Telemedicine Gaining Momentum

Posted on by Elias Tsapelas

Amidst the hardship and disruption of the coronavirus pandemic, the rise of telemedicine has been a small silver lining. Shortly after the public health emergency began, it became clear that adequate access to health care would be a problem. In the months that followed, actions taken by Missouri’s government, patients, and providers alike led to tremendous growth in remote care services. The question now is what role telemedicine should play once the virus is defeated.

Back in March, I wrote about the need for Missouri to make telemedicine more accessible. To contain the virus, Missourians were asked to stay at home even in cases where they’d normally receive care. It made sense to take advantage of telemedicine to allow those at risk to limit their exposure to COVID-19 wherever possible. The problem was that state laws and regulations were restricting access to the service (read more about the restrictions here). Fortunately, the governor rightfully waived many of those restrictions temporarily, and the state legislature followed suit by allowing out-of-state providers to begin caring for Missourians.

Over the next few months, many patients tried telemedicine for the very first time, and providers responded by ramping up their remote care offerings. In fact, by April, telemedicine grew to account for nearly 70 percent of all health care encounters in the country. And though that number has since declined, there are still far more remote visits happening today than there were before the pandemic.

While telemedicine may be a silver lining, it is certainly not a silver bullet. Many people’s health care issues are serious enough that they cannot be sufficiently addressed remotely. And for many Missourians, it is simply more desirable to see their health care providers in person rather than on their phone or computer screen. This does not mean that telemedicine services aren’t valuable. The takeaway should be that the complex issue of health care access cannot be solved by any one-size-fits-all approach. The issue also underscores the importance of patients and providers deciding the best ways to deliver care going forward, not government bureaucrats.

Policymakers need to remember what we’ve learned during this unprecedented time and take the necessary steps to keep the momentum going. That means permanently ending the regulations and barriers for telemedicine that were temporarily lifted back in the spring. Telemedicine may not fix everything that’s wrong with health care in Missouri, but it should be open and available to all who need and benefit from it.

Election Day Is a Great Day for Civics Education

Posted on by Michael McShane

My friend James Shuls is giving so-called “action civics” education a good fisking (here, here, and here) and I just wanted to add one quick point.

Frederick Hess of the American Enterprise Institute has been similarly concerned with American schools teaching students a form of civics that is “participation-centric.” It is of course important for students to learn how to vote and how to contact their elected officials, but, as Hess argues, this is the easy stuff of civics education.

As Hess puts it:

A participation-centric approach to civics education is insufficient because it emphasizes what citizens must do to get their way but slights the reality that we frequently won’t get our way—and can even give students the sense that it’s somehow illegitimate when we don’t.  In a nation as sprawling, dynamic, and diverse as ours, it’s a sure thing that many citizens won’t get their way—even when everyone is engaged and operating in good faith. Civics education must help students understand this reality and the safeguards that protect us when we don’t get our way.

Today’s election is a great opportunity to reinforce this idea. Very few people, anywhere, will cast a ballot in which every single candidate, ballot initiative, or constitutional amendment they select will win. Everyone will be a mix of disappointed and satisfied.

So what can teachers do? They can explain that our Founding Fathers anticipated this very thing. They can explain how our American system diffuses power both horizontally (among the branches of government) and vertically (among the federal, state, and local governments) so that no one group is ever entirely in control. This allows the various factions (as James Madison called them) to keep each other in check and work out their differences in a variety of different venues. They can tell students that are upset with the result of the federal election to look at what is happening in their state or local community, or vice versa. Teachers can explain that even if their preferred candidate did not win, our system of government has safeguards built in to protect them and that there will be more elections in the future, and more chances to have their voices heard.

Elections are about more than winning. They are the process by which a free people adjudicate their differences. If we focus too much on the result of elections, we risk delegitimizing the process. If we erode the norms and values upon which elections are built, we risk losing the means of maintaining a representative democracy.

Action Civics: Teaching Students to Become Activists (Part 3 of 3)

Posted on by James V. Shuls

In my previous two posts on action civics (which you can find here and here), I have suggested that this form of pedagogy is dangerous for two reasons. First, it asks students to become activists in solving problems while failing to give them the tools to fully consider the varying arguments and nuances of an issue. It encourages them to view issues in black and white terms. Second, action civics pushes a model of what it means to be an “active citizen” that many Americans may not agree with.

