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Actor LeVar Burton Raising Funds to Bring ‘Reading Rainbow’ to the Web

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My Students Don’t Know How to Have a Conversation

I have so many problems with this article and those that tout the similar argument of; “kids these days! all this newfangled technology is ruining them!”

Back in March, I posted an article that uses this argument (10 Reasons Why Handheld Devices Should Be Banned for Children Under the Age of 12), but, since then, I came across the above Atlantic article which sparked my anger enough to make me contribute to the comment thread. 

What was particularly interesting about this comment thread (and what kept me dedicated to getting my comments on public record) was that my comments with website links as citations, as proof of the evidence I was using in my arguments, kept being tagged and deleted as “Spam.” It’s nearly impossible to know for sure whether they were being tagged by an automatic computer program simply because I was using so many links in my comments, or whether they were being tagged by an administrator of the site with personal biases. But I can say that other comments of mine on other Atlantic articles with a similar amount of website citation links were not being deleted from the same comment board system (Disqus). Additionally, not only did my comments get deleted once, but one comment in particular (even though I reworded it each time) got deleted three times. Only when I worded the comment with my link as “news(dot)discovery(dot)com” was it finally allowed to stay. Paranoid conspiracy theory? Perhaps.

Either way, I feel like the above discrepancy is enough to warrant a discussion of the topic and article on a platform where the commentator makes the rules. 

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First off (even before I begin my argument for children’s use of new technology), I would like to examine the article itself and the logic pattern that the author uses.

The author uses contradicting information as “evidence” within the article itself:

In the 5th paragraph from the end: “Online discussion boards and Twitter are useful tools for exchanging ideas. But they often encourage a “read, reflect, forget about it” response that doesn’t truly engage students in extended critical thinking or conversation.”

In the next paragraph, literally two sentences later: “In a New York Times column, Turkle wrote, “Face-to-face conversation unfolds slowly. It teaches patience. When we communicate on our digital devices, we learn different habits … we start to expect faster answers.”

So, according to the author, digital communication encourages “a ‘read, reflect, forget about it’ response” while simultaneously “expecting faster answers”?

And the author is a teacher attempting to “school” teenagers in the art of communication? Shouldn’t they be able to, I don’t know, write a logically coherent article?

Now, onto my arguments:

Okay, yeah, kids should not be spending a lot of time watching mindless tv shows and playing mindless games. But what about toddlers that use laptops, ipads, iphones, etc. to skype with family? What about Leap Frog games? What about Reading Rainbow and Mister Rogers??

In the Huffington Post article, the American and Canadian Societies of Pediatrics recommend banning, and then strictly limiting later on, the use of all “new” technology for kids of various ages:

2014-03-06-Screenshot20140306at3.29.09PM.png

I couldn’t believe that these supposedly reputable organizations ignore the fact that there are useful and educational technologies out there for infants and children.

If they’re skyping with grandparents, or playing music, or making art in an app, or the like, then I don’t think it’s damaging. The Huffington Post article annoys me so much because I hate the concept of “banning” anything. People, and families, should be encouraged to learn the facts and make their own decisions. But when the “bans” are coming from the American and Canadian Societies of Pediatrics, then there’s a high chance of concerned families blindly imposing the “bans” without considering the situation thoroughly. They’re even banning pornography for children 13-18 years old, which brings up soo many problems. First, what is considered pornography (see: paintings of Cupid & Psyche and Courbet’s Origin of the World)? Second, if they’re banning it to “protect young minds,” did you know that sexual violence is more likely to occur in places that have sexually repressed atmospheres—including the banning of pornography and sex education? And did you know that there’s no sociological data that clearly links pornography to sexual violence? Don’t take my word for it. Just look it up.

Critical thinking, as defined by The National Council for Excellence in Critical Thinking (Canada), is “the intellectually disciplined process of actively and skilfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.”

Those who want to ban and/or strictly limit the use of technology by children often site statistics that correlate the formation of ADHD to television consumption. However, they rarely engage their critical thinking skills to ask: What if it’s the type of television shows, and the interruptions of commercials, that are the cause of the ADHD? What if it’s how we consume television in the US?

 

And, yes, while I understand the need to be “better safe than sorry,” I am all for opening up the world for exploration for children. The more access they have to people, and culture, and knowledge, the better. And more often than not these days, people, cultures, and knowledge come from iPads and iPhones: “new” technology.

It would be like if, back in the day, they banned toddlers from listening to a-tracs and records as modes of consuming music and culture. It’s just a new technology used to connect with the world outside the home.

An NPR story put it succinctly:

“Why not integrate the devices into family time?

“There’s no reason whatsoever that a caregiver can’t use an app with their child,” he says. “It’s a great opportunity for what we call ‘joint attention’ — the interactions between a child and a caregiver, the back-and-forth, which is critical not just to language development, but brain development.

Sound familiar? It should. This, says Christakis, isn’t much different from sitting down and reading a book with your child.”

Furthermore, Harvard clinical psychologist Catherine Steiner-Adair recently wrote “The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age”. And what she found in her interviews was the overwhelming consistency of children complaining about having to compete with technological devices for their parents’ attention.

The problem isn’t if children are exposed to “technology.” The problem is how much and in what way people (not just children) are using technology. Critical thinking is a lost art these days apparently. Semantics make all the difference when it comes to studies and statistics.

Case in point, one great example of children, and people in general, benefiting from children’s use of technology is a BuzzFeed Article: “A Toddler Used FaceTime To Save His Mom After She Was Attacked By A Dog.” If the toddler hadn’t know how to use FaceTime on an iPhone, the mother wouldn’t have had access to immediate medical attention.

