers offer an outline of best state level policy practices in telehealth and creates a report card of success for each state. Josh will share with us which criteria are vital for optimizing the benefits of telehealth and how well has Massachusetts scored in his analysis. When I return, I’ll be joined by Pioneer Institute’s Josh Archambault.
Joe Selvaggi:
Okay. We’re back. This is Hubwonk. I’m Joe Selvaggi, and I’m now joined by Pioneer Institute’s Senior Fellow on healthcare, Josh Archambault. Welcome back to Hubwonk, Josh.
Josh Archambault:
I always enjoy being on. Thanks, Joe.
Joe Selvaggi:
Well Josh, you, you have been on the show before and we’ve talked about telehealth in the past. You’ve you’ve, you’ve sung the praises of the benefits of telehealth, but largely in the beginning when you were first on, we were at the early phases of the pandemic and folks were terrified. They didn’t wanna risk getting sick by going into a hospital to see their, their doctors. So a lot of these telehealth measures were emergency procedures that we did at a desperation. And the unknown. Now we’re getting to a phase of the pandemic. It’s been with us almost two years and we wanna see what parts of telehealth makes sense going forward into the future.
Joe Selvaggi:
So you’re recently released pioneer paper entitled rating the states on telehealth practices, a toolkit for pro patient and provider landscape. You’ve offered a scorecard for state level policymakers to say, okay, how well are we embracing this technology called telehealth? So for the benefit of our listeners who may not have heard earlier conversations about telehealth, let’s start at the beginning and say, okay telehealth, it’s, it’s a good thing. We’re talking about communicating with our healthcare provider or with our hospital, the way you and I are communicating right now, virtually let’s talk about what this complimentary technology, how does it help a patient and a provider?
Josh Archambault:
Yeah. So as you mentioned, I mean, I think COVID brought telehealth not only into our headlines, but into many of our bedrooms into our dining rooms, into our living rooms, wherever many of us have done telehealth visits. And I think it’s really exciting about where we are right now is we are in this assessment phase where a lot of people have tried telehealth for the first time, including providers who were, many of them were reluctant pre COVID to use telehealth as a tool in their toolbox. There’s certainly been a lot of investors pouring money into digital health care and telehealth space. And I think also there’s two kind of tracks conversations happening right now, which are really interesting to me. One is on the policy side and that’s where the paper certainly looks at looking at these eight best practices, trying to understand what policy landscape do we need to have that allows for the most innovation to emerge that is probation and pro provider.
Josh Archambault:
But the secondary part of that is what is the best use to telehealth? The policy environment can be flexible or maybe restrictive, but ultimately providers and patients need to decide how do they wanna use telehealth? It are there ways in which in person visits are a hundred percent going to be the way to meet people going forward and get certain kinds of care. And in what instances is telehealth act you the most helpful? I think what’s interesting. And I think what the general public doesn’t fully still appreciate about telehealth is they think about what we’re doing sitting in front of a computer, on a smartphone video, chatting with somebody, but telehealth is actually much, much broader than that. So, and the report touches on this, looking at things like remote patient monitoring. This means you have something in your home that is maybe in real time, I’ll give you an example.
Josh Archambault:
Somebody with diabetes might be taking their blood sugar level on a regular basis and transmitting that information to their PA to their provider so that their provider has a much better sense of how compliant they are with whatever regimen they have given them, their drugs or other things. What’s interesting about this is that the providers now have not only when there’s a red flag can follow up with you much more quickly, but when they actually see you in person, they may have at their fingertips far more information about how you’re doing health wise than just seeing you once a year or every six months, whatever the condition you may be seeing them to. So the real promise and the potential increase in quality of care over telehealth is making sure that we’ve got all of this data, that’s at your fingertips, but that people aren’t overwhelmed by it, that it actually improves the quality of care. And that’s the kind of tipping point or middle ground that we are right now where people are really trying to assess as we come out of the pandemic. What adds the most value. And, and where is it? Was it just a necessity because of COVID
Joe Selvaggi:
I was struck by your the subtitle of your piece characterizing it as both pro patient and pro provider. We’re talking about the doctors and the hospitals at a high level before we dive into any details. There’s a lot of stakeholders involved here with telehealth. Is there any tension amongst stakeholders? Is it, is, is this great for patients and great for doctors and great for healthcare systems or, or is it some sort of a zero sum game here?
Josh Archambault:
You know, I, I, I don’t think anybody views it as a zero sum game anymore, perhaps pre pandemic that would’ve been the default for some, they were worried about competition or, you know, ways for this to take away business. I, I think people are seeing it as a compliment. There are still areas of disagreement, you know, payment rates, reimbursement rates certainly remain a sticking point of how much should be paid for services, telehealth services. And that’s covered a little bit in the report should be covered at the level that an in person office visit is for just a quick video chat or should it be paid at a different rate. And then who can use telehealth, there’s going to continue to be disagreements within the medical community on whether or just doctors should be able to use it, or whether any provider should be able to use it should a nutritionist, should a physical therapist be able to use it.
Josh Archambault:
And I think that there is largely emerging agreement outside of perhaps dentistry, which seems to be an outlier in this discussion, that telehealth is a helpful tool in the toolbox. And I think as long as acknowledge that it is just that it’s not a silver bullet, it does, it is not the best way to deliver all kinds of care. Then I think that there has been emerging consensus that it, it, it, it is a good tool and it’s just a matter of making sure that the policy landscape allows for the flexibility going forward to deliver care in really innovative ways.
Joe Selvaggi:
I’m glad you mention it, the, I like the word compliment because it’s in addition to traditional in-person medicine, we’ve had doctors on the show who have said, look I’m, I’m skeptical about telehealth. I catch half of the problems with my patients through laying of hands, right. I, I want to see my patients, they, they come in from, with one symptom and I, I find it a different pro problem. You can’t do that virtually do do, does the community acknowledge this limitation of telehealth?
Josh Archambault:
Yeah, I think by and large that there is, of course it’s gonna depend on the specialty area. You know, certain providers certainly think that in person is, should be the dominant way going forward. And you know what, I trust that it’s a little bit of an art in the science here, but I will say that, you know, with the emergence of artificial intelligence and other things, dermatology is a good example. You know, if you have a provider dermatologist, who’s looking at your skin and has seen a thousand examples of something, but if you’re able to use telehealth in which the AI has access to millions of images to compare what you have on your skin, there is actually an enhancement. There, there could be a value add by using telehealth. And so I think going forward really what it is is again, it’s using both.
Josh Archambault:
So do you use telehealth first to use the access millions of images say, Hey, we actually believe this is a problem. And then send that to a provider, say, you need a hundred percent to go see this provider for an in-person care to have that removed, to have it looked at more closely that that’s the value. I, I think what we, for those of us that have been around studying healthcare spending for a long time, we realize probably half at least of care spending is just wasted spending. And part of that is because the healthcare system is not very good at triaging who actually needs in-person care or not. The default is just to go, I mean let me give you a personal example of this. You know, I’ve had health insurance where they have a nurse hotline and you can call in I’ve called in probably a dozen times or so over the years for kids or things that my wife and I have.
Josh Archambault:
And inevitably every single recommendation is go to the ER to get this checked out, even just to cover themselves from a liability standpoint. And so I think ultimately we need a few more options here where people are able to triage much better to direct people. And this is where some of the savings can come from telehealth is really giving you a gap, a very well-informed technology driven. Now, of course, there’s limitations to that, and we wanna be aware of that. And that’s the learning that we need to be in from a medical side, like really assessing where the technology enhances the kind of care and quality of care that’s being provided and where it may not add as much value. And ultimately, and we cover this in the report. I think that’s policy mandates actually become a problem. If you mandate that insurance companies have to cover all kinds of telehealth, regardless of whether we deem it adds value or not, then we’re running into problems of wasted spending. We wanna really make sure that when we spend an additional healthcare dollar, we’re getting better quality care for the patient every single time. And that includes te health as well as it does in person.
Joe Selvaggi:
Now, this is clearly a disruptive technology. I’m asking you a question it’s not in your paper. I think what an investment slide deck would ask is what’s the addressable market. And when you talk about telehealth and, you know, you look at health, the healthcare system very broadly it, it could, is this just at the fringe of the margins 5% or, you know, you, you, you just characterize a lot of waste in the system. You know, could we potentially save hundreds of billions of dollars in the system? Is it 30% that that could be I dunno if the right word is not lo no longer wasted, but more efficiently deployed. Are we looking at that level of disruption?
Josh Archambault:
Yeah, well, we’re well over 3 trillion a year in healthcare spending. So there’s ample opportunity here to increase efficiency in the quality of care provided. No, I think this gets at the question of cost savings that can come from telehealth. And I think there’s, you know, probably at least a dozen ways that telehealth could deliver cost savings. One is it’s just a much more efficient, effective way to be able to deliver services. You can have a provider from their home office from a different state, being able to see people at 24 7, quite frankly, if somebody’s struggling with addiction and they need help at three 30 in the morning while their provider’s not gonna be available locally to see them in person. So there might be an opportunity to use telehealth, to get them in touch with a provider, right at that moment when they are struggling and they need some extra support or they want to try to get clean in that moment.
Josh Archambault:
So there are those kind of interventions in which telehealth can prevent those individuals from ending up in the ER and costing a lot more money, but there’s all sorts of other ways that I think telehealth can be save money in the long run going forward. You know, I think the future of healthcare, a lot of it for certain chronic conditions and remember 80% of healthcare spending is due to lifestyle choices. So finding more effective ways to help patients live healthier lives is really important. And I think team based care. So again, go back going back to the example of somebody with diabetes, yes, you want their primary care doctor engaged, but you also might want a nutritionist engaged, an endocrinologist engage. And in many communities, those specialists simply don’t exist telehealth for the first time allows you to pull together a team to intervene with the patient and say, what is our plan of attack going forward?
Josh Archambault:
Are we being adherent? How can we help support you more to meet your health goals going forward? And if those sorts of innovations are allowed to merge to emerge and they’re being used in some instances now, but if you don’t mandate that insurance companies have to pay one size fits all way, they, you allow them to pay for team based care, try it to see if it actually leads to better health outcomes. You might actually start to see huge long-term savings by using technology. I think everybody knows this and acknowledges this. It’s just a matter of how do we transition because our current health system, especially for large hospital systems is so real estate intensive. It’s very expensive sustain. And so a lot of those health systems are just focused on how do we increase our revenue to the point where we can support that large, large system.
Josh Archambault:
Ultimately, where we wanna go is to have a health system that is patient focused and allows for providers to be able to provide care in a multiple ways. So maybe they start by seeing you in person. Then they say, Hey, go home, bring this device home, take your readings once a day. So I can see how it’s going. Then maybe once a month we pop on and we video chat to make, look at the data to see how it’s going. And then we’ll determine from there, whether we need a follow up appointment or not, that’s the sort of different ways. And that’s what the report gets at. Does your state laws, are they flexible enough to allow for that health system to start to emerge or are there barriers in place? And quite frankly, one of the things we were surprised, Joe doing the report is there’s still a lot of work to do here. There’s a lot of states whose laws have not been updated sufficiently to allow for that, those sorts of health innovations to emerge a lot of states simply tweaked around the edges during the pandemic. And I think there’s a lot more opportunity here and that’s why we put out the report.
Joe Selvaggi:
Wonderful. Well, now let’s get into the, the meat of the report. As you say, it’s, it’s state level focused. We live in a state, more Commonwealth of Massachusetts, there’s 49 other states. So given there’s a difference between Massachusetts and Wyoming, how, how do you compare terms, meaning even the, even the term telehealth may be a vague and defined differently in different states. How did you account for those differences?
Josh Archambault:
Yeah. So there, I think that there’s been a, a growing consensus that there is telehealth. Well, it can be he called and defined slightly differently by states. You’re absolutely right. There are a couple different modalities in which people look for that allows for flexibility. So video synchronous, it’s live, we’re talking back and forth. We’re able to communicate in real time, back and forth, but there’s also asynchronous, which is like, think about texting back and forth with a provider. Maybe you start the relationship over text and then switch over to video if it’s sufficient. But in many instances, allowing for that kind of easy back and forth over text, or for me to record a message and then send it to you later is another kind of form of telehealth. So in the report, that’s what we were looking for. We were looking for state law definition and I give a lot of credit to the American telemedicine association.
Josh Archambault:
Who’s worked really hard with stakeholders to say, how do we come up with definitions that are all encompassing that allow for this flexibility going forward in its, in a state. And a lot of states have started to move in that direction of adopting some of those, the, the looser or broader definitions. Now the, the area where we found the most work to do is not every state allows you to start a patient provider relationship over all of the modalities. Some of them are still prescriptive. You have to do it this way, which I think coming out of COVID, we we’ve come to appreciate and realize that that’s, that’s simply outdated. We should allow for patients again, if we want to really patient centric center system, to be able to establish the relationship in the way that they prefer.
Joe Selvaggi:
So let’s get into the, I think you used eight criterion in your paper. And we’ve touched on some of the issues in each, but I wanna touch each idea discretely. And then I’d like to also, if we can talk about where Massachusetts falls you gave each state a guess a stoplight kind of rating either green, yellow, or red, green being the better and red being not so good. So let’s start at the beginning. You, you just touched on this notion of modality neutral, which is to say I would characterize your piece as saying there’s there’s time in place, right? You have synchronous and asynchronous, meaning I’m interacting live with my provider, but I may not be, as you mentioned and also place meaning I can get a, a blood test in the hospital, but I might be able to have some sort of measurement at a facil either more locally or in my own smartphone or something like this. Right. You, so tell us more, why does it, why is modality neutral so important?
Josh Archambault:
Yeah, I think it, it matters a lot because different kinds of care, demand, different ways of interacting. And, and, and I mentioned the example of somebody struggling with addiction. I mean, whether it’s mental health issues or whether it’s other issues related to addiction there has been consensus in all 50 states that we simply don’t have enough providers, that our system is not set up in a way to be able to meet the demand that’s there. And so we need to make sure that patients, whether it’s somebody that speaks their language, that may not be in their local community, or whether it’s just, I prefer to start by text because I’m feeling ashamed of where I am right now, or just not feeling like I can talk to somebody over a video. We need to make sure that we have that flexibility. And, and I think what’s also important is a lot of the invest investments and entrepreneurs in this space are the thinking really differently about the kinds of tools and ways that patients should interact with providers.
Josh Archambault:
And we just wanna make sure that we have that source of flexibility. I think it what’s encouraging on this one in particular is states are moving in this direction and Massachusetts is one of them, the most recent telehealth bill that passed significantly improved the definite for telehealth in Massachusetts for where it was pre pandemic. And so I do think that there’s, there’s been some great progress here. And, and Joe, maybe let’s just step back for one second and talk about what the report actually is. It’s meant to be a tool kit, and it’s pretty simple, straightforward. It’s four parts to it. The first one is just a brief introduction explaining why action is needed. Second part, what we’re talking about here, the stoplight chart, giving green, yellow, or red rating for all of the states. And then we explain the ratings. That’s the third part. And the fourth part is all 50 states get a page. They all get a profile of where are they on these eight best practices. And so that’s, what’s in the report. It’s meant to be able to for the reader to digest a lot of information, but very simply and very quickly
Joe Selvaggi:
I want to get into where we score relative to the other states. As you say, it’s very comprehensive and it’s, it’s not easy to cover 50 states. So congratulations. So let’s get back to the, the bullet points or the, the features on which you score each state which just talking about Mo modality being important. You alluded to the fact that to really start the ball rolling in telehealth, many systems require the first step to be an in-person requirement. Now that may saying, seem like a no brainer first, see your doctor, and then we’ll talk about virtual. But in many cases, a someone may not live in your doctors or may have some reticence about going to a doctor, say for instance, during a pandemic or, or some other time. So say more about why that in-person requirement may be really harmful to tele health uptake.
Josh Archambault:
Yeah. For, I mean, transportation remains an issue for those with chronic conditions or in rural communities. This is the one measure where we by far saw the most progress during the pandemic. There were a number of states pre COVID that required you to see a provider. First, you had to go have an in-person visit. And on one hand, you understand that you want there to be your relationship, and you want them to have a basic understanding of your health situation. But if you live in a community where there’s a provider, a primary care provider shortage, and you simply can’t get an appointment for three months, which is not that uncommon in many areas, this just seems impractical. And quite frankly, out of date. So a lot of states moved. There’s only a few lingering states that still requires some sort of in-person visit ahead of time. And I think this is again, when you talk to policy makers, the one that they shake their head, why would we have ever required an in-person visit? But that’s just what happens when state states pass laws that have to do with technology that are 10 years old at this point, technology changes. And as a result, when you need to change the policy landscape too.
Joe Selvaggi:
So our, our local legislators seem to get that. I mean, that’s, that’s Massachusetts understands why that might not be or that would be a, a good policy to remove the requirement for in-person visits first. Right?
Josh Archambault:
Correct. Yep. Massachusetts does not require an in-person visit. I think that’s really important. And I would hope with all of the tech companies that are in our backyard, again, we’re not trying to replace all in-person visits, but it just says that if you need to start by telehealth first, then, then you can do so if that’s appropriate
Joe Selvaggi:
Now, this way to be, I’d be curious about, and I can understand perhaps why, what motivates a rule like this, but no barriers to access across state lines. For me again, you and I, we, we believe in markets and we think state lines might be artificial barriers you know, contrived barriers but removing those lines and allowing a, a doctor in Boston to treat someone in, in Nebraska. You know, why, why is that so important to, to telehealth?
Josh Archambault:
Yeah. So the way that I actually think about this is an example outside of telehealth. So think about a pilot. We allow a pilot to take off in one state, then they land in another, and we haven’t assumed they’ve lost all of their skill and knowledge. And then we allow them to take off again. But yet for medical providers, we assume that as soon as they cross the state line, especially in a place like new England, where, you know, in half an hour, 45 minutes, you’re in another state. We just assume that they’re, they’re unqualified to see patients. I, I, I think this one is they’re in the telehealth world. This one is seen as a no brainer. There are still special interest groups or provider groups who are more hesitant on this one. So what we score, what we looked for and what we scored for was looking for a state policy that simply allowed providers who were in good standing in their home state.
Josh Archambault:
These people all go to the same medical schools and take the same tests for the most part. If you’re in good standing in one state, then we’re gonna allow you to have a pathway in our state to register with the relevant board or to pay the fee, whatever the basic requirements are. And you can start to see patients now think about the practical implications of this. I mean, the more you think about examples, the more silly you realize what the barriers and protectionism that we have in place right now is in almost every state. There are very few states that allow what, what we’re describing, think about how many people spend time in warmer climates. And yet we’re saying they cannot stay in touch with their providers back home who have maybe known them for decades. They have to establish a brand new relationship with somebody who does not know them.
Josh Archambault:
It because they cannot do across state lines, picture a doctor or a provider who goes on vacation. They are breaking the law. If they are not able to stay back in touch with their patient, cuz they are they’re in vacation in another state. Think about the numerous industries, pilots, flight, attendants, truck drivers who cross straight state lines all of the time as the nature of their employment. And yet we make it difficult. If not illegal for them to stay in touch with providers who maybe they’ve known for years or decades, this is how kind of impractical and silly it is. You hear people all of the time talking about coordination of care and healthcare and how important it is to save money, to have people stay in touch with their providers. That’s what we’re, we’re talking about here. What we’re trying to put that option on the table.
Josh Archambault:
I, I think the concern here from the provider groups is they want complete control over who is practicing in their state or not. And on one hand I underst in, they wanna keep PA patients safe, but on the other, we have shown that licensing does not lead to, I mean, these people are going to the same schools. If they go to the same medical school and they just land in two different states, somehow we’re assuming there are, have completely different qualifications or outcomes. So there are, there is a politically fee way to do this. I would point to states of Arizona and Florida who have relatively recently passed laws that allow for a registration in the state with a relevant board so that, you know, who’s providing care by telehealth in the state. And you also allow for them to take some sort of regulatory action if there is a complaint against a provider.
Josh Archambault:
And I think that ultimately addresses some of the quote unquote safety concerns that have been used to kill these sorts of reforms in the past, but it’s just really impractical the status quo. And if we wanna make sure that there are enough mental health providers, that there are enough providers, period, I mean the tum tsunami of retirements that are coming for doctors over the next 10 years, we have to think differently about how we deliver healthcare and telehealth. And especially this across state line has to be part of the, the process and the conversation. And I think it’s just a matter of time before states actually start to move on this one. Yeah.
Joe Selvaggi:
This seems like get an odd Relic. I certainly don’t imagine among our listeners that someone where they’d get sick in a different state would be concerned whether the doctor they would visit in the emergency room is qualified to practice medicine, right. It doesn’t have not everybody has to go to, you know, a certain school or go to a certain hospital. I, you know, that’s, that seems obvious, but an important point let’s talk about the, that telehealth in certainly in the emergency phase of the orders, it allowed for telehealth for primary care doctors, but not for other practices you, you mentioned in your paper nutritionist and other fields why would this be, why would we just say, okay primary care perhaps is okay with a telehealth, not all these other specialties.
Josh Archambault:
Good question. I don’t know. I mean, what was interesting during the pandemic is that a lot of governors did offer executive orders allowing for a lot more flexibility that just to return back to the across state line, many, many states allowed for that for the first time through executive order. And guess what this guy didn’t fall. In fact, people really came to appreciate they could access more providers. This is another example in which there was unevenness in when it came to executive orders on who could use telehealth. And when we really dug into this, I, I think what was interesting is pre pandemic. And even in a couple states now only doctors are allowed to use telehealth, which just seems, I mean, the nurse practitioners, physician assistants said, these are the backbones nurses. These are the backbones of our healthcare system. And to say that they can’t use telehealth under any instance just seems shortsighted.
Josh Archambault:
But I think in our report, what we were trying to highlight is in a number of states, they do allow a lot of providers to use telehealth, but what they do is, and this is the details that actually really, or is that they tie it to the currently licensed profess medical professions that are in, you know, whatever title that is in state law and the challenge and, and, and problem with that is that there may be some medical providers who aren’t currently listed in that title. And until they’re added to that title, they’re not allowed to use telehealth. The other thing that it does is that it doesn’t allow for new innovative provider types to emerge quickly. They have to go through the whole legislative process to be added to the title before they can use telehealth. So what we suggest is to follow the best practice, which is in a few states of allowing the definition for who can use the telehealth to just be broad, to just say, you know, we’re not gonna mandate that every, everybody has the insurers have to pay for all of this for all the provider types, but if they want to, if they want to try something different, if they wanna work with a different kind of medical provider, they should be allowed to do so.
Josh Archambault:
And that’s what we are really rating at for that factor.
Joe Selvaggi:
That that’s a great segue to another bullet when we talked about independent practice. Again, this sounds like a no brainer, but the phenomenon of nurse practitioners that they could use telehealth a, they should, of course be added to the list along with doctors. But the, the fact that there’s a requirement now that doctors have to oversee this interaction with nurse practitioners, you, you mentioned earlier, there’s an anticipated shortage of, of doctors. I imagine along with the massive tsunami, the of, of baby boomers retiring and along with that, many of those being doctors who are also retiring we’re gonna need a lot of nurse practitioners, I would imagine shouldn’t this telehealth facilitate that, that transition.
Josh Archambault:
Yeah. And that’s what we were looking at here. I mean, we, we could have looked at any number of different medical professions on whether they’re able to practice independently in the ways that they’ve been and trained to do. And I think there has been growing consensus in Massachusetts just joined this this group of states that have allowed nurse practitioners to practice on their own going forward. And that’s what we were looking at. We wanna make sure that the, again, the system is flexible, that can be patient centric. I mean, the challenge here is there’s a cost element to this and many dates. When you see a nurse practitioner, your insurance company, or you get actually charged a doctor’s rate, which in other professions would actually be illegal for you to do, but in medicine, for some reason, we allow it to happen. But there’s more of a practical reason here, why we think it’s important, nurse practitioners and others, they help extend the healthcare system.
Josh Archambault:
You know, whether it’s in a rural community or whether it’s just in an urban community in which getting a primary care doctor’s appointment can take 50, 60 days or longer, which is not uncommon in the Boston area. We wanna make sure that you can be able to see some of these other primary care providers in a more flexible way that they’re able to set up their own practices if they want to and use telehealth as part of that. And that’s what we were trying to look at as one example for nurse practitioners going forward, because that’s just the reality that we’re facing going forward.
Joe Selvaggi:
Well, that links also to a another point point of your paper, no payment mandate. Now you mentioned just in your earlier response that, that providers are charging the same, whether they, you see a doctor or a nurse, but I think what’s more unsettling is that or a nurse practitioner I’ll say is that whether you visit your doctor in the hospital or you have the meeting virtually again from the setting of maybe even the doctor’s own home you’re, it’s mandated that you be charged the same amount. Now some people would strongly prefer telehealth regardless of cost, but some people might use it as a way to save some money or the system saves some money. The system seems to now to forbid a differential in, in those payments you know, say more about that.
