3 Things 3-30-26

Thing One  

A Shameful Experiment The Name Of Equity

Last week, we talked about the severe negative impact that the lack of education is having on American students - on a macro level - while the people in charge focus on the wrong “problem”.  This week we highlight the issue on a micro level using an example from San Francisco.  This sad tale about a generation that local system has failed, without any accountability, is a reminder we should be more careful about choosing the people we put in charge of our kids and, even after we put them in charge, we should check in on them often.  

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It started in 2014 when the San Francisco Unified School District (SFUSD) made a what was called  by some a bold decision in the name of equity. Convinced that offering Algebra I in eighth grade created unfair "tracking" that disproportionately hurt minority and low-income students, district leaders eliminated the course from all middle schools. The idea was simple on paper: delay algebra until ninth grade for everyone. This would give struggling students more time to master foundational math skills, reduce racial achievement gaps, and create a more "equitable" learning environment.

It sounded compassionate. It was sold as a way to help the students who needed it most. Instead, it became a cautionary tale of what happens when ideology overrides evidence and basic educational common sense.

For over a decade, San Francisco's public school students lived with the consequences. Without access to Algebra I in middle school, high-achieving kids lost the chance to accelerate and reach advanced courses like calculus by senior year—a critical steppingstone for STEM majors and competitive college admissions. Meanwhile, the students the policy was meant to help didn't see the promised gains. A Stanford study later confirmed what many parents suspected all along: the reform failed to close persistent racial gaps in advanced math enrollment, and overall participation in AP math classes dropped by about 15%.

Math proficiency told an even clearer story. Eighth-grade math scores in the district declined noticeably after the change. Pre-pandemic figures hovered around 51% proficiency in the late 2010s; by 2023, they had fallen to roughly 40% for eighth graders, with similar downward trends across demographic groups. Black student proficiency, already low, dropped even further in some reports—from around 11% to 4%. The "equity" experiment didn't raise the floor. It simply lowered the ceiling for everyone.

Parents noticed. High-achieving students from all backgrounds suffered, and many families turned to expensive private tutors or summer programs to fill the gap. Frustration grew as it became obvious that the policy wasn't delivering equal outcomes—it was delivering uniformly worse ones for far too many kids.

Public pressure finally forced a reckoning. In March 2024, San Francisco voters overwhelmingly passed Proposition G with 81% support, sending a clear non-binding message: bring Algebra I back to eighth grade. After years of debate, delays, and pilot programs, the SFUSD school board voted 4-3 this week (late March 2026) to restore the course as an optional elective for eighth graders starting next school year. It was a narrow victory after twelve long years.

This reversal isn't just a policy tweak—it's an admission that the original experiment failed on its own terms. The district spent over a decade prioritizing abstract notions of equity over rigorous standards, student readiness, and actual results. In doing so, it shortchanged an entire generation of San Francisco kids, particularly those who could have thrived with earlier access to challenging material.

The lesson here is uncomfortable but necessary: true educational equity comes from raising expectations and providing strong foundational support for all students—not by holding back those who are ready to move forward. Pretending that equal outcomes can be engineered by delaying opportunity for everyone is not compassion. It's a disservice to every child in the system.

San Francisco's shameful experiment in equity is finally ending. Let's hope other districts learn from it before they repeat the same costly mistake. And, in the meantime, check in on them often.

Thing Two  

Medical Billers Take Your Ignorance To The Bank

You've just recovered from a medical procedure or doctor visit. The last thing you want to deal with is a confusing bill that arrives weeks later. But here's the uncomfortable truth: the medical billing system is so complex, opaque, and filled with jargon that many patients simply pay whatever is asked—often more than they should.

Medical billers (and the practices or hospitals they work for) know this. And in too many cases, they count on it.

Why Medical Bills Are a Perfect Storm for Overpayment

Healthcare billing isn't like any other industry. A single hospital stay can generate dozens or hundreds of line items, each tied to cryptic CPT codes, ICD-10 diagnoses, modifiers, and payer-specific rules. Insurance contracts add another layer of secrecy—what one insurer pays for a service can differ wildly from another.

Patients rarely see an itemized breakdown upfront. Instead, they get a summary bill with a big "Amount Due" at the bottom. Many people glance at it, feel overwhelmed, and write the check or click "pay now."

That ignorance is profitable.

Common ways patients get hit harder than necessary include:

• Upcoding or unbundling: Services that should be billed together under one code get broken out into multiple higher-paying codes. A routine procedure suddenly costs significantly more.

• Balance billing surprises: Even with laws like the No Surprises Act, patients still encounter unexpected charges from out-of-network providers who were involved in their care without their knowledge.

• Duplicate or phantom charges: Billing for services never received, inflated quantities of supplies, or the same item listed twice.

• Failure to apply insurance correctly: Claims get processed wrong, leaving patients on the hook for amounts that should have been covered or negotiated down.

• Aggressive patient responsibility collection: Some billing departments push hard on patients while being slower to chase insurance adjustments.

Studies and patient reports consistently show that a large percentage of medical bills contain errors—some estimates put it as high as 80-90% in certain settings. Many of those errors result in patients paying more than they legally or contractually owe.

The Incentive Problem

Medical practices and hospitals operate on thin margins in some areas, but revenue cycle management is a huge part of staying afloat. Billers are often incentivized (directly or indirectly) to maximize collections. When patients don't question charges, don't request itemized bills, or don't appeal denials, the system keeps flowing money in the easiest direction—toward the provider's bank account.

This isn't to say every medical biller is out to gouge patients. Many are hardworking professionals navigating an insanely complicated system. Coding and compliance rules change frequently, and honest mistakes happen. But the structure rewards complexity and punishes patients who stay passive.

How Patients Get Taken Advantage Of (Without Realizing It)

1. Paying before insurance processes: Some providers bill patients immediately, creating panic and quick payments before the Explanation of Benefits (EOB) arrives showing what insurance actually covered.

2. Not asking for an itemized bill: Summary bills hide the details. Always request the full itemized version and compare it against your medical records.

3. Assuming "in-network" means everything is covered: Ancillary providers (anesthesiologists, radiologists, assistants, labs) can still be out-of-network even if the main facility isn't.

4. Ignoring appeals windows: Most insurance and provider disputes have strict deadlines. Miss them, and your right to challenge the charge often disappears.

5. Lack of price transparency: Even with new rules requiring hospitals to post prices, the information is often hard to decipher and doesn't cover every scenario.

Protect Yourself — Don't Let Them Bank On Your Ignorance

The best defense is knowledge and vigilance:

• Request itemized bills for every significant service.

• Review your Explanation of Benefits carefully and compare it to the provider bill.

• Question everything that seems off—call the billing department and ask for clarification in writing.

• Negotiate: Many providers will reduce bills or set up interest-free payment plans if you push back politely but firmly.

• Get help: Patient advocacy services, medical billing advocates, or even your state's insurance department can assist with disputes.

• Know your rights: Laws like the No Surprises Act provide protections against certain surprise bills. Use them.

If you're dealing with a particularly messy bill, consider consulting a professional medical billing advocate. The fee is often far less than what you might save.

Bottom Line

Medical billers don't create the broken system—but some absolutely profit from patients who don't understand it. Your best weapon is refusing to stay ignorant. Question the bill. Demand details. Appeal when something doesn't add up.

Your health is stressful enough. Don't let sloppy, aggressive, or overly opportunistic billing add thousands to your burden.

Thing Three

Just A Thought  

"A system cannot fail those it was never designed to protect." - W.E.B. Du Bois