Many “adults” are so eager to blame children’s shortcomings and growing-phase awkwardness, when really it’s just a continuation of the age-old “when I was your age…” or “kids these days don’t respect their elders…” and other similar complaints.

I also found a great article listing “15 Historical Complaints About Young People Ruining Everything.” A few relevant examples:

“CORRUPTED THE MORALS OF MANY A PROMISING YOUTH

In the 1790 book Memoirs of the Bloomsgrove Family, Reverend Enos Hitchcock wrote,

‘The free access which many young people have to romances, novels, and plays has poisoned the mind and corrupted the morals of many a promising youth; and prevented others from improving their minds in useful knowledge. Parents take care to feed their children with wholesome diet; and yet how unconcerned about the provision for the mind, whether they are furnished with salutary food, or with trash, chaff, or poison?'”

And…

“THE TOTAL NEGLECT OF THE ART OF SPEAKING”

In the preface to the 1780 book A General Dictionary of the English Language, Thomas Sheridan wrote:

‘The total neglect of this art [speaking] has been productive of the worst consequences…in the conduct of all affairs ecclesiastical and civil, in church, in parliament, courts of justice…the wretched state of elocution is apparent to persons of any discernment and taste… if something is not done to stop this growing evil …English is likely to become a mere jargon, which every one may pronounce as he pleases.'”

When criticizing a new thing, whether it’s technology or an idea, just think that maybe, just maybe, there might be some advantages to counteract the disadvantages.

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May 6, 2014 · 9:35 pm

A warning to college profs from a high school teacher

By Valerie Strauss, Published: February 9 at 12:00 pm

“For more than a decade now we have heard that the high-stakes testing obsession in K-12 education that began with the enactment of No Child Left Behind 11 years ago has resulted in high school graduates who don’t think as analytically or as broadly as they should because so much emphasis has been placed on passing standardized tests. Here, an award-winning high school teacher who just retired, Kenneth Bernstein, warns college professors what they are up against. Bernstein, who lives near Washington, D.C. serves as a peer reviewer for educational journals and publishers, and he is nationally known as the blogger “teacherken.” His e-mail address is kber@earthlink.net. This appeared inAcademe, the journal of the American Association of University Professors.

By Kenneth Bernstein

You are a college professor.

I have just retired as a high school teacher.

I have some bad news for you. In case you do not already see what is happening, I want to warn you of what to expect from the students who will be arriving in your classroom, even if you teach in a highly selective institution.

No Child Left Behind went into effect for the 2002–03 academic year, which means that America’s public schools have been operating under the pressures and constrictions imposed by that law for a decade. Since the testing requirements were imposed beginning in third grade, the students arriving in your institution have been subject to the full extent of the law’s requirements. While it is true that the U.S. Department of Education is now issuing waivers on some of the provisions of the law to certain states, those states must agree to other provisions that will have as deleterious an effect on real student learning as did No Child Left Behind—we have already seen that in public schools, most notably in high schools.

Troubling Assessments

My primary course as a teacher was government, and for the last seven years that included three or four (out of six) sections of Advanced Placement (AP) U.S. Government and Politics. My students, mostly tenth graders, were quite bright, but already I was seeing the impact of federal education policy on their learning and skills.

In many cases, students would arrive in our high school without having had meaningful social studies instruction, because even in states that tested social studies or science, the tests did not count for “adequate yearly progress” under No Child Left Behind. With test scores serving as the primary if not the sole measure of student performance and, increasingly, teacher evaluation, anything not being tested was given short shrift.

Further, most of the tests being used consist primarily or solely of multiple-choice items, which are cheaper to develop, administer, and score than are tests that include constructed responses such as essays. Even when a state has tests that include writing, the level of writing required for such tests often does not demand that higher-level thinking be demonstrated, nor does it require proper grammar, usage, syntax, and structure. Thus, students arriving in our high school lacked experience and knowledge about how to do the kinds of writing that are expected at higher levels of education.

Recognizing this, those of us in public schools do what we can to work on those higher-order skills, but we are limited. Remember, high schools also have tests—No Child Left Behind and its progeny (such as Race to the Top) require testing at least once in high school in reading and math. In Maryland, where I taught, those tests were the state’s High School Assessments in tenth-grade English and algebra (which some of our more gifted pupils had taken as early as eighth grade). High schools are also forced to focus on preparing students for tests, and that leads to a narrowing of what we can accomplish in our classrooms.

I mentioned that at least half my students were in AP classes. The explosive growth of these classes, driven in part by high school rankings like the yearly Challenge Indexcreated by Jay Mathews of The Washington Post, is also responsible for some of the problems you will encounter with students entering your institutions. The College Board did recognize that not everything being labeled as AP met the standards of a college-level course, so it required teachers to submit syllabi for approval to ensure a minimal degree of rigor, at least on paper. But many of the courses still focus on the AP exam, and that focus can be as detrimental to learning as the kinds of tests imposed under No Child Left Behind.

Let me use as an example my own AP course, U.S. Government and Politics. I served several times as a reader for the examination that follows the course. In that capacity, I read the constructed responses that make up half of the score of a student’s examination. I saw several problems.

First (and I acknowledge that I bear some culpability here), in the AP U.S. Government exam the constructed responses are called “free response questions” and are graded by a rubric that is concerned primarily with content and, to a lesser degree, argument. If a student hits the points on the rubric, he or she gets the points for that rubric. There is no consideration of grammar or rhetoric, nor is credit given or a score reduced based on the format of the answer. A student who takes time to construct a clear topic sentence and a proper conclusion gets no credit for those words. Thus, a teacher might prepare the student to answer those questions in a format that is not good writing by any standard. If, as a teacher, you want your students to do their best, you have to have them practice what is effectively bad writing— no introduction, no conclusion, just hit the points of the rubric and provide the necessary factual support. Some critical thinkingmay be involved, at least, but the approach works against development of the kinds of writing that would be expected in a true college-level course in government and politics.

