As I observe health care rise to the top of the policy debates foreshadowing the 2020 election—seems to be second only to Donald Trump among the twenty-three Democrats now seeking the Oval Office—as K–12 education sinks lower on the policy horizon (such that several observers declare ed-reform a thing of the past), I’m struck by how much these two vast and troubled domains have in common, as do efforts to change them.
Most obviously, both are huge, both are expensive, and both of them affect just about everyone, either quite directly (health care) or via kids they love and care about. Though federal policy matters more in health care than in education, state decisions loom large in both, and the actual “delivery systems” of both are essentially local. Public funding dominates both budgets, though private dollars—user fees (e.g., tuition, doctors’ bills), philanthropy, profit-seeking—play important roles as well. (So, in the case of health care, does insurance, much of it subsidized by government and employers.)
Perhaps less obviously:
- In both domains, we see fundamental tension between what might be termed the “single-payer system” and the marketplace. “Medicare for all” is national, sure, but the “school district monopoly” that has long characterized K–12 education, however susceptible to a degree of “local control,” also feels like a single payer/player from the standpoint of its clients. Although it appears that health care may be moving toward greater top-down control even as education accommodates more exceptions to it, the fact is that government bureaucracies remain the principal sources of both these vital social services.
- Polls and surveys signal that most Americans think both systems are performing poorly and need reform: too expensive, inequitable, uneven quality, patchy access, etc.
- Yet polls and surveys also show that most Americans believe that they, themselves, are well served by the schools their kids attend and the health care their own family is getting. Which also means (a) it must be somebody else whose schools and medical treatment need fixing and (b) whatever you do for somebody else, please don’t change mine!
- Both sectors are dominated by large, politically influential interest groups with powerful lobbyists, all of whom want more money from taxpayers but will countenance minimal disruption of their longstanding cozy arrangements.
- In both domains, previous efforts at federally-driven reforms have not worked as well as intended and have proven hugely controversial. (Repeat after me: “NCLB and Obamacare.”) Yet because they’ve also benefited some people and places, and because the systems have in various ways adjusted to them, efforts to repeal or revamp them have proven incomplete (ESSA) or impossible (replace ACA with something else).
- We’re jaded, too, and cynical, because—in addition to not delivering the promised goods—previous reforms in both fields have partly rested on lies (“yes, you can keep your present insurance”) or fantasies (“100 percent proficient by 2014”). Unsurprisingly, the political terrain surrounding future reform efforts is rocky indeed, not least because Americans are loath to accept tradeoffs in either realm. They mostly just want more of the parts they like, to heck with the cost. That is, of course, a formula for debt and bankruptcy, yet nobody gets elected by promising less of something that people want more of or demanding higher taxes to pay for it. The “tragedy of the commons” repeats and repeats along with ever larger government and ever biggest deficits.
Perhaps those of us in education should be grateful that health care is in the political bullseye today and that our issues have been sidelined. If they stay over there on the policy margin, however, there’s little hope for the two-thirds of young Americans who are less than proficient in reading and math—and not much hope for the country’s long-term prosperity. Which will, of course, make it even harder to pay for all that additional health care.