Laura’s hardly alone — but that’s small comfort. A recent study from the Annie E. Casey Foundation found that one in six children who are not reading proficiently by the third grade does not graduate from high school on time. In other words, Laura’s abilities in third grade may very well determine her future.

By the time Laura finished third grade, however, she loved to read and was prepared for the fourth grade. How did she catch up? She had a highly effective teacher.

There are no silver bullets in the education reform movement, but one area we cannot afford to overlook is expanding the pool of talented teachers. Popular reform efforts tend to focus on supporting current teachers and improving the standards they teach. But to maximize Laura’s chances, and those of our country, we need to start even earlier.

Our lack of teacher accountability is akin to a drug company producing medicines without measuring if the pills actually cure disease.

Research shows that the No. 1 school-based factor in improving student achievement is a great teacher. Of course, other factors are important as well: High standards, strong school and district leadership, and parent and community involvement, to name a few. But great teaching is the lever that most dramatically changes the trajectory of a child’s future.

To foster great teaching, first we need to know what makes a great teacher. And the good news is, we’re making headway in better understanding teacher effectiveness. Many states are implementing new systems to evaluate teachers, designed to give them feedback on how they are doing and a clear picture of what they can improve on. These evaluation methods replace antiquated approaches in which teachers received feedback only once every few years — feedback that had little connection to what students were learning or to the day-to-day operations of a classroom.

But evaluations alone are of little use without providing the support for a teacher to improve. Thus, many of these new evaluation systems are being connected with professional learning to help teachers continuously improve, as is done in many other industries. Weaknesses identified through these new evaluations are addressed with ongoing, collaborative support, as teachers work in teams to improve their instruction.

Many school districts have also begun to reward teachers for effective teaching, paying them more if they are able to substantially improve student performance. Laura’s teacher, for instance, might see a bonus at the end of the year for the kind of dramatic achievement she brought forth in her students. This replaces the traditional and still-common system in which all teachers with similar education and years of service are paid the same, regardless of how effective they are at actually teaching. The concept of performance-based pay is not new, only new to teaching.

Identifying and rewarding great teaching is critical, but the reform movement is failing to tackle a third important area — focusing on the start of the teacher pipeline and growing the pool of better-prepared teachers before they enter the classroom. U.S. Secretary of Education Arne Duncan said last year that “unfortunately, we all know that the quality of teacher preparation programs is very uneven in the U.S. In fact, a staggering 62 percent of all new teachers — almost two-thirds — report they felt unprepared for the realities of their classroom.” Let’s better prepare our teachers before they enter the classroom by raising the quality of programs that train teachers to teach.

Here are three ways.

We must first enhance accountability in teacher preparation programs by tracking the success and effectiveness of candidates once they begin teaching. Most programs have no idea how their products, the teachers, actually fare in educating students over the ensuing years. This would be like a drug company producing medicines without measuring if the pills actually cure disease.

Second, we must align the curricula of teacher prep programs with the most current, innovative, and proven policies, so that teachers are prepared to teach effectively from the moment they first step into the classroom. There will always be on-the-job training, but our teachers should not have to start over from square one weeks after they themselves graduate.

Preparation should include the use of new teacher evaluation systems which highlight what effective teaching looks like, training on the use of data to improve classroom instruction, and robust preparation to teach the new Common Core State Standards, the state-led higher academic standards being implemented today in 45 states and the District of Columbia.

Third, it’s time to fully open the door to alternative teacher training programs, like Teach for America, that are able to recruit, train, and inspire effective teachers in a short period of time. More collaboration between alternative programs and traditional programs would allow for the sharing and replication of best practices across all teacher training programs.

Yes, all this takes time, and won’t be easy. But the time is ripe for systemic change to identify, prepare, support, and reward great teachers. Research suggests the results will be dramatic for kids. All must participate in this work — teachers and principals, backed up with a lot of backbone from policymakers. But remember: Catching up students like Laura and better preparing millions of other students for college and a career is worth the work.

A close second, however, is getting sick and not being able to afford the care you need. For seniors, Medicare has been the entitlement program that for 47 years has dependably provided health security and peace of mind.

But today, demographics are shifting. Fewer workers are contributing to the pay-as-you-go system that by 2030 will cover double the number of beneficiaries it does now. Those reaching 65 this year, on average, will take out in services more than twice what they paid in over their lifetime. That is simply unsustainable. Medicare cannot last as currently configured.

Absent real changes, Medicare will be unable to meet the needs of seniors in the future.

