Policy Market Blog

Colonoscopy Screenings, Risk, Behavior, and Policy

Martin Kennedy - Friday, March 22, 2019
The mortality rate from colorectal cancer is just 2.9% for those screened via colonoscopy.  For those un-screened, it is only slightly higher, 3.9%.  – Robert M Kaplan, ‘More Than Medicine’

Kaplan’s argument, neither original to him nor particularly controversial, is two-fold. 
  1. Diminishing returns:  As currently configured, increased spending on healthcare does little to improve outcomes 
  2. The greatest potential for improved outcomes lies in behavioral changes – diet & exercise – so there should be greater interest in policy that induces behavioral change
Just so with education.  If we spend more, we will have little to show for it.  Diminishing Returns set in a long time ago.  And, the greatest potential lies in behavioral change.

With ESAs, we embark on a path to change the relationship between the citizen and the state.  In the current model, we say ‘come, we’ll teach you.’ 
The citizen as passive client.  He learns to be helpless and un-accountable.  If his kid is not learning, the school is at fault.  The teacher doesn’t like his child maybe.

With ESAs the parent is accountable.  If he thinks the teacher does not like his child, he can pull his child out (and likely learn that his child really is a terror).  When the state treats people like adults, more will act like adults. 

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