My students did well on those questions because we practiced bad writing. My teaching was not evaluated on the basis of how well my students did, but I felt I had a responsibility to prepare them for the examination in a way that could result in their obtaining college credit.

I would like to believe that I prepared them to think more critically and to present cogent arguments, but I could not simultaneously prepare them to do well on that portion of the test and teach them to write in a fashion that would properly serve them at higher levels of education.

Even during those times when I could assign work that required proper writing, I was limited in how much work I could do on their writing. I had too many students. In my final year, with four sections of Advanced Placement, I had 129 AP students (as well as an additional forty-six students in my other two classes). A teacher cannot possibly give that many students the individualized attention they need to improve their writing. Do the math. Imagine that I assign all my students a written exercise. Let’s assume that 160 actually turn it in. Let’s further assume that I am a fast reader, and I can read and correct papers at a rate of one every three minutes. That’s eight hours—for one assignment. If it takes a more realistic five minutes per paper, the total is more than thirteen hours.

Further, the AP course required that a huge amount of content be covered, meaning that too much effort is spent on learning information and perhaps insufficient time on wrestling with the material at a deeper level. I learned to balance these seemingly contradictory requirements. For much of the content I would give students summary information, sufficient to answer multiple-choice questions and to get some of the points on rubrics for the free response questions. That allowed me more time for class discussions and for relating events in the news to what we learned in class, making the class more engaging for the students and resulting in deeper learning because the discussions were relevant to their lives.

From what I saw from the free response questions I read, too many students in AP courses were not getting depth in their learning and lacked both the content knowledge and the ability to use what content knowledge they had.

The structure of testing has led to students arriving at our school without what previously would have been considered requisite background knowledge in social studies, but the problem is not limited to this field. Students often do not get exposure to art or music or other nontested subjects. In high-need schools, resources not directly related to testing are eliminated: at the time of the teachers’ strike last fall, 160 Chicago public schools had no libraries. Class sizes exceeded forty students—in elementary school.

A Teacher’s Plea

As a retired public school teacher, I believe I have a responsibility to offer a caution to college professors, or perhaps to make a plea.

Please do not blame those of us in public schools for how unprepared for higher education the students arriving at your institutions are. We have very little say in what is happening to public education. Even the most distinguished and honored among us have trouble getting our voices heard in the discussion about educational policy. The National Teacher of the Year is supposed to be the representative of America’s teachers—if he or she cannot get teachers’ voices included, imagine how difficult it is for the rest of us. That is why, if you have not seen it, I strongly urge you to read 2009 National Teacher of the Year Anthony Mullen’s famous blog post, “Teachers Should Be Seen and Not Heard.” After listening to noneducators bloviate about schools and teaching without once asking for his opinion, he was finally asked what he thought. He offered the following:

Where do I begin? I spent the last thirty minutes listening to a group of arrogant and condescending noneducators disrespect my colleagues and profession. I listened to a group of disingenuous people whose own self-interests guide their policies rather than the interests of children. I listened to a cabal of people who sit on national education committees that will have a profound impact on classroom teaching practices. And I heard nothing of value. “I’m thinking about the current health-care debate,” I said. “And I am wondering if I will be asked to sit on a national committee charged with the task of creating a core curriculum of medical procedures to be used in hospital emergency rooms.”

The strange little man cocks his head and, suddenly, the fly on the wall has everyone’s attention.

“I realize that most people would think I am unqualified to sit on such a committee because I am not a doctor, I have never worked in an emergency room, and I have never treated a single patient. So what? Today I have listened to people who are not teachers, have never worked in a classroom, and have never taught a single student tell me how to teach.”

During my years in the classroom I tried to educate other adults about the realities of schools and students and teaching. I tried to help them understand the deleterious impact of policies that were being imposed on our public schools. I blogged, I wrote letters and op-eds for newspapers, and I spent a great deal of time speaking with and lobbying those in a position to influence policy, up to and including sitting members of the US House of Representatives and Senate and relevant members of their staffs. Ultimately, it was to little avail, because the drivers of the policies that are changing our schools—and thus increasingly presenting you with students ever less prepared for postsecondary academic work—are the wealthy corporations that profit from the policies they help define and the think tanks and activist organizations that have learned how to manipulate the levers of power, often to their own financial or ideological advantage.

If you, as a higher education professional, are concerned about the quality of students arriving at your institution, you have a responsibility to step up and speak out. You need to inform those creating the policies about the damage they are doing to our young people, and how they are undermining those institutions in which you labor to make a difference in the minds and the lives of the young people you teach as well as in the fields in which you do your research.

You should have a further selfish motivation. Those who have imposed the mindless and destructive patterns of misuse of tests to drive policy in K–12 education are already moving to impose it on higher education, at least in the case of the departments and schools of education that prepare teachers: they want to “rate” those departments by the test scores of the students taught by their graduates.

If you, as someone who teaches in the liberal arts or engineering or business, think that this development does not concern you, think again. It is not just that schools and colleges of education are major sources of revenue for colleges and universities—they are in fact often cash cows, which is why so many institutions lobby to be able initially to certify teachers and then to offer the courses (and degrees) required for continuing certification. If strictures like these can be imposed on schools and colleges of education, the time will be short before similar kinds of measure are imposed on other schools, including liberal arts, engineering, business, and conceivably even professional schools like medicine and law. If you teach either in a medical school or in programs that offer courses required as part of the pre-med curriculum, do you want the fatality rates of patients treated by the doctors whom you have taught to be used to judge your performance? If you think that won’t happen because you work at a private institution, remember that it is the rare private university that does not receive some form of funding from governments, local to national. Research grants are one example; the scholarships and loans used by students to attend your institution are another.

