Leaders will head to the G-20 Summit in Los Cabos, Mexico, among renewed serious concern about the world economy. The turmoil that started with the U.S. subprime mortgage crisis has resulted in now almost five years of ongoing instability. The emerging market economies fared much better than the advanced economies and pulled out of the crisis already in 2009, but the slowdown we are now facing in 2012 is again global, demonstrating the interdependence in the world economy. The emerging market economies have stronger underlying trend growth rates, but they remain vulnerable to a downturn in the advanced economies. The center of concern is now squarely on Europe, with a recession threatening most European countries, even those that had reasonably good performances so far. After an encouraging start in 2012, the U.S. economy, while not close to a recession, is also showing signs of a slowdown rather than the hoped for steady acceleration of growth. And the slowdown is spreading across the globe.

At a time like this it would be desirable and necessary that the G-20 show real initiative and cohesion. The essays in this collection look at the challenge from various angles. There is concern that the G-20 is losing its sense of purpose, that cohesion is decreasing rather than increasing, and that policy initiatives are reactive to events rather than proactive. Let us hope that at this moment of great difficulty, the G-20 will succeed in giving the world economy a new sense of direction and confidence. It is much needed.

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Editor's Note: The introduction to the 2015 Brown Center Report on American Education appears below. Use the Table of Contents to navigate through the report online, or download a PDF of the full report.

TABLE OF CONTENTS

Part I: Girls, Boys, and Reading

Part II: Measuring Effects of the Common Core

Part III: Student Engagement

INTRODUCTION

The 2015 Brown Center Report (BCR) represents the 14^th edition of the series since the first issue was published in 2000.  It includes three studies.  Like all previous BCRs, the studies explore independent topics but share two characteristics: they are empirical and based on the best evidence available.  The studies in this edition are on the gender gap in reading, the impact of the Common Core State Standards -- English Language Arts on reading achievement, and student engagement.

Part one examines the gender gap in reading.  Girls outscore boys on practically every reading test given to a large population.  And they have for a long time.  A 1942 Iowa study found girls performing better than boys on tests of reading comprehension, vocabulary, and basic language skills.  Girls have outscored boys on every reading test ever given by the National Assessment of Educational Progress (NAEP)—the first long term trend test was administered in 1971—at ages nine, 13, and 17.  The gap is not confined to the U.S.  Reading tests administered as part of the Progress in International Reading Literacy Study (PIRLS) and the Program for International Student Assessment (PISA) reveal that the gender gap is a worldwide phenomenon.  In more than sixty countries participating in the two assessments, girls are better readers than boys. 

Perhaps the most surprising finding is that Finland, celebrated for its extraordinary performance on PISA for over a decade, can take pride in its high standing on the PISA reading test solely because of the performance of that nation’s young women.  With its 62 point gap, Finland has the largest gender gap of any PISA participant, with girls scoring 556 and boys scoring 494 points (the OECD average is 496, with a standard deviation of 94).   If Finland were only a nation of young men, its PISA ranking would be mediocre.

Part two is about reading achievement, too. More specifically, it’s about reading and the English Language Arts standards of the Common Core (CCSS-ELA).  It’s also about an important decision that policy analysts must make when evaluating public policies—the determination of when a policy begins. How can CCSS be properly evaluated? 

Two different indexes of CCSS-ELA implementation are presented, one based on 2011 data and the other on data collected in 2013.  In both years, state education officials were surveyed about their Common Core implementation efforts.  Because forty-six states originally signed on to the CCSS-ELA—and with at least forty still on track for full implementation by 2016—little variability exists among the states in terms of standards policy.  Of course, the four states that never adopted CCSS-ELA can serve as a small control group.  But variation is also found in how the states are implementing CCSS.  Some states are pursuing an array of activities and aiming for full implementation earlier rather than later.  Others have a narrow, targeted implementation strategy and are proceeding more slowly. 

The analysis investigates whether CCSS-ELA implementation is related to 2009-2013 gains on the fourth grade NAEP reading test.  The analysis cannot verify causal relationships between the two variables, only correlations.  States that have aggressively implemented CCSS-ELA (referred to as “strong” implementers in the study) evidence a one to one and one-half point larger gain on the NAEP scale compared to non-adopters of the standards.  This association is similar in magnitude to an advantage found in a study of eighth grade math achievement in last year’s BCR.  Although positive, these effects are quite small.  When the 2015 NAEP results are released this winter, it will be important for the fate of the Common Core project to see if strong implementers of the CCSS-ELA can maintain their momentum.