And looming behind all this is our nation’s debt, skyrocketing on autopilot from $15 trillion today to $22 trillion in eight years. The higher the debt, the slower our economy grows, and the fewer jobs are created. Though a lot of people think Social Security is the culprit, it is not. As a percentage of GDP, it is our two government health programs, Medicare and Medicaid, which, left unchecked, will disproportionately balloon over the next 50 years.

For these reasons, the single most important reform that our next president must address is Medicare modernization.

Absent real changes, Medicare will be unable to meet the needs of seniors in the future.

This week marks the two-year anniversary of the President Obama’s health reform initiative. But that law did little to reform Medicare. Instead, it primarily addressed an entirely different issue, increasing access and expanding Medicaid so that one out of every four Americans will be on Medicaid in 36 months. Structurally, President Obama did not change Medicare at all.

If demographics, determined years in advance, define the impending bankruptcy of Medicare, why haven’t our elected leaders acted? Well, in fact, both President Clinton and President Obama, under mandates by Congress, appointed high-profile presidential commissions to address the issue of entitlement reform and Medicare modernization.

The irony is that both bipartisan commissions, one in 1998 and the other in 2010, demonstrated majority support for the exact same type of fundamental reform for Medicare, a plan that maximized security for our seniors, choice for the individual, and longterm sustainability of the program.

It’s called premium support. Here is how it would work:

When you become eligible for Medicare at 65, you choose a health plan from a menu of integrated private plans that all cover the basic benefit package provided under traditional Medicare today. They can vary in depth and scope of additional coverage. Or you can choose to keep traditional Medicare instead of choosing one of the more modern plans. It’s your choice. All the plans and the exchange system through which they are selected are regulated by the federal government to guarantee security, fairness, and accountability for the individual and a level playing field for the plans.

Your premium for the coverage will be paid partly by the government (known as a defined contribution or premium support). For example, hypothetically, this year the government might pay $8,000, and you pony up a supplementary sum — the total would depend on the additional benefits of the plan you selected. Your personal contribution would be means-tested, with more aggressive subsidies paid for those without resources to afford the basic coverage. The premium support level would be adjusted by income, geography, and health status. You would be able to afford it.

Is such a transformation of Medicare risky? Not really.

The government has a whole lot of experience successfully managing such an exchange, transparently ensuring its equity and value. It has been doing so with the FEHBP (Federal Employees Health Benefit Plan) for the past 52 years. This system has insured all federal employees, currently covering 9 million people, including me when I was a senator — making it the largest employer-sponsored group health insurance program in the world.

The advantages of premium support are many.

Each senior is empowered with a choice of comprehensive plans, similar to what each member of Congress enjoys. Plans can rapidly adopt improved innovations in benefits and coverage rather than wait years for Washington to pass another law. And increased price transparency demanded by active consumers interested in making a value-based choice of plans will empower 50 million Americans to powerfully participate in reducing waste, continually squeezing the fat out of the system.

Premium support would reduce total spending by stimulating price competition among plans (just as has been observed with the Medicare prescription drug coverage structure created in 2003). Beneficiaries become more cost conscious in choosing a plan that best suits their needs.

No longer would doctor and hospital reimbursement be determined by Washington-based price fixing (and arbitrary, blunt, across-the-board cuts) but rather, by value to beneficiaries. No longer will federal centralized pricing of 155,000 service codes based on episodic and unpredictable review be necessary. A side benefit would be a reduction in the costly and distorting power of lobbyists and Washington-based special interests who thrive on managing this centralized price setting to their advantage.

Premium support makes Medicare sustainable longterm, and goes a long way toward reversing the debt and entitlement problems that threaten America’s future.

And what are the naysayers worried about? First, they say providing seniors with more choice is just too confusing. But seniors can keep what they have in traditional Medicare if they want. Second, they argue premium support simply shifts costs and does nothing to reduce the overall price of care. But aligning reimbursement with value and quality rather than quantity will minimize this shift.

The premium support concept is neither novel nor new. Initially proposed in a bipartisan spirit by two congressmen in 1983, endorsed by two prominent health policy economists in 1994, supported by a majority of both of the last two presidential commissions, and more recently proposed by members of both political parties in Congress, premium support is the leading solution to achieve Medicare modernization for seniors and fiscal solvency for our country.

Is the new health care law constitutional? You might think it doesn’t matter — or at least, that it doesn’t matter to you. But the fact is, the Supreme Court’s decision on President Obama’s Affordable Care Act (ACA) will almost certainly affect you directly.

How, exactly? For one thing, the court’s decision could play a key role in determining our next president and possibly your next congressman. If you are poor, the ruling may decide whether or not you have coverage. If you are not poor, it will impact how much you pay for health care. If you own a small business, it might determine if you must purchase health insurance for your employees. And if you work for a large business, it may determine whether you still receive your insurance from your employer. If you’re a doctor, it will likely affect your reimbursement. If you’re a patient, it will determine your benefits.

