There’s been an excellent debate / discussion going on about school vouchers (here, here, and here), and the reasons they’re being resisted by some (many?) folks. Unions, and their motives / purposes, are interesting topics, but I have a separate question altogether.
Megan McArdle wrote (on the subject of school vouchers):
1) A voucher system which required lottery admission, gave out more money on the basis of disadvantage, and required schools to meet certain standards, would be preferable to the current system.
2) We can’t, however, get there, because there are too many political obstacles.a) It would be unconstitutional
b) It’s not feasible politically
c) It’s not feasible institutionally3) Therefore maybe we can muck around with charters, but don’t go crazy!
Point 1 we agree on; I think it’s fair to say that a voucher should not be used at Tom’s House of Arithmetic and Billiards. We undoubtedly will quibble about the details, but that’s a negotiation for later.
Point 2a seems silly in the context of a national healthcare debate; if nationalising the healthcare system can be done under the commerce clause, I bet I can find room for education, too.
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Can somebody explain to me why, exactly, nationalization has become The Vehicle for a healthcare system? There are a number of interesting state initiatives under consideration (or in the fledgling stages of implementation), and frankly, that’s about as wide an umbrella as I think can be efficiently managed.
We have federally-funded programs (Medicare and Medicaid) that are handled differently:
Medicare, as McArdle describes, is effectively a voucher program, wherein the beneficiary takes his “voucher” to the (participating) provider of choice.
Medicaid, however, is managed at the state-level, but funded jointly by federal and state tax dollars.
Has there been a comparison of these two models in terms of efficiency, quality, and rate-leverage?
I agree that the healthcare crisis is an enormous problem. I’m very interested in proposals and solutions — but I cannot get behind any plans that rely on the federal government’s management.
The national government does so well with levees, how could they not improve education?
People in favor of the national government throwing out huge sums of money for education make it sound like there will be no strings attached, ever. Highway transportation money bring up any memories?
In Texas, notice that when the STATE legislature has tried to remedy our public school system, that no matter what was being decided, there was huge opposition to giving up local control to just the state. Are these same people going to suddenly rally in favor of the possibility of Congress getting involved in local curriculum? These people haven’t said much because there is no serious or imminent event of Congressional control getting ready to happen. But they are out there, and are extremely passionate. I bet that when that happens, the first thing they will bring up is how Massachusetts schools teach elementary kids about homosexuals.
Jack —
Your observation that Texas resists state involvement in school system issues is, to me, yet one more reason why I think it’s unrealistic to be holding out “nationalization” as a solution to health care, too.
It just ain’t set up that way (in the TX vernacular…)
The schools issue is interesting to me in that it’s obvious that the vouchers will never fly, that no one will ever break the back of the teachers union while all the while you will observe as time goes by that as the state becomes ever more populous, public education takes on less significance in the mind of more and more of child bearing age. That’s a hard thing to explain, but I see it everywhere I go. There a lot of 20/30 somethings who’ve been hired to replace us codgers here at work, (codger=anyone over 50), and 2 out of 3 report pursuing either private schools or home school networks. They honestly don’t even consider the issue of public school. Their greater concern seems to be easy access location to work and play, i.e. not locating in suburbia and when I enquire about rejecting suburbia when my generation selected it FOR the schools they tell me they hated growing up in suburbia and that the suburban school districts they attended are in steep decline. You get to the point where in a very overcrowded state like California, no one of any appreciable means consider say, the L.A. school district.
So where does this take us? Well, for one thing, down the road to Tax Hell? As the State fills up with more and more people with more and more kids, more and more money is needed because the bucks are distributed on the basis of how many kids are in the schools so it would seem that more and more bucks must be thus spent. Reports I’ve heard lately indicate that what’s really happening in many big city environments is that budgets have been steadily increasing while pupil population is in decline. Why? From what I gather it’s because evermore these high density “urban” school districts find they are for the most part serving a special ed/special needs student base because the private schools won’t/can’t accomodate them or because their parents can’t afford the special education otherwise. I guess what I’m trying badly to describe is a paradox, i.e. vouchers die, Unions live, but their impact lessens over time and the districts shrink. It’s almost a mirror image of what the unions have done to the American Automotive industry. Kill it!
Well, when you say “nationalization” of health care, what do you mean? Do you mean a federally-run system like Britain’s NHS? Do you mean federal single payment with the health care delivery handled by state, local, or private providers (more like what you see in some other European countries)? Do you mean a national mandate that states provide health care funding (closer to Canada)?
The silliness of most discussion of “nationalizing” health care in the US is that nobody ever says what they mean by that – and that word covers a wide range of vastly different approaches.
We do have some data to look at; specifically, the health programs run by the feds are far more efficient than our private sector, and pretty much every gov’t health program in the western world provides better patient outcomes than ours for less money.
We don’t like to look at that data, though.
John — I’m reading your comment to say that you support a model like the UK’s NHS — or something similar…?
I’m going to recycle an earlier comment from TMV:
The government that brought us FEMA is a bloated, bureaucratic nightmare already — jam-packed with conflicting, self-patronizing, and partisan interests. I have very little confidence in them, generally.
More: The U.S. has a much, much larger, and more complex, population than Japan or Holland [or the UK, etc.). More importantly, though, this country’s foundational concepts are radically different. Via federalism, we’ve arrived at a different place altogether.
The problem with both Medicare and Medicaid is that they both set “reimbursement” levels somewhat arbitrarily, usually on the basis a standard rate nobody pays, unless they are too rich for Medicaid and too poor to buy insurance.
The entire system approaches randomness.
I absolutely do not support a model like the UK’s, and I say that as someone with lots of relatives in the UK. (None of whom, incidentially, would trade the NHS for what we’ve got here.)
I think a single payer (or limited number of payer) system does make sense – we spend an absurd amount on managing our healthcare bureacracies (in the form of insurance providers). Single payer is vastly more efficient. It could also take the form (seen in some European countries) of a group of insurers who follow strict guidelines about how they function.
I would not prevent practitioners from providing services directly for a fee outside the system (as Canada does), and there’s one British feature that’s good: private insurance is available for those who wish to pay for it (or get it as a job perk). What I’d like to see is a basic health plan for everybody with simple administration, and the option of buying more services or insurance for those who can and who care to.
And yes, this means that not everybody gets the same level of health care – but we’ve already got that problem. This would mean that everybody gets regular preventive care and basic services.
And I expect this would cost less that what we’ve got now, based on the experiences of other countries, who pay dramatically less than us, and (when viewed as a population) often live longer than us, have lower infant death rates than us, etc.
Which gets to my point: you say “nationalized” and everyone pictures Britain’s NHS. There is plenty of nationalized health care in the world that looks nothing at all like the system in the UK.
As for the US population being much more complicated than the UK’s, I think that’s a highly questionable statement. But that speaks to my point about delivery remaining local.
OK, here’s what got lost in the editing of that last comment: delivery should be what we have now, a combination of local public and private entities – not a centralized provider.