Thursday, April 30, 2009

Over the meadow and through the woods with Obama

In an interview with the Times' David Leonhardt, Obama told a story about his grandmother to frame a problem in our education system:
My grandmother never got a college degree. She went to high school. Unlike my grandfather, she didn’t benefit from the G.I. Bill, even though she worked on a bomber assembly line. She went to work as a secretary. But she was able to become a vice president at a bank partly because her high-school education was rigorous enough that she could communicate and analyze information in a way that, frankly, a bunch of college kids in many parts of the country can’t. She could write —

LEONHARDT: Today, you mean?

THE PRESIDENT: Today. She could write a better letter than many of my — I won’t say “many,” but a number of my former students at the University of Chicago Law School. So part of the function of a high-school degree or a community-college degree is credentialing, right? It allows employers in a quick way to sort through who’s got the skills and who doesn’t. But part of the problem that we’ve got right now is that what it means to have graduated from high school, what it means to have graduated from a two-year college or a four-year college is not always as clear as it was several years ago.

And that means that we’ve got to — in our education-reform agenda — we’ve got to focus not just on increasing graduation rates, but we’ve also got to make what’s learned in the high-school and college experience more robust and more effective.
Reading this made me recall my astonishment when I read in Doris Kearns Goodwin's biography of Eleanor and Franklin Roosevelt, No Ordinary Time, that on the eve of World War II only about 25% of American adults had graduated from high school. That's approximately the percentage that graduates from college today. Is the average U.S. college grad today better educated than the average high school grad in 1940? I'm sure that by meany measures the answer is 'yes,' and that by a few, it's probably no. And compelling as Obama's example is, we need to keep in mind that based on the genetic evidence before us, his grandmother probably had a bit of a brain in her head. She may have written like a mature adult when she was twelve.

In the same interview, Obama told a second, far more remarkable, story about his grandmother:

Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

LEONHARDT: Yes, where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
Twenty second gush timeout: I still cannot believe that we have as President a man capable of telling such a story without drawing any pat conclusions or scoring any cheap political points. That said, what exactly does he mean by "some independent group that give you guidance"? Just how could such a group have "guided" a funding decision about that hip replacement without being "determinative"?

P.S. Is it typical that about six months after the death of a loved one, that person starts to come back into focus?

P.P.S. As newspapers die on the vine, I can't quite shake the feeling that there's no reason I should be getting and freely sharing this remarkable article for free, even though I'm a Times subscriber.

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