Josh Archambault:
Yeah. So when we looked at this one in particular there’s probably about half and half, half states mandated and half the states don’t, and there’s kind of some practical implications. Let me tell you why supporters advocate for the payment mandate. You know, the primary reason that they do is they say, we need to encourage providers to do use telehealth. So we need to pay them the same rate or it’s the same sort of expertise. So we need to pay them the same rate. I, I think the challenge with that is a, a couple fold is that there are some big unintended consequences of mandating that same payment rate. The first is patients who have a deductible are paying the full cost for it. So you are now mandating that they have to pay an inflated rate for services. And what we have seen is, and there’s been survey data on this over the last few years, at least a third of Americans say that they skip needed care over cost concerns.
Josh Archambault:
So what you have just done is you have pulled the rug out from under those who would’ve used telehealth because it would’ve cost slightly less, but there’s actually longer term ramifications for this. The first is these state mandates only apply to the individual market and the small business market. They don’t apply to large companies. So you have now made an unlevel playing field for small companies who tend to pay some of the highest health insurance premium rates in most states. And you have just made it more expensive for them to deliver healthcare. And then finally, I would just say, going forward, it kills innovation. We still largely pay for healthcare and I for service manner. And for those of us that have been in the health policy community, there’s been a raging debate about trying to change the way we pay for healthcare to more value based or based on outcomes or, or pay on a budget instead of to try to change the incentives going forward for just providing more and more care.
Josh Archambault:
And so I, as a result of forcing the insurance companies to pay this inflated rate, you are gonna double down on cementing the uneven payment rates that go to different providers. And if a provider group comes to an insurance company and says, Hey, I wanna do team based care. I wanna try something different. Hey, I wanna follow up with phone calls on a more regular basis insurance, company’s gonna be hesitant to do it if they’re being forced to pay the same amount for an office visit. I mean, think about a phone call costing the same as a 15, 30 minute, 60 minute in person office visit. That’s just impractical. You’re gonna see a massive spike in spending as a result of that. And so I think that there are some big unintended consequences that I’m hoping that over time policy makers won’t just see as, oh, we gotta pay for this because it’s important. We wanna encourage more of it, but they actually understand what the moving pieces are and that there’s implications for forcing mandates on certain parts of the market that hurts patients, vulnerable patients, those with chronic conditions, those in rural communities, small businesses, and actually try to embrace a more even keeled sensible policy framework going forward.
Joe Selvaggi:
Yeah. So to me, it seems sort of economics 101, you take away the price signals and you really don’t understand preferences of patients and doctors, right? If everything costs the same I don’t care what the product is. You don’t understand which people prefer and you don’t encourage innovation. That’s very important. I think also then this we’re almost repeating ourselves. One of your features was no facility fee. Ironically, whether the doctors calling from an expensive place like mass general or from, you know, some rural setting or his home there’s a mandate that there’s a facility fee paid to a telehealth visit. Say more about that.
Josh Archambault:
Yeah. I think this is where we, when we start to really think about the, for flexibility of telehealth and how it can be delivered, I mean, literally from the home of the provider facility fees have been justified for in-person visits at large hospitals as a way to cross subsidize other activities, whether it’s to help pay for the ER or research and development or other things that the hospital might office offer, excuse me, to patients. But here, we’re talking about somebody sitting in their home office and delivering a telehealth visit where the patient pops up right in front of them. There’s no waiting for the patient. There’s no waiting for the provider. They can in theory, see more patients in a, a shorter period of time. And so I think facility fees, which are largely just this extra fee put on in the end again, when we talk about patients who are foregoing care, because of concerns about costs and are paying largely paying it outta pocket, because they have deductibles, we have to allow for a health system that doesn’t have all this cross cross subsidization, especially when it literally does not make sense and should not apply when somebody is sitting in their home and not in the office building in a tower, in a big hospital system.
Joe Selvaggi:
Well, all good points. We’re coming close to the end of the show. I, I also want to say what I loved about your paper is, and I think it’s come through in our conversation. Not all areas of medicine are equal in the eyes of telehealth. Some are easier to utilize telehealth others perhaps less. So you mentioned in the paper, no coverage mandate. And what you say is you, you have concerns with telehealth and in-person treatment with regard as the same in all practice areas without any supporting data. In other words, there’s no sort of measurement as to when we all uptake telehealth, some are going to double their efficiency and others may, may founder. You mentioned say dentistry, I, I, I wouldn’t want a virtual root canal but, but say more about why it’s so important to measure the efficacy of, of these different measures.
Josh Archambault:
Sure. Yeah. So I think the long term success of telehealth is going to be based on us measuring it and in the policy world and debate, it really shouldn’t be a political fight. It really should be. Do we get better health outcomes? I mean, some of the most promising innovations I’ve seen using telehealth has been in the, those dealing with addiction and recovery. You know, we have a sad situation in America with so many people struggling with opioids and other issues in which we pay lots and lots of money for people to go to inpatient programs repeatedly over and over again. And the outcomes are just their lackluster at best, in many instances. And I’ve seen telehealth models where not only are they able to interact with patients when they’re in their moment of crisis and wanting to get clean, but also able to stay in touch with them and keep them sober far, far long, or, I mean, we’re talking a year, two years beyond them, kind of the initial intervention, which if you were to look at the data for inpatient programs, it can’t even be touched in terms of having people cycle back to the program UN unfortunately.
Josh Archambault:
And so I think we need to make sure that we’re studying this, that we’re looking at data that we’re holding telehealth providers to a high standard of showing their efficacy and the quality of care that they are they’re providing. And I think what we’re going to find is that in some areas, telehealth is truly game changing. Telestroke other areas seems to be that these are telehealth should maybe become the standard for how we interact and provide services. And inevitably, we’re gonna find areas where, you know, we just can’t tell, we can’t tell if there’s added benefit here or maybe the outcomes are worse. And so we need to stop paying it. The coverage mandate falls on insurance companies. And as I mentioned previously says, we don’t care about the outcomes you have to pay for it if it’s so over by telehealth, if it’s otherwise covered by your health plan. And I just think that’s shortsighted, we wanna make sure that insurance companies and employers and even individuals, again, when we interact with the healthcare system, we’re actually getting more value for every dollar. And if we’re mandating it, then you remove that flexibility and you’re putting handcuffs on them, quite frankly, for them to try something different, innovative, and they are gonna have to keep paying for the same procedures or the same services over telehealth that may not be adding value
Joe Selvaggi:
Well that that’s a great way to work. We’re coming close to the end of the show. And you, you, you sort of, it seems a theme is policy makers have to insurance companies have to allow flexibility to to see telehealth embraced effectively and it may be different in different area policy area. So from my last question, I’ll just say we have a lot of policy makers that listen to the show and they’re probably excited by what you said about the promise of telehealth. If, if Massachusetts policy makers are listening to the show, what would you say? Where’s the low hanging fruit here in Massachusetts that we could do better to make telehealth a more essential part of our healthcare system.
Josh Archambault:
I, I, I, it’s interesting that you asked that question, Joe, because if you had interviewed me a year ago, I would have different answers than today. I, you know, I think what is encouraging in Massachusetts in particular is there has been some serious conversation about improving the telehealth landscape, you know, started with the governor, with his executive orders. The legislature followed up by passing a new law, which by my count, at least three of the eight things that we looked at improved to green as a result of that reform. So that, that is very promising, but there is certainly more work to be done here. I think we talked about the no barriers to across Stateline telehealth. I think that’s just a no brainer, especially in new England where so many states are so close to each other. This is actually, if you think about it, a business opportunity for Massachusetts providers, whether they want to be able to travel if they’re mobile or whether it’s, we wanna set the, an example for other states so that if they reciprocate Boston based or Massachusetts based providers can actually see patients from other states a lot more easily.
Josh Archambault:
So there’s work to be done there. We talked about the coverage mandate, unfortunately in the update, they did pass that insurance companies have to cover telehealth services and they did keep a payment mandate for behavioral health, which I understand they want to try to get more behavioral health providers, but I really hope that they revisit that going forward and make sure that they phase sit out over time so that again, people seeking behavioral health, aren’t being priced out of the market because it’s, they’re being forced to be charged the same rate as an in-person visit. And then finally, we, we didn’t touch on it, but compacts, this is just a kind of agreement between states to set standard agreements on how providers or nurses or others can kind of more easily move between states. Massachusetts is actually not a member of the compacts that we looked at.
Josh Archambault:
There, there are some downsides to compacts that are a little bit clunky at times, they’re kind of expensive. So allowing for a free flow or they’re easy registration is a, a preferred plan a for states. But if politically you can, can’t get there. Then compact may be another way for at least certain provider groups to be able to open the door for patients, sick patients, to not have to travel, to be able to see some expert providers that just may not happen to live here. They may live in Ohio or California or Texas, and we wanna make sure that patients are able to access the providers that are best for them or that their provider primary care provider might recommend. They
Joe Selvaggi:
See. Well, great answer. That’s a, there’s a lot to do even here in Massachusetts where we think we got, we get the right answer more often than not. So thank you very much for being on the show. Thank you for this wonderful paper. Again, it’s a pioneer institutes research entitled rating the states on telehealth best practices. Our listeners can go to the pioneer website to, to read more. Thank you for being on hub won again. Josh, thanks so much.
Joe Selvaggi:
Has been another episode of Hubwonk a podcast of pioneer Institute, a think tank in Boston. If you enjoyed today’s episode, there are several ways to support the podcast. It would be easier for you and better for us. If you subscribe to Hubwonk on your iTunes podcaster, if you’d like to help it, make it easier for others to find Hubwonk, it would help if you offer a five star rating or a favorable review, we’re always grateful. If you want to share Hubwonk with friends, if you have ideas or comments or suggestions about future episode topics, you’re welcome to email me at hubwonk@pioneerinstitute.org. Please join me next week for a new episode of Hubwonk.
Recent Episodes:
This report finds that analyses from the Massachusetts Department of Revenue (MADOR, 2016) (and more recently, Tufts University’s Center for State Policy Analysis (2022)) dramatically underestimated the number of households and businesses impacted by the constitutionally-imposed tax hike that the legislature is putting before voters in November 2022. The proposed tax would impact multiples of the number of people previously estimated, over a nine-year period, since the majority of “millionaires” only earn $1 million once during that time.
In Massachusetts, the Know-Nothing amendments prevent more than 100,000 urban families with children in chronically underperforming school districts from receiving scholarship vouchers that would allow them access to additional educational alternatives. These legal barriers, also known as Blaine amendments, restrict government funding from flowing to religiously affiliated organizations in nearly 40 states and are a violation of the first and fourteenth amendments.
The U.S. Supreme Court will hear a case this year, Espinoza v. Montana Department of Revenue, that could end these amendments. In 2018, Pioneer produced a 30-minute documentary on the impact of the Blaine amendments on families in Massachusetts, Georgia, and Michigan.
“She’s a good girl. She helps me a lot. She has big, big dreams. I don’t have the money, but she has big dreams. I hope she’s going to get everything, but she works so hard. She works so hard in school.”
“Our family is needing to make some really big sacrifices because we believe this is important, and so, we’re basically going to do whatever it takes… Sometimes we look at each other and go ‘I don’t know if I can do it again another month…’”
“A lot of the families have to sacrifice and work multiple jobs… And just scraping together enough money to just make tuition, just the basics.”
“It is discriminatory, that parents who want to choose an alternative to public school for their children, would not in any way receive any compensation for that, whether it be tax credit, whether it be a voucher…”
In the 1840s, nativist movement leaders formed official political parties and local chapters of the national Native American Party (later the American Party), although they continued to be commonly known as the Know-Nothing Party. Politicians sought to insert provisions into state constitutions against Catholics who refused to renounce the pope. The Know-Nothing movement brought bigotry and hatred to a new level of violence and organization.
The party’s legacy endured in the post-Civil War era, with laws and constitutional amendments it supported, still today severely limiting parents’ educational choices. A federal constitutional amendment was proposed by Speaker of the House James Blaine prohibiting money raised by taxation in any State to be under the control of any religious sect; nor shall any money so raised or lands so devoted be divided between religious sects or denominations. These were then named the Blaine Amendments of 1875.
in recent decades, often in response to challenges to school choice programs, the U.S. Supreme Court has demonstrated great interest in examining the issues of educational alternatives and attempts limit parental options. Massachusetts plays a key role in this debate. The Bay State was a key center of the Know-Nothing movement and has the oldest version of Anti-Aid Amendments in the nation, as well as a second such amendment approved in 1917. Two-fifths of Massachusetts residents are Catholic, and its Catholic schools outperform the state’s public schools, which are the best in the nation.
Help families like the Costons in Michigan to end the bigoted Blaine amendments in their state that are blocking tuition scholarships and other types of financial support that would make it possible for families to send their children to high-quality schools that are best suited for their children.
[ytp_video source=”uN8dMHYzofA”]
SHARE THIS STORY ON SOCIAL MEDIA!
This week on “The Learning Curve,” co-hosts Gerard Robinson and Cara Candal talk with Ian Rowe, a senior fellow at the American Enterprise Institute, where he focuses on education and upward mobility, family formation, and adoption. Ian shares his background in entrepreneurial school leadership and policy research, and how he became interested in K-12 education reform. They discuss his work to advance quality school options for poor and minority kids as CEO of Public Prep and now cofounder of Vertex Partnership Academies, a character-based network of schools based on International Baccalaureate’s (IB) world-class curriculum. He weighs in on why policymaking around school choice and academic content has become politicized, and the kinds of content K-12 students should be taught, through the 1776 Unites project for example, to prepare for college coursework, meaningful citizenship, and pathways to prosperity.
Stories of the Week: Should the state take over management of the Boston Public Schools? A Boston Globe opinion writer makes the case, noting the disproportionately low-income and minority student population enrolled in the district’s chronically underachieving schools. A US News story highlights the benefits of high school internship programs, to help students get a head start on career preparation before college.
Guest:
Ian Rowe is a senior fellow at the American Enterprise Institute, where he focuses on education and upward mobility, family formation, and adoption. Mr. Rowe is also the co-founder of Vertex Partnership Academies, a new network of character-based International Baccalaureate high schools opening in the Bronx in 2022; the chairman of the board of Spence-Chapin, a nonprofit adoption services organization; and the co-founder of the National Summer School Initiative. Ian is the former CEO of Public Prep, tuition-free Pre-K and single-sex elementary and middle public charter schools, educating more than 2,000 students in New York City. He concurrently serves as a senior visiting fellow at the Woodson Center and a writer for the 1776 Unites Campaign. Mr. Rowe earned an MBA from Harvard Business School, where he was the first Black editor-in-chief of The Harbus, the Harvard Business School newspaper, and a BS in computer science engineering from Cornell University.
The next episode will air on Weds., January 26th, with guest, Andrew Campanella, the president of National School Choice Week.
Tweet of the Week:
The $1 billion budget for the Tech Modernization Fund is a huge investment, but funds are only part of the solution. Tech Talent Project outlines tech fund best practices TMF can use to make gov work for people. #CivicTech https://t.co/KNbhyX29jw
— John Bailey (@John_Bailey) January 17, 2022
News Links:
Boston Public Schools should go into receivership
https://www.bostonglobe.com/2022/01/17/opinion/boston-public-schools-should-go-into-receivership/
The Rise of High School Internships
https://www.usnews.com/education/k12/articles/the-rise-of-high-school-internships
Read a Transcript of This Episode
Please excuse typos.
[00:00:00] Cara: welcome listeners to another week of The Learning Curve. This is Cara Candal here as always with the amazing Gerard Robinson. How you doing this week?
[00:00:32] GR: Doing well. How about you?
[00:00:34] Cara: Yeah, I’m doing okay. I mean, in some sense it was a somber weekend. I was thinking about how, sort of pressuring it was, we just recently had Barry Weiss on the show talking about the rise of anti-Semitism in the U S and then we have this hostage taking at a synagogue Colleyville, Texas this weekend, disturbing that it seems like events like this are happening more and more often in recent years.
[00:00:57] So a little bit of a time of reflection that coupled [00:01:00] with the fact that, of course yesterday, we celebrated Dr. King’s birthday. and we had a guest on last week to talk about Dr. King and his legacy. So, on the whole, restful weekend, but a little bit of unrest in my soul, Gerard thinking about some of this stuff.
[00:01:17] So I, but I hope you’re well, and I hope that our listeners are well. And it also just made me think that I think the content we bring to folks every week is super relevant, as unfortunate as that might be time to time.
[00:01:31] GR: Well, Dr. Carson was on last week. And we know he’s a professor emeritus now at Stanford, and he’s in charge of the MLK papers.
[00:01:40] In fact, we just brought on a new scholar, to, take the project to the next level, but so much of what he discussed in terms of keying and his international influence is really important because yesterday was sharing with the girls, little known fact about MLK is the fact that he was born Michael King.
[00:01:58] his father ended up changing his name to [00:02:00] Martin Luther king. Of course, after he traveled to Germany in 1934 as part of a delegation from the United States Baptist convention to Berlin. And again, this is 1934. We know the year before that, Hitler comes to power. he said he was there. His dad was there the time starting to see.
[00:02:19] Rise of Nazi-ism the Baptist delegation actually put out a statement saying that they were against all forms of racism, antisemitism 1934. And so we’re talking about this and what happened, unfortunately in Texas in 2022. And so it just put into an international context that him going to, Germany, , the home of Martin Luther and coming back and saying, wow, I’m, so moved.
[00:02:43] I’m going to change , my son’s name to Martin Luther king and the rest is history on the anti-Semitism side. We’ve also had J group. On our show. And he’s recently published a really good piece from the heritage foundation, which looked at diversity equity and inclusion [00:03:00] programs at universities.
[00:03:02] But in that report, he also talked about anti-Semitism and, or the lack of focus when we’re talking about diversity or inclusion or equity, and we’re talking about racism. anti-Semitism, isn’t getting a great deal of attention, but here in the Commonwealth, this past weekend, we had the inauguration of governor Youngkin.
[00:03:23] also Lieutenant Governor Sears was the first African-American woman elected statewide and our attorney general, who’s the first Latino elected statewide, , one of the executive orders and one of the executive directives that he signed had to deal with antisemitism, and he also quoted king, I’m not real address.
[00:03:42] So the things you brought up were part of the weekend, and I lived here in.
[00:03:48] Cara: Yeah, lots to think about and you know,, I want to root us firmly back in Boston because as you know, Gerard Dr. King did his doctoral work here in Boston, and I used to love to live really close to Boston [00:04:00] university campus just blocks away and there’s this beautiful, statue dedicated to his memory there.
[00:04:05] And you’ve never seen it, I highly recommended it is right outside of. Main library of the Boston university’s main library, as well as the, student center. It’s a beautiful work of art. So he’s got, a history here and relevant to my story of the week, which, , I asked our producers if I could just get a little Boston today, because we had a story out in the Boston globe this weekend, , an opinion piece highlighting just the absolute failure in many ways.
[00:04:33] I’m just going to name it of the Boston Public Schools. And it got me thinking so much about how disappointed Dr. King would be to know that in a system, where Massachusetts, just so consistently. number one in the nation on so many measures, including NAEP among other things. but we also consistently have some of the widest achievement gaps in the nation.
[00:04:55] Something that is just way too often overlooked, and those gaps are just horrific [00:05:00] in the Boston public school system. So this opinion piece out of the Boston globe, written by Roger Lowenstein talks about the need to consider receivership a controversial word, a controversial term for the Boston public schools.
[00:05:15] And the timing on this is great because my friend with pioneer Institute, I have a paper coming out soon on this very topic. Now I’m going to take just a moment to set the context. And that is that Boston public schools have been consistently persistently failing, , mainly children of color, but the system.
[00:05:33] Also, you know, heavily weighted serves, disproportionate numbers of children of color, because , one of the things that happens in Boston is that if you are in, this is just talking in demographic terms here. If you live in the city of Boston and you are white and. , upper income, you are much more likely not to use it’s public schools.
[00:05:53] so what happens then is that folks are locked into a system where they have what we call intra district choice, [00:06:00] but most times families are choosing among, , just a bunch of low performing schools, unless you can, as we’ve talked about on this show before test into one of the only high performing schools in the Boston public schools, which would be an exam school and admissions based school, some of that’s changing there, they’re revamping, , admissions via exam, , this coming year, , and there’s some changes made post pandemic, but it’s still, these exam schools.
[00:06:23] Have historically been disproportionately populated with higher income children and certainly with white children and many times what families do is they use private education up until the point when kids are eligible to go to the exam schools in middle school. And so where does this leave? The other Boston public schools and the families that are choosing amongst just many, many low performing schools?
[00:06:45] Well, it doesn’t leave them with much choice at all. And this opinion piece in the Boston globe makes the case for the state to essentially take over BPS. Now I’m going to do a little detour here and take our listeners [00:07:00] back to the spring of 2020. And all we’ll remember is the pandemic. But in fact, about a week, a week before schools across the country, shuttered their doors, the commissioner of education, Jeff Riley here in Massachusetts had requested, , had ordered actually study.
[00:07:17] As we do here, we, , , and in many states reviews of districts, but an in-depth review of the Boston public schools, which is one thing that is necessary for receivership. And, , that report was released. Very damning report was released just the week before schools closed due to the pandemic. So.
[00:07:34] Buried. probably not intentionally. I don’t think people really realize the pandemic was coming, but to make a long story short, the report Gerard was damning, absolutely damning. And it unearthed not just pockets of under-performance, but just persistent failure on the part of the system to serve kids persistent failure in terms of getting the right curricula into kids’ classrooms, a disjointed approach to education where schools had a lot of [00:08:00] autonomy and there was just very little accountability.
[00:08:02] We like autonomy generally, but when it’s coupled with accountability and, persistently putting, less skilled teachers in the classrooms where kids most need the high skilled teachers, , not a lot of professional development for teachers, the list goes on and on and on. So one would have thought that once this report was issued, the case for receivership would have been made.
[00:08:21] Unfortunately, that is not what happened. And here we sit years later, with renewed calls, especially as governor banks, , who I think is an ed reform minded person is, , has announced that he’s not going to run anymore. So we’re hearing renewed calls to put Boston public schools into receivership.
[00:08:40] It would require yet another review to confirm what we already know. And that is that the schools are wildly underperforming. And the really important thing here to note is that although receivership is controversial, sometimes it’s called turnaround here in Massachusetts, here in the Commonwealth. We do have a record of some success, some of the only success [00:09:00] stories in the country, and probably the most well-known success story of turnaround from Massachusetts is that of Lawrence, Massachusetts, where our current commissioner was in fact, the receiver.
[00:09:10] So here we have a gentleman who. it has a template for how to do it. Nobody’s suggesting he copy and paste, but receivership is something that we’re hearing renewed calls for, should be on the table. I will preview the pioneer report for folks saying we come to the same conclusion. so the problem is going to be, , will it happen or will it not?
[00:09:30] Because there are a lot of forces against it. It is not a popular idea. Sometimes least popular ideas are, are the best ideas when it comes to serving kids. Because as this, opinion piece in the Boston globe noted, it would be hard to imagine a school system that more poorly serves, especially kids of color, then the Boston public schools.
[00:09:52] So this is one to watch her. I think we’re going to be talking about it in the coming weeks and months, but one that I hope, all of our listeners will look into [00:10:00] controversial but important.
[00:10:01] GR: Wow controversial. And weren’t we here before 1991, if I’m not mistaken. I mean, the,
[00:10:11] Cara: yeah, about that receivership that you’re talking about, the BU Chelsea public schools partnership.
[00:10:17] Yes, very good members. I’m like,
[00:10:18] GR: wait a minute. There was a takeover of Chelsea and there was also, , a takeover. I’ll go guess really a law that abolished the elected school board in Boston.
[00:10:27] Cara: That’s right. in Chelsea. Yes, no. Yes. Boston as well. So we have mayoral control as many cities do. Yes.
[00:10:33] GR: It’s amazing.
[00:10:34] I mean, as you’re talking to our listeners, just think about it 1991, governor Wells says, you know what, we’re going to take over the school system and put it under what we call mayoral control. Now let’s put this in context. Boston had had an elected board since 18 22, 1 of the first urban systems in the country of its type to be open, to be free, and to really try to [00:11:00] push the ideas of a new Republic, trying to make sense of a changing economy.
[00:11:06] And I remember reading that back in the nineties because my graduate work at the time was on state marrow takeovers of schools. But to think that that was 1991, mayor Flynn, , supported it. City council supported it. A number of black leaders and community groups were opposed to it. But what are the reasons they took it over was because of what was then called academic bankruptcy.
[00:11:29] Todd Ziebarth, who was then working for education commissioner of the states, , last year, talked to Todd. He was working with, Nina at the national Alliance for public charter schools. he really laid out why it happened and things will forward. And then there were more changes. But the fact that we can even mention the term receivership in 2022 for the millions and millions of dollars invested in the school system, which is in a city with the largest university reach in the country.