This post is intended to address a concern that my critics may raise. I can already hear the question: Don’t you think students should have a voice in important issues that affect them and society?

The answer is a resounding yes!

But we can achieve that without pushing a political ideology on students and without the explicit aim of turning students into activists. And, importantly, giving students a voice should not be the only goal of civics education. Indeed, voice by itself is neither a good or bad thing. An uninformed voice can do harm to the individual and society.

The primary goal of civics education, apart from helping students understand how government works, should be to help students be reflective and compassionate individuals. It should be to equip them with the tools to weigh arguments and to decide on a course of action, not to leap to a course of action, consequences be damned.

In their report on action civics, Thomas Lindsay and Lucy Meckler examined 27 political projects listed on the website of Generation Citizen, an action civics organization. Let’s consider just two of the issues noted by Lindsay and Meckler—raising the minimum wage and funding a year-round homeless shelter for LGBTQ+ youth.

Action civics would have the students identify an issue (in this case, poverty), identify a cause (low wages), and advocate for a solution (increase the minimum wage). But of course, there are many other issues at play here. The goal of action civics is to have students do something about the problem. A better goal is to help students understand the issues surrounding a problem. In a discussion about the minimum wage, or any other contentious issue, a good teacher should ask students to consider various viewpoints. If those views do not come up naturally from other students, the teacher should even play devil’s advocate. They should ask: What will happen if businesses are required to raise the wages they pay? Where will the money come from? Do you think this will lead businesses to hire more or fewer workers? Who will be hurt or helped by increasing the minimum wage?

These are discussions students and teachers should have. It is okay at the end of the day for the students to still support raising the minimum wage. It is not okay for them to never hear the other arguments or question their assumptions.

Similarly, consider the project where students advocated for funding a homeless shelter for LGBTQ+ youth. Here is how the discussion between a teacher and students should go: “That’s an interesting idea. How much do you think something like that would cost? And how do you suppose the city should pay for it? Of course, city officials must balance the budget, so the money must come from somewhere. Either they will have to reduce costs somewhere else or they will have to increase revenue. Why does the government have to open the shelter? Is it possible this could be done through private philanthropy?” These are the issues students should be wrestling with.

There is a fundamental difference between the goals of action civics and what I consider to be the primary goals of civics education. Action civics proponents want students to do civics. The goal is to launch students to action, to become activists. But activism is not the goal of education; at least, not in my view.

I believe civics education should help students understand civics and civil dialogue. Not all problems require a government solution and even when they do, not all government solutions work the way we intend them. A good citizen is not one who leaps to action to impose their will on others, but one who reflectively contemplates issues from other points of view. Moreover, as the research of those supporting action civics suggests, most citizens believe being a personally responsible individual who exercises their rights as citizens is exactly what we want to see in our fellow citizens. Action civics downplays this notion of the “personally responsible citizen.” That is simply wrongheaded.

Action Civics: Teaching Students to Become Activists (Part 2 of 3)

Posted on by James V. Shuls

In my previous post, I introduced readers to a concept known in education circles as action civics. As I noted in that post, proponents claim action civics is a way to teach students about civics by engaging in civic activity—to learn by doing. The true aims and intents, however, seem much deeper—the idea is to mold students into a specific ideology about what it means to be a good citizen.

The iEngage summer camp at Baylor University uses an action civics curriculum. On day one, the students are asked to consider, “What does it mean to be a good citizen?” While this question may sound innocuous, the students are likely guided to a position that many citizens would be uncomfortable with. In their seminal work on the topic, “What Kind of Citizen? The Politics of Educating for Democracy,” Joel Westheimer and Joseph Kahne (scholars who heavily influenced the creation of action civics) create a hierarchy for kinds of citizens.

While many citizens support the idea of a “personally responsible citizen,” Westheimer and Kahne dismiss this conservative notion as inadequate for citizens in a democracy. Next, in the hierarchy of Westheimer and Kahne is the “participatory citizen,” who actively engages in community events such as food drives. Yet, this do-gooder is still not quite the right type of citizen for Westheimer and Kahne. The highest level in their hierarchy is the “justice-oriented citizen.” This type of citizen “critically assesses social, political, and economic structures to see beyond surface causes” and “knows about democratic social movements and how to effect systemic change.” Rest assured, this is the type of citizen students participating in iEngage will be pushed towards becoming.

