Category Archives: Healthcare

Postcript to Notes for a Science of Education

In case you believe there’s something new  (under the sun) about the public’s low opinion of their schools, or that attempts to reform the schools have not been around at least as long as the schools themselves. Well if you do believe it, that what’s happening today is not at least some 200 years old, read this shocking statement from a Wikepedia source on Common School founder, Horace Mann,

“In 1838 Horace Mann targeted the public school and its problems.”

And things have changed so little that one today would not be at all surprised to read in the news that the leaders of both Houses of Congress had “targeted the public school and its problems.”

Shocking because 1838, with the publication of Mann’s Common School Journal, was the moment in time when our public schools had their beginning, the beginning of free and compulsory education for all. So there were problems even before its founding, and there were problems immediately afterwards. And there are still problems. It does sound a bit like,,,  the launch of Obama Care?

For the founder of our public schools, like the rescuer and provider of health care for all, did suddenly appear on the scene much like a knight in shining armor setting out to correct what he perceived as a wrong. But from the beginning the problems encountered were without easy if any solutions. And in fact both “rescuers” were really Don Quixotes, and like the Don, were only masquerading as knights in shining armor, and would probably eventually realize like him that they had taken the wrong path.

Perhaps it’s the nature of government plans and programs that there are inevitably problems from the very start, and in too many instances (farm subsidies, public transportation, immigration, the mail, … and of course the public schools) the problems never seem to go away. But I would readily admit there are exceptions, the clean air and water acts, social security and health care for the deserving elderly, and a myriad of others, and that’s why we keep trying. And that’s what makes us the truly exceptional nation.

 

Fundamental rights to health care and education? I don’t think so.

About health care William Easterly once said that this could not be “a fundamental right, like, say, those of freedom of movement, speech, association, equal protection under the law etc.”

Why not? Because there would be no reasonable end point to that right. When, for example, would one have received all the care that could possibly improve one’s physical or mental health? There would always be another test one might undergo, another new treatment one might try, another medical opinion one might seek. And if no reasonable end point no end to the cost (that which seems to be happening to us right now).

Could one, I would ask myself, make a similar argument about education? There is certainly no reasonable end point to education. We don’t ever reach a point when we are educated, do we? Indeed, life long education is certainly what the schools say is the real goal (end) of schooling. So doesn’t that mean that there is no end?

Yet, you’ll say in response, but who would ever question the state’s right to provide an education for its citizens? Actually the state, by providing an education for its citizens, is doing what is absolutely necessary for its own survival. A right to an education? Rather the state is teaching, or trying to teach the children about the state, what it means to be a citizen of the state. Because by that means it would assure its own survival and continuation.

Does it make any sense at all to talk about the child’s right to an education. Isn’t right to education better understood as being much the same thing as right to life? Because education, in as much as education is learning, is really what life is all about. And it is no more given to the state the power to accord or take away learning, “the right to an education,” than it is to give or end that life itself.

Why are these “idle” considerations of mine of any importance? Because children by being told that education is their right might then expect and await for it to be given to them. It won’t be because it can’t be. Children ought rather to be told that learning comes right along with life, and that it is entirely up to them how and what they learn, no less than it is up to them how they live. The two may differ in that life was given to them, whereas what they do with that life, what they experience and learn, is primarily their own, not the teacher’s or the school’s, responsibility.*

Finally, why do so many schools fail, probably all of them in fact? The simple answer is that children go to school expecting to be given an education. They may be given words and numbers to memorize but what they end up knowing of what’s important will be what they have struggled with and learned mostly by themselves and often through that struggle. Give me a school where kids don’t struggle with their assignments and I’ll give you a failing one.

But I’m not at all saying that we learn primarily through some kind of great effort, through suffering. In fact, having raised children and grandchildren of my own I know that children learn even more from play than they do from work. Probably adults, too. Why is that? Because most often play is where they, and we, want to be, where they most commit themselves, and work is probably more often not. Although it doesn’t need to be that way.

The conclusion, remove from our talk about education, talk about rights. And hold onto the idea that there is no necessary connection between education and the school building, and that the school itself, being too often a distraction, may in fact bring a stop to learning.

Finally, education is what life is all about. Have you ever known, I’d ask, a child or young person who was not mostly learning all the time? Yes, I’d say, and he was in school.

*A footnote. The absurdity of grading the teachers on what the students learn, or don’t learn in school, —that’s going on right now and is being supported by our tax dollars.

Truths about Healthcare and Education

Today two op ed writers, Bret Stephens in the Wall Street Journal  and William Easterly in the Financial Times, express fundamental truths, the one about education and the other about health care, truths not shared or even recognized by our politicians, but that if they ever were could become powerful driving forces behind significant education and health care reforms, both of which at the present time seem to be going nowhere.

Bret Stephen’s truth about education? Education is not, as too many of us would like to have it, the solution to whatever be the problem. There is certainly no evidence that good schools make for a better world, or that just by attending school kids become good citizens. There is ample evidence on the contrary that schools, in particular the failed and failing schools of the inner cities, of which there are myriads, may be making the world worse.

The truth? Stop looking to education for what it can’t do. Look to it, at best, for what it should be doing, imparting skills and knowledge. With some we do this very well, in particular with those who attend our elite colleges and universities.

With others, with far too many, we do this very poorly. All our school reform efforts ought to be directed entirely at making whatever changes are necessary to enable larger numbers of kids to acquire new skills and knowledge. We ought not to be looking to the education of our kids to solve our adult problems.