Let me end by offering my deepest apologies, not because I may have offended some of you by what I have written, but because even those of us who understood the problems that were being created were unable to do more to stop the damage to the education of our young people. Many of us tried. We entered teaching because we wanted to make a difference in the lives of the students who passed through our classrooms. Many of us are leaving sooner than we had planned because the policies already in effect and those now being implemented mean that we are increasingly restricted in how and what we teach.

Now you are seeing the results in the students arriving at your institutions. They may be very bright. But we have not been able to prepare them for the kind of intellectual work that you have every right to expect of them. It is for this that I apologize, even as I know in my heart that there was little more I could have done. Which is one reason I am no longer in the classroom.”

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August 8, 2013 · 7:15 pm

American Way of Birth, Costliest in the World

Josh Haner/The New York Times

“I feel like I’m in a used-car lot.” Renée Martin, who, with her husband, is paying for her maternity care out of pocket.

By  | Published: June 30, 2013

“Throughout this article, readers have shared their experiences by responding to questions about their perspective on pregnancy care. Comments are now closed, but you may explore the responses received.

Elisabeth Rosenthal, reporter

LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epiduralanesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for anultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute thesingle biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

“It’s not primarily that we get a different bundle of services when we have a baby,” said Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs. “It’s that we pay individually for each service and pay more for the services we receive.”

Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care.

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey by Childbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

Only in America

In most other developed countries, comprehensive maternity care is free or cheap for all, considered vital to ensuring the health of future generations.

Ireland, for example, guarantees free maternity care at public hospitals, though women can opt for private deliveries for a fee. The average price spent on a normal vaginal delivery tops out at about $4,000 in Switzerland, France and the Netherlands, where charges are limited through a combination of regulation and price setting; mothers pay little of that cost.

The chasm in price is true even though new mothers in France and elsewhere often remain in the hospital for nearly a week to heal and learn to breast-feed, while American women tend to be discharged a day or two after birth, since insurers do not pay costs for anything that is not considered medically necessary.

Only in the United States is pregnancy generally billed item by item, a practice that has spiraled in the past decade, doctors say. No item is too small. Charges that 20 years ago were lumped together and covered under the general hospital fee are now broken out, leading to more bills and inflated costs. There are separate fees for the delivery room, the birthing tub and each night in a semiprivate hospital room, typically thousands of dollars. Even removing the placenta can be coded as a separate charge.

Each new test is a new source of revenue, from the hundreds of dollars billed for the simple blood typing required before each delivery to the $20 or so for the splash of gentian violet used as a disinfectant on the umbilical cord (Walgreens’ price per bottle: $2.59). Obstetricians, who used to do routine tests like ultrasounds in their office as part of their flat fee, now charge for the service or farm out such testing to radiologists, whose rates are far higher.

Add up the bills, and the total is startling. “We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.

In almost all other developed countries, hospitals and doctors receive a flat fee for the care of an expectant mother, and while there are guidelines, women have a broad array of choices. “There are no bills, and a hospital doesn’t get paid for doing specific things,” said Charlotte Overgaard, an assistant professor of public health at Aalborg University in Denmark. “If a woman wants acupuncture, an epidural or birth in water, that’s what she’ll get.”

Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.

Some social factors drive up the expenses. Mothers are now older than ever before, and therefore more likely to require or request more expensive prenatal testing. And obstetricians face the highest malpractice risks among physicians and pay hundreds of thousands of dollars a year for insurance, fostering a “more is safer” attitude.

But less than 25 percent of America’s high payments for pregnancy typically go to obstetricians, and they often charge a flat fee for their nine months of care, no matter how many visits are needed, said Dr. Robert Palmer, the chairman of the committee for health economics and coding at the American College of Obstetricians and Gynecologists. That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data.

Rather it is the piecemeal way Americans pay for this life event that encourages overtreatment and overspending, said Dr. Kozhimannil, the Minnesota professor. Recent studies have found that more than 30 percent of American women have Caesarean sections or have labor induced with drugs — far higher numbers than those of other developed countries and far above rates that the American College of Obstetricians and Gynecologists considers necessary.

During the course of her relatively uneventful pregnancy, Ms. Martin was charged one by one for lab tests, scans and emergency room visits that were not included in the doctor’s or the hospital’s fee. During her seventh month, she described one week’s experience: “I have high glucose, and I tried to take a three-hour test yesterday and threw up all over the lab. So I’m probably going to get charged for that. And my platelets are low, so I’m going to have to see a hematologist. So I’m going to get charged for that.”

She sighed and put her head in her hands. “Welcome to my world,” she said.

Extras Add Up

Though Ms. Martin has yet to receive her final bills, other couples describe being blindsided by enormous expenses. After discovering that their insurance did not cover pregnancy when the first ultrasound bill was denied last year, Chris Sullivan and his wife, both freelance translators in Pennsylvania, bought a $4,000 pregnancy package from Delaware County Memorial Hospital; a few hospitals around the country are starting to offer such packages to those patients paying themselves.

The couple knew that price did not cover extras like amniocentesis, a test for genetic defects, or an epidural during labor. So when the obstetrician suggested an additional fetal heart scan to check for abnormalities, they were careful to ask about price and got an estimate of $265. Performed by a specialist from the Children’s Hospital of Philadelphia, it took 30 minutes and showed no problems — but generated a bill of $2,775.