[00:11:59] And we [00:12:00] turned to the number of colleges in the greater Boston area, almost 250,000 students there, you have some of the best minds there. And yet this is a challenge, but that I was shocked to
[00:12:10] Cara: see thousand dollars per year. $23,000 people in Boston public schools. And I’m proud to say well-paid teachers on average, more than a hundred thousand dollars in teacher salary per, teacher.
[00:12:24] So, I mean, this is a system that, the adults are doing well, there’s money going into the system. The outcomes are absolutely not there. Most kids in BPS still cannot read on grade level. So anyway, like I said, Gerard, thank you for your long memory. , but it’s, unfortunately it’s the same old story here.
[00:12:40] And so hopefully these calls for reform will have.
[00:12:45] GR: Well, maybe my story will be helpful for if in fact the school system is in receivership and you bring in a trustee or whatever term you want to use, maybe he or she could think about this idea. And so my story is from us news and world report is from [00:13:00] Heidi Borst and it’s titled the rise of high school internships.
[00:13:04] so let’s put it in perspective. In 2021, we had 15.1 million public high school students, and 1.5 million private school students. And according to Heidi, We know that a lot of students in college participated in internships. I was an intern for three years, at a corporation when I was at Howard university, a ton of my friends were, but she said, that’s great for you, but let’s try to get drawings started in high school.
[00:13:31] And I think she’s right. And so one person who also thinks she’s right is Lori cop Weingarten. She is a certified educational planner and president of one stop college constantly in New Jersey. And she said working and interacting with various employers and employees. It’s really about bringing exposure of the basics of what a future career could look like in an industry.
[00:13:55] And she said, it’s one thing just to say, you should get a job, but it’s really about learning the [00:14:00] skills, both verbal nonverbal, social, emotional learning skills, all the dynamics that you need in order to mature, because when students find an internship opportunity, it often provides them an opportunity to mature.
[00:14:12] So that’s what Lori’s saying. Well, there’s a guy named Kevin Davis. He’s the founder and chair of first workings, which is a non-profit organization that pairs low-income students with paid internships. that students who work for nonprofits or for-profit corporations are getting really good exposure before they get to college into the importance of creating a work-based culture.
[00:14:35] Because as you and I have talked about on the show, everyone’s not going to go to college. It shouldn’t be because they don’t have the academic, skillset to do so it’s because they do and decide to go directly into the workforce. Or become an entrepreneur, but creating high school internships, according to both Kevin and Lori, makes a lot of sense.
[00:14:54] In fact, Kevin said, quote, through the internship experience, high schoolers gained the confidence to [00:15:00] succeed in their chosen path. We also know that students who are involved in this work are going to likely do better academically. So what about the higher education level? Since that’s what we know a lot about according to a 2019 survey of internship programs sponsored by the national association of colleges and employers, they found that 70% of the college students who were interns received a job offer.
[00:15:25] If we were back in 1991, when I graduated, I would be one of the people in the 70%, but that’s at the college level, not so great at. High school level. So according to a 2020 study by the American student assistance, it’s a nonprofit that helps students obtain college degrees. It identify through its survey.
[00:15:45] Only 2% of high school students had completed an internship. So if we’re looking for examples, let’s look at Washington DC, my former hometown, the Madeira school, which is outside of Washington, DC is a private high school for girls. [00:16:00] They emphasize experimental learning and they’d had an internship program that has been a part of the school’s curriculum for more than 50 years today.
[00:16:09] At school in turn at community-based organizations as sophomores, they also internal capitol hill as juniors, and then into career oriented positions as seniors, we can also look to the Midwest, although not your state, a nearby state of Ohio, , Trinity high school has an internship program that has placed students in internships at the Cleveland museum of art and the Cleveland botanical garden, along with healthcare and municipal services.
[00:16:38] So there’s one professor who said, you know what I can tell when a student who walks in my class has been involved in an internship, and this is from Joseph Danini director of clinical experience and assessment at the college of education and human development at the university of Nevada Reno.
[00:16:54] Here’s what he says. Quote, through most prepared a student is when they enter [00:17:00] college, the easiest. time, he or she will have when adjusting to the rigors of college level academics, as well as social pressures in higher education, we try to do everything we can to support students in their press appearance toward degree and completion.
[00:17:14] And so what he basically said, okay, I have an idea. When students walk into my classroom, who’s been involved within an internship. So on my side of the fence, I am proud to say that when I was president of the black Alliance for educational options, we actually use some of our high school students in internships.
[00:17:31] Some were supported locally, some nationally, some paid, some volunteer, but the main goal was twofold. One to give them an opportunity in high school, to be involved with planning a conference, a planning and agenda to go to Capitol hill or doing something in the community. Number two, for some, it was paid cash for others.
[00:17:52] It was actually credit they can earn. So I’m a big believer in the idea of internships. I like this article because it’s reminded me that I [00:18:00] need to do more for those students in high school. What are your. I
[00:18:03] Cara: think it’s huge. I mean, I would point simply to the Cristo Rey network of Catholic schools where, students pay for their education because they only serve kids who can’t afford the cost of private school education.
[00:18:14] So they pay for their education through internships. I’ve done research on these schools and it shows exactly what you’re talking about. That is through internal. The kids cultivate the life skills, soft skills, so to speak that they need for success. So I think you are right on. I couldn’t agree with you more.
[00:18:30] I am shocked that nationally only 2% of kids participate in internships. And I’d also like to say that, like, I would hope that in conjunction with thinking about internships, we can think about pathways to college and career as well as, making students and parents aware of internship opportunities, pathways opportunities, and also like to really give a quick shout out.
[00:18:51] And this is more about apprenticeships that the Tennessee department of education just became the first state to get approval from the department of labor to [00:19:00] have. High school students, engage in apprenticeships to become teachers. So you can start learning as early as high school, whether or not you want to pursue a teaching career, they will pay for a bachelor’s degree.
[00:19:09] They will pay for current teaching assistants to do the same. So I think this is great theme and I hope we keep hitting on it. Gerard, we’ve got to get to our guests because we’ve got a fabulous guest today. Dread friend of yours, your colleague at AEI. We are going to be speaking with Ian Rowe.
[00:19:26] He is a senior fellow at the American enterprise Institute, focusing on education and upward mobility, family formation and adoption. So we’re going to take a quick musical break. We’ll be ready.[00:20:00]
[00:20:38] GR: Hello listeners. Welcome back to The Learning Curve. As you know, every week, we bring you an exciting guest to talk about something in the field of education. Public policy entrepreneurship, where we’re lucky today to have Ian Rowe who actually has a footprint in those three areas and many others. Ian Rowe is a senior fellow at [00:21:00] the American Enterprise Institute where he focuses on education and upward mobility, family formation.
[00:21:06] Adoption. Mr. Rowe is also the co-founder of Vertex Partnership Academies, a new network of charter base international baccalaureate high schools opening in the Bronx in 2022. He’s also the chairman of the board of the spent Chapman. it is a nonprofit adoption service organization and he’s the co-founder of the national summer school initiative.
[00:21:28] Ian is a former CEO of public prep, a tuition free pre-K and single-sex elementary and middle public charter school network educating more than 2000 students in New York city. He currently serves as a senior visiting fellow at the wisdom center and a writer for the 1776 Unites campaign and earned an MBA from Harvard business school, where he was the first black editor in chief of the harvest, which is Harvard universities, , school of business newspaper, and he [00:22:00] has a BS in computer science engineering.
[00:22:02] From Cornell, Ian, welcome to The Learning Curve. Hello,
[00:22:06] Ian: Gerard. Gosh, exhausted.
[00:22:12] Just listening to all of that. Oh my gosh. I better live up to expectations that bio set, but it’s good to hear your voice.
[00:22:19] GR: Doing well, listeners may not know this, but, , Ian and I, both fellows at the American enterprise Institute. And even though we’re in the same shop with COVID and everything else , we haven’t had a chance to see each other in person walking the halls of AEI.
[00:22:32] But, , you continue the good work. I read what you write. I’ve seen you on television a couple of times and you do really good things. And in fact, as you were talking about your background, all the things you’ve done, this is just a great way to open up our conversation. We’ve given people a brief overview of some of your accomplishments and your academic background.
[00:22:53] Would you share with our listeners a little bit more about your biography that I didn’t cover? And what was your aha [00:23:00] moment that made you become interested in K-12 education reform?
[00:23:04] Ian: Well, first of all, jars, great to speak with you. Thank you for having me on. in terms of why I’m interested in K to 12 education, principally is because I, , myself am a great beneficiary of a great K-12, public education, in New York city.
[00:23:23] My parents came to this country from Jamaica, west Indies, via England. when we first came to the U S we lived in Brooklyn and, enrolled in the public schools. And, we ultimately moved to Queens. And then actually for high school, I went to Brooklyn tech high school. I had a great, great education, so I’m very aware of what it means to have access to a tuition free K to 12 education, you know, and then from there for my K to 12, I was able to then get into Cornell, which, another great platform and went to engineering school.
[00:23:58] I can’t underscore enough. Of [00:24:00] course, the role my parents played in valuing education and providing a stable home. so my early days were, I would go to school. I would come home, I’d do my homework, we’d have dinner and I’d go to bed. And I wake up, I go to school, come home, do my homework, go to bed, you so they created a routine, And instead of predictable, , experiences, growing up for me and my brother. So it is the combination certainly of a strong stable household with my parents who, you know, who stayed together for 48 years before my dad passed away. And, my dad always saw public education as great equalizer.
[00:24:40] no matter where you come from, as long as , the state provides a solid, , public education or, if you take education in your own hands, but one way or the other that young people get inculcated into a system where they, learn the knowledge, skills, habits to be successful, they understand the ways of [00:25:00] being within a given society.
[00:25:01] So even, even as immigrants, as we came over from Jamaica, we have our own, food and likes and ways of being there was also, an American college. To become part of and to be, , inculcated in and that’s important. as I’ve gone through my journey in life, I have now seen what it means to have access to a great education and also what it means to not have access to a great education.
[00:25:27] So when I graduated from Cornell, I went to work for what was then Arthur Anderson became Anderson consulting, which then became Accenture. I was doing all sorts of. Strategic planning for these big consumer products firms and, and did a few big projects. And, but I wasn’t really feeling that inspired, frankly.
[00:25:47] I started mentoring and public schools in New York city, and I just saw all these great kids, who by virtue of zip code or the family structure that they were born into had a really hard time. in school [00:26:00] and it just didn’t seem fair, that they either didn’t have access, to really great schools or because they were, , in challenging home environments, it just made it really tough for them to Excel.
[00:26:12] So that just put me on a whole different journey. I decided to leave Anderson, you know, get off the partner track there. I was fortunate enough to get into Harvard business school. and then I started this really weird journey. I met this young lady whose name is Wendy cup. Who’s the founder of teach for America.
[00:26:29] So I started talking to her in the , early days when they were recruiting outstanding people that teach in urban and rural public schools. did the crazy thing. after business school, I went to work for teach for America, with Wendy. , and then, through various activities, I worked at the white house.
[00:26:45] The bill and Melinda gates foundation, even MTV, but all throughout all of these, there was an education component that I was connected to and ultimately wanted the opportunity to run my own network of schools. So I ran public prep, as you [00:27:00] mentioned, which is a network of single-sex, , public charter schools, , in the heart of the south Bronx and lower east side of Manhattan.
[00:27:06] So ran that for 10 years and amazing. Again, we can talk more about it, but, pre-K through eighth grade, more than 2000, primarily low income kids, primarily black and Hispanic kids. And the whole idea was to build a sense of agency and self-sufficiency, and, ensure that they had. that they had a real shot to compete.
[00:27:26] And now I’m launching a new network of, as you said, character-based international baccalaureate high schools in the Bronx because, , there’s just, aren’t enough great high schools in the city. And I like to be a think tanker, and a doer, , and to demonstrate institutions that live up to the values of, you know, equality of opportunity, individual dignity, common humanity.
[00:27:52] Cause I think those are the kinds of things that young people should be exposed to. and there aren’t enough institutions , that stand,[00:28:00] , for these things, especially in the current environment, there’s a lot of woke ideology, telling young people that they’re either an oppressor or an oppressed, based on their skin color.
[00:28:10] And we want young people to understand that they have the ability to achieve at the highest levels, but we need our institutions to be focused on. Rigorous curriculum, high expectations, and this whole idea of viewpoint diversity as well. So that’s a long winded story that, I myself, , had a great K to 12 education, and I want to make that opportunity available for other kids.
[00:28:32] GR: I had no idea that you worked for MTV. We can talk offline about that. We’re talking about shaping character , , and just doing some of the math you were there, , at a point when it had a really big imprint upon like high school thought and what people were thinking about sociology, culture and life, let’s go back to your immigrant parents.
[00:28:53] You know, we think about black people in the United States. we overlooked the fact that according to research from pew, that [00:29:00] approximately 9% of the people we call black in fact are immigrants. And if you look at the immigrant families who are black, who come to the United States, a disproportionate number of them compared to African-Americans have gone on to major success.
[00:29:14] You’re one example we think of vice-president Kamala her father from Jamaica. We think of Colin Powell, his parents from the island, And a lot of them actually ended up in New York, other places as well, but a lot in New York. What about the immigrant story? Is a part of not only your narrative, but also the broader narrative about the whole idea of social agency.
[00:29:36] What is it about that? Immigrant dynamic that sometimes we overlook when we’re having the black conversation?
[00:29:43] Ian: Yeah. You know, this, is a tough conversation because sometimes people don’t want to admit, , that if you actually look within the black community and in particular recent immigrants from the Caribbean, , parts of, , African countries, , Nigeria [00:30:00] Ghanaians, incredibly high levels of success.
[00:30:03] and yet if you listen to the dominant narrative, as it relates to. , the black community. if you get a, you listen to a Nicole Hannah Jones of, New York times, 16, 19 project, she wrote an 8,000 word essay. basically saying if you’re black, it doesn’t matter what you do.
[00:30:24] Doesn’t matter if you buy a home. Does it matter if you save doesn’t matter, if you get educated, doesn’t matter. Uh, essentially none of that, none of those activities quote, make up for 400 years of racialized plundering unquote, period. And it just leaves you with has this idea that, gosh, if you’re black, I mean, you’re, going to get shot on the street or you have no shot in the end, her and her whole reason for saying these things was that was her rationale for a thing of $14 trillion reparations program.
[00:30:56] Because if you’re black, , you just don’t have the agency [00:31:00] to move forward. And yet, , if you look at certain communities and by the way, not only immigrant black communities, but. African-American families who’ve been here, who do the things that, by the way, Nicole, Hannah Jones has done in her own life.
[00:31:13] So Nicole, Hannah Jones has gotten married, gotten educated, bought a home, , done those things and, you know, cause her accountant would be very surprised to hear her say these things. And so what it indicates is that perhaps there are factors that transcend race that really are the driving factors behind the economic and other forms of prosperity.
[00:31:37] And it’s just the case, that, you know, and this is now back to some data, which I often sites often refer to as the success sequence. But if a kid has the opportunity to get a good, good, basic education, even just a high school degree than a full-time job of any kind, just so we learned the dignity and discipline of work.
[00:31:57] And then if they have children and they [00:32:00] had been married for. 97% of the time amongst millennials, you avoid poverty, and that just so happens to be the kind of behaviors that most immigrants, certainly recent immigrants practice. You know, there’s a huge value placed on education and educational choice, huge value placed on family, and huge value placed on staying together and reinvesting across generation.
[00:32:28] , and so that’s the story, in Jamaica, like my, and my parents came here, it was not only my parents, but you know, their brothers and sisters and, , we all got together every Sunday night and It was a cocoon of safety and education and love.
[00:32:43] And by the way, expectations like expectations , and not just expectations to get by, but expectations to be an engineer, to be a lawyer, to be a doctor like , to, succeed, but succeed superbly. [00:33:00] so sometimes we have this conversation. some people resent like, oh, you’re saying that, black Americans who are in this country are lazy.
[00:33:07] No, it’s just recognizing that, , if there’s a white supremacist on every corner, that’s oppressing every black person. Well, for some reason, there are certain black people that like, oh, I see you’re from Nigeria, then you’re good. You know what I mean? Like that there actually must be some other factors that are driving success and you start to see that these are the habits.
[00:33:29] These are the decisions, either behaviors that right now seem to be more entrenched in communities that, , come into the United States who have an immigrant ethos who come to this country with more of the, I’m going to make sure I take advantage of the opportunities. And so if we’re able to divorce those, behaviors and attitudes, From skin color and say that you’re not inherently oppressed because of skin color.
[00:33:58] that if you adopt [00:34:00] these certain behaviors, then you can be successful too. To me, it’s liberating. Final point is that when we think about empowering and liberating messages for young people, especially young black kids, it’s important that they know that simply because they’ve been born, , in the hood or, wherever that they’re not inherently oppressed or inherently powerless or inherently dependent upon the government in order to solve their problem.
[00:34:27] As Nicole, Hannah Jones likes to articulate that there are people that look just like them. People who may have come from another country recently, or people who have been in, in the country for generations, but for both sets of people. Agency is within their grasp self-sufficiency is within their grasp.
[00:34:46] And it’s not a mystery that their actual behaviors, their actual decisions around family formation, getting your education, full-time work. All those things in a particular order can lead you [00:35:00] on a pathway. And by the way, let’s not forget having a faith commitment to cause we don’t often talk about the power of religion, but that these things are within your grasp to be successful regardless of skin color.
[00:35:11] GR: As I hear you talk. And I know you’re from New York. I also think about another person with the immigrant background, Shirley Chisholm, , who ran for president, , in the early 1970s, wrote a book on boughten on boss. And she’s saying,, something. She said, then some of the things things are saying now.
[00:35:26] So also think there’s something in the water in New York and new Yorkers to do these kinds of things. and speaking of immigrants, who’ve done well. Also want to, give them granulations to Lieutenant governor, , winsome series here in Virginia. I had a chance to go to her Naugle events, earlier this week.
[00:35:42] And that’s, another example of someone with Jamaican roots, who is now changing tide here in Virginia.
[00:35:49] Ian: I was waiting to hear the announcement that you were going to be the secretary of education.
[00:35:53] GR: All know I was so excited to hear the announcement about, , Amy Gudera
[00:35:58] Ian: secretary. I know Amy [00:36:00] knows great stuff, but When Younkin Sears one, I thought, oh my God, going to be populating their candidate, who were some amazing people who are already in Virginia, who, uh, so I thought of you. but it’s all good.
[00:36:11] GR: It’s all good. No, I appreciate the kind of thought you talking about New York and you’ve got to end printing in a few of the burls and you made a really good point about IB.
[00:36:20] , talk to our listeners about why international baccalaureate, and also talk about why character, because we hear the word, we just celebrated, King’s holiday. And I think about an article that king wrote, get this at age 18, he wrote an article called the purpose of education, and it appeared in the January, February, 1947 edition of the maroon tiger.
[00:36:44] And in it, he said, quote, we must remember that intelligence is not enough intelligence plus character. That is the goal of a true education. So why a network of character schools and why IB?
[00:36:58] Ian: Yeah, it’s such an [00:37:00] essential question. I’ve just written a book called agency. and the whole thrust of the book is, to empower the rising generation, to overcome the victimhood narrative to determine how to, create their own pathway to power.
[00:37:16] I put a lot of thought into this word called agency, , which I define as the force of your free will guided by moral discernment. think of velocity, it’s a vector. Think of velocity, velocity. Isn’t just speed, but it’s speed and directly. Right. So we, as human beings, we have free, will we have the ability to make decisions?
[00:37:41] We’ve got the ability to move our life in one direction or the other, the question is what does that direction come from? where do you get a sense of what the likely rewards or consequences are of decisions that you make? And so, for me, that’s where the [00:38:00] power of mediating institutions come from, because, first and foremost, there’s your family, that’s the first place. And in fact, I’ve even created a framework called free family religion. Education entrepreneurship. Those are the pillars that if a young person really thinks about their life, those are the character forming institutions, the character shaping institutions that help young people understand how do I navigate this force of free will that I have.
[00:38:35] And so that’s why I’m launching a network of character based international baccalaureate schools. You know, this new network of vertex partnership academies, the anchored in the four Cardinal virtues of courage, justice. Wisdom temperance, those are virtues that are .
[00:38:54] Every other virtue is derivative of those four. then I think young people need a [00:39:00] grounding. And what does it mean to have courage? What does it mean to stand in the face of fear to understand the risks and yet to have the power. To do something to still move forward , in that moment where you’re, the most scared, you’re the most terrified, but like, for example, having a great family is, a place where, you know, you always have a safe place to come back to.
[00:39:21] I remember when my parents, , shared stories about, , coming, first they moved to England. My mom moved to, my dad wrote for her hand in marriage for her to travel from Jamaica to England. This is in the mid 1950s. so they could be together and get married. And she, had a ton of support for her family and that we will always be here for you.
[00:39:41] And, and so you start to realize got there that these institutions, they have my back. Right. So, and that’s where a faith commitment also is really important that there are a set of morals and, , structures that help you make decisions. So why a character based school is [00:40:00] it, first of all, what’s interesting is every school is a character based school, right?
[00:40:04] The question is, are you explicit about what you’re teaching or not? If you’re a school that doesn’t have expectations, for example, around timeliness or high expectations, or being diligent about doing your homework every night, or building study habits, then you’re actually a character-based school too, but you’re actually building the wrong.
[00:40:27] , character-based traits. So it’s really just owning the fact that kids are in our school building, for a significant portion of their life. And hopefully us working alongside with parents help to build those character-based strengths that young people will need throughout their lives to make good decisions.
[00:40:48] And so agencies, this building’s idea of the force of your free will guided by moral discernment. And that moral discernment has to come from somewhere that the ability to [00:41:00] discern decisions from a moral perspective has to come from somewhere. And I put forth that family, religion, education entrepreneurship, if you embrace those four pillars that you’ll have a much greater likelihood of leading a life of freedom, the life that you choose, the life that you want.
[00:41:20] And that’s what I want for our young people in our schools.
[00:41:23] GR: I’ve already, pre-ordered a copy of your book. , at least on Amazon, it says it’s scheduled to come on March.
[00:41:30] Ian: I think it’s more going to be April just because of, , supply chain issues. But, ah,
[00:41:35] GR: that is true. Well, listeners, you can go to Amazon or you can go , to his Templeton, press your publishing.
[00:41:41] Yes, yes, yes. Yeah. Yeah. And they are at the Templeton foundation and the current family foundation are two of the, major funders of character education across the country. They fund the organization where I work as well. So I want to give them a shout out, someone who. With this someone I know. Well, and, , Bob Woodson, he’s been on our [00:42:00] show.
[00:42:00] I first met Bob in September of 1987 when I was a freshman at Howard and he spoke about race and about getting young black men in Detroit, , to marry women that they had impregnated. And I walked up to him afterwards, shook his hand, and no idea that years later, our paths would cross different ways.
[00:42:23] Including his granddaughter, who went to the university of Richmond school of law and my wife at the time about wife at the time she worked at university of Richmond law school was her mentor. Bob and I have been in conversation and I know you were working with him with 1776 unites. Talk to us about your work there and how you guys are influencing conversations about America’s founding documents about Supreme court cases, slavery.
[00:42:47] Those, yeah. Yeah.
[00:42:48] Ian: It’s such, such a great question. , So you met Bob Woodson back in 1987. I honestly had never heard of him her’s work until, I think it was about [00:43:00] February of 2020. Just to give you a sense. I mean, here’s this incredible icon to think about the work that he has done in the United States of America as a man period, and as a black man in particular, and for someone like me, who’s worked in education at MTV at the gates foundation.
[00:43:20] I’ve never really known his work. Gives you a sense diminishes. The work of someone like a Bob Woodson and yet elevates the work of, , Al Sharpton or a ton of FC codes or Nicole Hannah Jones like this. These are the people who are viewed by the larger society of those who speak for the black community.
[00:43:40] so even that is, of a Testament. So I got to know Bob, , because he had, , again, after 40 years of running the Woodson center, uplifting people from, , in thousands of communities across the country to become agents of their own uplift. He saw that the New York times [00:44:00] had just published the 16, 19 project, which, , , as many of your viewers are probably familiar with was initially just the magazine issue was a series of essays that had a pretty robust, , and provocative view of American history.
[00:44:14] And in fact, , it clearly intended to quote unquote re-imagine history and say that maybe the country’s founding was not 1776. And in fact it was 16, 19, and maybe, , this country is not all that, you know, maybe the founding ideals were quote unquote false when they were written that the America was, was founded as a slave ocracy and not at the mock.
[00:44:36] and that country has anti-black racism running in its very DNA. I mean, you think about in your DNA, it means it’s a permanent malignancy. And Bob said, wait a minute, you don’t speak for all black people. And we have to stand up country doesn’t just, run on autopilot and [00:45:00] that it will be threatened.