Part three is on student engagement.  PISA tests fifteen-year-olds on three subjects—reading, math, and science—every three years.  It also collects a wealth of background information from students, including their attitudes toward school and learning.  When the 2012 PISA results were released, PISA analysts published an accompanying volume, Ready to Learn: Students’ Engagement, Drive, and Self-Beliefs, exploring topics related to student engagement.

Part three provides secondary analysis of several dimensions of engagement found in the PISA report.  Intrinsic motivation, the internal rewards that encourage students to learn, is an important component of student engagement.  National scores on PISA’s index of intrinsic motivation to learn mathematics are compared to national PISA math scores.  Surprisingly, the relationship is negative.  Countries with highly motivated kids tend to score lower on the math test; conversely, higher-scoring nations tend to have less-motivated kids. 

The same is true for responses to the statements, “I do mathematics because I enjoy it,” and “I look forward to my mathematics lessons.”  Countries with students who say that they enjoy math or look forward to their math lessons tend to score lower on the PISA math test compared to countries where students respond negatively to the statements.  These counterintuitive finding may be influenced by how terms such as “enjoy” and “looking forward” are interpreted in different cultures.  Within-country analyses address that problem.  The correlation coefficients for within-country, student-level associations of achievement and other components of engagement run in the anticipated direction—they are positive.  But they are also modest in size, with correlation coefficients of 0.20 or less. 

Policymakers are interested in questions requiring analysis of aggregated data—at the national level, that means between-country data.  When countries increase their students’ intrinsic motivation to learn math, is there a concomitant increase in PISA math scores?  Data from 2003 to 2012 are examined.  Seventeen countries managed to increase student motivation, but their PISA math scores fell an average of 3.7 scale score points.  Fourteen countries showed no change on the index of intrinsic motivation—and their PISA scores also evidenced little change.  Eight countries witnessed a decline in intrinsic motivation.  Inexplicably, their PISA math scores increased by an average of 10.3 scale score points.  Motivation down, achievement up.

Correlation is not causation.  Moreover, the absence of a positive correlation—or in this case, the presence of a negative correlation—is not refutation of a possible positive relationship.  The lesson here is not that policymakers should adopt the most effective way of stamping out student motivation.  The lesson is that the level of analysis matters when analyzing achievement data.  Policy reports must be read warily—especially those freely offering policy recommendations.  Beware of analyses that exclusively rely on within- or between-country test data without making any attempt to reconcile discrepancies at other levels of analysis.  Those analysts could be cherry-picking the data.  Also, consumers of education research should grant more credence to approaches modeling change over time (as in difference in difference models) than to cross-sectional analyses that only explore statistical relationships at a single point in time. 

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Editor's note: This post originally appeared in the New England Journal of Medicine's Perspective online series on April 22, 2015.

Congress has finally euthanized the sustainable growth rate formula (SGR). Enacted in 1997 and intended to hold down growth of Medicare spending on physician services, the formula initially worked more or less as intended. Then it began to call for progressively larger and more unrealistic fee cuts — nearly 30% in some years, 21% in 2015. Aware that such cuts would be devastating, Congress repeatedly postponed them, and most observers understood that such cuts would never be implemented. Still, many physicians fretted that the unthinkable might happen.

Now Congress has scrapped the SGR, replacing it with still-embryonic but promising incentives that could catalyze increased efficiency and greater cost control than the old, flawed formula could ever really have done, in a law that includes many other important provisions. How did such a radical change occur?  And why now?

The “how” was logrolling — the trading of votes by legislators in order to pass legislation of interest to each of them. Logrolling has become a dirty word, a much-reviled political practice. But the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA), negotiated by House leaders John Boehner (R-OH) and Nancy Pelosi (D-CA) and their staffs, is a reminder that old-time political horse trading has much to be said for it.

The answer to “why now?” can be found in the technicalities of budget scoring. Under the SGR, Medicare’s physician fees were tied through a complex formula to a target based on caseloads, practice costs, and the gross domestic product. When current spending on physician services exceeded the targets, the formula called for fee cuts to be applied prospectively. Fee cuts that were not implemented were carried forward and added to any future cuts the formula might generate. Because Congress repeatedly deferred cuts, a backlog developed. By 2012, this backlog combined with assumed rapid future growth in Medicare spending caused the Congressional Budget Office (CBO) to estimate the 10-year cost of repealing the SGR at a stunning $316 billion.

For many years, Congress looked the costs of repealing the SGR squarely in the eye — and blinked. The cost of a 1-year delay, as estimated by the CBO, was a tiny fraction of the cost of repeal. So Congress delayed — which is hardly surprising.