“All of a sudden I have a bill that’s as much as I make in a month, and is more than 10 times what I’d been quoted,” Mr. Sullivan said. “I don’t know how I could have been a better consumer, I asked for a quote. Then I get this six-part bill.” After months of disputing the large discrepancy between the estimate and the bill, the hospital honored the estimate.

Christopher Gregory/The New York Times

“Most insurance companies wouldn’t blink at my bill, but it was absurd.” Dr. Marguerite Duane, who questioned line items on her hospital bill.

Mr. Sullivan noted that the couple ended up paying $750 for an epidural, a procedure that has a list price of about $100 in his wife’s native Germany.

Even women with the best insurance can still encounter high prices. After her daughter was born five years ago, Dr. Marguerite Duane, 42, was flabbergasted by the line items on the bills, many for blood tests she said were unnecessary and medicines she never received. She and her husband, Dr. Kenneth Lin, both associate professors of family medicine at Georgetown Medical School, had delivered babies in their early years of practice.

So when she became pregnant again in 2011, she decided to be more assertive about holding down costs. After a routine ultrasound scan at 20 weeks showed a healthy baby, she refused to go back for weekly follow-up scans that the radiologist suggested during the last months of her pregnancy even though medical guidelines do not recommend them. When in the hospital for the delivery of her son Ellis in February, she kept a list of every medicine and every item she received.

Though she delivered Ellis with a midwife 12 minutes after arriving at the hospital and was home the next day, the hospital bill alone was more than $6,000, and her insurance co-payment was about $1,500. Her first two pregnancies, both more than five years ago, were fully covered by federal government insurance because her husband worked for the Agency for Health Care Research and Quality.

“Most insurance companies wouldn’t blink at my bill, but it was absurd — it was the least medical delivery in history,” said Dr. Duane, who is taking a break from practice to stay home with her children. “There were no meds. I had no anesthesia. He was never in the nursery. I even brought my own heating pad. I tried to get an explanation, but there were items like ‘maternity supplies.’ What was that? A diaper?”

Ms. Martin is similarly well positioned to be an expert consumer of health care. She administered the health plan for a large art gallery she managed in Los Angeles before marrying and moving to Vermont in 2011 to enroll in a year of pre-med classes at the University of Vermont. She has a scholarship this fall for a master’s degree program at Vanderbilt University’s Center for Medicine, Health and Society, and then she plans to go on to medical school. Her father-in-law is a pediatrician.

RENÉE MARTIN’S PREGNANCY COSTS

prenatal

She and her husband, who works for a small music licensing company that does not provide insurance, hoped to start their family during the year they were covered by university insurance in Vermont, she said, but “nature didn’t cooperate.”

Then they moved to the New Hampshire summer resort of Laconia, her husband’s hometown, for a year before she started the grind of medical training. But in New Hampshire, they discovered, health insurance they could buy on the individual market did not cover maternity care without the purchase of an additional “pregnancy rider” for $800 a month. With their limited finances and unsuccessful efforts at conceiving, it seemed an unwise, if not impossible, investment.

Soon after buying insurance coverage without the rider for $450 a month, Ms. Martin discovered she was pregnant. Her elation was quickly undercut by worry.

“We’re not poor. We pay our bills. We have medical insurance. We’re not looking for a handout,” Ms. Martin said, noting that her husband makes too much money for her to qualify for Medicaid or other subsidized programs for low-income women. “The hospital is doing what it can. Our doctors are taking wonderful care of us. But the economics of this system are a mess.”

Not knowing whether the pregnancy would fall at the $4,000 or $45,000 end of the range the hospital cited, the couple had a hard time budgeting their finances or imagining their future. The hospital promised a 30 percent discount on its final bill. “I’m trying not to be stressed, but it’s really stressful,” Ms. Martin said as her due date approached.

Package Deals

With costs spiraling, some hospitals are starting to offer all-inclusive rates for pregnancy. Maricopa Medical Center, a public hospital in Phoenix, began offering uninsured patients a comprehensive package two years ago. “Making women choose during labor whether you want to pay $1,000 for an epidural, that didn’t seem right,” said Dr. Dean Coonrod, the hospital’s chief of obstetrics and gynecology.

The hospital charges $3,850 for a vaginal delivery, with or without an epidural, and $5,600 for a planned C-section — prices that include standard hospital, doctors’ and testing fees. To set the price, the hospital — which breaks even on maternity care and whose doctors are on salaries — calculated the average payment it gets from all insurers. While Dr. Coonrod said the hospital might lose a bit of money, he saw other benefits in a market where everyone will have insurance in just a few years: mothers tend to feel allegiance to the place they give birth to their babies and might seek other care at Maricopa in the future.

Laura Segall for The New York Times

“Making women choose during labor whether you want to pay $1,000 for an epidural, that didn’t seem right.” Dr. Dean Coonrod, chief of obstetrics and gynecology at Maricopa Medical Center in Phoenix

The Catalyst for Payment Reform, a California policy group, has proposed that all hospitals should offer such bundled prices and that rates should be the same, no matter the type of delivery. It suggests that $8,000 might be a reasonable starting point. But that may be hard to imagine in markets like New York City, where $8,000 is less than many private doctors charge for their fees alone.

One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need. Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States. In Germany, midwives were paid less than $325 for an 11-hour delivery and about $30 for an office visit in 2011.

Dr. Palmer of the American College of Obstetricians and Gynecologists acknowledged the preference for what he called “medicalized” deliveries in the United States, with IVs, anesthesia and a proliferation of costly ultrasounds. He said the organization was working to define standards for the scans.