The next few days build on this effort to turn the students into activists:

Day 2 – “How can citizens investigate community issues?”

Day 3 – “What does it mean to advocate?”

Day 4 -“How can we advocate effectively for an issue?”

Day 5 – Advocacy project workday and issue showcase

This is the model of instruction that is being pushed to educators throughout the country. As Thomas Lindsay and Lucy Meckler note in their recent report on action civics for the Texas Public Policy Foundation, much of the language of action civics sounds good. Who wouldn’t want kids to actively learn how government works?

The problem is much more subtle. Students are not learning how government works—they are learning how activism works and, more importantly, they are learning a philosophical view of politics. Students engaged in an action civics curriculum are asked to consider a problem, such as homelessness or income inequality, and then asked to find solutions to these issues Forget for a moment that we are asking students to come up with solutions to perennial problems of the human condition and consider the types of solutions action civics requires of them—governmental solutions. Action civics does not ask students to consider whether it is right or proper for the government to intervene or whether there may be a more suitable non-governmental solution. The only tool in the belt appears to be a hammer in search of a nail

The goal of action civics is not to teach students how government works. The goal is to change how students see their role as citizens, and the model of citizenship that is being pushed is not politically neutral. Indeed, it is a model that many Americans, especially those who believe in a limited role for government, may fundamentally disagree with.

Driver Privacy and Electronic Tolling

Posted on by Jakob Puckett

My recent posts have explored ways to connect paying for road maintenance with the damage drivers’ vehicles inflict upon roads (rather than with the amount and type of fuel those vehicles consume). Having covered odometer readings and GPS tracking, I’ll turn now to tolling.

Modern tolling is electronic rather than using traditional stop-and-go toll booths. Drivers have transponders that send a signal that is picked up at certain checkpoints along the road. Payments can either be deducted from an online account with the tolling organization, or drivers can receive a bill in the mail. For drivers without a transponder, license plate photos direct the tolling organization—whether state-run or private—where to mail the bill.

Electronic tolling is widely employed in several states, and each new state that adopts the technology benefits from the years of experience gained by the others. Missouri would not have to reinvent the wheel should tolling be adopted here.

The main privacy concern with electronic tolling is whether transponders remain active outside of toll roads on which they are meant to be used—as could happen if the state transportation department wanted to use the transponders to collect traffic flow data (for example, to inform decisions about adding lanes in congested areas).

One method by which states have attempted to mitigate this concern is by allowing anonymous transponder accounts, where data is stripped of personal information and reported by an internal account number. Again, though, drivers who aren’t comfortable with having a transponder in their car could still have bills sent to them via mail based on their license plate.

Ultimately, the current fuel tax system of funding road maintenance is becoming less viable, as the increasing popularity of electronic vehicles renders fuel taxes less effective and more unfair. Policymakers can begin the transition to road-usage charges, but this will require balancing the efficiency and accuracy of various measurement options while also respecting the privacy of motorists.

Action Civics: Teaching Students to Become Activists (Part 1 of 3)

Posted on by James V. Shuls

Jurassic Park was a tremendous movie for a number of reasons. I remember sitting on the edge of my seat as I watched the suspenseful scene where the cup of water jostled as the T-Rex approached. What I didn’t pick up on as a 12-year-old in that Wehrenberg theatre were the important ethical questions raised by Dr. Ian Malcolm (played by Jeff Goldblum): “Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.” Yet, somehow, all these years later, I see this important ethical dilemma cropping up in important ways. No, I’m not referring to the idiots doing crazy things on Youtube or TikTok. I am talking about the increasingly popular method for teaching civics instruction—action civics.

As the sub-headline of Catherine Gewertz 2019 Education Week article states, “Through ‘action civics’ lessons, students become activists in their communities.” As Gewertz notes, “The name of this instructional model—’action civics’—signals its mission: not only to teach students how their government works but to harness that knowledge to launch them into collective action on issues they care about.”

