【每日阅读训练第四期——速度越障3系列】【3-14】文史哲

泾渭不凡

速度
Liberal-Arts Education: Has the Global Migration Stalled?
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New efforts to develop liberal-arts education in Asia have recently grabbed headlines and generated a buzz in academe. Yale University is helping Singapore build a liberal-arts college, for instance, while in Malaysia, a new liberal-arts institution for women is being developed under the wing of Smith College. Such work has led some observers to speculate that we are on the cusp of a global resurgence of liberal education, spurred in part by an increase in international outreach by American colleges and universities.
However, we need to be cautious about such pronouncements. The examples of Yale and others, such as New York University's liberal-arts college in Abu Dhabi and Bard's affiliated colleges in Russia and Germany, are so far only islands in an uneven global sea of undergraduate education. And while there are some interesting indigenous efforts to revamp the undergraduate curriculum in places like China, the big question is whether liberal education can develop on its own, with deep indigenous roots, and be available to larger numbers of students, particularly in developing countries that face rapidly growing demand for higher education.
That is why China, having made a commitment to widespread reform of undergraduate education, is a key country to watch. What is happening in the universities of Hong Kong, as well as those on the mainland, presents a curricular model capable of reaching many students. The introduction of general education is viewed as an important aspect of Chinese universities' ability to be world class and to prepare their students to meet the demands of a fast-changing, increasingly competitive global environment.
However, if it truly encourages liberal education, this may lead to unintended consequences. Exposing students to a broad spectrum of ideas and habits of critical inquiry may result in a more questioning student body and citizenry. At this point, it's not clear how freely and broadly Western liberal arts and Chinese cultural studies will be featured in mainland China's new curriculum.
A substantial number of required courses in political ideology and military science persist at China's universities. If such deeply integrated ideological views continue to pervade the curriculum and are presented for automatic acceptance, it will be virtually impossible for the spirit of liberal education to gain traction and flourish.
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What finally emerges from this reform effort will merit careful attention to determine where it fits in the spectrum of the global migration of liberal education.
In other countries where vast numbers of people have no access to higher education, a commitment to liberal-arts education at the undergraduate level is often viewed as an unaffordable luxury. For those fortunate to be admitted, there is no opportunity for intellectual exploration. They move directly to their chosen fields of study.
Why, then, should the option of liberal education be considered? First, the forces of globalization and rapidly expanding knowledge mean that hyperspecialization and narrow training can leave countries and their citizens on the slag pile of obsolescence. And second, nation building is complicated; it requires more than just economic development. A strong civil society is an essential ingredient, and educating citizens to participate meaningfully and peacefully in national-development discussions can be a function of a liberal-arts education.
But developing and transitional countries often feel that they face a litany of Solomon's choices: human development versus economic development, enlightenment versus employment, individual benefit versus societal benefit, general education versus professional and vocational education, and teaching versus research. Nations that become world leaders embrace a combination of all of those dimensions.
If liberal education is to flourish and continue its global migration, it must take on myriad forms, adapting to local needs and circumstances. That may include stand-alone liberal-arts institutions as well as hybrid models where it is woven into specialized education. While there may not be a resurgent global movement of liberal education, there are signs that it is at least being viewed as a necessary component of a first-class education. Such developments open the door to new and exciting possibilities.
Patti McGill Peterson is the presidential adviser for global initiatives at the American Council on Education and the author of Confronting Challenges to the Liberal Arts Curriculum: Perspectives of Developing and Transitional Countries (Routledge, 2012).
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The Worrisome Ascendance of Business in Higher Education
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Recently the Board of Visitors—not a particularly apt name given their actions—at the University of Virginia forced the ouster of President Teresa A. Sullivan after two years in office. Since then we have learned that the rector and vice rector of the board, Helen E. Dragas and Mark J. Kington, who has since resigned, have M.B.A.'s from UVa's Darden School of Business. Peter D. Kiernan, a powerful alumnus who evidently weighed in on the decision, is also a Darden graduate and, before he resigned in the midst of the furor, was chairman of the Darden School Foundation Board.
The trio, having made their chops in real estate, construction, and investing, apparently saw an opportunity to transfer their knowledge to higher education. Though colleges can learn many things from the ways businesses operate, treating a college strictly like a business would be a mistake.
In an e-mail to Darden board members justifying Ms. Sullivan's ouster, Mr. Kiernan uses the business term du jour "strategic dynamism" to describe the ever-reactive leadership style he prefers, which is opposed to the older, more static "strategic planning" style employed by Ms. Sullivan. (Apparently engaging in "strategic dynamism" means excluding faculty, students, and most alumni.) In truth, when challenges arise quickly, successful businesses have always responded accordingly¬—i.e., dynamically. Strategic dynamism at UVa is nothing more than a euphemism for Thomas Paine's adage, "Lead, follow, or get out of the way."