To control costs in the United States, patients may also have to alter their expectations, including the presence of an obstetrician at every prenatal visit and delivery. “It’s amazing how much patients buy into our tendency to do a lot of tests,” said Eugene Declercq, a professor at Boston University who studies international variations in pregnancy. “We’ve met the problem, and it’s us.”

Starting next year, insurance policies will be required under the Affordable Care Act to include maternity coverage, so no woman should be left paying entirely on her own, like Ms. Martin. But the law is not explicit about what services must be included in that coverage. “Exactly what that means is the crux of the issue,” Dr. Kozhimannil said.

If the high costs of maternity care are not reined in, it could break the bank for many states, which bear the brunt of Medicaid payouts. Medicaid, the federal-state government health insurance program for the poor, pays for more than 40 percent of all births nationally, including more than half of those in Louisiana and Texas. But even Medicaid, whose payments are regarded as so low that many doctors refuse to take patients covered under the program, paid an average of $9,131 for vaginal births and $13,590 for Caesarean deliveries in 2011.

Insured women are still getting the recommended prenatal care, despite rising out-of-pocket costs, according to a recent study. But that does not mean they are not feeling the strain, said Dr. Kozhimannil, the study’s lead author. The average amount of savings among pregnant women in the study was $3,000 to $5,000. “People will find ways to scrape by for medical care for their new baby, but are young mothers taking care of themselves? And what happens when they need to start buying diapers?” she asked. “Something’s got to give.”

Ms. Martin, who busied herself making toys as her due date neared, could not stop fretting about the potential cost of a complicated delivery. “I know that a C-section could ruin us financially,” she said.

On May 25, she had a healthy daughter, Isla Daisy, born by vaginal delivery. Mother and daughter went home two days later.

She and her husband are both overjoyed and tired. And, she said, they are “dreading” the bills, which she estimates will be over $32,000 before negotiations begin. Her labor was induced, which required intense monitoring, and she also had an epidural.

“We’re bracing for it,” she said.

This article has been revised to reflect the following correction:

Correction: July 2, 2013

An article on Monday about the high cost of maternity and newborn care in the United States misstated the number of years ago that Dr. Marguerite Duane’s daughter was born. It was five years ago, not seven. The article also misidentified which of Dr. Duane’s sons was born in February. He is Ellis — not Isaac, who is her older son.

A version of this article appeared in print on July 1, 2013, on page A1 of the New York edition with the headline: American Way of Birth, Costliest in the World.”

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July 11, 2013 · 3:20 pm

An ‘Adventure’ For Kids, And Maybe For Their Parents Too

June 17, 2013 2:54 AM
Finn is in the middle, with the skinny arms. Jake is the dog. Together, they have Adventure Time.

Finn is in the middle, with the skinny arms. Jake is the dog. Together, they have Adventure Time.

Cartoon Network

“Count plenty of grownups among the millions of fans of Adventure Time, a kids’ show on Cartoon Network. Some are surely Emmy voters. (It’s won three.) Others are very possibly stoners. Still others are intellectuals. Lev Grossman falls in the last category. He wrote two best-selling novels, The Magicians and The Magician King, and he’s Time‘s senior book critic.

Grossman’s critique of Adventure Time? “It’s soooo smart! It’s sooo intelligent!”

Hang on. He’s just getting started.

“I am a little bit obsessed with it,” Grossman continues. “It’s rich and complicated the way Balzac’s work is. Which is a funny thing to say about a cartoon.”

For the uninitiated, Adventure Time is set in a surreally pastel post-apocalyptic kingdom crawling with mutated candy creatures, bizarre princesses — think Slime Princess and Lumpy Space Princess — and our two heroes. They’re Finn and Jake, a gangly human boy and his moon-eyed yellow dog.

The show’s creator, Pendleton Ward, modeled Jake partly after Bill Murray’s sardonic camp counselor in the 1979 movie Meatballs, a cooler-than-cool older-brother figure who can laugh at his charges without being mean, and whose teachable moments are anything but cloying.

“Jake sees his own death in one episode,” says Ward. “And Finn has to deal with that. Jake’s a hip guy. He can watch his own death and he’s comfortable with it. And that’s a weird thing especially for Finn, who’s super young, and it’s really hard on him.”

In the episode, called “New Frontier,” Jake experiences a vision during which he’s taken to an afterlife of stars and darkness by a little banana-like creature (voiced by Weird Al Yankovic).

“When I die, I’m gonna be all around you,” he reassures Finn. “In your nose. And your dreams. And socks! I’ll be a part of you in your earth mind. It’s gonna be great!”

“That episode was really tough to tackle, writing for a children’s television show,” Ward remembers. “And it was hard for us to really not make it so sad and scary that you feel really sad and scared watching it.”

Adventure Time insists on emotional honesty— even in its bad guys, usually depicted as cardboard villains in kids’ cartoons.

Grossman offers the shrill, socially maladapted Earl of Lemongrab as an example. An unlikable character, his story is movingly explored and raises questions nearly every kid has wondered about: Why do I seem weird to other people? Why do I seem weird to myself?

Or take the buffoonish, bandy-legged and morally compromised Ice King. “[He’s] psychologically plausible,” Grossman observes. “He’s an old lecherous man who has a magical crown. It’s made him into this strange, awful individual who goes around capturing princesses.”

The King’s crown wiped his mind and warped his body. He’ll die if he takes it off.

“Which is this rather moving tension, and he doesn’t remember who he used to be, but other people do,” Grossman says. “It’s very affecting. My dad has been going through having Alzheimer’s and he’s forgotten so much about who he used to be. And I look at him and … this cartoon is about my father dying.”

In spite of the critical admiration, the warm feelings of fans and the prestigious awards,Adventure Time nearly never aired. “It actually felt like a great risk,” says Rob Sorcher, the Cartoon Network’s chief content officer. “It’s not slick. It doesn’t feel manufactured for kids, so who’s it for?”

