Why Do We Have Universal Education? Why Not Universal Health Care?

I left this post in the form of a comment over at Michael van der Galiën’s place in the comments section of a post on this article by Paul Krugman.

I have the utmost respect for Dr. Krugman as an economist; as an historian, not so much. The reason that universal education was adopted in the United States roughly 100 years ago had little to do with fundamental rights or equality. Its purpose was acculturation.

An enormous number of immigrants, many from Eastern and Southern Europe (in contrast to their Western and Northern European predecessors). Quite a few were (gasp!) Jews and Catholics. White Anglo-Saxon Protestant Americans believed that there was an urgent necessity to turn these invaders into Good Americans and the public schools were the mechanism for doing this.

The public schools in the United States are now and always have been overwhelmingly funded and administered locally.

There’s no comparable purpose for children’s healthcare.

Actually, I wouldn’t oppose universal healthcare for primary school-aged children, funded and administered locally. Why aren’t more municipalities stepping up to the plate?

The answer, of course, is that health care is too expensive. Access is largely a red herring; at a lower cost the problem would solve itself.

Why is health care so expensive? It bears noting that there are for practical purposes no barriers to becoming an education provider. The cost is nominal and there are plenty of billets for education students available.

It’s quite the opposite in the case of health care providers. The number of physicians educated in the U. S. hasn’t increased in a generation. There are waiting lists for both medical and nursing schools. It’s enormously expensive.

Remove the barriers, increase the supply of health care, and the problems of cost and allocation take care of themselves. Leave the supply alone and increase the demand and you set the stage for a fiscal meltdown. Fortunately, the program would have lost political support long before that happened (cf. TennCare).


Tim Worstall quite correctly notes that public education is not without its problems.

12 comments… add one
  • I don’t know how important or widespread a phenomenon it is, but I know two surgeons personally. One quit to raise her kids. No apparent interest in going back.

    The other is a fairly big deal in his field (but in less lucrative university practice) and he’s attending biz school looking to get out and do something different, probably in drugs and medical devices where his background would bring him bigger money.

    I wonder how many doctors quit for family reasons, or because less useful but more lucrative options beckon.

  • Tom Strong Link


    What do you think of the argument that increasing the number of doctors and nurses would increase the incidence of malpractice (and malpractice suits), due to more under-qualified people becoming certified for practice?

  • It would make sense if there were a clear relationship between medical malpractice and medical competence; there isn’t. Medical malpractice is a lottery.

    But return to my point that the number of U. S. medical graduates hasn’t increased since, roughly 1980. The population of the country has increased roughly 30%; the number of medical graduates hasn’t increased at all.

    The top X applicants are being taken. Not the top Y%. And X is a fixed number. That leads to a couple of possible conclusions:

    1) Americans aren’t as smart as they used to be;
    2) today’s graduates are much smarter than the graduates of 25 years ago because we’re taking the highest group of a larger pool (implication: older docs should be forcibly retired as unfit);
    3) some level of competence is enough to keep malpractice manageable i.e. a lot of qualified applicants aren’t being admitted to med school.

    I pick 3.

  • Plus there are other ways to increase the supply of health care without reducing quality. The most important: automation and telemedicine.

    Note BTW that I don’t claim that insufficient supply is the only reason for high costs of health care. Other reasons include defensive medicine, anti-competitive regulations, increasing bureaucracy, inefficiency due to excessive paperwork, adverse selection, that the health insurance system creates a condition of moral hazard.

  • Tom Strong Link

    Your argument seems sound to me. Really, I’m surprised more people aren’t making it. I’m just trying to get a sense of some of the more likely objections.

    Having worked on the fringes of the alternative medicine community for years, I’ve suspected that a large part of its recent success has to do with the much more personal level of care given by the caregiver. When I go to the doctor, I can rely on her/him to forget my name and most details of who I am within five minutes of leaving my presence. When I speak to a naturopath or a massage therapist, I can rely on them to remember me weeks or months afterward.

    So I can see they’re meeting the demand for personalized care that the shrinking certified practitioner class cannot. And its not hard to see why many people would be willing to suspend their disbelief at things like naturopathy (or even more out-there stuff like reiki or magnet-therapy) in return for that level of personal attention.

  • Question for those better informed than I: Is there a federal law that requires states to provide public education?

  • It’s a bit complicated, Andy. The short answer is, no. The longer answer is that the federal government provides a variety of incentives for the states to provide K-12 education along certain guidelines.

    However, every state that I know of mandates K-12 education and specifies how that education will be funded. There’s quite a bit of idiocy and hypocrisy about this. For example, in Illinois, the state in which I reside, the state constitution mandates K-12 education and requires the state to have the primary responsibility for funding that education. Problem: the state has never in its history shouldered the primary responsibility for funding education. It’s always been local, mostly supported by property taxes (another discussion entirely).

  • Well then it seems that comparisons of “nationalized” health care are not really comparable to “nationalized” education. I wonder what sort of health-care system we’d have if it was primarily funded through property taxes.

  • PD Shaw Link

    The closest to an affirmative answer to Andy’s question is the Northwest Ordinance, which required the states carved out of the territory of the Old Northwest (OH, IN, IL, MI & WI*) to be administed such that “Religion, morality, and knowledge, being necessary to good government and the happiness of mankind, schools and the means of education shall forever be encouraged.”

    * And a portion of Minnesota.

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