To be sure, higher education faces unprecedented challenges: growing competition for new populations of students at home and abroad; the opportunities, costs, and uncertainties of new technology; declining state support for public institutions; rising tuition; increasing student debt. All demand a careful look at budgets. Stagnant or declining incomes and uncertain employment prospects sharpen pressure to demonstrate what a college degree offers.
In response, some critics have called for a more businesslike approach to higher education. Why? Because colleges face the same fundamental challenges of any business: securing steady revenue streams, covering expenses, using resources well, and planning for an uncertain future.
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Over recent decades, we have heard about students as customers, learned to "manage" enrollments, shared and decentralized budgets with the goal of increasing accountability, identified per-student costs per major, and generally dissected the "service" of higher education. We have learned that programs in art and music are not cost effective. Engineering and equipment-intensive courses are expensive. Even as students and parents in the United States rail against the lack of low-cost public education, those in other countries that have such systems face unprecedented tuition increases.
So what have we learned? First, the student-as-customer model fits poorly. Certainly some educational experiences are better than others, and information about quality differences needs to be readily available. However, anyone who has listened to students and parents demand results not earned or special privileges at special prices knows the customer model has flaws. Of course that does not prevent some institutions from using customer satisfaction to determine the price of a dorm room. I remember the well-heeled student who told me that the university could gain revenue by "selling" preferred parking places to those willing to pay.
Second, discussions among faculty and administrators about multiple revenue streams, costs per student, program efficiency, budget accountability, and the like can be difficult. As an institution, academe has much more experience resisting change than embracing it.
Third, even as some people resist change, there is an increasing awareness that the future will be different. We will not go backward. Budgets present real constraints, public support will not return to previous levels, domestic and international competition to offer new educational options will continue, as will calls for increased accountability.
What we need is to learn the discipline of business without the short-term orientation. Markets are amoral. A competitive market will determine a fair price—whether for cocaine or cocoa—but not necessarily the enduring social value.
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A one-year increase of 25 percent in the price of a house does not reveal the underlying forces causing the price increase, or its real value.Markets do not know the worth of a mature forest three generations hence. Nor can a market accurately determine the lifetime value of thoughtful exposure to the classics or art or music. Enduring acts of civility are not bought and sold. The qualities that professional educators worry about often do not lend themselves to short-term market valuation.
We can learn from business to allocate resources responsibly, have transparent and disciplined budgets, and plan for a more secure financial future. At the same time, we need to avoid the hubris of business "success." Too many successful business leaders espouse the benefits of a free-market system while accepting that some sellers can be too big to fail and must be protected from market forces. Too many successful business leaders hypocritically accept money from the government while at the same time decrying the intrusion of government in the economy. And what happens when money is at risk? Manhattan prosecutors recently opened an investigation into grades in M.B.A. courses at the City University of New York's Baruch College, some of which were apparently falsified for the purpose of maintaining revenue.
If Rector Dragas, former Vice Rector Kington, and Mr. Kiernan know all of this, the evidence is lacking. Ms. Dragas and Mr. Kington also serve on the board of the parent firm of Dominion Power, a business whose code of ethics calls for "the highest level of ethical standards," with board members expected "to behave with respect, honesty and decency toward everyone affected by our business." We in academe need to choose carefully between those aspects of business that serve us well and those that do not.
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越障
Supreme decision: Healthcare reform hangs in the balance
? The Supreme Court decision will affect access and coverage for patients who don't have health insurance.
? Experts advise that physicians take a wait-and-see approach on some matters until the Supreme Court announces its ruling.
? You can still purchase technology and participate in efforts to provide team-based care and advanced access scheduling, and you can take part in disease registries now.
The future of the U.S. healthcare delivery system hangs in the balance.
In fact, as healthcare awaits the much-anticipated Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act next month, experts say the top four scenarios all will affect you and your fellow primary care physicians (PCPs). The heart of the issue for PCPs is access and coverage for those patients currently uninsured. The possible long-term ramifications of the decision have many doctors sitting on the edge of their seats, says American Academy of Family Physicians (AAFP) President Glen R. Stream, MD, FAAFP, MBI.
According to Matthew E. Albers, JD, an attorney in the healthcare group with Vorys, Sater, Seymour, and Pease LLP in Cleveland, Ohio, four possible outcomes from the court exist:
    1. The court could rule that the entire law is acceptable constitutionally.
    2. The "mandate" that citizens buy health insurance or pay a fine could be ruled a violation of the Commerce Clause.
    3. The entire law could be deemed unconstitutional.
    4. The court could say that because the mandate does not take effect until 2014, it is not yet ripe for a challenge.
Here is a look at how each of the first three outcomes could affect you and your colleagues in primary care.