Um, perhaps partly for the kind of grownup who might watch Yo Gabba Gabba with a little chemical assist?

“For me, it doesn’t come from that place,” says Adventure Time‘s creator, Pendelton Ward. “For me, it comes from my childhood, wandering in my mind. You can’t really go anywhere when you’re a kid. You don’t have a car. You don’t have anything but a backyard and a brain. And that’s where I’m coming from when I’m writing it.” He pauses. “I can’t speak for all the writers on the show.”

Ward and his mom used to watch cartoons together when he was a kid, but he claims today he’s not writing specifically for a co-viewing audience of parents and kids. Still, author Lev Grossman says Adventure Time works for him and his eight-year-old daughter Lily equally.

“It’s really important for us to have something we can enjoy together and talk about together. It gives us in some ways a common language for talking about more important issues,” he says.

Adventure Time‘s world used to be our world. Then it was destroyed by a war. It’s strewn with detritus such as old computers, VHS tapes, and video games from the 1980s.

“It takes my childhood, the shattered pieces of it, and builds it into something new, which is now part of Lily’s childhood,” he says, almost in wonder.”

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June 18, 2013 · 6:53 pm

The Problem with ‘Boys Will Be Boys’

Posted: 05/06/2013 12:26 pm

 

“This post was originally published inRole/Reboot.

For months, every morning when my daughter was in preschool, I watched her construct an elaborate castle out of blocks, colorful plastic discs, bits of rope, ribbons and feathers, only to have the same little boy gleefully destroy it within seconds of its completion.

It was obvious that this little guy got massive joy out of doing this. The first time, my daughter just stared in amazement and I tried to help her rebuild. Second time: sadness. Third time: The Injustice! “Why did he do that again?” Fourth time: Royally Pissed Girl wanted to know why his parent didn’t stop him. And what about me? Fifth time: She was ready with some ideas about stopping him.

During the course of this socialization exercise, we tried several strategies and his parents engaged in conversation with us, but mostly me. One or the other of them would occasionally, always after the fact, smile and apologize as they whisked him away. Figuring out what they would say next became a fun game:

“You know! Boys will be boys!” 

“He’s just going through a phase!”

“He’s such a boy! He LOVES destroying things!”

“Oh my god! Girls and boys are SO different!”

“He. Just. Can’t. Help himself!”

No matter how many times he did it, they never swooped in BEFORE the morning’s live 3-D reenactment of “Invasion of AstroMonster.”

I tried to teach my daughter how to stop this from happening. She asked him politely not to do it. We talked about some things she might do. She moved where she built. She stood in his way. She built a stronger foundation to the castle, so that, if he did get to it, she wouldn’t have to rebuild the whole thing. In the meantime, I imagine his parents thinking, “What red-blooded boy wouldn’t knock it down?”

She built a beautiful, glittery castle in a public space.

It was so tempting.

He just couldn’t control himself and, being a boy, had violent inclinations.

She had to keep her building safe.

Her consent didn’t matter. Besides, it’s not like she made a big fuss when he knocked it down. It wasn’t a “legitimate” knocking over if she didn’t throw a tantrum.

His desire — for power, destruction, control, whatever- – was understandable.

Maybe she “shouldn’t have gone to preschool” at all. OR, better if she just kept her building activities to home.

I know it’s a lurid metaphor, but I taught my daughter the preschool block precursor of don’t “get raped” and this child, Boy #1, did not learn the preschool equivalent of “don’t rape.

Not once did his parents talk to him about invading another person’s space and claiming for his own purposes something that was not his to claim. Respect for my daughter and her work and words was not something he was learning. It was, to them, some kind of XY entitlement. How much of the boy’s behavior in coming years would be excused in these ways, be calibrated to meet these expectations and enforce the “rules” his parents kept repeating?

There was another boy who, similarly, decided to knock down her castle one day. When he did it his mother took him in hand, explained to him that it was not his to destroy, asked him how he thought my daughter felt after working so hard on her building and walked over with him so he could apologize. That probably wasn’t much fun for him, but he did not do it again.

There was a third child. He was really smart. He asked if he could knock her building down. She, beneficent ruler of all pre-circle-time castle construction, said yes… but only after she was done building it and said it was OK. They worked out a plan together and eventually he started building things with her and they would both knock the thing down with unadulterated joy. You can’t make this stuff up.

Take each of these three boys and consider what he might do when he’s older, say, at college, drunk at a party, mad at an ex-girlfriend who rebuffs him and uses words that she expects will be meaningful and respecte, “No, I don’t want to. Stop. Leave.”

Based on Boy #1’s parents blanket gender essentialisms and explanations, my daughter and the kids around her could easily have come to the conclusion that all boys went through this phase, are so different from girls, cannot control themselves, and love destroying things. But, that’s not the case. Some do. Some don’t. There are also lots of girls who are very interested in ripping things apart systematically.

I have one of those, too. “Destructo Girl” was our nickname for this daughter. Given the slightest opportunity,she would grab whatever toy either of her sisters was playing with and run, giddy with power, to the top of a landing only to dash whatever was in her hand down two flights of stairs. She beamed with joy as it clattered and shattered. But, we figured just because she could do it, didn’t mean she should and eventually she understood that, even if she wanted to and it was fun, she couldn’t continue to violate her sisters’ rights as citizens of our household.

“Girls will be girls?” I don’t think so. Nor do we say things like, “She just can’t help herself.” I have heard parents of daughters so inclined say things like, “She’s just so rambunctious!” But, in my experience, most people assume girls, as a class, can control themselves better, faster, more completely, and that boys have a harder time. There are many studies that indicate the reasons why this might be true, including the fact that we teach girls to delay gratification more and also to put their needs last. But, it does not appear to be innate.