[00:45:01] I mean, democracy requires an informed, electorate to continue to move it forward and uphold its principles. So he got together a group of people, , myself, Glen Lowery, John McWhorter, Coleman Hughes. I mean just an amazing group of, quote unquote elders as well as newbies who wrote just trying to.
[00:45:19] Create greater opportunity for not just black kids, but all kids across the country to understand that we do live in a country that has an incredibly, , in some ways flawed history and yet incredible stories of resiliency and progress and the whole idea of slavery, the fact that it existed in the United States.
[00:45:38] Yes, but it existed all over the world. And the United States was one of the pioneers for how slavery was not only overturned, but the people who had been once oppressed haves thrive and can continue to thrive if we unlock the secrets that at least some of our community has had access to. and so joined Bob and the 1776 [00:46:00] unites and team.
[00:46:01] And , when we also heard that the 16, 19 project partnered with the Pulitzer center to actually create a corrective. And we’re like, what? Wait a minute. Like they, they don’t just want a magazine issue. they want to indoctrinate kids into this view of America as this permanently oppressed society that if you’re black, I mean, you are screwed according to Nicole, Hannah Jones pen, her team and her ilk.
[00:46:26] And so, you know, maybe that’s another idea. Maybe there’s an alternative point of view and it wasn’t to demonize or to cancel, but to stand strong and say, we decided. We disagree. And here’s our proof. Here’s our evidence. Here’s people throughout American history who have fought against this idea of America being a country with a permanent malignancy.
[00:46:49] And so we said, you know what, if she’s going to create a curriculum, , let’s create one, not just in response, but to highlight the incredible stories of the African-American experience in United States, warts and [00:47:00] all, not just cherry picking. So if you’re going to tell the story, for example, about the Tulsa massacre, then tell the whole story, tell stories of black wealth and entrepreneurship that create that led up to the Tulsa massacre.
[00:47:16] And then tell the story of what happened afterwards, the recovery, the resilience, tell the whole story so that people can see that. Yes, I mean, America has parts of it is a wretched. Unfortunately like many other countries in the world. And yet there seems to be this through-line where the very values and principles that the country was founded upon were the values and principles and informed laws like the civil rights act and the voting rights act and everything else that has created the opportunity that yes, exists today for low-income Americans, black Americans, for people, billions of people around the world, that’s still yearn to come to this country.
[00:47:58] so Bob and [00:48:00] I, and the team, that curriculum that we created has now been downloaded more than 25,000 times. By teachers in all 50 states, it’s been downloaded in public schools, private schools, charter schools, homeschools after-schools prison ministries, anywhere where character formation is happening for kids.
[00:48:25] And we’re very proud of that because you know, again. We’re not looking to, call people bad names or, cancel, but to show that there is an empowering alternative. If we want to look at American history, bring it up. This country has a lot to be proud of there parts of the country, like many others, unfortunately that it’s a very negative past learn from it.
[00:48:45] Be honest, but tell the whole story. Don’t sanitize American history so that you cleanse it of all the bad things nor cherry picks. You only focus on the most increase jus atrocious events is I think most of the 1619 [00:49:00] project does. And so that’s what we’re trying to do to show that there was a compelling alternative.
[00:49:05] And, the nice thing is I think many people are responding to say, , we appreciate it that you’re not running away from the America’s past or, our experience with slavery or Jim Crow, or even present day racism. but the key is recognizing that what once may have been literally structural racism in trined into law is now.
[00:49:28] Surmountable racism, um, by people who, again, based on some of the things we talked about before are thriving in our country and 1776 unites stands to make that story known to millions of black and other kids across the country.
[00:49:47] GR: No, that’s a powerful story on so many fronts. As we get ready to close.
[00:49:52] What are two things you think, for example, we are going to have over 30 gubernatorial elections of this [00:50:00] year. What are two things that, , sitting governors or people who are seeking to unseat a governor or have a seat is going to be open because of term limits? What a couple of ideas that those candidates should be thinking about for their campaign, not just for education, but the whole part of just understanding human development.
[00:50:19] Ian: Yeah. Well, I think they should look to your state of Virginia and look,, at what, governor Yuncken made a point of, during his campaign. And it was pretty straightforward. parents have a voice families matter, education matters, choice, educational choice matters. And parents would have a say in development of their kids.
[00:50:42] sometimes we make things a lot more complex than they need to be. And I thought in his campaign, things were pretty simple. I think over the last few years, you know, since the tragic, murder of George Floyd, which was a heinous event, and yet reaction to it unleashed the awoke [00:51:00] ideology that again, paints the country as this permanently racist, all of our institutions are infiltrated with racist.
[00:51:08] and yet there are a number of people who were tiring of that ideology, which seems to, just place people in boxes. Regardless and says that the only factors that matter are your skin color or your gender. And based on that, you’re either going to be oppressed, or you’re an oppressor full stop and ignoring the more developmental aspects of what makes a human, being a human being, your family, the family that raises you religious or faith commitment that you’re part of the quality of education that you have in school choice.
[00:51:47] And then ultimately, so idea of entrepreneurship, your ability to generate wealth in all of its forms, social wealth, financial wealth, free family, religion, education, entrepreneurship. [00:52:00] If I were someone running for governor or running for political office, those would be the things I would, run on.
[00:52:05] you know, , I would trying to revitalize the institutions that make us all free family. Education entrepreneurship. That’s what we need to come together on as a country, across race, across class, across gender. That’s what I would run on because that’s the future of our country.
[00:52:27] GR: Well, Ian, thank you for the work that you do, both at a think tank.
[00:52:31] And in your role as an entrepreneur, who’s creating do tanks, known as schools. our listeners are here to support you, let us know what we can do in the future, , look forward to seeing you soon. Thank
[00:52:43] Ian: you so much. It was a very inspiring conversation.[00:53:00]
[00:53:24] Cara: Gerard, we are going to close it out as always with the tweet of the week. This one from John Bailey. So at John underscore Bailey the $1 billion budget for the tech modernization fund, known to those who know about it as the TMF is a huge investment, but funds are only part of the solution. Tech talent, project outlines tech fund, best practices.
[00:53:46] So the tech modernization fund, this is tons of money tech infrastructure, but we need an outline for how to get it done because as he points out, money is not enough. I encourage everybody to look up John Bailey on Twitter. [00:54:00] This will take you to a nice link that has a great policy brief with the best practices and steps that folks need to take in order to make the best use.
[00:54:09] As John says, to make government work for people. What do you think about that? That’s something hunter next week, Gerard, you know, it is national school choice week. So we’re going to be back with our friend, Andrew Campanella, and, I hope you bring your yellow.
[00:54:22] GR: I will.
[00:54:23] Cara: I bet you, I bet you got a lot of them at this point.
[00:54:26] I’ve got a few, they’re hanging out somewhere with purses that I only use once a year. So Gerard until next week you take care of yourself. You stay warm and I hope we can open the show next week with some cheerful news. [00:55:00]
Recent Episodes:
Hubwonk host Joe Selvaggi talks with Pioneer Senior Fellow in Healthcare Josh Archambault about his newest research paper, produced with the Cicero Institute and the Reason Foundation, on states’ success in implementing telehealth to improve healthcare outcomes. They discuss how Massachusetts has used remote medicine to better reach patients and serve their needs.
Guest:
Josh Archambault is President and Founder of Presidents Lane Consulting. He is a Senior Fellow at both Pioneer Institute and the Cicero Institute. His work experience has ranged from work as a Senior Legislative Aide to a governor, Legislative Director for a state senator, to years working for think tanks operating in thirty-five states, and in D.C. He is a regular contributor to the influential Forbes.com blog, The Apothecary. Josh holds a master’s in public policy from Harvard University’s Kennedy School of Government and a B.A. in political studies and economics from Gordon College.
WATCH:
Read a Transcript of This Episode
Please excuse typos.
Joe Selvaggi:
This is Hubwonk. I’m Joe Selvaggi.
Joe Selvaggi:
Welcome to Hubwonk a podcast of Pioneer Institute, a think tank in Boston. The strain to our healthcare system created by the COVID 19 pandemic has given rise to innovations that will forever change the face of medicine, perhaps chief among these is the embrace of telehealth. The ability to access healthcare remotely telehealth smokes, obvious benefit is that it can facilitate a connection between patient and provider in a convenient and less costly setting, but an overlooked if perhaps is the promise of improving patient care itself, by offering more targeted and coordinated expertise while providing health data from tests performed at home. Imagine the benefit to a diabetic patient with mobility issues of having remote access to a diabetes specialist and nutritionist, and being able to provide real time medical data to those providers from home for populations like these telehealth can be a lifesaver. How well has Massachusetts done to ensure this technology is integrated into our system and how can we improve in the future?
Joe Selvaggi:
My guest today is Pioneer Institute’s senior fellow in healthcare. Josh Archambault. In a new paper produced by Pioneer Institute in coordination with the Cicero Institute and the Reason Foundation entitled “Rating the states on telehealth practices, a toolkit for pro patient and provider landscape.” The researchers offer an outline of best state level policy practices in telehealth and creates a report card of success for each state. Josh will share with us which criteria are vital for optimizing the benefits of telehealth and how well has Massachusetts scored in his analysis. When I return, I’ll be joined by Pioneer Institute’s Josh Archambault.
Joe Selvaggi:
Okay. We’re back. This is Hubwonk. I’m Joe Selvaggi, and I’m now joined by Pioneer Institute’s Senior Fellow on healthcare, Josh Archambault. Welcome back to Hubwonk, Josh.
Josh Archambault:
I always enjoy being on. Thanks, Joe.
Joe Selvaggi:
Well Josh, you, you have been on the show before and we’ve talked about telehealth in the past. You’ve you’ve, you’ve sung the praises of the benefits of telehealth, but largely in the beginning when you were first on, we were at the early phases of the pandemic and folks were terrified. They didn’t wanna risk getting sick by going into a hospital to see their, their doctors. So a lot of these telehealth measures were emergency procedures that we did at a desperation. And the unknown. Now we’re getting to a phase of the pandemic. It’s been with us almost two years and we wanna see what parts of telehealth makes sense going forward into the future.
Joe Selvaggi:
So you’re recently released pioneer paper entitled rating the states on telehealth practices, a toolkit for pro patient and provider landscape. You’ve offered a scorecard for state level policymakers to say, okay, how well are we embracing this technology called telehealth? So for the benefit of our listeners who may not have heard earlier conversations about telehealth, let’s start at the beginning and say, okay telehealth, it’s, it’s a good thing. We’re talking about communicating with our healthcare provider or with our hospital, the way you and I are communicating right now, virtually let’s talk about what this complimentary technology, how does it help a patient and a provider?
Josh Archambault:
Yeah. So as you mentioned, I mean, I think COVID brought telehealth not only into our headlines, but into many of our bedrooms into our dining rooms, into our living rooms, wherever many of us have done telehealth visits. And I think it’s really exciting about where we are right now is we are in this assessment phase where a lot of people have tried telehealth for the first time, including providers who were, many of them were reluctant pre COVID to use telehealth as a tool in their toolbox. There’s certainly been a lot of investors pouring money into digital health care and telehealth space. And I think also there’s two kind of tracks conversations happening right now, which are really interesting to me. One is on the policy side and that’s where the paper certainly looks at looking at these eight best practices, trying to understand what policy landscape do we need to have that allows for the most innovation to emerge that is probation and pro provider.
Josh Archambault:
But the secondary part of that is what is the best use to telehealth? The policy environment can be flexible or maybe restrictive, but ultimately providers and patients need to decide how do they wanna use telehealth? It are there ways in which in person visits are a hundred percent going to be the way to meet people going forward and get certain kinds of care. And in what instances is telehealth act you the most helpful? I think what’s interesting. And I think what the general public doesn’t fully still appreciate about telehealth is they think about what we’re doing sitting in front of a computer, on a smartphone video, chatting with somebody, but telehealth is actually much, much broader than that. So, and the report touches on this, looking at things like remote patient monitoring. This means you have something in your home that is maybe in real time, I’ll give you an example.
Josh Archambault:
Somebody with diabetes might be taking their blood sugar level on a regular basis and transmitting that information to their PA to their provider so that their provider has a much better sense of how compliant they are with whatever regimen they have given them, their drugs or other things. What’s interesting about this is that the providers now have not only when there’s a red flag can follow up with you much more quickly, but when they actually see you in person, they may have at their fingertips far more information about how you’re doing health wise than just seeing you once a year or every six months, whatever the condition you may be seeing them to. So the real promise and the potential increase in quality of care over telehealth is making sure that we’ve got all of this data, that’s at your fingertips, but that people aren’t overwhelmed by it, that it actually improves the quality of care. And that’s the kind of tipping point or middle ground that we are right now where people are really trying to assess as we come out of the pandemic. What adds the most value. And, and where is it? Was it just a necessity because of COVID
Joe Selvaggi:
I was struck by your the subtitle of your piece characterizing it as both pro patient and pro provider. We’re talking about the doctors and the hospitals at a high level before we dive into any details. There’s a lot of stakeholders involved here with telehealth. Is there any tension amongst stakeholders? Is it, is, is this great for patients and great for doctors and great for healthcare systems or, or is it some sort of a zero sum game here?
Josh Archambault:
You know, I, I, I don’t think anybody views it as a zero sum game anymore, perhaps pre pandemic that would’ve been the default for some, they were worried about competition or, you know, ways for this to take away business. I, I think people are seeing it as a compliment. There are still areas of disagreement, you know, payment rates, reimbursement rates certainly remain a sticking point of how much should be paid for services, telehealth services. And that’s covered a little bit in the report should be covered at the level that an in person office visit is for just a quick video chat or should it be paid at a different rate. And then who can use telehealth, there’s going to continue to be disagreements within the medical community on whether or just doctors should be able to use it, or whether any provider should be able to use it should a nutritionist, should a physical therapist be able to use it.
Josh Archambault:
And I think that there is largely emerging agreement outside of perhaps dentistry, which seems to be an outlier in this discussion, that telehealth is a helpful tool in the toolbox. And I think as long as acknowledge that it is just that it’s not a silver bullet, it does, it is not the best way to deliver all kinds of care. Then I think that there has been emerging consensus that it, it, it, it is a good tool and it’s just a matter of making sure that the policy landscape allows for the flexibility going forward to deliver care in really innovative ways.
Joe Selvaggi:
I’m glad you mention it, the, I like the word compliment because it’s in addition to traditional in-person medicine, we’ve had doctors on the show who have said, look I’m, I’m skeptical about telehealth. I catch half of the problems with my patients through laying of hands, right. I, I want to see my patients, they, they come in from, with one symptom and I, I find it a different pro problem. You can’t do that virtually do do, does the community acknowledge this limitation of telehealth?
Josh Archambault:
Yeah, I think by and large that there is, of course it’s gonna depend on the specialty area. You know, certain providers certainly think that in person is, should be the dominant way going forward. And you know what, I trust that it’s a little bit of an art in the science here, but I will say that, you know, with the emergence of artificial intelligence and other things, dermatology is a good example. You know, if you have a provider dermatologist, who’s looking at your skin and has seen a thousand examples of something, but if you’re able to use telehealth in which the AI has access to millions of images to compare what you have on your skin, there is actually an enhancement. There, there could be a value add by using telehealth. And so I think going forward really what it is is again, it’s using both.
Josh Archambault:
So do you use telehealth first to use the access millions of images say, Hey, we actually believe this is a problem. And then send that to a provider, say, you need a hundred percent to go see this provider for an in-person care to have that removed, to have it looked at more closely that that’s the value. I, I think what we, for those of us that have been around studying healthcare spending for a long time, we realize probably half at least of care spending is just wasted spending. And part of that is because the healthcare system is not very good at triaging who actually needs in-person care or not. The default is just to go, I mean let me give you a personal example of this. You know, I’ve had health insurance where they have a nurse hotline and you can call in I’ve called in probably a dozen times or so over the years for kids or things that my wife and I have.
Josh Archambault:
And inevitably every single recommendation is go to the ER to get this checked out, even just to cover themselves from a liability standpoint. And so I think ultimately we need a few more options here where people are able to triage much better to direct people. And this is where some of the savings can come from telehealth is really giving you a gap, a very well-informed technology driven. Now, of course, there’s limitations to that, and we wanna be aware of that. And that’s the learning that we need to be in from a medical side, like really assessing where the technology enhances the kind of care and quality of care that’s being provided and where it may not add as much value. And ultimately, and we cover this in the report. I think that’s policy mandates actually become a problem. If you mandate that insurance companies have to cover all kinds of telehealth, regardless of whether we deem it adds value or not, then we’re running into problems of wasted spending. We wanna really make sure that when we spend an additional healthcare dollar, we’re getting better quality care for the patient every single time. And that includes te health as well as it does in person.
Joe Selvaggi:
Now, this is clearly a disruptive technology. I’m asking you a question it’s not in your paper. I think what an investment slide deck would ask is what’s the addressable market. And when you talk about telehealth and, you know, you look at health, the healthcare system very broadly it, it could, is this just at the fringe of the margins 5% or, you know, you, you, you just characterize a lot of waste in the system. You know, could we potentially save hundreds of billions of dollars in the system? Is it 30% that that could be I dunno if the right word is not lo no longer wasted, but more efficiently deployed. Are we looking at that level of disruption?
Josh Archambault:
Yeah, well, we’re well over 3 trillion a year in healthcare spending. So there’s ample opportunity here to increase efficiency in the quality of care provided. No, I think this gets at the question of cost savings that can come from telehealth. And I think there’s, you know, probably at least a dozen ways that telehealth could deliver cost savings. One is it’s just a much more efficient, effective way to be able to deliver services. You can have a provider from their home office from a different state, being able to see people at 24 7, quite frankly, if somebody’s struggling with addiction and they need help at three 30 in the morning while their provider’s not gonna be available locally to see them in person. So there might be an opportunity to use telehealth, to get them in touch with a provider, right at that moment when they are struggling and they need some extra support or they want to try to get clean in that moment.
Josh Archambault:
So there are those kind of interventions in which telehealth can prevent those individuals from ending up in the ER and costing a lot more money, but there’s all sorts of other ways that I think telehealth can be save money in the long run going forward. You know, I think the future of healthcare, a lot of it for certain chronic conditions and remember 80% of healthcare spending is due to lifestyle choices. So finding more effective ways to help patients live healthier lives is really important. And I think team based care. So again, go back going back to the example of somebody with diabetes, yes, you want their primary care doctor engaged, but you also might want a nutritionist engaged, an endocrinologist engage. And in many communities, those specialists simply don’t exist telehealth for the first time allows you to pull together a team to intervene with the patient and say, what is our plan of attack going forward?
Josh Archambault:
Are we being adherent? How can we help support you more to meet your health goals going forward? And if those sorts of innovations are allowed to merge to emerge and they’re being used in some instances now, but if you don’t mandate that insurance companies have to pay one size fits all way, they, you allow them to pay for team based care, try it to see if it actually leads to better health outcomes. You might actually start to see huge long-term savings by using technology. I think everybody knows this and acknowledges this. It’s just a matter of how do we transition because our current health system, especially for large hospital systems is so real estate intensive. It’s very expensive sustain. And so a lot of those health systems are just focused on how do we increase our revenue to the point where we can support that large, large system.
Josh Archambault:
Ultimately, where we wanna go is to have a health system that is patient focused and allows for providers to be able to provide care in a multiple ways. So maybe they start by seeing you in person. Then they say, Hey, go home, bring this device home, take your readings once a day. So I can see how it’s going. Then maybe once a month we pop on and we video chat to make, look at the data to see how it’s going. And then we’ll determine from there, whether we need a follow up appointment or not, that’s the sort of different ways. And that’s what the report gets at. Does your state laws, are they flexible enough to allow for that health system to start to emerge or are there barriers in place? And quite frankly, one of the things we were surprised, Joe doing the report is there’s still a lot of work to do here. There’s a lot of states whose laws have not been updated sufficiently to allow for that, those sorts of health innovations to emerge a lot of states simply tweaked around the edges during the pandemic. And I think there’s a lot more opportunity here and that’s why we put out the report.
Joe Selvaggi:
Wonderful. Well, now let’s get into the, the meat of the report. As you say, it’s, it’s state level focused. We live in a state, more Commonwealth of Massachusetts, there’s 49 other states. So given there’s a difference between Massachusetts and Wyoming, how, how do you compare terms, meaning even the, even the term telehealth may be a vague and defined differently in different states. How did you account for those differences?
Josh Archambault:
Yeah. So there, I think that there’s been a, a growing consensus that there is telehealth. Well, it can be he called and defined slightly differently by states. You’re absolutely right. There are a couple different modalities in which people look for that allows for flexibility. So video synchronous, it’s live, we’re talking back and forth. We’re able to communicate in real time, back and forth, but there’s also asynchronous, which is like, think about texting back and forth with a provider. Maybe you start the relationship over text and then switch over to video if it’s sufficient. But in many instances, allowing for that kind of easy back and forth over text, or for me to record a message and then send it to you later is another kind of form of telehealth. So in the report, that’s what we were looking for. We were looking for state law definition and I give a lot of credit to the American telemedicine association.
Josh Archambault:
Who’s worked really hard with stakeholders to say, how do we come up with definitions that are all encompassing that allow for this flexibility going forward in its, in a state. And a lot of states have started to move in that direction of adopting some of those, the, the looser or broader definitions. Now the, the area where we found the most work to do is not every state allows you to start a patient provider relationship over all of the modalities. Some of them are still prescriptive. You have to do it this way, which I think coming out of COVID, we we’ve come to appreciate and realize that that’s, that’s simply outdated. We should allow for patients again, if we want to really patient centric center system, to be able to establish the relationship in the way that they prefer.
Joe Selvaggi:
So let’s get into the, I think you used eight criterion in your paper. And we’ve touched on some of the issues in each, but I wanna touch each idea discretely. And then I’d like to also, if we can talk about where Massachusetts falls you gave each state a guess a stoplight kind of rating either green, yellow, or red, green being the better and red being not so good. So let’s start at the beginning. You, you just touched on this notion of modality neutral, which is to say I would characterize your piece as saying there’s there’s time in place, right? You have synchronous and asynchronous, meaning I’m interacting live with my provider, but I may not be, as you mentioned and also place meaning I can get a, a blood test in the hospital, but I might be able to have some sort of measurement at a facil either more locally or in my own smartphone or something like this. Right. You, so tell us more, why does it, why is modality neutral so important?
Josh Archambault:
Yeah, I think it, it matters a lot because different kinds of care, demand, different ways of interacting. And, and, and I mentioned the example of somebody struggling with addiction. I mean, whether it’s mental health issues or whether it’s other issues related to addiction there has been consensus in all 50 states that we simply don’t have enough providers, that our system is not set up in a way to be able to meet the demand that’s there. And so we need to make sure that patients, whether it’s somebody that speaks their language, that may not be in their local community, or whether it’s just, I prefer to start by text because I’m feeling ashamed of where I am right now, or just not feeling like I can talk to somebody over a video. We need to make sure that we have that flexibility. And, and I think what’s also important is a lot of the invest investments and entrepreneurs in this space are the thinking really differently about the kinds of tools and ways that patients should interact with providers.
Josh Archambault:
And we just wanna make sure that we have that source of flexibility. I think it what’s encouraging on this one in particular is states are moving in this direction and Massachusetts is one of them, the most recent telehealth bill that passed significantly improved the definite for telehealth in Massachusetts for where it was pre pandemic. And so I do think that there’s, there’s been some great progress here. And, and Joe, maybe let’s just step back for one second and talk about what the report actually is. It’s meant to be a tool kit, and it’s pretty simple, straightforward. It’s four parts to it. The first one is just a brief introduction explaining why action is needed. Second part, what we’re talking about here, the stoplight chart, giving green, yellow, or red rating for all of the states. And then we explain the ratings. That’s the third part. And the fourth part is all 50 states get a page. They all get a profile of where are they on these eight best practices. And so that’s, what’s in the report. It’s meant to be able to for the reader to digest a lot of information, but very simply and very quickly
Joe Selvaggi:
I want to get into where we score relative to the other states. As you say, it’s very comprehensive and it’s, it’s not easy to cover 50 states. So congratulations. So let’s get back to the, the bullet points or the, the features on which you score each state which just talking about Mo modality being important. You alluded to the fact that to really start the ball rolling in telehealth, many systems require the first step to be an in-person requirement. Now that may saying, seem like a no brainer first, see your doctor, and then we’ll talk about virtual. But in many cases, a someone may not live in your doctors or may have some reticence about going to a doctor, say for instance, during a pandemic or, or some other time. So say more about why that in-person requirement may be really harmful to tele health uptake.