IF THE LAW REMAINS INTACT
The entire law being left intact could be positive news for PCPs, because it promises to increase their role in healthcare, Albers says.
"CPs will be in a good place, as this and most reform initiatives focus on cost reduction and quality improvement," both of which are achieved through decreased use of high-acuity care and increased use of preventive care, he says.
"CPs who have a large Medicare caseload may see these patients more often as [these patients] see specialists less," he adds.
Physicians with a lot of Medicare patients might benefit as plans for accountable care organizations (ACOs) move ahead. The Centers for Medicare and Medicaid Services are promoting ACOs as a way to improve the quality of patient care and save costs through coordination among doctors, hospitals, and other healthcare providers to avoid duplicating services and prevent medical errors. Those offering care through an ACO have the opportunity to share in any savings realized if the care they provide is less expensive than predetermined benchmarks for similar care offered in Medicare's fee-for-service program. PCP participation is crucial to the success of these ventures, because they bring the defined populations that the other partners (hospitals, rehabilitation centers, nursing homes, home healthcare agencies, etc.) need.
As the new law moves forward, 20 million to 60 million Americans will be newly insured. Because preventive and primary care are among the first types of care people give up when they lose their health insurance or face a tight budget, many of them will now show up in your office, Albers says.
He stresses that PCPs who do not want to join an ACO don't have to do so. For example, those who do not see many older patients might not be interested. "It would be their choice," he says.
The AAFP's Stream emphasizes that the law being kept intact would not be the end of the road for change.
"The current system is far from perfect, and it needs more refinement, such as meaningful medical liability reform and [sustainable growth rate] adjustments," he says.
He praises the law's role in recognizing that primary care is central to any successful transformation, however.
"It has raised awareness of our importance," Stream says.
Craig M. Wax, DO, a family physician in Mullica Hill, New Jersey, and founder of Independent Physicians for Patient Independence, believes that if the law is upheld, the true flaws of its underlying premise will be fully revealed.
"The government cannot afford it. It does not live by a budget, and it has maxed out its credit cards," he says.
He also says that just because millions more people will have health insurance does not mean they will have access to care, because the reimbursement it will offer will be so low that many physicians will not accept it.
"Insurance does not equal healthcare," he says. "It equals an expensive reimbursement process."
Lee S. Gross, MD, a family medicine practitioner in North Port, Florida, and president of the Florida chapter of Docs4PatientCare, a group that does not support the federal reforms, maintains that problems with access to care are only going to get worse under this scenario.
"In Florida, 1 million people would be added to Medicaid, double what there is now," he says. "But most PCPs in Florida do not accept Medicaid. The system is already buckling under its own weight. Emergency rooms serve as primary care for many of these patients."
Wax's group favors having patients pay their physicians directly, taking third-party payers out of the mix. "We have this notion of insurance and our employer and the government will take care of us. It's a fallacy. You need to take care of yourself."
He also predicts that ACOs will not be the panacea that many people are expecting them to be.
"I think they will collapse on themselves eventually," he says. "They build them for a reason: to make money. The government doesn't want to pay us to prevent illness. It's like a casino."
Steven Shell, DO, a family medicine physician in Port Charlotte, Florida, and vice president of the Florida chapter of Docs4PatientCare, believes that if the reform law stays in place, ACOs will pull all providers under one roof. With this vertical integration, physician compensation will be tied to the quantity of care that is delivered.
"This will be a terrible ethical dilemma and will be very precarious financially," he says. "Being incentivized to withhold care is not why we went into this."