This post is the first of three related to the topic of action civics. It is prompted, in part, by a recently released report from the Texas Public Policy Foundation. In their report, Thomas Lindsay and Lucy Meckler lay out important reasons for concern regarding action civics. They note:

In the course of this examination, we will come to see that, in the final count, the debate over Action Civics presents two contrasting views of democracy. Action Civics stems from a communitarian, participatory view of democracy, which finds its roots in Rousseau’s concept of the “general will.” At its philosophic roots, this agenda tends to distrust the checks on popular will offered by the representative democracy crafted by our founders and enshrined in the Constitution.

As this blog series will make clear, the proponents of action civics are clear in their intent—they hope to produce students who are more inclined toward activism. Importantly, the goal is not just to address social ills, but to address them through government action.

Many teachers throughout the country and within Missouri may have adopted an action civics pedagogy for teaching students because of the rich platitudes offered by its supporters. They may agree that students learn better by doing rather than by “sitting and getting” as is often common in social studies classrooms. The problem here, as I have alluded to in my intro, is that proponents of action civics and the teachers that implement this strategy in their classrooms were so concerned with whether they could teach students in this way that they did not stop to think whether they should.

Asking students to “become activists in their communities” or to advocate for collective government action before laying a foundation of understanding regarding political philosophy (including that of federalism and limited government) is a recipe for disaster. It leads to the types of outcomes we currently see in our political landscape where the very people advocating for the rights of one group are quick to trample on the rights of others. It drives students to see their actions as right and noble and those who oppose them as cruel and mean spirited.

Despite what proponents of action civics might say, it is not the duty of public schools to launch activists. Rather, it is the duty of public school teachers to help students understand this great American experiment in self-government. It is their duty to teach students about our institutions and their roles, as presented in our founding documents and the writings of the founding fathers. Furthermore, it is the duty of teachers to help students understand that people today have different views on the role of government and on the best policy solutions to the problems we face. If your goal is solely to create activists (and activists of a particular kind), you might skip some of these essential lessons.

Entrepreneurs, Not Governments, Solve Uncertainty

Posted on by Jacob Dowell

In these times of economic uncertainty and shortages, it’s easy to forget what makes an economy run. Many turn to the government when things get difficult. But government solutions aren’t conducive to lasting economic prosperity. It’s especially important right now to remember that private-sector actors are key—in particular entrepreneurs.

First, what is an entrepreneur? Some define an entrepreneur as someone who starts a new business. But this doesn’t capture the whole picture. Entrepreneurship is an ongoing process by which individuals attempt to forecast what consumers will want in the future and then organize production to satisfy those demands.

This might sound bland, but it’s immensely important. Without people thinking about what consumers might want, nothing will get done—our economy will just be a lump of raw materials, tools, and factories. Entrepreneurs are the men and women that act now to create value for consumers in an uncertain future.

The key point here is that entrepreneurs are acting in the face of uncertainty. Entrepreneurs that consistently make profits prove themselves capable of forecasting the constantly changing demands of consumers.

Now we can see why entrepreneurs are so vital in today’s economy. Taking action in the face of uncertainty is precisely what entrepreneurs do. So who could be better qualified to meet our changing needs in these very uncertain times?

And we do, in fact, see entrepreneurs adapting and expanding their services for the needs of health-conscious consumers. As my colleague Corianna Baier noted in a recent post:

Most stores now have curbside or delivery options, gyms and restaurants are moving things outdoors, and socially-distanced concerts are the latest form of entertainment. There is also plenty of innovation in education, with pods facilitating or replacing virtual learning.

However, entrepreneurs need the freedom to innovate and act on their ideas. The immense number of regulations in Missouri hinders their ability to adapt to our needs. The more Missouri dictates what can be done in education, restaurants, and public meeting places, the less freedom entrepreneurs have to provide for our needs.

Missouri faces a difficult challenge. The COVID-19 crisis has changed our behavior and the goods and services we need. Entrepreneurs have already adapted to these changes and will continue to innovate in order to provide for our needs. Shouldn’t we celebrate these men and women and allow them the freedom to serve us in this uncertain economy?

