Outcome Based Compensation

I'm not directly involved in teaching policies, but some of my friends are teachers, so I've been peripherally involved.  An interesting discussion is "outcome-based" teaching.  At first glance, this seems like a good idea.  Why shouldn't teachers' salaries be based on outcomes?  After all, their job is totally about pounding some facts into the kids' heads -- isn't it?

Now those questions lead to other questions like, "Are facts the most important things the kids learn?  Or is it important that they learn to think critically and how do you outcome test that?  Do we want kids to spout government-issued facts or do we want them to know how to dig up the evidence, evaluate it, and decide for themselves what the facts are? How do you outcome test that?"  Or how about this: "Should the kids be taught to be solid, upstanding adults with a work ethic and a sense of competition and a respect for innovation (the old-fashioned American individualist)?  And how do you outcome test that"

Then there are the questions of how a teacher can get better outcomes on government tests thereby earning more.  I'd say that if they can pick and choose their students, they can earn a raise.  Don't necessarily choose the thinkers and innovators, just choose those who've proven in the past they can memorize the official facts about things.  The good little robots.

Given choices, who will teach the average children?  Who will teach the special needs children?  And who will teach the real thinkers and innovators who may disparage the official facts?

But for the most part, teachers cannot pick and choose their students - at least not blatantly. At least, not yet.  So all the kids will at least have a classroom and a teacher.

Outcome-based medical care has also been proposed, and for all anyone knows, is already mandated in the monstrous healthcare bill.  Probably no one has read and interpreted the entire thing yet, so we still don't know what is in it.

But here's the thing: outcome-based health care is even more questionable than outcome-based teaching.  One big problem is that doctors can pick and choose who they will treat, and if their salaries are based on outcomes, why would they choose to treat difficult cases?  Who will take care of those people whose outcomes are questionable?

We all know of someone whose severe condition was considered fatal and who miraculously pulled through by the grace of God and the hands of a competent physician who was focused on helping, not worried about outcome figures that would be reported to the government.  Will people like this get care under an outcome-based system?

One of the great concerns regarding the health bill is rationing of care.  This bill dumps everyone, citizen or alien, legal or illegal into the health care pot.  If doctors can't possibly take all the patients who apply to them, why not take the sure-to-have-a-good-outcome patients?  They'll get paid for those.

But what happens to the questionable-outcome patients?

Will there be facilities where they can await their outcome without the attention of a physician?  Will they at least get comfort-aid?  Or will the outcome be hastened to save money?

OofDah! What kind of country have we become?