IF THE MANDATE IS RULED UNCONSTITUTIONAL
If just the mandate is thrown out, the rest of the law will become "unwieldy" to administer, Albers predicts. Most uninsured people will stay that way and will continue to receive care through emergency rooms on an uncompensated basis. Cost savings that were anticipated to help fund the rest of the plan's components will vanish.
Because he believes that insurance exchanges and ACOs will form anyway, however, Albers says he thinks PCPs will still be better off than they are now.
The American College of Physicians agrees that this outcome would be undesirable, saying that studies suggest that an individual requirement is needed for such reforms to work.
"Without an individual insurance requirement, some people may wait to obtain insurance until they are sick, aware that insurers will not turn them down or charge them higher premiums (except for family size and tobacco use). This will drive up premiums for everyone else, causing more persons to drop coverage, and potentially, resulting in millions more uninsured persons," the ACP said in a recent statement.
Gross agrees, stating that overturning the mandate would "immediately destabilize the insurance industry. They would have open checkbooks with no source of revenue.
"If they cannot turn anyone away and cannot impose caps on coverage (among other reforms) and do not have a stream of healthy patients paying into the system, they will collapse.
"The government will have to bail them out," he says. "This is the sure road to a government-controlled, single-payer system."
Paul Keckley, executive director of the Deloitte Center for Health Solutions, says that many of the deals that were made to get this bill passed depended on the existence of the mandate. If the mandate is rejected, he expects that many entities such as medical device companies, pharmaceutical companies, insurance companies, and hospitals will appeal the concessions that they made, which he estimates to be worth about $155 billion.
"They will want a redo," he says. "Without the expected revenue coming in to the system, they will need it."
Notably, he says, physicians did not make concessions, and if things start to unravel, he predicts they will not find much sympathy on Capitol Hill.
"It is hard for Congress to feel too sorry for doctors right now, as Joe Six Pack's disposable income is going down," Keckley says.
Primary care is going to find itself "in a holy war to say we are central to a rationally delivered system and we demand a place," especially as compared with specialty care (see "reparing for the future, regardless of reform," page 25). Keckley says he also thinks that it is likely that in this scenario, Congress may let the matter default to the states, because they are not bound by the Commerce Clause.
"This is a popular concept among a lot of governors, who want to keep the decisions closer to home," he says. "However, you should expect the states to ask the federal government for more money in this scenario."
Wax, however, disagrees that overturning the mandate would be a bad decision, saying it would be a victory for freedom of choice and the free market. It would be good for PCPs, he believes, because it could open the door to applying free market reform to healthcare, such as allowing insurers to compete across state lines.
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spencerX

沙发^_^饭饭辛苦了！

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7min

teddybearj4

板凳~饭饭酱要注意休息哦~
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速度：
2'22      2'17      2'12       1'75      1'37
很喜欢速度的第一篇呀~第二篇看得有些晕~
今天的越障好难啊~可能也是对内容不太了解的缘故~回忆不出来T.T文史哲是我的克星！

猫咪团团

占下~饭饭酱滴头像是金素恩么？
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我表示，我认真地看了越障，但真心的没看进去，就大概知道是和米国的医疗改革相关的。

