SAT Essay Prompt from April 2019 School Day SAT Test

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SAT Essay Prompt from April 23, 2019 School Day SAT Test

As you read the passage below, consider how Sandeep Jauhar uses:

- evidence, such as facts or examples, to support claims.

- reasoning to develop ideas and to connect claims and evidence.

- stylistic or persuasive elements, such as word choice or appeals to emotion, to add power to the ideas expressed.

Adapted from Sandeep Jauhar, “Busy Doctors, Wasteful Spending” ©2014 The New York Times Company. Originally published July 20, 2014.

1 Of all the ways to limit health care costs, perhaps none is as popular as cutting payments to doctors. In recent years payment cuts have resulted in a sharp downturn in revenue for many hospitals and private practices. What this has meant for most physicians is that in order to maintain their income, they’ve had to see more patients. When you reduce the volume of air per breath, the only way to maintain ventilation is to breathe faster.

2 As our workdays have gotten busier, we doctors have had less time to devote to individual patients. An internist I know in private practice used to see 15 patients a day. “Now reimbursement is so low I have to see at least 30,” he told me. “If I stay in the room more than 10 minutes, my assistant will call me and tell me to hurry up.”

3 Racing through patient encounters, we practice with an ever-present fear that we will miss something, hurt someone and open ourselves up to legal (not to mention moral) liability. To cope with the anxiety, we start to call in experts for problems that perhaps we could handle ourselves if we had more time to think through a case. The specialists, in turn, order more tests, scans and the like.

4 And therein lies the sad irony of the health cost containment paradigm in this country. There is no more wasteful entity in medicine than a rushed doctor.

The Institute of Medicine, a federally funded research group in Washington, has estimated that wasteful health care spending—i.e., spending that does not improve health outcomes—costs about $750 billion in the United States every year. Excessive paperwork and administrative costs explain some of this waste, but unnecessary or inefficiently delivered services, especially in hospitals, account for by far the largest chunk. Total payments to physicians, in comparison, are much smaller, making up a fifth or less of the money this country spends on health care.

5 But even though physicians’ salaries account for a relatively small fraction of health care costs, physicians’ decisions may affect upward of 80 percent of total health spending. We order tests, prescribe drugs, hospitalize patients and—one of the costliest decisions a doctor can make today—call specialists for help.

6 There are many downsides besides cost to having too many doctors on a case. Specialists’ recommendations are often contradictory. The kidney doctor advises careful hydration; the cardiologist advises discontinuing intravenous fluid. Because specialists aren’t paid to confer with each other or to coordinate care—although the Affordable Care Act is putting payment systems into place that will do just this—they often leave primary physicians without clear direction on what to do.

7 More important, patients don’t always require specialists. Patients, especially older adults, often have disease syndromes that cannot be compartmentalized into individual problems and are probably best managed by a good general physician. When specialists are called in, each is apt to view a problem through the lens of his specific expertise. Patients generally end up worse off. I have seen it over and over.

8 One of my patients went to the emergency room after swallowing a tiny fish bone. She told me about the experience when she came to see me. “They kept me down in that E.R. for two days!” she said. “They did X-rays, EKGs, CAT scans, God knows what. They had an ear, nose and throat specialist come by. They called a pulmonologist. They told me to follow up with my cardiologist. I told them it had nothing to do with it. It was the fish!”

9 What is the solution to this predicament? One option is to hire doctors as employees and put them on a salary, as they do at the Mayo and Cleveland Clinics, which takes away some of the financial impetus to cram more and more patients into a workday.

10 Another option is to use bundled payments, which are calculated on the basis of the expected costs of a particular treatment (for example, an entire hospitalization) rather than discrete for every service. A major driver of health care overutilization is that doctors are paid piecemeal. There is little financial incentive to call in specialists if payments are bundled.

11 Reforms will also have to focus more on education. Through an initiative of the American Board of Internal Medicine called Choosing Wisely, medical- specialty societies recently released lists of tests and procedures that are not beneficial to patients, including M.R.I.s for most lower back pain and stress tests when there are no signs of heart disease. These criteria are essential for educating physicians and patients alike about wasteful medical services that they should avoid. If patients were more involved in medical decision-making, there would be more constraints on doctors’ behavior, thus decreasing the possibility of these tests and consultations.

12 Health care costs must be contained, but cutting payments to doctors is a self-defeating strategy. Policy makers need to focus on the drivers of waste. And one of the most potent is when doctors reflexively call other doctors for help.

Write an essay in which you explain how Sandeep Jauhar builds an argument to persuade his audience that Americans need to work fewer hours. In your essay, analyze how Marcus Stern uses one or more of the features listed in the box above (or features of your own choice) to strengthen the logic and persuasiveness of his argument. Be sure that your analysis focuses on the most relevant features of the passage.

Your essay should not explain whether you agree with the author's claims, but rather explain how Marcus Stern builds an argument to persuade his audience.

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