Using Education As a Model for Healthcare

As I was driving between appointments this morning I heard an interview on the radio with Theodore Marmor, a grizzled veteran in the Washington battles over healthcare reform. In the course of the interview he said something that I think is worth pondering. He said something to the effect that the Obama Administration has been posing the issue of healthcare incorrectly and should have been making the analogy with education. Like education, he said, healthcare shouldn’t be a “market good” but should be something that we expect to be provided to all.

Leaving aside for the moment the improperly posed dichotomy of market goods versus, presumably, non-market goods and whether most Americans would actually be satisfied with a healthcare system that functioned as effectively as the public education system does, I think it’s a perfectly good analogy as long as you’ve got the courage to follow it to its logical conclusion.

First, education is and has been something that is preponderantly a state and local responsibility. If healthcare were to be treated like education, we’d abolish the Medicare system in favor of state and local programs that performed similar functions. Here in the United States we spend roughly $1 trillion per year on education. The federal government’s contribution to that is a relative pittance of that, perhaps 15%.

Second, when all is said and done there’s a limit on how much public education is provided to an individual. Generally speaking, it supports kindergarten through 12th grade without charge to the student or the student’s parents. After that the individual is expected to contribute substantially to financing his or her own education and the best, most prestigious educational institutions charge mightily for that. There’s not even a pretense of equality.

So, to follow through with the analogy, are proponents of treating healthcare like education suggesting that a fixed menu of healthcare should be offered without charge to an individual or the individual’s parents until the individual reaches age 25, at which point financing his or her healthcare would be left to the individual? If that’s what’s being suggested I must have been asleep during class.

Checkups, immunizations, and routine treatment would be covered. Pediatric intensive or extraordinary care wouldn’t. For most people, most of the time this could well be adequate and might even be an improvement over what they experience now. I would certainly be less expensive.

I think it also is worth pointing out that most teachers are employees of the public school systems and primary education is considered for the most part an entry-level field (and compensated commensurately). The starting salary for a teacher in the city of Chicago is around $40,000. If the only healthcare that most people ever experienced was delivered by RN’s (the comparable in this analogy of healthcare and education), I doubt we’d hear quite as many complaints about healthcare being too expensive. Ineffective, maybe, but not too expensive.

7 comments… add one
  • PD Shaw Link

    Summer vacation would be a peach.

    But as to your second point, there’s no reason to limit healthcare to thirteen years in early life by analogy to education. We could provide public healthcare to thirteen years late in life.

    Here’s how it would work. At age 65 (thirteen years prior to the current life expectancy), everyone would be eligible for government healthcare, paid for by forced savings during one’s working life. Some people might live longer than 13 years, some may not make it to 65 at all, but that’s kind of like the variability in our schools. I would support such a program as long as it retained actuarial solvency.

  • Yeah 50 Californias are so much better than one.

    Next idea!

  • Brett Link

    That’s perilously close to a strawman of his argument, Dave.

    I think his greater point has merit, though. While the state and local governments do provide most of the money for the public education system, generally speaking it is considered a good thing to have a public education, to provide education to all the children in the US, and that’s been the case for well over a century.

    Why not health care? It’s not exactly unprecedented either – the Canadian system is largely paid for at the provincial level.

  • Why not health care? It’s not exactly unprecedented either – the Canadian system is largely paid for at the provincial level.

    Canada’s health care system is in serious financial trouble, not as bad as ours, but that isn’t saying anything at all.

    Like I said, is having 50 Californias better than just 1? It was somewhat sarcastic, but Dave is more aware of the budget problems here in CA.

    And yeah, school teachers get paid $40k/year. Has everyone here put on blinders to the public employee pension issue? That little bubble is sitting out there waiting to pop.

    Like I said Dave, get used to these crises.

  • PD Shaw Link

    Do we really value public education? In many areas, people vote with their feat to opt out. To help funding, states generally don’t check to see if homeschoolers or private schools are learning anything. I’d say we like the idea of education availability, but we are not too obsessed with definitions on what an “education” means.

    And the unfunded Medicaid expansion is going to divert state and local money from public education. It seems to me that if you truly value public education, you have to oppose the current bills.

  • malthus Link

    When you compare the healthcare system to the public educational system, the healthcare system sometimes comes out much worse:

    There are some tests (like SATs) to grade outcome in education. Nothing similar for health care.

    Health care is financed by insurance, so that the young and capable subsidize the old and infirm.

    But the worst features they do indeed share:

    You can’t Google the qualifications or even abuse record of those teachers or healthcare providers, licensed by the state, that you are virtually forced to deal with. Consumer Reports won’t help you either.

    You can struggle to stay healthy (& childfree) yourself, but still pay through the nose for the illness (& education of children) of others much less prudent.

    You can get better and cheaper offerings overseas, but taxes you have paid in Amerika won’t offset the fees you will have to pay there.

    You pay for the right to participate in the mediocre system, but, as Catholics know, pay yet again if you want quality outcomes.

    The providers are certified and licensed, with the result that libertarians and other self-respecting folk are discouraged from even considering entering the profession.

    A bad apple is never fired. The worst are either promoted or allowed to seek employment in another state.

  • I don’t think it’s a strawman argument, Brett. The author of the op-ed is arguing that healthcare should be treated like education. I’m pointing out that the differences between the two are substantial enough that it makes sense to treat them differently.

    However, I also think that the direction that appears to be preferred by many Democrats (me included) makes a lot more sense under a system in which the menu of services that are subsidized by the government-subsidized healthcare system is significantly smaller.

    Under the French system for example, there are arguably different standards of care depending on whether you have private insurance in addition to public insurance or not. The public insurance system doesn’t cover everything.

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