On March 26, 27, and 28, the Supreme Court will hear extensive oral arguments on the constitutionality of the ACA. This is the culmination of 26 states filing suits in federal district courts and opinions from seven federal appellate courts. A final written opinion likely will be delivered in June, 18 months before the individual mandate kicks in and just five months before the presidential election.

If the individual mandate is ultimately deemed constitutional, then for the first time in our history, you will have to purchase a product to live in America.

The ACA is a highly charged law that, according to the latestRealClearPoliticsaverage, is viewed unfavorably by half of Americans. The law essentially does two massive, controversial things: (1) Mandates that individuals purchase health insurance coverage, and (2) expands Medicaid by 16 million enrollees. This expansion means almost one in four Americans will be on Medicaid, the government program originally intended for our poorest citizens. If you don’t purchase insurance, you will pay a fine of $695 per adult and $347 per child.

Together, these provisions will reduce the uninsured by 32 million, but will still leave an estimated 23 million individuals uninsured in 2020.

The focus of the Supreme Court opinion will be on the constitutionality of these two issues, though two additional items will also be considered. One is whether the entire law falls if a part of it, such as the mandate, is ruled unconstitutional, and the other is whether the court has jurisdiction to rule at all now, since the law has yet to go fully into effect.

There is already plenty of discussion on the legal merits of the case, particularly as it regards the taxing power and the Commerce Clause. But what are the very real implications of the upcoming ruling? Here is what to look for:

1. If the court upholds the individual mandate, it will take effect 18 months later — unless Congress acts to repeal or postpone it (which won’t happen as long as Obama is in the White House). If the individual mandate is ultimately deemed constitutional, then for the first time in our history, you will have to purchase a product to live in America.

2. If the individual mandate is ruled unconstitutional, the court will then decide whether to let the rest of the law stand, including the expansion of Medicaid and the largely popular individual insurance reforms. If the rest is left intact, the Congressional Budget Office projects that 16 million of the 32 million Americans expected to gain insurance under the law would be ineligible for the new coverage and that non-group, individual premiums might increase 15 to 20 percent. It would then be up to each state to decide whether or not to adopt the individual mandate.

3. If the court decides that the Medicaid expansion is constitutional, it will take effect in 2014 — unless Congress acts to postpone, repeal, or not fund it. But if the expansion is left intact, with almost a quarter of all Americans covered by Medicaid, the program would grow to include a portion of the middle class.

4. If Medicaid expansion is overruled, coverage will remain at current, varying state levels, and an estimated 16 million low-income individuals will not be able to take advantage of the new Medicaid coverage that would have begun in 2014.

5. Politically, if the new law is judged constitutional, Democrats will celebrate the judicial affirmation of the spirit and substance of the historic reform, illustrating President Obama’s leadership. Republicans would fan the existing flames of unpopularity among the majority of Americans, citing federal government overreach, rallying around an election call for repeal as they did in 2010. If any part is unconstitutional, the bases of both parties will be emboldened to make health reform the defining issue, after the economy, in the elections in November.

This one is worth following. It will be a game-changer. And not just for the politicians and pundits in Washington. It’s a game-changer for you, too.

Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books. Learn more about his work at BillFrist.com.

Let me tell you where I see the worst decline — but also our nation’s best hope.

One in five kids in America lives in poverty. That’s 20 percent of America’s future left behind. Left to drop out of high school, suffer through shorter lives, commit crimes, have a child in their teens — and then perpetuate this cycle with their own children.

With better education, kids live longer, earn more, wait longer to have a child, and are less likely to commit a crime.

It doesn’t have to be like this. Imagine an America with 20 percent fewer high school dropouts, 20 percent fewer teen pregnancies, and a 20 percent reduction in chronic health problems like diabetes and hypertension. Picture an America with a workforce that is 20 percent more productive and packed with 20 percent more qualified job applicants. Dream of an America with 20 percent more middle-class citizens. We would be a country poised to soar.

So how do we get there?

The fastest route out of poverty lies with education. With better education, kids live longer, earn more, wait longer to have a child, and are less likely to commit a crime. More importantly, these benefits pass on to their children, snapping the cruel cycle of poverty.

Poverty, especially during formative early years, can be an enormous hurdle for a child’s development. At U.S. schools where less than 10 percent of the student body is impoverished, reading scores rank first in the world. Yet these same scores for U.S. schools where 75 percent or more of the student body is impoverished rank 45th.

