Apart from national defense, the two giants of the U.S. economy are health care and education. In terms of expenditure, number of employees, and importance to every American family they are unique. They are very similar in that both face mammoth challenges regarding cost containment and the equitable distribution of services.
Both are also very high priorities for a new national administration that clearly has a goal of dramatically transforming American society into the statist social welfare model that prevails in Western Europe.
It is however the systemic differences between American health care and education that are most instructive because they illustrate better than anything else the stark choices facing our country at what is obviously a critical turning point in our history.
To understand these differences it is best to view them via a litmus test of the varying levels of government control and union dominance in both industries.
Throughout the first three hundred years of American history education was largely a local affair constructed and run by private individuals. K-12 education was disproportionately the province of single women who read very well and were able to convey that skill to pupils who were thus empowered to read books on literature, history, geography, science etc. Post-secondary education was in the hands of older people possessing college degrees who for relatively modest fees were willing to share what they had learned with younger people who wished to acquire said degrees.
Throughout this period the influence of state government financially and otherwise was negligible, the federal role virtually non-existent. As late as 1949 a United Nations survey of international education described the U.S. system as the world’s leader in performance, freedom, cost-effectiveness, and particularly breadth and equity of access.
The second half of the 20th century however saw U.S. education moving in an accelerating downward spiral in which performance, and accountability sagged while costs soared. Coincident with and the major cause of this decline was the growth of government control and labor union membership from minimal levels to positions of overwhelming dominance. Thus today while an ever-shrinking private sector still exists it is fair to describe American education as a system of “government schools” where teachers belong to unions much more interested in member benefits than in student achievement.
American Medicine grew from the tiniest acorn into the mighty oak of the global pre-eminence it enjoys today. In the 17th century doctors were few and far between. When possible veteran doctors shared their knowledge with aspiring young physicians. The latter however were greatly reliant on their close study of classic medical texts.
“Hospitals” as that term is properly understood did not appear until the late 18th century. Formal medical education first put down roots in the 19th century.
Only in the 20th century did American medicine evolve into what we can call a “Health Care System”. By gradual stages medical education, hospitals, research, and insurance came together to produce constantly improving patient care for an ever growing proportion of the population.
Though significant government monies went to research, education and insurance in recent decades, the overall enterprise remains largely in private hands. Standards for professional competence, hospital effectiveness and research probity remain essentially and successfully within the province of the medical community. In effect while government offers support, it does not control governance, and unions while present-mostly among lower ranking employees- are decidedly not dominant.
Perhaps the starkest difference between our educational and our health care systems is seen in who has choices and who does not.
In government controlled schools, not surprisingly the government makes the choices about what’s available, where, when, and for whom, and also supports a system of quality control that essentially grants veto power to labor unions.
In our health care system patients get to make important choices regarding their doctors and treatments. Unlike education money follows client choices, and quality control is firmly in private non-union hands and is committed to the high standard of patient well-being rather than the low standard of employee convenience.
In sum, for both education and health care a citizen’s right to choose goes hand in hand with both quality service and customer satisfaction. Government control and union dominance are hostile to both.
Very soon citizen choice in both health care and education will face major tests against the power of government and unions. It is hard to exaggerate how much is at stake.
William Moloney’s columns have appeared in the Wall St. Journal, USA Today, Washington Post, Washington Times, Philadelphia Inquirer, Baltimore Sun, Denver Post, and Rocky Mountain News.