Elizabeth Warren's bold, risky, well-intentioned plan to improve health outcomes for African-American mothers giving birth

African-American women suffer a much higher level of maternal mortality than the national average, and Elizabeth Warren has proposed a bold -- but high-risk -- plan to incentivize hospitals to root out the institutional, systemic racism that produces these terrible outcomes.

Under Warren's proposal, hospitals that continue to produce higher-than-average levels of maternal mortality for African-American patients will lose funding; while hospitals that improve will get bonuses. As Warren tweeted: "Don't just observe and debate racism in health care. Make providers pay until this crisis is fixed."

I am 100% in favor of fixing institutional racism in health-care, and maternal care is a great place to start, but I'm really worried about this kind of plan.

Structurally, Warren's plan mirrors GW Bush's "No Child Left Behind" program, in which "underperforming" teachers and schools lost money, and teachers and schools that had improved test scores got bonuses. This produced terrible outcomes: teachers whose students scored poorly due to factors beyond their control (teaching in neighborhoods with high levels of unemployment, homelessness and discriminatory policing practices that locked up their students' parents) got less money to help the students who needed it the most, while teachers and schools that had structural advantages got money they needed less than their underperforming counterparts in worse-situated schools. And then there's the incredible incentive to cheat that these carrot-and-stick measures produce.

Even without cheating, there are lots of ways that hospitals can juke their stats: when Tony Blair started punishing hospitals whose ambulances took too long to arrive, the ambulance services responded with a raft of bizarre, terrible tactics. Read the rest