Josh Archambault:
Yeah. For, I mean, transportation remains an issue for those with chronic conditions or in rural communities. This is the one measure where we by far saw the most progress during the pandemic. There were a number of states pre COVID that required you to see a provider. First, you had to go have an in-person visit. And on one hand, you understand that you want there to be your relationship, and you want them to have a basic understanding of your health situation. But if you live in a community where there’s a provider, a primary care provider shortage, and you simply can’t get an appointment for three months, which is not that uncommon in many areas, this just seems impractical. And quite frankly, out of date. So a lot of states moved. There’s only a few lingering states that still requires some sort of in-person visit ahead of time. And I think this is again, when you talk to policy makers, the one that they shake their head, why would we have ever required an in-person visit? But that’s just what happens when state states pass laws that have to do with technology that are 10 years old at this point, technology changes. And as a result, when you need to change the policy landscape too.
Joe Selvaggi:
So our, our local legislators seem to get that. I mean, that’s, that’s Massachusetts understands why that might not be or that would be a, a good policy to remove the requirement for in-person visits first. Right?
Josh Archambault:
Correct. Yep. Massachusetts does not require an in-person visit. I think that’s really important. And I would hope with all of the tech companies that are in our backyard, again, we’re not trying to replace all in-person visits, but it just says that if you need to start by telehealth first, then, then you can do so if that’s appropriate
Joe Selvaggi:
Now, this way to be, I’d be curious about, and I can understand perhaps why, what motivates a rule like this, but no barriers to access across state lines. For me again, you and I, we, we believe in markets and we think state lines might be artificial barriers you know, contrived barriers but removing those lines and allowing a, a doctor in Boston to treat someone in, in Nebraska. You know, why, why is that so important to, to telehealth?
Josh Archambault:
Yeah. So the way that I actually think about this is an example outside of telehealth. So think about a pilot. We allow a pilot to take off in one state, then they land in another, and we haven’t assumed they’ve lost all of their skill and knowledge. And then we allow them to take off again. But yet for medical providers, we assume that as soon as they cross the state line, especially in a place like new England, where, you know, in half an hour, 45 minutes, you’re in another state. We just assume that they’re, they’re unqualified to see patients. I, I, I think this one is they’re in the telehealth world. This one is seen as a no brainer. There are still special interest groups or provider groups who are more hesitant on this one. So what we score, what we looked for and what we scored for was looking for a state policy that simply allowed providers who were in good standing in their home state.
Josh Archambault:
These people all go to the same medical schools and take the same tests for the most part. If you’re in good standing in one state, then we’re gonna allow you to have a pathway in our state to register with the relevant board or to pay the fee, whatever the basic requirements are. And you can start to see patients now think about the practical implications of this. I mean, the more you think about examples, the more silly you realize what the barriers and protectionism that we have in place right now is in almost every state. There are very few states that allow what, what we’re describing, think about how many people spend time in warmer climates. And yet we’re saying they cannot stay in touch with their providers back home who have maybe known them for decades. They have to establish a brand new relationship with somebody who does not know them.
Josh Archambault:
It because they cannot do across state lines, picture a doctor or a provider who goes on vacation. They are breaking the law. If they are not able to stay back in touch with their patient, cuz they are they’re in vacation in another state. Think about the numerous industries, pilots, flight, attendants, truck drivers who cross straight state lines all of the time as the nature of their employment. And yet we make it difficult. If not illegal for them to stay in touch with providers who maybe they’ve known for years or decades, this is how kind of impractical and silly it is. You hear people all of the time talking about coordination of care and healthcare and how important it is to save money, to have people stay in touch with their providers. That’s what we’re, we’re talking about here. What we’re trying to put that option on the table.
Josh Archambault:
I, I think the concern here from the provider groups is they want complete control over who is practicing in their state or not. And on one hand I underst in, they wanna keep PA patients safe, but on the other, we have shown that licensing does not lead to, I mean, these people are going to the same schools. If they go to the same medical school and they just land in two different states, somehow we’re assuming there are, have completely different qualifications or outcomes. So there are, there is a politically fee way to do this. I would point to states of Arizona and Florida who have relatively recently passed laws that allow for a registration in the state with a relevant board so that, you know, who’s providing care by telehealth in the state. And you also allow for them to take some sort of regulatory action if there is a complaint against a provider.
Josh Archambault:
And I think that ultimately addresses some of the quote unquote safety concerns that have been used to kill these sorts of reforms in the past, but it’s just really impractical the status quo. And if we wanna make sure that there are enough mental health providers, that there are enough providers, period, I mean the tum tsunami of retirements that are coming for doctors over the next 10 years, we have to think differently about how we deliver healthcare and telehealth. And especially this across state line has to be part of the, the process and the conversation. And I think it’s just a matter of time before states actually start to move on this one. Yeah.
Joe Selvaggi:
This seems like get an odd Relic. I certainly don’t imagine among our listeners that someone where they’d get sick in a different state would be concerned whether the doctor they would visit in the emergency room is qualified to practice medicine, right. It doesn’t have not everybody has to go to, you know, a certain school or go to a certain hospital. I, you know, that’s, that seems obvious, but an important point let’s talk about the, that telehealth in certainly in the emergency phase of the orders, it allowed for telehealth for primary care doctors, but not for other practices you, you mentioned in your paper nutritionist and other fields why would this be, why would we just say, okay primary care perhaps is okay with a telehealth, not all these other specialties.
Josh Archambault:
Good question. I don’t know. I mean, what was interesting during the pandemic is that a lot of governors did offer executive orders allowing for a lot more flexibility that just to return back to the across state line, many, many states allowed for that for the first time through executive order. And guess what this guy didn’t fall. In fact, people really came to appreciate they could access more providers. This is another example in which there was unevenness in when it came to executive orders on who could use telehealth. And when we really dug into this, I, I think what was interesting is pre pandemic. And even in a couple states now only doctors are allowed to use telehealth, which just seems, I mean, the nurse practitioners, physician assistants said, these are the backbones nurses. These are the backbones of our healthcare system. And to say that they can’t use telehealth under any instance just seems shortsighted.
Josh Archambault:
But I think in our report, what we were trying to highlight is in a number of states, they do allow a lot of providers to use telehealth, but what they do is, and this is the details that actually really, or is that they tie it to the currently licensed profess medical professions that are in, you know, whatever title that is in state law and the challenge and, and, and problem with that is that there may be some medical providers who aren’t currently listed in that title. And until they’re added to that title, they’re not allowed to use telehealth. The other thing that it does is that it doesn’t allow for new innovative provider types to emerge quickly. They have to go through the whole legislative process to be added to the title before they can use telehealth. So what we suggest is to follow the best practice, which is in a few states of allowing the definition for who can use the telehealth to just be broad, to just say, you know, we’re not gonna mandate that every, everybody has the insurers have to pay for all of this for all the provider types, but if they want to, if they want to try something different, if they wanna work with a different kind of medical provider, they should be allowed to do so.
Josh Archambault:
And that’s what we are really rating at for that factor.
Joe Selvaggi:
That that’s a great segue to another bullet when we talked about independent practice. Again, this sounds like a no brainer, but the phenomenon of nurse practitioners that they could use telehealth a, they should, of course be added to the list along with doctors. But the, the fact that there’s a requirement now that doctors have to oversee this interaction with nurse practitioners, you, you mentioned earlier, there’s an anticipated shortage of, of doctors. I imagine along with the massive tsunami, the of, of baby boomers retiring and along with that, many of those being doctors who are also retiring we’re gonna need a lot of nurse practitioners, I would imagine shouldn’t this telehealth facilitate that, that transition.
Josh Archambault:
Yeah. And that’s what we were looking at here. I mean, we, we could have looked at any number of different medical professions on whether they’re able to practice independently in the ways that they’ve been and trained to do. And I think there has been growing consensus in Massachusetts just joined this this group of states that have allowed nurse practitioners to practice on their own going forward. And that’s what we were looking at. We wanna make sure that the, again, the system is flexible, that can be patient centric. I mean, the challenge here is there’s a cost element to this and many dates. When you see a nurse practitioner, your insurance company, or you get actually charged a doctor’s rate, which in other professions would actually be illegal for you to do, but in medicine, for some reason, we allow it to happen. But there’s more of a practical reason here, why we think it’s important, nurse practitioners and others, they help extend the healthcare system.
Josh Archambault:
You know, whether it’s in a rural community or whether it’s just in an urban community in which getting a primary care doctor’s appointment can take 50, 60 days or longer, which is not uncommon in the Boston area. We wanna make sure that you can be able to see some of these other primary care providers in a more flexible way that they’re able to set up their own practices if they want to and use telehealth as part of that. And that’s what we were trying to look at as one example for nurse practitioners going forward, because that’s just the reality that we’re facing going forward.
Joe Selvaggi:
Well, that links also to a another point point of your paper, no payment mandate. Now you mentioned just in your earlier response that, that providers are charging the same, whether they, you see a doctor or a nurse, but I think what’s more unsettling is that or a nurse practitioner I’ll say is that whether you visit your doctor in the hospital or you have the meeting virtually again from the setting of maybe even the doctor’s own home you’re, it’s mandated that you be charged the same amount. Now some people would strongly prefer telehealth regardless of cost, but some people might use it as a way to save some money or the system saves some money. The system seems to now to forbid a differential in, in those payments you know, say more about that.
Josh Archambault:
Yeah. So when we looked at this one in particular there’s probably about half and half, half states mandated and half the states don’t, and there’s kind of some practical implications. Let me tell you why supporters advocate for the payment mandate. You know, the primary reason that they do is they say, we need to encourage providers to do use telehealth. So we need to pay them the same rate or it’s the same sort of expertise. So we need to pay them the same rate. I, I think the challenge with that is a, a couple fold is that there are some big unintended consequences of mandating that same payment rate. The first is patients who have a deductible are paying the full cost for it. So you are now mandating that they have to pay an inflated rate for services. And what we have seen is, and there’s been survey data on this over the last few years, at least a third of Americans say that they skip needed care over cost concerns.
Josh Archambault:
So what you have just done is you have pulled the rug out from under those who would’ve used telehealth because it would’ve cost slightly less, but there’s actually longer term ramifications for this. The first is these state mandates only apply to the individual market and the small business market. They don’t apply to large companies. So you have now made an unlevel playing field for small companies who tend to pay some of the highest health insurance premium rates in most states. And you have just made it more expensive for them to deliver healthcare. And then finally, I would just say, going forward, it kills innovation. We still largely pay for healthcare and I for service manner. And for those of us that have been in the health policy community, there’s been a raging debate about trying to change the way we pay for healthcare to more value based or based on outcomes or, or pay on a budget instead of to try to change the incentives going forward for just providing more and more care.
Josh Archambault:
And so I, as a result of forcing the insurance companies to pay this inflated rate, you are gonna double down on cementing the uneven payment rates that go to different providers. And if a provider group comes to an insurance company and says, Hey, I wanna do team based care. I wanna try something different. Hey, I wanna follow up with phone calls on a more regular basis insurance, company’s gonna be hesitant to do it if they’re being forced to pay the same amount for an office visit. I mean, think about a phone call costing the same as a 15, 30 minute, 60 minute in person office visit. That’s just impractical. You’re gonna see a massive spike in spending as a result of that. And so I think that there are some big unintended consequences that I’m hoping that over time policy makers won’t just see as, oh, we gotta pay for this because it’s important. We wanna encourage more of it, but they actually understand what the moving pieces are and that there’s implications for forcing mandates on certain parts of the market that hurts patients, vulnerable patients, those with chronic conditions, those in rural communities, small businesses, and actually try to embrace a more even keeled sensible policy framework going forward.
Joe Selvaggi:
Yeah. So to me, it seems sort of economics 101, you take away the price signals and you really don’t understand preferences of patients and doctors, right? If everything costs the same I don’t care what the product is. You don’t understand which people prefer and you don’t encourage innovation. That’s very important. I think also then this we’re almost repeating ourselves. One of your features was no facility fee. Ironically, whether the doctors calling from an expensive place like mass general or from, you know, some rural setting or his home there’s a mandate that there’s a facility fee paid to a telehealth visit. Say more about that.
Josh Archambault:
Yeah. I think this is where we, when we start to really think about the, for flexibility of telehealth and how it can be delivered, I mean, literally from the home of the provider facility fees have been justified for in-person visits at large hospitals as a way to cross subsidize other activities, whether it’s to help pay for the ER or research and development or other things that the hospital might office offer, excuse me, to patients. But here, we’re talking about somebody sitting in their home office and delivering a telehealth visit where the patient pops up right in front of them. There’s no waiting for the patient. There’s no waiting for the provider. They can in theory, see more patients in a, a shorter period of time. And so I think facility fees, which are largely just this extra fee put on in the end again, when we talk about patients who are foregoing care, because of concerns about costs and are paying largely paying it outta pocket, because they have deductibles, we have to allow for a health system that doesn’t have all this cross cross subsidization, especially when it literally does not make sense and should not apply when somebody is sitting in their home and not in the office building in a tower, in a big hospital system.
Joe Selvaggi:
Well, all good points. We’re coming close to the end of the show. I, I also want to say what I loved about your paper is, and I think it’s come through in our conversation. Not all areas of medicine are equal in the eyes of telehealth. Some are easier to utilize telehealth others perhaps less. So you mentioned in the paper, no coverage mandate. And what you say is you, you have concerns with telehealth and in-person treatment with regard as the same in all practice areas without any supporting data. In other words, there’s no sort of measurement as to when we all uptake telehealth, some are going to double their efficiency and others may, may founder. You mentioned say dentistry, I, I, I wouldn’t want a virtual root canal but, but say more about why it’s so important to measure the efficacy of, of these different measures.
Josh Archambault:
Sure. Yeah. So I think the long term success of telehealth is going to be based on us measuring it and in the policy world and debate, it really shouldn’t be a political fight. It really should be. Do we get better health outcomes? I mean, some of the most promising innovations I’ve seen using telehealth has been in the, those dealing with addiction and recovery. You know, we have a sad situation in America with so many people struggling with opioids and other issues in which we pay lots and lots of money for people to go to inpatient programs repeatedly over and over again. And the outcomes are just their lackluster at best, in many instances. And I’ve seen telehealth models where not only are they able to interact with patients when they’re in their moment of crisis and wanting to get clean, but also able to stay in touch with them and keep them sober far, far long, or, I mean, we’re talking a year, two years beyond them, kind of the initial intervention, which if you were to look at the data for inpatient programs, it can’t even be touched in terms of having people cycle back to the program UN unfortunately.
Josh Archambault:
And so I think we need to make sure that we’re studying this, that we’re looking at data that we’re holding telehealth providers to a high standard of showing their efficacy and the quality of care that they are they’re providing. And I think what we’re going to find is that in some areas, telehealth is truly game changing. Telestroke other areas seems to be that these are telehealth should maybe become the standard for how we interact and provide services. And inevitably, we’re gonna find areas where, you know, we just can’t tell, we can’t tell if there’s added benefit here or maybe the outcomes are worse. And so we need to stop paying it. The coverage mandate falls on insurance companies. And as I mentioned previously says, we don’t care about the outcomes you have to pay for it if it’s so over by telehealth, if it’s otherwise covered by your health plan. And I just think that’s shortsighted, we wanna make sure that insurance companies and employers and even individuals, again, when we interact with the healthcare system, we’re actually getting more value for every dollar. And if we’re mandating it, then you remove that flexibility and you’re putting handcuffs on them, quite frankly, for them to try something different, innovative, and they are gonna have to keep paying for the same procedures or the same services over telehealth that may not be adding value
Joe Selvaggi:
Well that that’s a great way to work. We’re coming close to the end of the show. And you, you, you sort of, it seems a theme is policy makers have to insurance companies have to allow flexibility to to see telehealth embraced effectively and it may be different in different area policy area. So from my last question, I’ll just say we have a lot of policy makers that listen to the show and they’re probably excited by what you said about the promise of telehealth. If, if Massachusetts policy makers are listening to the show, what would you say? Where’s the low hanging fruit here in Massachusetts that we could do better to make telehealth a more essential part of our healthcare system.
Josh Archambault:
I, I, I, it’s interesting that you asked that question, Joe, because if you had interviewed me a year ago, I would have different answers than today. I, you know, I think what is encouraging in Massachusetts in particular is there has been some serious conversation about improving the telehealth landscape, you know, started with the governor, with his executive orders. The legislature followed up by passing a new law, which by my count, at least three of the eight things that we looked at improved to green as a result of that reform. So that, that is very promising, but there is certainly more work to be done here. I think we talked about the no barriers to across Stateline telehealth. I think that’s just a no brainer, especially in new England where so many states are so close to each other. This is actually, if you think about it, a business opportunity for Massachusetts providers, whether they want to be able to travel if they’re mobile or whether it’s, we wanna set the, an example for other states so that if they reciprocate Boston based or Massachusetts based providers can actually see patients from other states a lot more easily.
Josh Archambault:
So there’s work to be done there. We talked about the coverage mandate, unfortunately in the update, they did pass that insurance companies have to cover telehealth services and they did keep a payment mandate for behavioral health, which I understand they want to try to get more behavioral health providers, but I really hope that they revisit that going forward and make sure that they phase sit out over time so that again, people seeking behavioral health, aren’t being priced out of the market because it’s, they’re being forced to be charged the same rate as an in-person visit. And then finally, we, we didn’t touch on it, but compacts, this is just a kind of agreement between states to set standard agreements on how providers or nurses or others can kind of more easily move between states. Massachusetts is actually not a member of the compacts that we looked at.
Josh Archambault:
There, there are some downsides to compacts that are a little bit clunky at times, they’re kind of expensive. So allowing for a free flow or they’re easy registration is a, a preferred plan a for states. But if politically you can, can’t get there. Then compact may be another way for at least certain provider groups to be able to open the door for patients, sick patients, to not have to travel, to be able to see some expert providers that just may not happen to live here. They may live in Ohio or California or Texas, and we wanna make sure that patients are able to access the providers that are best for them or that their provider primary care provider might recommend. They
Joe Selvaggi:
See. Well, great answer. That’s a, there’s a lot to do even here in Massachusetts where we think we got, we get the right answer more often than not. So thank you very much for being on the show. Thank you for this wonderful paper. Again, it’s a pioneer institutes research entitled rating the states on telehealth best practices. Our listeners can go to the pioneer website to, to read more. Thank you for being on hub won again. Josh, thanks so much.
Joe Selvaggi:
Has been another episode of Hubwonk a podcast of pioneer Institute, a think tank in Boston. If you enjoyed today’s episode, there are several ways to support the podcast. It would be easier for you and better for us. If you subscribe to Hubwonk on your iTunes podcaster, if you’d like to help it, make it easier for others to find Hubwonk, it would help if you offer a five star rating or a favorable review, we’re always grateful. If you want to share Hubwonk with friends, if you have ideas or comments or suggestions about future episode topics, you’re welcome to email me at hubwonk@pioneerinstitute.org. Please join me next week for a new episode of Hubwonk.
Recent Episodes:
This report finds that analyses from the Massachusetts Department of Revenue (MADOR, 2016) (and more recently, Tufts University’s Center for State Policy Analysis (2022)) dramatically underestimated the number of households and businesses impacted by the constitutionally-imposed tax hike that the legislature is putting before voters in November 2022. The proposed tax would impact multiples of the number of people previously estimated, over a nine-year period, since the majority of “millionaires” only earn $1 million once during that time.
AEI’s Ian Rowe on School Leadership, Civic Education, & Upward Mobility
/in Featured, Podcast, School Choice /by Editorial StaffThis week on “The Learning Curve,” co-hosts Gerard Robinson and Cara Candal talk with Ian Rowe, a senior fellow at the American Enterprise Institute, where he focuses on education and upward mobility, family formation, and adoption. Ian shares his background in entrepreneurial school leadership and policy research, and how he became interested in K-12 education reform. They discuss his work to advance quality school options for poor and minority kids as CEO of Public Prep and now cofounder of Vertex Partnership Academies, a character-based network of schools based on International Baccalaureate’s (IB) world-class curriculum. He weighs in on why policymaking around school choice and academic content has become politicized, and the kinds of content K-12 students should be taught, through the 1776 Unites project for example, to prepare for college coursework, meaningful citizenship, and pathways to prosperity.
Stories of the Week: Should the state take over management of the Boston Public Schools? A Boston Globe opinion writer makes the case, noting the disproportionately low-income and minority student population enrolled in the district’s chronically underachieving schools. A US News story highlights the benefits of high school internship programs, to help students get a head start on career preparation before college.
Guest:
The next episode will air on Weds., January 26th, with guest, Andrew Campanella, the president of National School Choice Week.
Tweet of the Week:
News Links:
Boston Public Schools should go into receivership
https://www.bostonglobe.com/2022/01/17/opinion/boston-public-schools-should-go-into-receivership/
The Rise of High School Internships
https://www.usnews.com/education/k12/articles/the-rise-of-high-school-internships
Get new episodes of The Learning Curve in your inbox!
Read a Transcript of This Episode
Please excuse typos.
[00:00:00] Cara: welcome listeners to another week of The Learning Curve. This is Cara Candal here as always with the amazing Gerard Robinson. How you doing this week?
[00:00:32] GR: Doing well. How about you?
[00:00:34] Cara: Yeah, I’m doing okay. I mean, in some sense it was a somber weekend. I was thinking about how, sort of pressuring it was, we just recently had Barry Weiss on the show talking about the rise of anti-Semitism in the U S and then we have this hostage taking at a synagogue Colleyville, Texas this weekend, disturbing that it seems like events like this are happening more and more often in recent years.
[00:00:57] So a little bit of a time of reflection that coupled [00:01:00] with the fact that, of course yesterday, we celebrated Dr. King’s birthday. and we had a guest on last week to talk about Dr. King and his legacy. So, on the whole, restful weekend, but a little bit of unrest in my soul, Gerard thinking about some of this stuff.
[00:01:17] So I, but I hope you’re well, and I hope that our listeners are well. And it also just made me think that I think the content we bring to folks every week is super relevant, as unfortunate as that might be time to time.
[00:01:31] GR: Well, Dr. Carson was on last week. And we know he’s a professor emeritus now at Stanford, and he’s in charge of the MLK papers.
[00:01:40] In fact, we just brought on a new scholar, to, take the project to the next level, but so much of what he discussed in terms of keying and his international influence is really important because yesterday was sharing with the girls, little known fact about MLK is the fact that he was born Michael King.
[00:01:58] his father ended up changing his name to [00:02:00] Martin Luther king. Of course, after he traveled to Germany in 1934 as part of a delegation from the United States Baptist convention to Berlin. And again, this is 1934. We know the year before that, Hitler comes to power. he said he was there. His dad was there the time starting to see.
[00:02:19] Rise of Nazi-ism the Baptist delegation actually put out a statement saying that they were against all forms of racism, antisemitism 1934. And so we’re talking about this and what happened, unfortunately in Texas in 2022. And so it just put into an international context that him going to, Germany, , the home of Martin Luther and coming back and saying, wow, I’m, so moved.
[00:02:43] I’m going to change , my son’s name to Martin Luther king and the rest is history on the anti-Semitism side. We’ve also had J group. On our show. And he’s recently published a really good piece from the heritage foundation, which looked at diversity equity and inclusion [00:03:00] programs at universities.
[00:03:02] But in that report, he also talked about anti-Semitism and, or the lack of focus when we’re talking about diversity or inclusion or equity, and we’re talking about racism. anti-Semitism, isn’t getting a great deal of attention, but here in the Commonwealth, this past weekend, we had the inauguration of governor Youngkin.
[00:03:23] also Lieutenant Governor Sears was the first African-American woman elected statewide and our attorney general, who’s the first Latino elected statewide, , one of the executive orders and one of the executive directives that he signed had to deal with antisemitism, and he also quoted king, I’m not real address.
[00:03:42] So the things you brought up were part of the weekend, and I lived here in.
[00:03:48] Cara: Yeah, lots to think about and you know,, I want to root us firmly back in Boston because as you know, Gerard Dr. King did his doctoral work here in Boston, and I used to love to live really close to Boston [00:04:00] university campus just blocks away and there’s this beautiful, statue dedicated to his memory there.
[00:04:05] And you’ve never seen it, I highly recommended it is right outside of. Main library of the Boston university’s main library, as well as the, student center. It’s a beautiful work of art. So he’s got, a history here and relevant to my story of the week, which, , I asked our producers if I could just get a little Boston today, because we had a story out in the Boston globe this weekend, , an opinion piece highlighting just the absolute failure in many ways.
[00:04:33] I’m just going to name it of the Boston Public Schools. And it got me thinking so much about how disappointed Dr. King would be to know that in a system, where Massachusetts, just so consistently. number one in the nation on so many measures, including NAEP among other things. but we also consistently have some of the widest achievement gaps in the nation.
[00:04:55] Something that is just way too often overlooked, and those gaps are just horrific [00:05:00] in the Boston public school system. So this opinion piece out of the Boston globe, written by Roger Lowenstein talks about the need to consider receivership a controversial word, a controversial term for the Boston public schools.
[00:05:15] And the timing on this is great because my friend with pioneer Institute, I have a paper coming out soon on this very topic. Now I’m going to take just a moment to set the context. And that is that Boston public schools have been consistently persistently failing, , mainly children of color, but the system.