Olina加油

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jolene91

2.07
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13.46为什么我觉得今天好难T T
1.the supreme court decision about healthcare and its possible outcomes.pcp为uninsured的人治疗，让很多医生成为边缘人（？）
2.ACO让医疗质量上升；PCP很重要带给其他partner defined population，PCP可以选择是否加入ACO
这个政策的不足：insurance≠healthcare，因为赔偿很少
3.个人需求如果缺乏→只有生病时才买保险→提高保费for everyone else→more uninsured persons
一些人说应该禁止这个mandate→many entities will make concessions，但PCP不会

铁板神猴

人过留痕~

好吧，我被虐了……

小祝就是我

3’10
In academic field, the education of liberal arts has attracted big attention: yale university helps some university in AISAN, such as hokong or china mainland…so art education has bright future. But the explanation of liberal education still though: most universities in china pay attention to the ideological education.

2’59
In some developing countries lack of access to higher education, difficult to choose liberal education : human education vs economic education….. continue and flourish global migration

2’28
The reform in the university to opposite  to operate the university/colleagues as business…but they  do have something in common: securing revenue flew and plan for future.

3’00
The “student as costumer ”modeal: the education cost largely increased. The lesson we can learn: 1. The s-c model fits poorly
2,
3.the future can be different.

2’41
Business success consider many factors. Free market brings a lot of benefits and opportunities. But we choose pay attention to emergence of too strong market power. On the other hand, business ethics is very important: for the company inside, what we want is those who give the stuff real respect.

哎呀呀。。。今天的东东好难。。。速度就花了好久，越障也米有做~~

跟大家请教一下一下哦~~我做速度一般是
先掐时间；
然后看完之后回忆。。。你们呢？是看完之后直接写回忆吗？

还有啊，大家做阅读的时候都看不看计时器捏？？？

peill

没有计时，但是估计仍然是150w/m。没有提高。

第一篇讲一些美国学校在亚洲简历文科学院Liberral-art。由此讲人文学科怎么重要，怎么个现状。尤其是对中国这样还在讲意识形态的大学环境，还要在观察。
第二篇讲大学不是买卖。虽然要学习做买卖的一些技巧解决现实问题，更重要的是不能太短视，文学艺术的重要性，市场价值，不是这么短的时间能被市场看见的。

越障，仍然是第一篇看个框架，第二遍才能看的很明白。
因为最近看了大法官Stephen Breyer的两个访谈，加上高晓松前几周讲美国的时候说的平等和自由是矛盾的，以及前两天China Drive上那个有磁性声音的老米男DJ跟中国女DJ大吵中国政府强迫他们交保险是不对的，在这么几个背景下，基本上我知道这文章讲的事情。如果高等法院通过全民医保PCP，如果高等法院说全民医保违宪，如果高院全部否定（省略了），会有什么情况。第一遍也就看了这么个意思。

第一遍看的太快，习惯性的漏过所有专用名词，以至于后来频繁PCP和ACO的时候，完全不明白。大大影响了理解。尤其是第二种情况的时候讲PCP会怎么样的垮掉，一遍心里很明白，这必须得是出题点啊！一边着急还是看不懂~~~郁闷死。

第二遍，没有全看，重点看了没看懂的PCP和ACO，以及PCP将如何垮掉。当然也顺便理解了，如果全法通过，什么样的医生最呀最摇摆，以及如果部分违宪，那些曾经made concession的仪器商一定会要求redo。还是没明白，医生为什么didnt make concession，they will not find much sympathy on Capitol Hill。以及为什么as Joe Six Pack's disposable income is going down

最后那个自由派的Wax的话印象深刻，在美国反社会主义的思想是很彻底的，他们坚信应该通过自由市场解决问题，一切平等化的行为都将最终失败。。。

总之，穷人最好不要去美国，灰常之惨。

romanyck

3’25
There is a trend that more developing countries build the liberal art college
2’57
2’51
The universities are facing more and more challenges, especially in finance.
3’01
2’39
没怎么看懂。。。