In a country with a failing K-12 school system, is it really possible to improve education for impoverished children? Yes, and here are three ways: Providing a boost for kids, lending a hand to parents, and pulling together crumbling neighborhoods.

First, we must start young, much younger than you might think. Most poor children are already behind on their first day of school. At age 4, poor children are 18 months behind developmentally, and without access to early education, kids are 25 percent more likely to drop out of high school.

Communities must target vigorous pre-K education and daycare programs for the one in five kids whose parents simply can’t afford them. Soft skills such as sharing, negotiation, reason, and concentration are instilled between finger-painting and building with blocks. The critical ingredient of high expectations is introduced. These are not luxury goods. They are essential in making communities more prosperous. When states think about job training, they should begin with pre-K education.

More than one in five American children lives in poverty. In my home state Tennessee it is an astounding one in four.

And it’s only getting worse. Less than four years ago, the national number was one in six children. Childhood poverty has increased 18% since 2000, as 2.5 million more children live in poverty today. But those are just cold, hard numbers. It’s what happens to kids who happen to be born into poverty that matters.

Childhood poverty does not just mean a family of four makes below $23,050 a year (it’s estimated that a family needs over twice that income to actually meet basic needs). No, childhood poverty limits access to the simplest, most basic things such as healthy foods, books, the Internet, and a secure place to play, exercise, or even sleep.

It means poor children,nearly half of whom are overweight, grow up with worse health..

It means at the age of four, poor children are already 18 months behind developmentally.

It means without early education programs, poorer children struggle and are 25% more likely to drop out of high school.

It means they are more likely to become teen parents, commit a violent crime, and be unemployed as adults.

It is a sad fact that at birth, one in five Americans today is well behind in the pursuit of happiness. The evidence increasingly points to the fact that once a child falls behind in the crucial early years, they may never catch up.

As a doctor, I focus on the devastating, long-lasting impact poverty has on a child’s health. Simply put, on average, the lower on the “socio-economic ladder” a child falls, the shorter life he will live. Americans in the lowest income category are more than three times more likely to die before the age of 65 than those in the highest income bracket.

For a child, a healthy body, a strong heart, normal development, and progressive learning all require adequate and balanced nutrition. But poor families too often don’t have access to nearby, affordable healthy foods. This stands as a major reason that debilitating chronic conditions like obesity and diabetes disproportionately afflict these impoverished youths.

“Food deserts” are those all too frequent regions of a city or rural areas, wherever poverty may exist, where affordable, healthy, fresh and nutritious foods are nowhere to be found. A 2011 Food Trust Report found that nearly one million Tennesseans, including 200,000 children, live in communities underserved by healthy food-providing supermarkets.

Across America 23.5 million live in areas that lack stores selling affordable, nutritious food. Without access to healthy foods, the cheap, fried, over-processed foods that accelerate the path to obesity become the mainstay diet. And the cause of early death.

This can be fixed. And an effective way to do so is for enterprising grocery retailers to partner with others in the private sector.

For example, just this year the Partnership for a Healthier America secured commitments from seven leading grocery companies to build new stores in areas where they’re needed most. All told, these commitments will bring fresh, affordable foods to ten million people!

Calhoun Enterprises alone will be building ten new stores in Alabama and Tennessee, creating 500 new jobs while figuratively bringing water to these deserts. And forward-thinking companies are increasingly learning that such “social partnering” not only helps the health and welfare of millions of Americans, but it also improves their own bottom lines.

And our government can also be a lot smarter. For many impoverished children, the majority of their meals, breakfast, lunch and even an afternoon snack, come from their schools. In 2010, almost half of all Tennessee students received government-subsidized school lunches. However, for longer life and better learning, we as tax-paying parents and citizens must insist on trading out pizza and tater tots for more whole grains, fresh fruit and vegetables.

Tennessee has recently started on this process. In June of last year, Tennessee, along with Kentucky and Illinois, joined a USDA pilot program for the “Community Eligibility Option,” allowing kids in low-income areas to skip the applications and red tape and receive the benefits of a free, healthy breakfast and lunch at their schools.

Nationally, last month the Obama administration overhauled the school lunch program for the first time in 15 years. Overall the menu will include items with less sodium, more whole grains and a greater selection of fruits and vegetables. Don’t worry, pizza will still be on the menu, but made with better ingredients.

Partnerships that focus on health and nutrition between the public and private sector, and between faith-based and secular nonprofits, will help lift children from the dire consequences of poverty.

America is the wealthiest nation in the world. The most technologically advanced. The most generous and accepting. We are the fastest car on the fastest track. We cannot afford to leave more than a fifth of our children behind.

To see the full article on the Huffington Post, please click here