[00:05:33] Also, you know, heavily weighted serves, disproportionate numbers of children of color, because , one of the things that happens in Boston is that if you are in, this is just talking in demographic terms here. If you live in the city of Boston and you are white and. , upper income, you are much more likely not to use it’s public schools.
[00:05:53] so what happens then is that folks are locked into a system where they have what we call intra district choice, [00:06:00] but most times families are choosing among, , just a bunch of low performing schools, unless you can, as we’ve talked about on this show before test into one of the only high performing schools in the Boston public schools, which would be an exam school and admissions based school, some of that’s changing there, they’re revamping, , admissions via exam, , this coming year, , and there’s some changes made post pandemic, but it’s still, these exam schools.
[00:06:23] Have historically been disproportionately populated with higher income children and certainly with white children and many times what families do is they use private education up until the point when kids are eligible to go to the exam schools in middle school. And so where does this leave? The other Boston public schools and the families that are choosing amongst just many, many low performing schools?
[00:06:45] Well, it doesn’t leave them with much choice at all. And this opinion piece in the Boston globe makes the case for the state to essentially take over BPS. Now I’m going to do a little detour here and take our listeners [00:07:00] back to the spring of 2020. And all we’ll remember is the pandemic. But in fact, about a week, a week before schools across the country, shuttered their doors, the commissioner of education, Jeff Riley here in Massachusetts had requested, , had ordered actually study.
[00:07:17] As we do here, we, , , and in many states reviews of districts, but an in-depth review of the Boston public schools, which is one thing that is necessary for receivership. And, , that report was released. Very damning report was released just the week before schools closed due to the pandemic. So.
[00:07:34] Buried. probably not intentionally. I don’t think people really realize the pandemic was coming, but to make a long story short, the report Gerard was damning, absolutely damning. And it unearthed not just pockets of under-performance, but just persistent failure on the part of the system to serve kids persistent failure in terms of getting the right curricula into kids’ classrooms, a disjointed approach to education where schools had a lot of [00:08:00] autonomy and there was just very little accountability.
[00:08:02] We like autonomy generally, but when it’s coupled with accountability and, persistently putting, less skilled teachers in the classrooms where kids most need the high skilled teachers, , not a lot of professional development for teachers, the list goes on and on and on. So one would have thought that once this report was issued, the case for receivership would have been made.
[00:08:21] Unfortunately, that is not what happened. And here we sit years later, with renewed calls, especially as governor banks, , who I think is an ed reform minded person is, , has announced that he’s not going to run anymore. So we’re hearing renewed calls to put Boston public schools into receivership.
[00:08:40] It would require yet another review to confirm what we already know. And that is that the schools are wildly underperforming. And the really important thing here to note is that although receivership is controversial, sometimes it’s called turnaround here in Massachusetts, here in the Commonwealth. We do have a record of some success, some of the only success [00:09:00] stories in the country, and probably the most well-known success story of turnaround from Massachusetts is that of Lawrence, Massachusetts, where our current commissioner was in fact, the receiver.
[00:09:10] So here we have a gentleman who. it has a template for how to do it. Nobody’s suggesting he copy and paste, but receivership is something that we’re hearing renewed calls for, should be on the table. I will preview the pioneer report for folks saying we come to the same conclusion. so the problem is going to be, , will it happen or will it not?
[00:09:30] Because there are a lot of forces against it. It is not a popular idea. Sometimes least popular ideas are, are the best ideas when it comes to serving kids. Because as this, opinion piece in the Boston globe noted, it would be hard to imagine a school system that more poorly serves, especially kids of color, then the Boston public schools.
[00:09:52] So this is one to watch her. I think we’re going to be talking about it in the coming weeks and months, but one that I hope, all of our listeners will look into [00:10:00] controversial but important.
[00:10:01] GR: Wow controversial. And weren’t we here before 1991, if I’m not mistaken. I mean, the,
[00:10:11] Cara: yeah, about that receivership that you’re talking about, the BU Chelsea public schools partnership.
[00:10:17] Yes, very good members. I’m like,
[00:10:18] GR: wait a minute. There was a takeover of Chelsea and there was also, , a takeover. I’ll go guess really a law that abolished the elected school board in Boston.
[00:10:27] Cara: That’s right. in Chelsea. Yes, no. Yes. Boston as well. So we have mayoral control as many cities do. Yes.
[00:10:33] GR: It’s amazing.
[00:10:34] I mean, as you’re talking to our listeners, just think about it 1991, governor Wells says, you know what, we’re going to take over the school system and put it under what we call mayoral control. Now let’s put this in context. Boston had had an elected board since 18 22, 1 of the first urban systems in the country of its type to be open, to be free, and to really try to [00:11:00] push the ideas of a new Republic, trying to make sense of a changing economy.
[00:11:06] And I remember reading that back in the nineties because my graduate work at the time was on state marrow takeovers of schools. But to think that that was 1991, mayor Flynn, , supported it. City council supported it. A number of black leaders and community groups were opposed to it. But what are the reasons they took it over was because of what was then called academic bankruptcy.
[00:11:29] Todd Ziebarth, who was then working for education commissioner of the states, , last year, talked to Todd. He was working with, Nina at the national Alliance for public charter schools. he really laid out why it happened and things will forward. And then there were more changes. But the fact that we can even mention the term receivership in 2022 for the millions and millions of dollars invested in the school system, which is in a city with the largest university reach in the country.
[00:11:59] And we [00:12:00] turned to the number of colleges in the greater Boston area, almost 250,000 students there, you have some of the best minds there. And yet this is a challenge, but that I was shocked to
[00:12:10] Cara: see thousand dollars per year. $23,000 people in Boston public schools. And I’m proud to say well-paid teachers on average, more than a hundred thousand dollars in teacher salary per, teacher.
[00:12:24] So, I mean, this is a system that, the adults are doing well, there’s money going into the system. The outcomes are absolutely not there. Most kids in BPS still cannot read on grade level. So anyway, like I said, Gerard, thank you for your long memory. , but it’s, unfortunately it’s the same old story here.
[00:12:40] And so hopefully these calls for reform will have.
[00:12:45] GR: Well, maybe my story will be helpful for if in fact the school system is in receivership and you bring in a trustee or whatever term you want to use, maybe he or she could think about this idea. And so my story is from us news and world report is from [00:13:00] Heidi Borst and it’s titled the rise of high school internships.
[00:13:04] so let’s put it in perspective. In 2021, we had 15.1 million public high school students, and 1.5 million private school students. And according to Heidi, We know that a lot of students in college participated in internships. I was an intern for three years, at a corporation when I was at Howard university, a ton of my friends were, but she said, that’s great for you, but let’s try to get drawings started in high school.
[00:13:31] And I think she’s right. And so one person who also thinks she’s right is Lori cop Weingarten. She is a certified educational planner and president of one stop college constantly in New Jersey. And she said working and interacting with various employers and employees. It’s really about bringing exposure of the basics of what a future career could look like in an industry.
[00:13:55] And she said, it’s one thing just to say, you should get a job, but it’s really about learning the [00:14:00] skills, both verbal nonverbal, social, emotional learning skills, all the dynamics that you need in order to mature, because when students find an internship opportunity, it often provides them an opportunity to mature.
[00:14:12] So that’s what Lori’s saying. Well, there’s a guy named Kevin Davis. He’s the founder and chair of first workings, which is a non-profit organization that pairs low-income students with paid internships. that students who work for nonprofits or for-profit corporations are getting really good exposure before they get to college into the importance of creating a work-based culture.
[00:14:35] Because as you and I have talked about on the show, everyone’s not going to go to college. It shouldn’t be because they don’t have the academic, skillset to do so it’s because they do and decide to go directly into the workforce. Or become an entrepreneur, but creating high school internships, according to both Kevin and Lori, makes a lot of sense.
[00:14:54] In fact, Kevin said, quote, through the internship experience, high schoolers gained the confidence to [00:15:00] succeed in their chosen path. We also know that students who are involved in this work are going to likely do better academically. So what about the higher education level? Since that’s what we know a lot about according to a 2019 survey of internship programs sponsored by the national association of colleges and employers, they found that 70% of the college students who were interns received a job offer.
[00:15:25] If we were back in 1991, when I graduated, I would be one of the people in the 70%, but that’s at the college level, not so great at. High school level. So according to a 2020 study by the American student assistance, it’s a nonprofit that helps students obtain college degrees. It identify through its survey.
[00:15:45] Only 2% of high school students had completed an internship. So if we’re looking for examples, let’s look at Washington DC, my former hometown, the Madeira school, which is outside of Washington, DC is a private high school for girls. [00:16:00] They emphasize experimental learning and they’d had an internship program that has been a part of the school’s curriculum for more than 50 years today.
[00:16:09] At school in turn at community-based organizations as sophomores, they also internal capitol hill as juniors, and then into career oriented positions as seniors, we can also look to the Midwest, although not your state, a nearby state of Ohio, , Trinity high school has an internship program that has placed students in internships at the Cleveland museum of art and the Cleveland botanical garden, along with healthcare and municipal services.
[00:16:38] So there’s one professor who said, you know what I can tell when a student who walks in my class has been involved in an internship, and this is from Joseph Danini director of clinical experience and assessment at the college of education and human development at the university of Nevada Reno.
[00:16:54] Here’s what he says. Quote, through most prepared a student is when they enter [00:17:00] college, the easiest. time, he or she will have when adjusting to the rigors of college level academics, as well as social pressures in higher education, we try to do everything we can to support students in their press appearance toward degree and completion.
[00:17:14] And so what he basically said, okay, I have an idea. When students walk into my classroom, who’s been involved within an internship. So on my side of the fence, I am proud to say that when I was president of the black Alliance for educational options, we actually use some of our high school students in internships.
[00:17:31] Some were supported locally, some nationally, some paid, some volunteer, but the main goal was twofold. One to give them an opportunity in high school, to be involved with planning a conference, a planning and agenda to go to Capitol hill or doing something in the community. Number two, for some, it was paid cash for others.
[00:17:52] It was actually credit they can earn. So I’m a big believer in the idea of internships. I like this article because it’s reminded me that I [00:18:00] need to do more for those students in high school. What are your. I
[00:18:03] Cara: think it’s huge. I mean, I would point simply to the Cristo Rey network of Catholic schools where, students pay for their education because they only serve kids who can’t afford the cost of private school education.
[00:18:14] So they pay for their education through internships. I’ve done research on these schools and it shows exactly what you’re talking about. That is through internal. The kids cultivate the life skills, soft skills, so to speak that they need for success. So I think you are right on. I couldn’t agree with you more.
[00:18:30] I am shocked that nationally only 2% of kids participate in internships. And I’d also like to say that, like, I would hope that in conjunction with thinking about internships, we can think about pathways to college and career as well as, making students and parents aware of internship opportunities, pathways opportunities, and also like to really give a quick shout out.
[00:18:51] And this is more about apprenticeships that the Tennessee department of education just became the first state to get approval from the department of labor to [00:19:00] have. High school students, engage in apprenticeships to become teachers. So you can start learning as early as high school, whether or not you want to pursue a teaching career, they will pay for a bachelor’s degree.
[00:19:09] They will pay for current teaching assistants to do the same. So I think this is great theme and I hope we keep hitting on it. Gerard, we’ve got to get to our guests because we’ve got a fabulous guest today. Dread friend of yours, your colleague at AEI. We are going to be speaking with Ian Rowe.
[00:19:26] He is a senior fellow at the American enterprise Institute, focusing on education and upward mobility, family formation and adoption. So we’re going to take a quick musical break. We’ll be ready.[00:20:00]
[00:20:38] GR: Hello listeners. Welcome back to The Learning Curve. As you know, every week, we bring you an exciting guest to talk about something in the field of education. Public policy entrepreneurship, where we’re lucky today to have Ian Rowe who actually has a footprint in those three areas and many others. Ian Rowe is a senior fellow at [00:21:00] the American Enterprise Institute where he focuses on education and upward mobility, family formation.
[00:21:06] Adoption. Mr. Rowe is also the co-founder of Vertex Partnership Academies, a new network of charter base international baccalaureate high schools opening in the Bronx in 2022. He’s also the chairman of the board of the spent Chapman. it is a nonprofit adoption service organization and he’s the co-founder of the national summer school initiative.
[00:21:28] Ian is a former CEO of public prep, a tuition free pre-K and single-sex elementary and middle public charter school network educating more than 2000 students in New York city. He currently serves as a senior visiting fellow at the wisdom center and a writer for the 1776 Unites campaign and earned an MBA from Harvard business school, where he was the first black editor in chief of the harvest, which is Harvard universities, , school of business newspaper, and he [00:22:00] has a BS in computer science engineering.
[00:22:02] From Cornell, Ian, welcome to The Learning Curve. Hello,
[00:22:06] Ian: Gerard. Gosh, exhausted.
[00:22:12] Just listening to all of that. Oh my gosh. I better live up to expectations that bio set, but it’s good to hear your voice.
[00:22:19] GR: Doing well, listeners may not know this, but, , Ian and I, both fellows at the American enterprise Institute. And even though we’re in the same shop with COVID and everything else , we haven’t had a chance to see each other in person walking the halls of AEI.
[00:22:32] But, , you continue the good work. I read what you write. I’ve seen you on television a couple of times and you do really good things. And in fact, as you were talking about your background, all the things you’ve done, this is just a great way to open up our conversation. We’ve given people a brief overview of some of your accomplishments and your academic background.
[00:22:53] Would you share with our listeners a little bit more about your biography that I didn’t cover? And what was your aha [00:23:00] moment that made you become interested in K-12 education reform?
[00:23:04] Ian: Well, first of all, jars, great to speak with you. Thank you for having me on. in terms of why I’m interested in K to 12 education, principally is because I, , myself am a great beneficiary of a great K-12, public education, in New York city.
[00:23:23] My parents came to this country from Jamaica, west Indies, via England. when we first came to the U S we lived in Brooklyn and, enrolled in the public schools. And, we ultimately moved to Queens. And then actually for high school, I went to Brooklyn tech high school. I had a great, great education, so I’m very aware of what it means to have access to a tuition free K to 12 education, you know, and then from there for my K to 12, I was able to then get into Cornell, which, another great platform and went to engineering school.
[00:23:58] I can’t underscore enough. Of [00:24:00] course, the role my parents played in valuing education and providing a stable home. so my early days were, I would go to school. I would come home, I’d do my homework, we’d have dinner and I’d go to bed. And I wake up, I go to school, come home, do my homework, go to bed, you so they created a routine, And instead of predictable, , experiences, growing up for me and my brother. So it is the combination certainly of a strong stable household with my parents who, you know, who stayed together for 48 years before my dad passed away. And, my dad always saw public education as great equalizer.
[00:24:40] no matter where you come from, as long as , the state provides a solid, , public education or, if you take education in your own hands, but one way or the other that young people get inculcated into a system where they, learn the knowledge, skills, habits to be successful, they understand the ways of [00:25:00] being within a given society.
[00:25:01] So even, even as immigrants, as we came over from Jamaica, we have our own, food and likes and ways of being there was also, an American college. To become part of and to be, , inculcated in and that’s important. as I’ve gone through my journey in life, I have now seen what it means to have access to a great education and also what it means to not have access to a great education.
[00:25:27] So when I graduated from Cornell, I went to work for what was then Arthur Anderson became Anderson consulting, which then became Accenture. I was doing all sorts of. Strategic planning for these big consumer products firms and, and did a few big projects. And, but I wasn’t really feeling that inspired, frankly.
[00:25:47] I started mentoring and public schools in New York city, and I just saw all these great kids, who by virtue of zip code or the family structure that they were born into had a really hard time. in school [00:26:00] and it just didn’t seem fair, that they either didn’t have access, to really great schools or because they were, , in challenging home environments, it just made it really tough for them to Excel.
[00:26:12] So that just put me on a whole different journey. I decided to leave Anderson, you know, get off the partner track there. I was fortunate enough to get into Harvard business school. and then I started this really weird journey. I met this young lady whose name is Wendy cup. Who’s the founder of teach for America.
[00:26:29] So I started talking to her in the , early days when they were recruiting outstanding people that teach in urban and rural public schools. did the crazy thing. after business school, I went to work for teach for America, with Wendy. , and then, through various activities, I worked at the white house.
[00:26:45] The bill and Melinda gates foundation, even MTV, but all throughout all of these, there was an education component that I was connected to and ultimately wanted the opportunity to run my own network of schools. So I ran public prep, as you [00:27:00] mentioned, which is a network of single-sex, , public charter schools, , in the heart of the south Bronx and lower east side of Manhattan.
[00:27:06] So ran that for 10 years and amazing. Again, we can talk more about it, but, pre-K through eighth grade, more than 2000, primarily low income kids, primarily black and Hispanic kids. And the whole idea was to build a sense of agency and self-sufficiency, and, ensure that they had. that they had a real shot to compete.
[00:27:26] And now I’m launching a new network of, as you said, character-based international baccalaureate high schools in the Bronx because, , there’s just, aren’t enough great high schools in the city. And I like to be a think tanker, and a doer, , and to demonstrate institutions that live up to the values of, you know, equality of opportunity, individual dignity, common humanity.
[00:27:52] Cause I think those are the kinds of things that young people should be exposed to. and there aren’t enough institutions , that stand,[00:28:00] , for these things, especially in the current environment, there’s a lot of woke ideology, telling young people that they’re either an oppressor or an oppressed, based on their skin color.
[00:28:10] And we want young people to understand that they have the ability to achieve at the highest levels, but we need our institutions to be focused on. Rigorous curriculum, high expectations, and this whole idea of viewpoint diversity as well. So that’s a long winded story that, I myself, , had a great K to 12 education, and I want to make that opportunity available for other kids.
[00:28:32] GR: I had no idea that you worked for MTV. We can talk offline about that. We’re talking about shaping character , , and just doing some of the math you were there, , at a point when it had a really big imprint upon like high school thought and what people were thinking about sociology, culture and life, let’s go back to your immigrant parents.
[00:28:53] You know, we think about black people in the United States. we overlooked the fact that according to research from pew, that [00:29:00] approximately 9% of the people we call black in fact are immigrants. And if you look at the immigrant families who are black, who come to the United States, a disproportionate number of them compared to African-Americans have gone on to major success.
[00:29:14] You’re one example we think of vice-president Kamala her father from Jamaica. We think of Colin Powell, his parents from the island, And a lot of them actually ended up in New York, other places as well, but a lot in New York. What about the immigrant story? Is a part of not only your narrative, but also the broader narrative about the whole idea of social agency.
[00:29:36] What is it about that? Immigrant dynamic that sometimes we overlook when we’re having the black conversation?
[00:29:43] Ian: Yeah. You know, this, is a tough conversation because sometimes people don’t want to admit, , that if you actually look within the black community and in particular recent immigrants from the Caribbean, , parts of, , African countries, , Nigeria [00:30:00] Ghanaians, incredibly high levels of success.
[00:30:03] and yet if you listen to the dominant narrative, as it relates to. , the black community. if you get a, you listen to a Nicole Hannah Jones of, New York times, 16, 19 project, she wrote an 8,000 word essay. basically saying if you’re black, it doesn’t matter what you do.
[00:30:24] Doesn’t matter if you buy a home. Does it matter if you save doesn’t matter, if you get educated, doesn’t matter. Uh, essentially none of that, none of those activities quote, make up for 400 years of racialized plundering unquote, period. And it just leaves you with has this idea that, gosh, if you’re black, I mean, you’re, going to get shot on the street or you have no shot in the end, her and her whole reason for saying these things was that was her rationale for a thing of $14 trillion reparations program.
[00:30:56] Because if you’re black, , you just don’t have the agency [00:31:00] to move forward. And yet, , if you look at certain communities and by the way, not only immigrant black communities, but. African-American families who’ve been here, who do the things that, by the way, Nicole, Hannah Jones has done in her own life.
[00:31:13] So Nicole, Hannah Jones has gotten married, gotten educated, bought a home, , done those things and, you know, cause her accountant would be very surprised to hear her say these things. And so what it indicates is that perhaps there are factors that transcend race that really are the driving factors behind the economic and other forms of prosperity.
[00:31:37] And it’s just the case, that, you know, and this is now back to some data, which I often sites often refer to as the success sequence. But if a kid has the opportunity to get a good, good, basic education, even just a high school degree than a full-time job of any kind, just so we learned the dignity and discipline of work.
[00:31:57] And then if they have children and they [00:32:00] had been married for. 97% of the time amongst millennials, you avoid poverty, and that just so happens to be the kind of behaviors that most immigrants, certainly recent immigrants practice. You know, there’s a huge value placed on education and educational choice, huge value placed on family, and huge value placed on staying together and reinvesting across generation.
[00:32:28] , and so that’s the story, in Jamaica, like my, and my parents came here, it was not only my parents, but you know, their brothers and sisters and, , we all got together every Sunday night and It was a cocoon of safety and education and love.
[00:32:43] And by the way, expectations like expectations , and not just expectations to get by, but expectations to be an engineer, to be a lawyer, to be a doctor like , to, succeed, but succeed superbly. [00:33:00] so sometimes we have this conversation. some people resent like, oh, you’re saying that, black Americans who are in this country are lazy.
[00:33:07] No, it’s just recognizing that, , if there’s a white supremacist on every corner, that’s oppressing every black person. Well, for some reason, there are certain black people that like, oh, I see you’re from Nigeria, then you’re good. You know what I mean? Like that there actually must be some other factors that are driving success and you start to see that these are the habits.
[00:33:29] These are the decisions, either behaviors that right now seem to be more entrenched in communities that, , come into the United States who have an immigrant ethos who come to this country with more of the, I’m going to make sure I take advantage of the opportunities. And so if we’re able to divorce those, behaviors and attitudes, From skin color and say that you’re not inherently oppressed because of skin color.
[00:33:58] that if you adopt [00:34:00] these certain behaviors, then you can be successful too. To me, it’s liberating. Final point is that when we think about empowering and liberating messages for young people, especially young black kids, it’s important that they know that simply because they’ve been born, , in the hood or, wherever that they’re not inherently oppressed or inherently powerless or inherently dependent upon the government in order to solve their problem.
[00:34:27] As Nicole, Hannah Jones likes to articulate that there are people that look just like them. People who may have come from another country recently, or people who have been in, in the country for generations, but for both sets of people. Agency is within their grasp self-sufficiency is within their grasp.
[00:34:46] And it’s not a mystery that their actual behaviors, their actual decisions around family formation, getting your education, full-time work. All those things in a particular order can lead you [00:35:00] on a pathway. And by the way, let’s not forget having a faith commitment to cause we don’t often talk about the power of religion, but that these things are within your grasp to be successful regardless of skin color.
[00:35:11] GR: As I hear you talk. And I know you’re from New York. I also think about another person with the immigrant background, Shirley Chisholm, , who ran for president, , in the early 1970s, wrote a book on boughten on boss. And she’s saying,, something. She said, then some of the things things are saying now.
[00:35:26] So also think there’s something in the water in New York and new Yorkers to do these kinds of things. and speaking of immigrants, who’ve done well. Also want to, give them granulations to Lieutenant governor, , winsome series here in Virginia. I had a chance to go to her Naugle events, earlier this week.
[00:35:42] And that’s, another example of someone with Jamaican roots, who is now changing tide here in Virginia.
[00:35:49] Ian: I was waiting to hear the announcement that you were going to be the secretary of education.
[00:35:53] GR: All know I was so excited to hear the announcement about, , Amy Gudera
[00:35:58] Ian: secretary. I know Amy [00:36:00] knows great stuff, but When Younkin Sears one, I thought, oh my God, going to be populating their candidate, who were some amazing people who are already in Virginia, who, uh, so I thought of you. but it’s all good.
[00:36:11] GR: It’s all good. No, I appreciate the kind of thought you talking about New York and you’ve got to end printing in a few of the burls and you made a really good point about IB.
[00:36:20] , talk to our listeners about why international baccalaureate, and also talk about why character, because we hear the word, we just celebrated, King’s holiday. And I think about an article that king wrote, get this at age 18, he wrote an article called the purpose of education, and it appeared in the January, February, 1947 edition of the maroon tiger.
[00:36:44] And in it, he said, quote, we must remember that intelligence is not enough intelligence plus character. That is the goal of a true education. So why a network of character schools and why IB?
[00:36:58] Ian: Yeah, it’s such an [00:37:00] essential question. I’ve just written a book called agency. and the whole thrust of the book is, to empower the rising generation, to overcome the victimhood narrative to determine how to, create their own pathway to power.
[00:37:16] I put a lot of thought into this word called agency, , which I define as the force of your free will guided by moral discernment. think of velocity, it’s a vector. Think of velocity, velocity. Isn’t just speed, but it’s speed and directly. Right. So we, as human beings, we have free, will we have the ability to make decisions?
