Thursday, September 3, 2009

Public Education, why not Public Health Care?

Lauren had asked me what I thought about the differences between free public education(k-12) and free public health care. She writes....

“I've been trying recently to figure out the difference between public taxpayer-bought education (k-12) and public, taxpayer-bought health care. Both have (or will/may have) flaws both in spending and results, and both are a public service that a libertarian could argue are unnecessary excesses of large government. However..."

It is an interesting comparison to be sure. Education, she pointed out, is something you can pay for your self. In fact many people already do so. She pointed out that public education is not perfect and it is likely that the health care reform will not be perfect either. The perfect should not be the enemy of the good. So why one but not the other?

Lauren further states.....

"Through government, the taxpayers now give all children a free education UP TO 12th grade, and though admittedly flawed in many ways, I doubt you'll find a whole lot of people who think the US should be without public education. If you want more than that (ie college) then you get to pay for it with money - which not all people have."

As I stated in my quick reply to her comment, I don't think you can lump all "government" together. One of the characteristics of our government is that is a federal style of government. Think of a cake with three layers. One the top is the U.S. Federal government. Below that is the State governments. And on the bottom are the local governments. Now you still don't really know what kind of cake you could be a marble cake where the federal layer reaches down into the state level and the state level mixes into the local level.

When you think about how our government was formed, it was from the states agreeing to give the federal government certain duties, and those only. The state itself was formed from local governments who relinquished certain rights to the state and in turn local governments were formed by the people giving certain powers to the local government. This way the most power was retained by the people, not the governments.

Personally I think we have a marble cake. I can only hope all three layers are chocolate!

Regardless of which view you take, each layer of government has specific areas of responsibility. The Federal government is limited in its powers by the U.S. Constitution. The U.S. Constitution specifically reserves all powers not enumerated to the federal government to the states and or the people.

This is part of the reason why the Federal government does not run education. Education is run primarily by local school boards that are elected by the people they serve. Yes, the Federal government does play a part in education, but it is a very limited one, but like all things that government does its role is increasing. Over the last decade, federal spending on education is up more than 50% from roughly 5% to over 8%. I'll just add that the quality of our education system has not gone up 50%. In fact most people might agree that our education system is in big trouble despite the near doubling of federal money. Hint, hint.

Lauren goes on to say:

"Right now, when I try to translate the US's health care system into public
education, it seems like NOBODY has a "right" to be given the opportunity to
learn to read or do basic math. If there's someone in your life to teach it to
you or your family has enough money to pay for a private school, good. If not, looks like you're going to be illiterate and unable to do basic math like balancing a checkbook, and you'll probably be broke and undereducated for your entire life. Which is something that I know some people would argue in favor of. I wouldn't be one of those people."

Most states require, by state law, attendance to some type of school. Children and parents alike can be issued citations for not attending school. In fact the Nevada State Constitution directly addresses education in its "Bill of Rights". Here is a relevant section:

"Sec: 5. Establishment of normal schools and grades of schools; oath of teachers and professors. The Legislature shall have power to establis [establish] Normal schools, and such different grades of schools, from the primary department to the University, as in their discretion they may deem necessary........"

In my old state Michigan, the Michigan State Constitution also mandates "free public education" as shown here:

2 Free public elementary and secondary schools; discrimination. Sec. 2. The
legislature shall maintain and support a system of free public elementary and
schools as defined by law. Every school district shall provide for
the education of its pupils without
discrimination as to religion, creed,
race, color or national origin.
I doubt there is a state that does not address education.

I think that translation fails because of different powers granted to the federal government and the state government. It would be more appropriate for a State government to require health insurance and several already have. All states already mandate insurance for cars.

That is the best reason as to why a national "universal public health care" plan has never evolved in this country.

That leaves the issue of Medicare, Medicaid and Social Security. These are three programs that are federal and universal.

Lets begin with Social Security. In a nut shell Social Security was originally designed to keep older poor or disabled people from starving. Although many people consider it a retirement plan, they will find it very lacking in that regards. You get enough to survive.

Where I used to work we had people that pulled in over $100,000 of earned income a year, collecting Social Security!!! That is just not right. It should be for people who cannot take care of themselves. I think that would fall in line with the U.S. Constitution.
Personally, I would like to see Social Security severely restricted though. Financially, it is a disaster. By the time I will be able to retire, you will need to be 90 years old to collect it and will be lucky to get $.50 for your trouble. The eligibility age keeps going up. That's how they try to solve the financial mess that is Social Security. They also lower benefits and raise the FICA tax.

With respect to Medicaid/Medicare they also increase premiums, raise the cap on earnings subject to Medicare withholding. And lets not forget that they also plan to cut reimbursements to doctors, hospitals and such. That's where the $500 billion in savings to pay for "health insurance reform" comes from. Medicaid is in way worse financial condition than Social Security. Medicare and Medicaid, unlike Social Security, target specific groups like the disable, poor, and elderly. That makes it easier to see them as part of a federal plan.

Anyways, I hope some of this made some kind of sense.



Lauren said...

Nice post, and you definitely found the biggest flaw in my metaphor that I hadn't thought about: the fact that education is mainly run and funded by local governments, and this current healthcare debate is taking place at a national level.