The Burden of Special Taxing Districts

Posted on by Corianna Baier

I recently wrote about Chesterfield’s plans to hike taxes during a pandemic. It looks like more tax increases could be coming, but this time in the form of a sales tax. A plan released last week to develop $84 million worth of projects on Delmar Boulevard also includes a request for a special taxing district that would raise sales taxes in the area. More special taxing districts and higher sales tax is a bad idea in general, but it’s an especially bad idea during a pandemic.

Since moving to Missouri, I’ve (reluctantly) become accustomed to high sales tax rates that vary from city to city, and even from street to street. Special taxing districts, political subdivisions that can impose taxes, are often to blame for these high sales tax rates, as they add additional taxes on top of state, county, and city taxes. As we work through this economic downturn, many will feel the burden of these high sales taxes.

The chart below shows the highest general sales tax rates in select cities according to Missouri’s Department of Revenue. As you can see, general sales taxes can get pretty high all over the state, peaking at 11.679% in several areas of St. Louis City (specific sales taxes, such as hotel room rates, can get even higher). Even in places with smaller populations like Joplin, there are enough special taxing districts to push sales tax rates up to nearly double digits.

With little oversight and a flawed implementation system, special taxing districts have taken over Missouri. While these districts have been a growing problem for years, the poor state of the economy underscores how little we can afford more special taxing districts right now. Isn’t it time for Missouri to stop taking money out of the pockets of regular citizens and giving it away to wealthy developers?

Funding Roads by Miles Traveled—There’s an App for That

Posted on by Jakob Puckett

Yesterday’s post explored odometer reporting as an imperfect but straightforward way to replace fuel taxes with a funding mechanism that tied road usage more closely to the amount a driver pays. However, the most accurate way to know how many in-state miles someone drives is to track their vehicles. Several states have initiated road-usage-charge programs that offer drivers the option of using GPS-equipped vehicle plug-in devices, or even an app, to record their mileage.

Recording mileage via GPS tracking has some advantages over the odometer-reading method I described in yesterday’s post. For one thing, the GPS method would allow out-of-state miles to be excluded. Additionally, as some roads—such as urban freeways and interstates—are more expensive to build and maintain than typical roads, drivers could pay different rates for using different roads.

However, this type of mileage recording raises privacy concerns. How do these programs work in states that have tried it?

The longest-running and best-established program to date is in Oregon. Drivers who voluntarily participate in the OReGO program can pay a per-mile fee for driving and have any fuel taxes reimbursed. Drivers have several options of how to track those miles, such as paying for a block of miles in advance, odometer readings, or using GPS technology to record miles driven. If drivers choose the latter option, a third-party provider places a GPS-equipped plug-in device in their car, and the device uses vehicle data to determine in-state miles driven and fuel consumption. In order to protect drivers’ privacy, Oregon state law mandates that only the total weekly miles driven may be reported to the Department of Transportation. Personal data not delivered to the Department of Transportation is encrypted and destroyed on a set schedule, in accordance with Department of Transportation policy and OReGO program requirements laid down legislatively. This information cannot be sold or traded without the driver’s express consent.

Utah’s Road Usage Charge program operates similarly, although it is only for electric vehicle drivers. The program’s voluntary participants can pre-select their privacy settings, and a transponder run by a third-party service provider is installed in the vehicle. The third-party system sends monthly total miles driven to the Department of Transportation without disclosing additional data unless tied to a criminal investigation.

Several other states are exploring variants of these programs. Delaware and other east coast states are exploring mileage-based user fees in a series of pilots. California also conducted a road-usage charge pilot program, but legislators have not decided whether to continue the program.

It is also important to note what GPS technology does and does not do. GPS satellites do not necessarily track cars (or phones, etc.) that have receivers. It is the GPS receiver itself, whether in a cell phone or transponder, that tracks its own position in relation to a satellite. But unless the receiver is equipped with reporting capability, the device’s location is not shared with the satellite.

Protecting drivers’ privacy is a serious concern, and reporting of personal or location-specific data should only be allowed when explicitly agreed to by drivers. Further, while it offers the potential for the most accurate measuring of a driver’s miles logged, a GPS-based option must continue to be one of several options for reporting miles. In the next post, I’ll talk about a third method of pairing funding for road maintenance with miles driven.

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