Boy #1? Yes, maybe he had impulse control issues. Maybe it would take a lot of time to teach him about self-control, like Daughter #2. Maybe it would take even longer to teach him about personal boundaries and other people’s rights. Maybe he had genuine problems with all of those things that needed to be addressed in more thorough ways than morning time social interactions.

But that boy — and many others like him — never got the benefit of the doubt. This behavior gets rewarded or not, amplified or not, sanctioned tacitly or not. Both on individual and cultural levels. To be clear: I’m not saying that there is causality between knocking down blocks in preschool and assaulting people later. I am not saying that all boys with bad manners, poor impulse control, ADHD or other behavioral issues will be rapists or abuse spouses. I’m saying the world would be a different kind of place if children were taught to respect other children’s rights from the start. Rights to be, to do, to look certain ways and not others. And that teaching children these things has profound implications for society. Anyone who has studied or worked in the field of domestic violence can tell you that the “overarching attitudinal characteristic” of abusive men is entitlement and the belief that they have rights without responsibility to or respect for others. Similar attitudes feed our steady stream of sexual assault and rape.

In general, I’m a strict non-interventionist when it comes to other people’s children, unless I am explicitly responsible for them and their safety. But, one morning, when it really became clear that Boy #1’s parents were utterly useless as people who could teach their son to be aware of others, empathetic and yes, kinder, I picked him up and moved him away from my daughter. I asked him gently if he understood the word “forever.” He said yes. Putting him down, I added that he was to stay away from my daughter and her castles for that length of time. So far, so good.”

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June 14, 2013 · 4:11 pm

Toddlers Killed More Americans Than Terrorists Did This Year

By Stacie Borrello, Tue, June 11, 2013

article image

“Americans hate terrorists and love our kids, right? So you might be shocked to know that preschoolers with guns have taken more lives so far this year than the single U.S. terrorist attack, which claimed four lives in Boston.

This is admittedly tongue-in-cheek, but one has to wonder if the NSA’s PRISM program would have saved more lives had it been monitoring toddlers – or gun owners – rather than suspected terrorists.

11 Deaths in Five Months Where Shooter Was 3 to 6 Years Old

Listed below are the 11 gun fatalities I found where a preschooler pulled the trigger (from Jan. 1 to June 9, 2013). Starting with a list of five toddler shooting deaths The Jewish Daily Forwardpublished in early May, I unearthed six additional cases. This tragic, unthinkable event has happened every month, like clock-work.

Jan. 10: 6-year-old playmate shoots and kills 4-year-old Trinity Ross, Kansas City, Kan.

Feb. 11: 4-year-old Joshua Johnson shoots and kills himself, Memphis, Tenn.

Feb. 24: 4-year-old Jaiden Pratt dies after shooting himself in the stomach while his father sleeps, Houston.

March 30: 4-year-old Rahquel Carr shot and killed either by 6-year-old brother or another young playmate, Miami.

April 6: Josephine Fanning, 48, shot and killed by 4-year-old boy at a barbecue, Wilson County, Tenn.

April 8: 4-year-old shoots and kills 6-year-old friend Brandon Holt, Toms River, N.J.

April 9: 3-year-old is killed after he finds a pink gun that he thinks is a toy, Greenville, S.C.

April 30: 2-year-old Caroline Sparks killed by her 5-year-old brother with his Cricket “My First Rifle” marketed to kids, Cumberland County, Ky.

May 1: 3-year-old Darrien Nez shoots himself in the face and dies after finding his grandmother’s gun, Yuma, Ariz.

May 7: 3-year-old Jadarrius Speights fatally shoots himself with his uncle’s gun, Tampa, Fla.

June 7: 4-year-old fatally shoots his father, Green Beret Justin Thomas, Prescott Valley, Ariz.

At least 10 more toddlers have shot but not killed themselves or someone else this year (seehereherehereherehereherehereherehere and here). In the first three cases, the shooter was only 2 years old.

I also found nine instances where children and teens 7 to 19 years old accidentally killed themselves, a family member or friend since January (see herehereherehereherehere,herehere and here).

Of course, most if not all of the above deaths and injuries can be attributed to careless adult gun owners.

While this analysis focuses on children, another equally accurate headline could read: “U.S. Gun Culture Kills More Americans Than Terrorists Worldwide.”

In 2010, 13,186 people died in terrorist attacks worldwide, while 31,672 people were killed with firearms in America alone, reports CNN’s Samuel Burke. 

We Need a Return to ‘Well-Regulated’ Gun Ownership

We cannot deny that guns pose a real danger to innocent American lives and especially to children. While no one is “coming to take the guns” of responsible people, we still must reach a compromise to address gun violence. I do not have all the answers, but I know as responsible citizens we have to do something.

While some people refuse to accept any limits on gun ownership, we simply do not have the right in America to circumvent personal restrictions that protect society as a whole. We can drink and we can drive, but we cannot mix the two. We have free speech, but we cannot shout “fire” in a crowded theater. We have the Fourth Amendment, but we still submit to searches of our bodies and belongings for the sake of air safety.

People who worship the Second Amendment should recognize the “well-regulated” aspect of gun ownership that the forefathers intended. Instead, we have a gun lobby that pays off senators to vote against background checks and gun culture that welcomes a 3-year-old as a lifetime NRA member. I worry for that child’s playmates.

Follow the author: @LiberaLLamp on Twitter – On Facebook

Sources: The Jewish Daily ForwardCNN

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June 14, 2013 · 4:05 pm