[00:37:41] We’ve got the ability to move our life in one direction or the other, the question is what does that direction come from? where do you get a sense of what the likely rewards or consequences are of decisions that you make? And so, for me, that’s where the [00:38:00] power of mediating institutions come from, because, first and foremost, there’s your family, that’s the first place. And in fact, I’ve even created a framework called free family religion. Education entrepreneurship. Those are the pillars that if a young person really thinks about their life, those are the character forming institutions, the character shaping institutions that help young people understand how do I navigate this force of free will that I have.
[00:38:35] And so that’s why I’m launching a network of character based international baccalaureate schools. You know, this new network of vertex partnership academies, the anchored in the four Cardinal virtues of courage, justice. Wisdom temperance, those are virtues that are .
[00:38:54] Every other virtue is derivative of those four. then I think young people need a [00:39:00] grounding. And what does it mean to have courage? What does it mean to stand in the face of fear to understand the risks and yet to have the power. To do something to still move forward , in that moment where you’re, the most scared, you’re the most terrified, but like, for example, having a great family is, a place where, you know, you always have a safe place to come back to.
[00:39:21] I remember when my parents, , shared stories about, , coming, first they moved to England. My mom moved to, my dad wrote for her hand in marriage for her to travel from Jamaica to England. This is in the mid 1950s. so they could be together and get married. And she, had a ton of support for her family and that we will always be here for you.
[00:39:41] And, and so you start to realize got there that these institutions, they have my back. Right. So, and that’s where a faith commitment also is really important that there are a set of morals and, , structures that help you make decisions. So why a character based school is [00:40:00] it, first of all, what’s interesting is every school is a character based school, right?
[00:40:04] The question is, are you explicit about what you’re teaching or not? If you’re a school that doesn’t have expectations, for example, around timeliness or high expectations, or being diligent about doing your homework every night, or building study habits, then you’re actually a character-based school too, but you’re actually building the wrong.
[00:40:27] , character-based traits. So it’s really just owning the fact that kids are in our school building, for a significant portion of their life. And hopefully us working alongside with parents help to build those character-based strengths that young people will need throughout their lives to make good decisions.
[00:40:48] And so agencies, this building’s idea of the force of your free will guided by moral discernment. And that moral discernment has to come from somewhere that the ability to [00:41:00] discern decisions from a moral perspective has to come from somewhere. And I put forth that family, religion, education entrepreneurship, if you embrace those four pillars that you’ll have a much greater likelihood of leading a life of freedom, the life that you choose, the life that you want.
[00:41:20] And that’s what I want for our young people in our schools.
[00:41:23] GR: I’ve already, pre-ordered a copy of your book. , at least on Amazon, it says it’s scheduled to come on March.
[00:41:30] Ian: I think it’s more going to be April just because of, , supply chain issues. But, ah,
[00:41:35] GR: that is true. Well, listeners, you can go to Amazon or you can go , to his Templeton, press your publishing.
[00:41:41] Yes, yes, yes. Yeah. Yeah. And they are at the Templeton foundation and the current family foundation are two of the, major funders of character education across the country. They fund the organization where I work as well. So I want to give them a shout out, someone who. With this someone I know. Well, and, , Bob Woodson, he’s been on our [00:42:00] show.
[00:42:00] I first met Bob in September of 1987 when I was a freshman at Howard and he spoke about race and about getting young black men in Detroit, , to marry women that they had impregnated. And I walked up to him afterwards, shook his hand, and no idea that years later, our paths would cross different ways.
[00:42:23] Including his granddaughter, who went to the university of Richmond school of law and my wife at the time about wife at the time she worked at university of Richmond law school was her mentor. Bob and I have been in conversation and I know you were working with him with 1776 unites. Talk to us about your work there and how you guys are influencing conversations about America’s founding documents about Supreme court cases, slavery.
[00:42:47] Those, yeah. Yeah.
[00:42:48] Ian: It’s such, such a great question. , So you met Bob Woodson back in 1987. I honestly had never heard of him her’s work until, I think it was about [00:43:00] February of 2020. Just to give you a sense. I mean, here’s this incredible icon to think about the work that he has done in the United States of America as a man period, and as a black man in particular, and for someone like me, who’s worked in education at MTV at the gates foundation.
[00:43:20] I’ve never really known his work. Gives you a sense diminishes. The work of someone like a Bob Woodson and yet elevates the work of, , Al Sharpton or a ton of FC codes or Nicole Hannah Jones like this. These are the people who are viewed by the larger society of those who speak for the black community.
[00:43:40] so even that is, of a Testament. So I got to know Bob, , because he had, , again, after 40 years of running the Woodson center, uplifting people from, , in thousands of communities across the country to become agents of their own uplift. He saw that the New York times [00:44:00] had just published the 16, 19 project, which, , , as many of your viewers are probably familiar with was initially just the magazine issue was a series of essays that had a pretty robust, , and provocative view of American history.
[00:44:14] And in fact, , it clearly intended to quote unquote re-imagine history and say that maybe the country’s founding was not 1776. And in fact it was 16, 19, and maybe, , this country is not all that, you know, maybe the founding ideals were quote unquote false when they were written that the America was, was founded as a slave ocracy and not at the mock.
[00:44:36] and that country has anti-black racism running in its very DNA. I mean, you think about in your DNA, it means it’s a permanent malignancy. And Bob said, wait a minute, you don’t speak for all black people. And we have to stand up country doesn’t just, run on autopilot and [00:45:00] that it will be threatened.
[00:45:01] I mean, democracy requires an informed, electorate to continue to move it forward and uphold its principles. So he got together a group of people, , myself, Glen Lowery, John McWhorter, Coleman Hughes. I mean just an amazing group of, quote unquote elders as well as newbies who wrote just trying to.
[00:45:19] Create greater opportunity for not just black kids, but all kids across the country to understand that we do live in a country that has an incredibly, , in some ways flawed history and yet incredible stories of resiliency and progress and the whole idea of slavery, the fact that it existed in the United States.
[00:45:38] Yes, but it existed all over the world. And the United States was one of the pioneers for how slavery was not only overturned, but the people who had been once oppressed haves thrive and can continue to thrive if we unlock the secrets that at least some of our community has had access to. and so joined Bob and the 1776 [00:46:00] unites and team.
[00:46:01] And , when we also heard that the 16, 19 project partnered with the Pulitzer center to actually create a corrective. And we’re like, what? Wait a minute. Like they, they don’t just want a magazine issue. they want to indoctrinate kids into this view of America as this permanently oppressed society that if you’re black, I mean, you are screwed according to Nicole, Hannah Jones pen, her team and her ilk.
[00:46:26] And so, you know, maybe that’s another idea. Maybe there’s an alternative point of view and it wasn’t to demonize or to cancel, but to stand strong and say, we decided. We disagree. And here’s our proof. Here’s our evidence. Here’s people throughout American history who have fought against this idea of America being a country with a permanent malignancy.
[00:46:49] And so we said, you know what, if she’s going to create a curriculum, , let’s create one, not just in response, but to highlight the incredible stories of the African-American experience in United States, warts and [00:47:00] all, not just cherry picking. So if you’re going to tell the story, for example, about the Tulsa massacre, then tell the whole story, tell stories of black wealth and entrepreneurship that create that led up to the Tulsa massacre.
[00:47:16] And then tell the story of what happened afterwards, the recovery, the resilience, tell the whole story so that people can see that. Yes, I mean, America has parts of it is a wretched. Unfortunately like many other countries in the world. And yet there seems to be this through-line where the very values and principles that the country was founded upon were the values and principles and informed laws like the civil rights act and the voting rights act and everything else that has created the opportunity that yes, exists today for low-income Americans, black Americans, for people, billions of people around the world, that’s still yearn to come to this country.
[00:47:58] so Bob and [00:48:00] I, and the team, that curriculum that we created has now been downloaded more than 25,000 times. By teachers in all 50 states, it’s been downloaded in public schools, private schools, charter schools, homeschools after-schools prison ministries, anywhere where character formation is happening for kids.
[00:48:25] And we’re very proud of that because you know, again. We’re not looking to, call people bad names or, cancel, but to show that there is an empowering alternative. If we want to look at American history, bring it up. This country has a lot to be proud of there parts of the country, like many others, unfortunately that it’s a very negative past learn from it.
[00:48:45] Be honest, but tell the whole story. Don’t sanitize American history so that you cleanse it of all the bad things nor cherry picks. You only focus on the most increase jus atrocious events is I think most of the 1619 [00:49:00] project does. And so that’s what we’re trying to do to show that there was a compelling alternative.
[00:49:05] And, the nice thing is I think many people are responding to say, , we appreciate it that you’re not running away from the America’s past or, our experience with slavery or Jim Crow, or even present day racism. but the key is recognizing that what once may have been literally structural racism in trined into law is now.
[00:49:28] Surmountable racism, um, by people who, again, based on some of the things we talked about before are thriving in our country and 1776 unites stands to make that story known to millions of black and other kids across the country.
[00:49:47] GR: No, that’s a powerful story on so many fronts. As we get ready to close.
[00:49:52] What are two things you think, for example, we are going to have over 30 gubernatorial elections of this [00:50:00] year. What are two things that, , sitting governors or people who are seeking to unseat a governor or have a seat is going to be open because of term limits? What a couple of ideas that those candidates should be thinking about for their campaign, not just for education, but the whole part of just understanding human development.
[00:50:19] Ian: Yeah. Well, I think they should look to your state of Virginia and look,, at what, governor Yuncken made a point of, during his campaign. And it was pretty straightforward. parents have a voice families matter, education matters, choice, educational choice matters. And parents would have a say in development of their kids.
[00:50:42] sometimes we make things a lot more complex than they need to be. And I thought in his campaign, things were pretty simple. I think over the last few years, you know, since the tragic, murder of George Floyd, which was a heinous event, and yet reaction to it unleashed the awoke [00:51:00] ideology that again, paints the country as this permanently racist, all of our institutions are infiltrated with racist.
[00:51:08] and yet there are a number of people who were tiring of that ideology, which seems to, just place people in boxes. Regardless and says that the only factors that matter are your skin color or your gender. And based on that, you’re either going to be oppressed, or you’re an oppressor full stop and ignoring the more developmental aspects of what makes a human, being a human being, your family, the family that raises you religious or faith commitment that you’re part of the quality of education that you have in school choice.
[00:51:47] And then ultimately, so idea of entrepreneurship, your ability to generate wealth in all of its forms, social wealth, financial wealth, free family, religion, education, entrepreneurship. [00:52:00] If I were someone running for governor or running for political office, those would be the things I would, run on.
[00:52:05] you know, , I would trying to revitalize the institutions that make us all free family. Education entrepreneurship. That’s what we need to come together on as a country, across race, across class, across gender. That’s what I would run on because that’s the future of our country.
[00:52:27] GR: Well, Ian, thank you for the work that you do, both at a think tank.
[00:52:31] And in your role as an entrepreneur, who’s creating do tanks, known as schools. our listeners are here to support you, let us know what we can do in the future, , look forward to seeing you soon. Thank
[00:52:43] Ian: you so much. It was a very inspiring conversation.[00:53:00]
[00:53:24] Cara: Gerard, we are going to close it out as always with the tweet of the week. This one from John Bailey. So at John underscore Bailey the $1 billion budget for the tech modernization fund, known to those who know about it as the TMF is a huge investment, but funds are only part of the solution. Tech talent, project outlines tech fund, best practices.
[00:53:46] So the tech modernization fund, this is tons of money tech infrastructure, but we need an outline for how to get it done because as he points out, money is not enough. I encourage everybody to look up John Bailey on Twitter. [00:54:00] This will take you to a nice link that has a great policy brief with the best practices and steps that folks need to take in order to make the best use.
[00:54:09] As John says, to make government work for people. What do you think about that? That’s something hunter next week, Gerard, you know, it is national school choice week. So we’re going to be back with our friend, Andrew Campanella, and, I hope you bring your yellow.
[00:54:22] GR: I will.
[00:54:23] Cara: I bet you, I bet you got a lot of them at this point.
[00:54:26] I’ve got a few, they’re hanging out somewhere with purses that I only use once a year. So Gerard until next week you take care of yourself. You stay warm and I hope we can open the show next week with some cheerful news. [00:55:00]
Recent Episodes:
Massachusetts Telehealth Report Card: Are We Embracing Disruption for Better Quality of Care?
/in COVID Health, COVID Podcasts, Featured, Healthcare, News, Podcast Hubwonk /by Editorial StaffHubwonk host Joe Selvaggi talks with Pioneer Senior Fellow in Healthcare Josh Archambault about his newest research paper, produced with the Cicero Institute and the Reason Foundation, on states’ success in implementing telehealth to improve healthcare outcomes. They discuss how Massachusetts has used remote medicine to better reach patients and serve their needs.
Read the report here: https://bit.ly/50StateTelehealth.
Guest:
Josh Archambault is President and Founder of Presidents Lane Consulting. He is a Senior Fellow at both Pioneer Institute and the Cicero Institute. His work experience has ranged from work as a Senior Legislative Aide to a governor, Legislative Director for a state senator, to years working for think tanks operating in thirty-five states, and in D.C. He is a regular contributor to the influential Forbes.com blog, The Apothecary. Josh holds a master’s in public policy from Harvard University’s Kennedy School of Government and a B.A. in political studies and economics from Gordon College.
Get new episodes of Hubwonk in your inbox!
WATCH:
Read a Transcript of This Episode
Please excuse typos.
Joe Selvaggi:
This is Hubwonk. I’m Joe Selvaggi.
Joe Selvaggi:
Welcome to Hubwonk a podcast of Pioneer Institute, a think tank in Boston. The strain to our healthcare system created by the COVID 19 pandemic has given rise to innovations that will forever change the face of medicine, perhaps chief among these is the embrace of telehealth. The ability to access healthcare remotely telehealth smokes, obvious benefit is that it can facilitate a connection between patient and provider in a convenient and less costly setting, but an overlooked if perhaps is the promise of improving patient care itself, by offering more targeted and coordinated expertise while providing health data from tests performed at home. Imagine the benefit to a diabetic patient with mobility issues of having remote access to a diabetes specialist and nutritionist, and being able to provide real time medical data to those providers from home for populations like these telehealth can be a lifesaver. How well has Massachusetts done to ensure this technology is integrated into our system and how can we improve in the future?
Joe Selvaggi:
My guest today is Pioneer Institute’s senior fellow in healthcare. Josh Archambault. In a new paper produced by Pioneer Institute in coordination with the Cicero Institute and the Reason Foundation entitled “Rating the states on telehealth practices, a toolkit for pro patient and provider landscape.” The researchers offer an outline of best state level policy practices in telehealth and creates a report card of success for each state. Josh will share with us which criteria are vital for optimizing the benefits of telehealth and how well has Massachusetts scored in his analysis. When I return, I’ll be joined by Pioneer Institute’s Josh Archambault.
Joe Selvaggi:
Okay. We’re back. This is Hubwonk. I’m Joe Selvaggi, and I’m now joined by Pioneer Institute’s Senior Fellow on healthcare, Josh Archambault. Welcome back to Hubwonk, Josh.
Josh Archambault:
I always enjoy being on. Thanks, Joe.
Joe Selvaggi:
Well Josh, you, you have been on the show before and we’ve talked about telehealth in the past. You’ve you’ve, you’ve sung the praises of the benefits of telehealth, but largely in the beginning when you were first on, we were at the early phases of the pandemic and folks were terrified. They didn’t wanna risk getting sick by going into a hospital to see their, their doctors. So a lot of these telehealth measures were emergency procedures that we did at a desperation. And the unknown. Now we’re getting to a phase of the pandemic. It’s been with us almost two years and we wanna see what parts of telehealth makes sense going forward into the future.
Joe Selvaggi:
So you’re recently released pioneer paper entitled rating the states on telehealth practices, a toolkit for pro patient and provider landscape. You’ve offered a scorecard for state level policymakers to say, okay, how well are we embracing this technology called telehealth? So for the benefit of our listeners who may not have heard earlier conversations about telehealth, let’s start at the beginning and say, okay telehealth, it’s, it’s a good thing. We’re talking about communicating with our healthcare provider or with our hospital, the way you and I are communicating right now, virtually let’s talk about what this complimentary technology, how does it help a patient and a provider?
Josh Archambault:
Yeah. So as you mentioned, I mean, I think COVID brought telehealth not only into our headlines, but into many of our bedrooms into our dining rooms, into our living rooms, wherever many of us have done telehealth visits. And I think it’s really exciting about where we are right now is we are in this assessment phase where a lot of people have tried telehealth for the first time, including providers who were, many of them were reluctant pre COVID to use telehealth as a tool in their toolbox. There’s certainly been a lot of investors pouring money into digital health care and telehealth space. And I think also there’s two kind of tracks conversations happening right now, which are really interesting to me. One is on the policy side and that’s where the paper certainly looks at looking at these eight best practices, trying to understand what policy landscape do we need to have that allows for the most innovation to emerge that is probation and pro provider.
Josh Archambault:
But the secondary part of that is what is the best use to telehealth? The policy environment can be flexible or maybe restrictive, but ultimately providers and patients need to decide how do they wanna use telehealth? It are there ways in which in person visits are a hundred percent going to be the way to meet people going forward and get certain kinds of care. And in what instances is telehealth act you the most helpful? I think what’s interesting. And I think what the general public doesn’t fully still appreciate about telehealth is they think about what we’re doing sitting in front of a computer, on a smartphone video, chatting with somebody, but telehealth is actually much, much broader than that. So, and the report touches on this, looking at things like remote patient monitoring. This means you have something in your home that is maybe in real time, I’ll give you an example.
Josh Archambault:
Somebody with diabetes might be taking their blood sugar level on a regular basis and transmitting that information to their PA to their provider so that their provider has a much better sense of how compliant they are with whatever regimen they have given them, their drugs or other things. What’s interesting about this is that the providers now have not only when there’s a red flag can follow up with you much more quickly, but when they actually see you in person, they may have at their fingertips far more information about how you’re doing health wise than just seeing you once a year or every six months, whatever the condition you may be seeing them to. So the real promise and the potential increase in quality of care over telehealth is making sure that we’ve got all of this data, that’s at your fingertips, but that people aren’t overwhelmed by it, that it actually improves the quality of care. And that’s the kind of tipping point or middle ground that we are right now where people are really trying to assess as we come out of the pandemic. What adds the most value. And, and where is it? Was it just a necessity because of COVID
Joe Selvaggi:
I was struck by your the subtitle of your piece characterizing it as both pro patient and pro provider. We’re talking about the doctors and the hospitals at a high level before we dive into any details. There’s a lot of stakeholders involved here with telehealth. Is there any tension amongst stakeholders? Is it, is, is this great for patients and great for doctors and great for healthcare systems or, or is it some sort of a zero sum game here?
Josh Archambault:
You know, I, I, I don’t think anybody views it as a zero sum game anymore, perhaps pre pandemic that would’ve been the default for some, they were worried about competition or, you know, ways for this to take away business. I, I think people are seeing it as a compliment. There are still areas of disagreement, you know, payment rates, reimbursement rates certainly remain a sticking point of how much should be paid for services, telehealth services. And that’s covered a little bit in the report should be covered at the level that an in person office visit is for just a quick video chat or should it be paid at a different rate. And then who can use telehealth, there’s going to continue to be disagreements within the medical community on whether or just doctors should be able to use it, or whether any provider should be able to use it should a nutritionist, should a physical therapist be able to use it.
Josh Archambault:
And I think that there is largely emerging agreement outside of perhaps dentistry, which seems to be an outlier in this discussion, that telehealth is a helpful tool in the toolbox. And I think as long as acknowledge that it is just that it’s not a silver bullet, it does, it is not the best way to deliver all kinds of care. Then I think that there has been emerging consensus that it, it, it, it is a good tool and it’s just a matter of making sure that the policy landscape allows for the flexibility going forward to deliver care in really innovative ways.
Joe Selvaggi:
I’m glad you mention it, the, I like the word compliment because it’s in addition to traditional in-person medicine, we’ve had doctors on the show who have said, look I’m, I’m skeptical about telehealth. I catch half of the problems with my patients through laying of hands, right. I, I want to see my patients, they, they come in from, with one symptom and I, I find it a different pro problem. You can’t do that virtually do do, does the community acknowledge this limitation of telehealth?
Josh Archambault:
Yeah, I think by and large that there is, of course it’s gonna depend on the specialty area. You know, certain providers certainly think that in person is, should be the dominant way going forward. And you know what, I trust that it’s a little bit of an art in the science here, but I will say that, you know, with the emergence of artificial intelligence and other things, dermatology is a good example. You know, if you have a provider dermatologist, who’s looking at your skin and has seen a thousand examples of something, but if you’re able to use telehealth in which the AI has access to millions of images to compare what you have on your skin, there is actually an enhancement. There, there could be a value add by using telehealth. And so I think going forward really what it is is again, it’s using both.
Josh Archambault:
So do you use telehealth first to use the access millions of images say, Hey, we actually believe this is a problem. And then send that to a provider, say, you need a hundred percent to go see this provider for an in-person care to have that removed, to have it looked at more closely that that’s the value. I, I think what we, for those of us that have been around studying healthcare spending for a long time, we realize probably half at least of care spending is just wasted spending. And part of that is because the healthcare system is not very good at triaging who actually needs in-person care or not. The default is just to go, I mean let me give you a personal example of this. You know, I’ve had health insurance where they have a nurse hotline and you can call in I’ve called in probably a dozen times or so over the years for kids or things that my wife and I have.
Josh Archambault:
And inevitably every single recommendation is go to the ER to get this checked out, even just to cover themselves from a liability standpoint. And so I think ultimately we need a few more options here where people are able to triage much better to direct people. And this is where some of the savings can come from telehealth is really giving you a gap, a very well-informed technology driven. Now, of course, there’s limitations to that, and we wanna be aware of that. And that’s the learning that we need to be in from a medical side, like really assessing where the technology enhances the kind of care and quality of care that’s being provided and where it may not add as much value. And ultimately, and we cover this in the report. I think that’s policy mandates actually become a problem. If you mandate that insurance companies have to cover all kinds of telehealth, regardless of whether we deem it adds value or not, then we’re running into problems of wasted spending. We wanna really make sure that when we spend an additional healthcare dollar, we’re getting better quality care for the patient every single time. And that includes te health as well as it does in person.
Joe Selvaggi:
Now, this is clearly a disruptive technology. I’m asking you a question it’s not in your paper. I think what an investment slide deck would ask is what’s the addressable market. And when you talk about telehealth and, you know, you look at health, the healthcare system very broadly it, it could, is this just at the fringe of the margins 5% or, you know, you, you, you just characterize a lot of waste in the system. You know, could we potentially save hundreds of billions of dollars in the system? Is it 30% that that could be I dunno if the right word is not lo no longer wasted, but more efficiently deployed. Are we looking at that level of disruption?
Josh Archambault:
Yeah, well, we’re well over 3 trillion a year in healthcare spending. So there’s ample opportunity here to increase efficiency in the quality of care provided. No, I think this gets at the question of cost savings that can come from telehealth. And I think there’s, you know, probably at least a dozen ways that telehealth could deliver cost savings. One is it’s just a much more efficient, effective way to be able to deliver services. You can have a provider from their home office from a different state, being able to see people at 24 7, quite frankly, if somebody’s struggling with addiction and they need help at three 30 in the morning while their provider’s not gonna be available locally to see them in person. So there might be an opportunity to use telehealth, to get them in touch with a provider, right at that moment when they are struggling and they need some extra support or they want to try to get clean in that moment.
Josh Archambault:
So there are those kind of interventions in which telehealth can prevent those individuals from ending up in the ER and costing a lot more money, but there’s all sorts of other ways that I think telehealth can be save money in the long run going forward. You know, I think the future of healthcare, a lot of it for certain chronic conditions and remember 80% of healthcare spending is due to lifestyle choices. So finding more effective ways to help patients live healthier lives is really important. And I think team based care. So again, go back going back to the example of somebody with diabetes, yes, you want their primary care doctor engaged, but you also might want a nutritionist engaged, an endocrinologist engage. And in many communities, those specialists simply don’t exist telehealth for the first time allows you to pull together a team to intervene with the patient and say, what is our plan of attack going forward?
Josh Archambault:
Are we being adherent? How can we help support you more to meet your health goals going forward? And if those sorts of innovations are allowed to merge to emerge and they’re being used in some instances now, but if you don’t mandate that insurance companies have to pay one size fits all way, they, you allow them to pay for team based care, try it to see if it actually leads to better health outcomes. You might actually start to see huge long-term savings by using technology. I think everybody knows this and acknowledges this. It’s just a matter of how do we transition because our current health system, especially for large hospital systems is so real estate intensive. It’s very expensive sustain. And so a lot of those health systems are just focused on how do we increase our revenue to the point where we can support that large, large system.