But then, something genuinely surprising did happen. The growth of overall health care spending slowed, causing the CBO to slash its estimates of the long-term cost of repealing the SGR. By 2015, the 10-year price of repeal had fallen to $136 billion. Even this number was a figment of budget accounting, since the chance that the fee cuts would ever have been imposed was minuscule. But the smaller number made possible the all-too-rare bipartisan collaboration that produced the legislation that President Barack Obama has just signed.

The core of the law is repeal of the SGR and abandonment of the 21% cut in Medicare physician fees it called for this year. In its place is a new method of paying physicians under Medicare. Some elements are specified in law; some are to be introduced later. The hard-wired elements include annual physician fee updates of 0.5% per year through 2019 and 0% from 2020 through 2025, along with a “merit-based incentive payment system” (MIPS) that will replace current incentive programs that terminate in 2018. The new program will assess performance in four categories: quality of care, resource use, meaningful use of electronic health records, and clinical practice improvement activities. Bonuses and penalties, ranging from +12% to –4% in 2020, and increasing to +27% to –9% for 2022 and later, will be triggered by performance scores in these four areas. The exact content of the MIPS will be specified in rules that the secretary of health and human services is to develop after consultation with physicians and other health care providers.

Higher fees will be available to professionals who work in “alternative payment organizations” that typically will move away from fee-for-service payment, cover multiple services, show that they can limit the growth of spending, and use performance-based methods of compensation. These and other provisions will ramp up pressure on physicians and other providers to move from traditional individual or small-group fee-for-service practices into risk-based multi-specialty settings that are subject to management and oversight more intense than that to which most practitioners are yet accustomed.

Both parties wanted to bury the SGR. But MACRA contains other provisions, unrelated to the SGR, that appeal to discrete segments of each party. Democrats had been seeking a 4-year extension of CHIP, which serves 8 million children and pregnant women. They were running into stiff head winds from conservatives who wanted to scale back the program. MACRA extends CHIP with no cuts but does so for only 2 years.  It also includes a number of other provisions sought by Democrats: a 2-year extension of the Maternal, Infant, and Early Childhood Home Visiting program, plus permanent extensions of the Qualified Individual program, which pays Part B Medicare premiums for people with incomes just over the federal poverty thresholds, and transitional medical assistance, which preserves Medicaid eligibility for up to 1 year after a beneficiary gets a job.

The law also facilitates access to health benefits. MACRA extends for two years states’ authority to enroll applicants for health benefits on the basis of data on income, household size, and other factors gathered when people enroll in other programs such as the Supplemental Nutrition Assistance Program, the National School Lunch Program, Temporary Assistance to Needy Families (“welfare”), or Head Start. It also provides $7.2 billion over the next two years to support community health centers, extending funding established in the Affordable Care Act.

Elements of each party, concerned about budget deficits, wanted provisions to pay for the increased spending. They got some of what they wanted, but not enough to prevent some conservative Republicans in both the Senate and the House from opposing final passage. Many conservatives have long sought to increase the proportion of Medicare Part B costs that are covered by premiums. Most Medicare beneficiaries pay Part B premiums covering 25% of the program’s actuarial value. Relatively high-income beneficiaries pay premiums that cover 35, 50, 65, or 80% of that value, depending on their income. Starting in 2018, MACRA will raise the 50% and 65% premiums to 65% and 80%, respectively, affecting about 2% of Medicare beneficiaries. No single person with an income (in 2015 dollars) below $133,501 or couple with income below $267,001 would be affected initially. MACRA freezes these thresholds through 2019, after which they are indexed for inflation. Under previous law, the thresholds were to have been greatly increased in 2019, reducing the number of high-income Medicare beneficiaries to whom these higher premiums would have applied. (For reference, half of all Medicare beneficiaries currently have incomes below $26,000 a year.)

A second provision bars Medigap plans from covering the Part B deductible, which is now $147. By exposing more people to deductibles, this provision will cause some reduction in Part B spending. Everyone who buys such plans will see reduced premiums; some will face increased out-of-pocket costs. The financial effects either way will be small.

Inflexible adherence to principle contributes to the political gridlock that has plunged rates of public approval of Congress to subfreezing lows. MACRA is a reminder of the virtues of compromise and quiet negotiation. A small group of congressional leaders and their staffs crafted a law that gives something to most members of both parties. Today’s appalling norm of poisonously polarized politics make this instance of political horse trading seem nothing short of miraculous.