(I had a big rant here about public education and its flaws and propagation of our society's systemic class-ism and racism, and how I'd go about starting to fix it, but I decided to delete it because it really was kind of off topic... even for me lol).

But the school stuff aside, I'm now wondering why people seem to be in favor of laws (I know, state laws) mandating that children attend school. Even though they often complain about it, everyone (homeowners at least) pays a percentage into their local government to fund schools. Not everyone is capable of paying for school, and some pay more than others, but everyone's kid does get to go to school.

So even if we chucked the whole current FEDERAL healthcare bit out the window, why aren't people still in favor of some type of government healthcare, even if it's at a state level? I know there has been at least one state that's tried it, but I wonder why there isn't more thought put into getting it right, and more support for doing that research to get it right? It's good to "force" kids to get a basic education through taxpayers' money, but it's not good to "force" people to provide basic non-emergency-room and preventative healthcare to these same children through taxpayers' money? Why are people so outraged about even discussing healthcare reform ideas, but they still send their children to public schools without throwing fits at town hall meetings? Ha, voters even occasionally have been known to vote to approve levies for their public school districts!

I know it's lame to play on the whole "what about the children" thing, but it was my best angle when comparing it to public schooling. Sorry :-)

Lauren said...

Unfortunately, I have to admit my lack of knowledge about medicare/medicaid, though I do know at least that they have some serious issues that make doctors often not even want to take those people on as patients! I would hope that whatever happens with healthcare reform in the coming months, that they will be able to do something that turns out better than those programs.

Just one last sort of interesting tidbit... I had to have my appendix removed a couple of years ago when I had just started grad school and couldn't afford any insurance - it was right after I moved to the town that the college was in, and at the time I only had a crappy temporary 3rd shift job. Couldn't have been worse timing. Afterward, I owed a lot of money to surgeons, anesthesiologists, etc. Every office I called and asked to set up a payment plan with told me that they would lower my total bill (often in half or more), and that they actually like customers with no insurance. Even after reducing my bill, they all told me that they were still getting a lot more money that way than if they'd had to deal with insurance for payment. Something is definitely wrong with our healthcare system... And I hope, fingers crossed, that whatever bill gets passed will do more good than harm in trying to "fix" things.

All right, another cluttered bunch of thoughts from Lauren is complete. There's so much that goes through my head when I think about healthcare, that it's hard to stay on topic and keep one coherent thought going. But at the very least, I enjoy reading your thoughts on it. I wish that right or right-leaning or libertarian-ish folks could all be more like you and discuss their "side" more rationally and with facts (though of course I know that left-leaning people are also often guilty of skewed and "sound bite" type arguments too). But I seem to have a hard time finding conservative friends who are able to thoughtfully explain why they believe what they do without calling Obama a racist Hitler-wanna-be with a secret evil socialist agenda to take over the world, lol. It's hard to take people like that seriously, ya know! :-) So anyways, thank you!

Rob said...

Thanks. Overall I think most people just do not want government with an overbearing influence on health care or health insurance, federal or state. As you know, several states do have "universal health care" and at least one city (San Francisco) has a version of it. It is yet to be seen how well it works or doesn't work. I do know that on the state level it has cost way more than they originally estimated.

I think the reason more people are not outraged about health care it that, for most people, it works.

Why are they not outraged about sending kids to public schools? I think many people are upset about the public education system in the U.S. Hence the large support for charter, private, and religious schools or even home schooling. Even President Obama supports charter schools, although I don't believe him when he says it. I doubt you'll even hear him say it now that the election is over.

I'd also say that most children are indeed covered by insurance of one form or another. Poor children are covered by various federal and state programs such as SCHIP, Medicaid/Medicare on the federal level, and a host of various plans at the state level that provide coverage for an even larger pool of children than the federal programs do. SCHIP was recently expanded to cover even more children, some of whom already had private medical insurance. Rich children pay cash or buy insurance.

Most middle class children are insured through their parents.
So, in many ways, what you are talking about is already being done. Are all children covered? No. Should they all be? Probably, but that is a different debate.

You should read up on Medicare/Medicaid. The reason doctors do not like medicare patients is that medicare only pays them $.55 for every dollar the doctor should get. No negotiation, thats what they get. For a while that little provision was in the current House Bill 3200. The doctors were freaking out about it, so it was changed to allow the doctors to negotiate with the government for reimbursement rates.

I suppose another reason why people freak out about health insurance from the government versus education from the government is that they, more or less, want the government to provide education, but not health insurance.

As usual as soon as I press "Publish you comment" I think, I should have said this, or had made a point

Health Care does need to be fixed. I think it can be fixed without throwing out the baby with the bath water, as it were.

Most of my family/friends are "birthers" who think Obama is the I know they all suspect, deep down, that I voted for

Truth be told, I'm just a socially liberal conservative, except for abortion. Almost a libertarian of sorts.

Just to be clear, I use Medicare or Medicaid inter changeably, while in truth they are not. You can read here about the differences here

Medicare is the program that is having sever financial problems.

Lauren said...

Thanks for the medicare and medicaid links - I really do need to learn more about them!

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