Josh Archambault:
Ultimately, where we wanna go is to have a health system that is patient focused and allows for providers to be able to provide care in a multiple ways. So maybe they start by seeing you in person. Then they say, Hey, go home, bring this device home, take your readings once a day. So I can see how it’s going. Then maybe once a month we pop on and we video chat to make, look at the data to see how it’s going. And then we’ll determine from there, whether we need a follow up appointment or not, that’s the sort of different ways. And that’s what the report gets at. Does your state laws, are they flexible enough to allow for that health system to start to emerge or are there barriers in place? And quite frankly, one of the things we were surprised, Joe doing the report is there’s still a lot of work to do here. There’s a lot of states whose laws have not been updated sufficiently to allow for that, those sorts of health innovations to emerge a lot of states simply tweaked around the edges during the pandemic. And I think there’s a lot more opportunity here and that’s why we put out the report.
Joe Selvaggi:
Wonderful. Well, now let’s get into the, the meat of the report. As you say, it’s, it’s state level focused. We live in a state, more Commonwealth of Massachusetts, there’s 49 other states. So given there’s a difference between Massachusetts and Wyoming, how, how do you compare terms, meaning even the, even the term telehealth may be a vague and defined differently in different states. How did you account for those differences?
Josh Archambault:
Yeah. So there, I think that there’s been a, a growing consensus that there is telehealth. Well, it can be he called and defined slightly differently by states. You’re absolutely right. There are a couple different modalities in which people look for that allows for flexibility. So video synchronous, it’s live, we’re talking back and forth. We’re able to communicate in real time, back and forth, but there’s also asynchronous, which is like, think about texting back and forth with a provider. Maybe you start the relationship over text and then switch over to video if it’s sufficient. But in many instances, allowing for that kind of easy back and forth over text, or for me to record a message and then send it to you later is another kind of form of telehealth. So in the report, that’s what we were looking for. We were looking for state law definition and I give a lot of credit to the American telemedicine association.
Josh Archambault:
Who’s worked really hard with stakeholders to say, how do we come up with definitions that are all encompassing that allow for this flexibility going forward in its, in a state. And a lot of states have started to move in that direction of adopting some of those, the, the looser or broader definitions. Now the, the area where we found the most work to do is not every state allows you to start a patient provider relationship over all of the modalities. Some of them are still prescriptive. You have to do it this way, which I think coming out of COVID, we we’ve come to appreciate and realize that that’s, that’s simply outdated. We should allow for patients again, if we want to really patient centric center system, to be able to establish the relationship in the way that they prefer.
Joe Selvaggi:
So let’s get into the, I think you used eight criterion in your paper. And we’ve touched on some of the issues in each, but I wanna touch each idea discretely. And then I’d like to also, if we can talk about where Massachusetts falls you gave each state a guess a stoplight kind of rating either green, yellow, or red, green being the better and red being not so good. So let’s start at the beginning. You, you just touched on this notion of modality neutral, which is to say I would characterize your piece as saying there’s there’s time in place, right? You have synchronous and asynchronous, meaning I’m interacting live with my provider, but I may not be, as you mentioned and also place meaning I can get a, a blood test in the hospital, but I might be able to have some sort of measurement at a facil either more locally or in my own smartphone or something like this. Right. You, so tell us more, why does it, why is modality neutral so important?
Josh Archambault:
Yeah, I think it, it matters a lot because different kinds of care, demand, different ways of interacting. And, and, and I mentioned the example of somebody struggling with addiction. I mean, whether it’s mental health issues or whether it’s other issues related to addiction there has been consensus in all 50 states that we simply don’t have enough providers, that our system is not set up in a way to be able to meet the demand that’s there. And so we need to make sure that patients, whether it’s somebody that speaks their language, that may not be in their local community, or whether it’s just, I prefer to start by text because I’m feeling ashamed of where I am right now, or just not feeling like I can talk to somebody over a video. We need to make sure that we have that flexibility. And, and I think what’s also important is a lot of the invest investments and entrepreneurs in this space are the thinking really differently about the kinds of tools and ways that patients should interact with providers.
Josh Archambault:
And we just wanna make sure that we have that source of flexibility. I think it what’s encouraging on this one in particular is states are moving in this direction and Massachusetts is one of them, the most recent telehealth bill that passed significantly improved the definite for telehealth in Massachusetts for where it was pre pandemic. And so I do think that there’s, there’s been some great progress here. And, and Joe, maybe let’s just step back for one second and talk about what the report actually is. It’s meant to be a tool kit, and it’s pretty simple, straightforward. It’s four parts to it. The first one is just a brief introduction explaining why action is needed. Second part, what we’re talking about here, the stoplight chart, giving green, yellow, or red rating for all of the states. And then we explain the ratings. That’s the third part. And the fourth part is all 50 states get a page. They all get a profile of where are they on these eight best practices. And so that’s, what’s in the report. It’s meant to be able to for the reader to digest a lot of information, but very simply and very quickly
Joe Selvaggi:
I want to get into where we score relative to the other states. As you say, it’s very comprehensive and it’s, it’s not easy to cover 50 states. So congratulations. So let’s get back to the, the bullet points or the, the features on which you score each state which just talking about Mo modality being important. You alluded to the fact that to really start the ball rolling in telehealth, many systems require the first step to be an in-person requirement. Now that may saying, seem like a no brainer first, see your doctor, and then we’ll talk about virtual. But in many cases, a someone may not live in your doctors or may have some reticence about going to a doctor, say for instance, during a pandemic or, or some other time. So say more about why that in-person requirement may be really harmful to tele health uptake.
Josh Archambault:
Yeah. For, I mean, transportation remains an issue for those with chronic conditions or in rural communities. This is the one measure where we by far saw the most progress during the pandemic. There were a number of states pre COVID that required you to see a provider. First, you had to go have an in-person visit. And on one hand, you understand that you want there to be your relationship, and you want them to have a basic understanding of your health situation. But if you live in a community where there’s a provider, a primary care provider shortage, and you simply can’t get an appointment for three months, which is not that uncommon in many areas, this just seems impractical. And quite frankly, out of date. So a lot of states moved. There’s only a few lingering states that still requires some sort of in-person visit ahead of time. And I think this is again, when you talk to policy makers, the one that they shake their head, why would we have ever required an in-person visit? But that’s just what happens when state states pass laws that have to do with technology that are 10 years old at this point, technology changes. And as a result, when you need to change the policy landscape too.
Joe Selvaggi:
So our, our local legislators seem to get that. I mean, that’s, that’s Massachusetts understands why that might not be or that would be a, a good policy to remove the requirement for in-person visits first. Right?
Josh Archambault:
Correct. Yep. Massachusetts does not require an in-person visit. I think that’s really important. And I would hope with all of the tech companies that are in our backyard, again, we’re not trying to replace all in-person visits, but it just says that if you need to start by telehealth first, then, then you can do so if that’s appropriate
Joe Selvaggi:
Now, this way to be, I’d be curious about, and I can understand perhaps why, what motivates a rule like this, but no barriers to access across state lines. For me again, you and I, we, we believe in markets and we think state lines might be artificial barriers you know, contrived barriers but removing those lines and allowing a, a doctor in Boston to treat someone in, in Nebraska. You know, why, why is that so important to, to telehealth?
Josh Archambault:
Yeah. So the way that I actually think about this is an example outside of telehealth. So think about a pilot. We allow a pilot to take off in one state, then they land in another, and we haven’t assumed they’ve lost all of their skill and knowledge. And then we allow them to take off again. But yet for medical providers, we assume that as soon as they cross the state line, especially in a place like new England, where, you know, in half an hour, 45 minutes, you’re in another state. We just assume that they’re, they’re unqualified to see patients. I, I, I think this one is they’re in the telehealth world. This one is seen as a no brainer. There are still special interest groups or provider groups who are more hesitant on this one. So what we score, what we looked for and what we scored for was looking for a state policy that simply allowed providers who were in good standing in their home state.
Josh Archambault:
These people all go to the same medical schools and take the same tests for the most part. If you’re in good standing in one state, then we’re gonna allow you to have a pathway in our state to register with the relevant board or to pay the fee, whatever the basic requirements are. And you can start to see patients now think about the practical implications of this. I mean, the more you think about examples, the more silly you realize what the barriers and protectionism that we have in place right now is in almost every state. There are very few states that allow what, what we’re describing, think about how many people spend time in warmer climates. And yet we’re saying they cannot stay in touch with their providers back home who have maybe known them for decades. They have to establish a brand new relationship with somebody who does not know them.
Josh Archambault:
It because they cannot do across state lines, picture a doctor or a provider who goes on vacation. They are breaking the law. If they are not able to stay back in touch with their patient, cuz they are they’re in vacation in another state. Think about the numerous industries, pilots, flight, attendants, truck drivers who cross straight state lines all of the time as the nature of their employment. And yet we make it difficult. If not illegal for them to stay in touch with providers who maybe they’ve known for years or decades, this is how kind of impractical and silly it is. You hear people all of the time talking about coordination of care and healthcare and how important it is to save money, to have people stay in touch with their providers. That’s what we’re, we’re talking about here. What we’re trying to put that option on the table.
Josh Archambault:
I, I think the concern here from the provider groups is they want complete control over who is practicing in their state or not. And on one hand I underst in, they wanna keep PA patients safe, but on the other, we have shown that licensing does not lead to, I mean, these people are going to the same schools. If they go to the same medical school and they just land in two different states, somehow we’re assuming there are, have completely different qualifications or outcomes. So there are, there is a politically fee way to do this. I would point to states of Arizona and Florida who have relatively recently passed laws that allow for a registration in the state with a relevant board so that, you know, who’s providing care by telehealth in the state. And you also allow for them to take some sort of regulatory action if there is a complaint against a provider.
Josh Archambault:
And I think that ultimately addresses some of the quote unquote safety concerns that have been used to kill these sorts of reforms in the past, but it’s just really impractical the status quo. And if we wanna make sure that there are enough mental health providers, that there are enough providers, period, I mean the tum tsunami of retirements that are coming for doctors over the next 10 years, we have to think differently about how we deliver healthcare and telehealth. And especially this across state line has to be part of the, the process and the conversation. And I think it’s just a matter of time before states actually start to move on this one. Yeah.
Joe Selvaggi:
This seems like get an odd Relic. I certainly don’t imagine among our listeners that someone where they’d get sick in a different state would be concerned whether the doctor they would visit in the emergency room is qualified to practice medicine, right. It doesn’t have not everybody has to go to, you know, a certain school or go to a certain hospital. I, you know, that’s, that seems obvious, but an important point let’s talk about the, that telehealth in certainly in the emergency phase of the orders, it allowed for telehealth for primary care doctors, but not for other practices you, you mentioned in your paper nutritionist and other fields why would this be, why would we just say, okay primary care perhaps is okay with a telehealth, not all these other specialties.
Josh Archambault:
Good question. I don’t know. I mean, what was interesting during the pandemic is that a lot of governors did offer executive orders allowing for a lot more flexibility that just to return back to the across state line, many, many states allowed for that for the first time through executive order. And guess what this guy didn’t fall. In fact, people really came to appreciate they could access more providers. This is another example in which there was unevenness in when it came to executive orders on who could use telehealth. And when we really dug into this, I, I think what was interesting is pre pandemic. And even in a couple states now only doctors are allowed to use telehealth, which just seems, I mean, the nurse practitioners, physician assistants said, these are the backbones nurses. These are the backbones of our healthcare system. And to say that they can’t use telehealth under any instance just seems shortsighted.
Josh Archambault:
But I think in our report, what we were trying to highlight is in a number of states, they do allow a lot of providers to use telehealth, but what they do is, and this is the details that actually really, or is that they tie it to the currently licensed profess medical professions that are in, you know, whatever title that is in state law and the challenge and, and, and problem with that is that there may be some medical providers who aren’t currently listed in that title. And until they’re added to that title, they’re not allowed to use telehealth. The other thing that it does is that it doesn’t allow for new innovative provider types to emerge quickly. They have to go through the whole legislative process to be added to the title before they can use telehealth. So what we suggest is to follow the best practice, which is in a few states of allowing the definition for who can use the telehealth to just be broad, to just say, you know, we’re not gonna mandate that every, everybody has the insurers have to pay for all of this for all the provider types, but if they want to, if they want to try something different, if they wanna work with a different kind of medical provider, they should be allowed to do so.
Josh Archambault:
And that’s what we are really rating at for that factor.
Joe Selvaggi:
That that’s a great segue to another bullet when we talked about independent practice. Again, this sounds like a no brainer, but the phenomenon of nurse practitioners that they could use telehealth a, they should, of course be added to the list along with doctors. But the, the fact that there’s a requirement now that doctors have to oversee this interaction with nurse practitioners, you, you mentioned earlier, there’s an anticipated shortage of, of doctors. I imagine along with the massive tsunami, the of, of baby boomers retiring and along with that, many of those being doctors who are also retiring we’re gonna need a lot of nurse practitioners, I would imagine shouldn’t this telehealth facilitate that, that transition.
Josh Archambault:
Yeah. And that’s what we were looking at here. I mean, we, we could have looked at any number of different medical professions on whether they’re able to practice independently in the ways that they’ve been and trained to do. And I think there has been growing consensus in Massachusetts just joined this this group of states that have allowed nurse practitioners to practice on their own going forward. And that’s what we were looking at. We wanna make sure that the, again, the system is flexible, that can be patient centric. I mean, the challenge here is there’s a cost element to this and many dates. When you see a nurse practitioner, your insurance company, or you get actually charged a doctor’s rate, which in other professions would actually be illegal for you to do, but in medicine, for some reason, we allow it to happen. But there’s more of a practical reason here, why we think it’s important, nurse practitioners and others, they help extend the healthcare system.
Josh Archambault:
You know, whether it’s in a rural community or whether it’s just in an urban community in which getting a primary care doctor’s appointment can take 50, 60 days or longer, which is not uncommon in the Boston area. We wanna make sure that you can be able to see some of these other primary care providers in a more flexible way that they’re able to set up their own practices if they want to and use telehealth as part of that. And that’s what we were trying to look at as one example for nurse practitioners going forward, because that’s just the reality that we’re facing going forward.
Joe Selvaggi:
Well, that links also to a another point point of your paper, no payment mandate. Now you mentioned just in your earlier response that, that providers are charging the same, whether they, you see a doctor or a nurse, but I think what’s more unsettling is that or a nurse practitioner I’ll say is that whether you visit your doctor in the hospital or you have the meeting virtually again from the setting of maybe even the doctor’s own home you’re, it’s mandated that you be charged the same amount. Now some people would strongly prefer telehealth regardless of cost, but some people might use it as a way to save some money or the system saves some money. The system seems to now to forbid a differential in, in those payments you know, say more about that.
Josh Archambault:
Yeah. So when we looked at this one in particular there’s probably about half and half, half states mandated and half the states don’t, and there’s kind of some practical implications. Let me tell you why supporters advocate for the payment mandate. You know, the primary reason that they do is they say, we need to encourage providers to do use telehealth. So we need to pay them the same rate or it’s the same sort of expertise. So we need to pay them the same rate. I, I think the challenge with that is a, a couple fold is that there are some big unintended consequences of mandating that same payment rate. The first is patients who have a deductible are paying the full cost for it. So you are now mandating that they have to pay an inflated rate for services. And what we have seen is, and there’s been survey data on this over the last few years, at least a third of Americans say that they skip needed care over cost concerns.
Josh Archambault:
So what you have just done is you have pulled the rug out from under those who would’ve used telehealth because it would’ve cost slightly less, but there’s actually longer term ramifications for this. The first is these state mandates only apply to the individual market and the small business market. They don’t apply to large companies. So you have now made an unlevel playing field for small companies who tend to pay some of the highest health insurance premium rates in most states. And you have just made it more expensive for them to deliver healthcare. And then finally, I would just say, going forward, it kills innovation. We still largely pay for healthcare and I for service manner. And for those of us that have been in the health policy community, there’s been a raging debate about trying to change the way we pay for healthcare to more value based or based on outcomes or, or pay on a budget instead of to try to change the incentives going forward for just providing more and more care.
Josh Archambault:
And so I, as a result of forcing the insurance companies to pay this inflated rate, you are gonna double down on cementing the uneven payment rates that go to different providers. And if a provider group comes to an insurance company and says, Hey, I wanna do team based care. I wanna try something different. Hey, I wanna follow up with phone calls on a more regular basis insurance, company’s gonna be hesitant to do it if they’re being forced to pay the same amount for an office visit. I mean, think about a phone call costing the same as a 15, 30 minute, 60 minute in person office visit. That’s just impractical. You’re gonna see a massive spike in spending as a result of that. And so I think that there are some big unintended consequences that I’m hoping that over time policy makers won’t just see as, oh, we gotta pay for this because it’s important. We wanna encourage more of it, but they actually understand what the moving pieces are and that there’s implications for forcing mandates on certain parts of the market that hurts patients, vulnerable patients, those with chronic conditions, those in rural communities, small businesses, and actually try to embrace a more even keeled sensible policy framework going forward.
Joe Selvaggi:
Yeah. So to me, it seems sort of economics 101, you take away the price signals and you really don’t understand preferences of patients and doctors, right? If everything costs the same I don’t care what the product is. You don’t understand which people prefer and you don’t encourage innovation. That’s very important. I think also then this we’re almost repeating ourselves. One of your features was no facility fee. Ironically, whether the doctors calling from an expensive place like mass general or from, you know, some rural setting or his home there’s a mandate that there’s a facility fee paid to a telehealth visit. Say more about that.
Josh Archambault:
Yeah. I think this is where we, when we start to really think about the, for flexibility of telehealth and how it can be delivered, I mean, literally from the home of the provider facility fees have been justified for in-person visits at large hospitals as a way to cross subsidize other activities, whether it’s to help pay for the ER or research and development or other things that the hospital might office offer, excuse me, to patients. But here, we’re talking about somebody sitting in their home office and delivering a telehealth visit where the patient pops up right in front of them. There’s no waiting for the patient. There’s no waiting for the provider. They can in theory, see more patients in a, a shorter period of time. And so I think facility fees, which are largely just this extra fee put on in the end again, when we talk about patients who are foregoing care, because of concerns about costs and are paying largely paying it outta pocket, because they have deductibles, we have to allow for a health system that doesn’t have all this cross cross subsidization, especially when it literally does not make sense and should not apply when somebody is sitting in their home and not in the office building in a tower, in a big hospital system.
Joe Selvaggi:
Well, all good points. We’re coming close to the end of the show. I, I also want to say what I loved about your paper is, and I think it’s come through in our conversation. Not all areas of medicine are equal in the eyes of telehealth. Some are easier to utilize telehealth others perhaps less. So you mentioned in the paper, no coverage mandate. And what you say is you, you have concerns with telehealth and in-person treatment with regard as the same in all practice areas without any supporting data. In other words, there’s no sort of measurement as to when we all uptake telehealth, some are going to double their efficiency and others may, may founder. You mentioned say dentistry, I, I, I wouldn’t want a virtual root canal but, but say more about why it’s so important to measure the efficacy of, of these different measures.
Josh Archambault:
Sure. Yeah. So I think the long term success of telehealth is going to be based on us measuring it and in the policy world and debate, it really shouldn’t be a political fight. It really should be. Do we get better health outcomes? I mean, some of the most promising innovations I’ve seen using telehealth has been in the, those dealing with addiction and recovery. You know, we have a sad situation in America with so many people struggling with opioids and other issues in which we pay lots and lots of money for people to go to inpatient programs repeatedly over and over again. And the outcomes are just their lackluster at best, in many instances. And I’ve seen telehealth models where not only are they able to interact with patients when they’re in their moment of crisis and wanting to get clean, but also able to stay in touch with them and keep them sober far, far long, or, I mean, we’re talking a year, two years beyond them, kind of the initial intervention, which if you were to look at the data for inpatient programs, it can’t even be touched in terms of having people cycle back to the program UN unfortunately.
Josh Archambault:
And so I think we need to make sure that we’re studying this, that we’re looking at data that we’re holding telehealth providers to a high standard of showing their efficacy and the quality of care that they are they’re providing. And I think what we’re going to find is that in some areas, telehealth is truly game changing. Telestroke other areas seems to be that these are telehealth should maybe become the standard for how we interact and provide services. And inevitably, we’re gonna find areas where, you know, we just can’t tell, we can’t tell if there’s added benefit here or maybe the outcomes are worse. And so we need to stop paying it. The coverage mandate falls on insurance companies. And as I mentioned previously says, we don’t care about the outcomes you have to pay for it if it’s so over by telehealth, if it’s otherwise covered by your health plan. And I just think that’s shortsighted, we wanna make sure that insurance companies and employers and even individuals, again, when we interact with the healthcare system, we’re actually getting more value for every dollar. And if we’re mandating it, then you remove that flexibility and you’re putting handcuffs on them, quite frankly, for them to try something different, innovative, and they are gonna have to keep paying for the same procedures or the same services over telehealth that may not be adding value
Joe Selvaggi:
Well that that’s a great way to work. We’re coming close to the end of the show. And you, you, you sort of, it seems a theme is policy makers have to insurance companies have to allow flexibility to to see telehealth embraced effectively and it may be different in different area policy area. So from my last question, I’ll just say we have a lot of policy makers that listen to the show and they’re probably excited by what you said about the promise of telehealth. If, if Massachusetts policy makers are listening to the show, what would you say? Where’s the low hanging fruit here in Massachusetts that we could do better to make telehealth a more essential part of our healthcare system.
Josh Archambault:
I, I, I, it’s interesting that you asked that question, Joe, because if you had interviewed me a year ago, I would have different answers than today. I, you know, I think what is encouraging in Massachusetts in particular is there has been some serious conversation about improving the telehealth landscape, you know, started with the governor, with his executive orders. The legislature followed up by passing a new law, which by my count, at least three of the eight things that we looked at improved to green as a result of that reform. So that, that is very promising, but there is certainly more work to be done here. I think we talked about the no barriers to across Stateline telehealth. I think that’s just a no brainer, especially in new England where so many states are so close to each other. This is actually, if you think about it, a business opportunity for Massachusetts providers, whether they want to be able to travel if they’re mobile or whether it’s, we wanna set the, an example for other states so that if they reciprocate Boston based or Massachusetts based providers can actually see patients from other states a lot more easily.
Josh Archambault:
So there’s work to be done there. We talked about the coverage mandate, unfortunately in the update, they did pass that insurance companies have to cover telehealth services and they did keep a payment mandate for behavioral health, which I understand they want to try to get more behavioral health providers, but I really hope that they revisit that going forward and make sure that they phase sit out over time so that again, people seeking behavioral health, aren’t being priced out of the market because it’s, they’re being forced to be charged the same rate as an in-person visit. And then finally, we, we didn’t touch on it, but compacts, this is just a kind of agreement between states to set standard agreements on how providers or nurses or others can kind of more easily move between states. Massachusetts is actually not a member of the compacts that we looked at.
Josh Archambault:
There, there are some downsides to compacts that are a little bit clunky at times, they’re kind of expensive. So allowing for a free flow or they’re easy registration is a, a preferred plan a for states. But if politically you can, can’t get there. Then compact may be another way for at least certain provider groups to be able to open the door for patients, sick patients, to not have to travel, to be able to see some expert providers that just may not happen to live here. They may live in Ohio or California or Texas, and we wanna make sure that patients are able to access the providers that are best for them or that their provider primary care provider might recommend. They
Joe Selvaggi:
See. Well, great answer. That’s a, there’s a lot to do even here in Massachusetts where we think we got, we get the right answer more often than not. So thank you very much for being on the show. Thank you for this wonderful paper. Again, it’s a pioneer institutes research entitled rating the states on telehealth best practices. Our listeners can go to the pioneer website to, to read more. Thank you for being on hub won again. Josh, thanks so much.
Joe Selvaggi:
Has been another episode of Hubwonk a podcast of pioneer Institute, a think tank in Boston. If you enjoyed today’s episode, there are several ways to support the podcast. It would be easier for you and better for us. If you subscribe to Hubwonk on your iTunes podcaster, if you’d like to help it, make it easier for others to find Hubwonk, it would help if you offer a five star rating or a favorable review, we’re always grateful. If you want to share Hubwonk with friends, if you have ideas or comments or suggestions about future episode topics, you’re welcome to email me at hubwonk@pioneerinstitute.org. Please join me next week for a new episode of Hubwonk.
Recent Episodes:
The Great Understatement: Far more taxpayers and businesses than previously estimated will be affected by the proposed surtax
/in Economic Opportunity, Massachusetts Economy, Pioneer Research /by Greg SullivanThis report finds that analyses from the Massachusetts Department of Revenue (MADOR, 2016) (and more recently, Tufts University’s Center for State Policy Analysis (2022)) dramatically underestimated the number of households and businesses impacted by the constitutionally-imposed tax hike that the legislature is putting before voters in November 2022. The proposed tax would impact multiples of the number of people previously estimated, over a nine-year period, since the majority of “millionaires” only earn $1 million once during that time.
Download “The Great Understatement: Far more taxpayers and businesses than previously estimated will be affected by the proposed surtax.”