Here is how Bret Stephens in today’s Wall Street Journal, A Perfect Nobel Pick, The committee didn’t recognize Truman, after all, puts it:

The “Goodists” are the people who believe all conflict stems from avoidable misunderstanding. Who think that the world’s evils spring from technologies, systems, complexes and everything else except from the hearts of men, where love abides. Who mistake wishes for possibilities. Who put a higher premium on their own moral intentions than on the efficacy of their actions. Who champion education as the solution, whatever the problem.

And William Easterly’s truth about health care? A right to health care cannot be, in spite of all the rhetoric to the contrary, a fundamental right, like those of freedom of movement, speech, association, equal protection under the law etc.

Why not? Because there is no reasonable end point to that right. When, for example, has one received all the care that could possibly improve one’s physical and mental systems? There will always be another test one might undergo, another new treatment one might try, another medical opinion one might seek.

At some point the right to health care has to be ended because the cost of providing the care will have exceeded our ability to pay for it. Either there will be those who will be left out entirely, as now in the case of the uninsured or those with “pre-existing conditions,” or treatments will be strictly rationed, in accordance with what acceptable criteria?

When only some speech is allowed we might do well to avoid the expression a right to free speech.  Because what we really mean is a right to say certain things, and not others. That’s not so much a right as a permission from those who make the rules.

Similarly when the right to health care means only a right to certain generic drugs, physical exams, one or two xrays a year etc., or some more realistic combination, we would do better not to talk about a right, but rather, as in the case of limited free speech, of the treatments that are currently permitted by those in power, these at best being at least those we can pay for.

Here is how William Easterly puts it, in the Financial times of October 12, Human Rights are the Wrong Basis for Healthcare. The BOLD is mine:

The pragmatic approach – directing public resources to where they have the most health benefits for a given cost – historically achieved far more than the moral approach. In the US and other rich countries, a “right to health” is a claim on funds that has no natural limit, since any of us could get healthier with more care. We should learn from the international experience that this “right” skews public resources towards the most politically effective advocates, who will seldom be the neediest.

Public Health and Public Education

Here’s a question no one is asking. Which, public health or public education, should receive the lion’s share of tax payers’ dollars? Or are the education of our children and young people and the health care of our citizens equally important, equally deserving of our resources?

Frame the question in anyway you like. Should my aged parents or my children in college be receiving the largest share of my salary? Should my medical insurance payments be higher or less than my property taxes, a good portion of which, if not most, go to supporting the schools?

In any case both health and education costs, in absolute terms and as percentages of our gross national product, are rising. Medical expenditures in 2005 amounted to nearly $2 trillion, about one fifth of GDP for the year.

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Total educational expenditures are also rising and in that same year were one half that amount, or nearly $1 trillion, one tenth of GDP.

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Together these expenditures make up one quarter of the gross national product, and the  consensus is at this time, when Barack Obama is about to take offce, that this is not enough.

The question we’re not asking is how much of our national wealth, all of which is created by inventive and hardworking men and women, can we place in non productive, non wealth producing industries?

No one disputes the importance of health and education for the safety and prosperity of the country. But what are the limits to our expenditures in these two areas? Are there any limits? To listen to the promises of the politicians as well as the claims of the citizens too often it seems there are none.

Doctors and Teachers

While creating and establishing its present system of public school education this country made two huge mistakes of which we are still sufffering the tragic consequences.

First of all, probably at some time during the latter part of the 19th. century, medical doctors were given or assumed what should have been just as much or more the rightful of teachers in regard to the respect and remuneration accorded them by the population. The result is that people now look up to doctors and pay them accordingly, whereas teachers are looked down upon and are poorly paid. If you’re a parent who should be more important in the life of your child, the teacher or the doctor? It’s strange that we need even ask this question, and not be sure of the response. A symptom of the problem our country is up against in regard to the education of its children. We’re probably the only developed country in the world where teachers are not held in high regard, respected even more than medical doctors. Why this came about is for another, probably book-length post, but it did come about, and we’re still paying for the consequences, on the one hand with the exorbitant cost of medicare care and the resulting absence of health insurance for millions, and on the other hand with the mediocre achievement of our schools over all, and their failure in particular among the poor and the disadvantaged youth of our inner cities.

So in the 19th. century our teachers saw the position they should have had go to the doctors, although this didn’t have to be a competition, or a zero sum game. Both could have been well remunerated and well respected. Then in the 20th century, in spite of their loss of respect among the population as a whole, the teachers gained many more students as state after state provided free schooling, from Kindergarten through high school, to every child. It was at this point that our country made its second big mistake. For some reason the schools placed the burden of the child’s learning on the teacher, the curriculum, and the conditions of the classroom, and not on the child. Was this a conscious decision on the part of the school authorities? I don’t know. But the children were not made to understand that if they learned anything at all it would be mostly through their own efforts, and that the school and the teacher could help, but could never replace what they had to do for themselves. The children were never told that they would learn only to the extent they made an effort to do so. So they ended up, huge numbers of them, going to school and waiting to be taught, and in many cases, when they realized they were not learning, dropping out of school along the way, often well before finishing high school.

Now this is a tragedy because lives, those of teachers as well as students, are still being lost, and we seem powerless to turn things around. The doctors are still well paid (although less so today than yesterday) and are well respected, and the teachers are still poorly paid and not respected. Americans are constantly hearing about all the efforts, one after the other, on the part of politicians, business leaders, school superintendents, principals, and teachers to reform and improve teaching and learning in the schools, and then they invariably see how each reform effort brings about little or no substantive change for the better. And the students, instead of being confronted with the fact that they are responsible for their own learning, go on, mostly at ease, and probably amused, while observing the reform efforts made constantly in their behalf. The fact that children during the first few years of school do seem to be learning illustrates this point, for very young children haven’t yet learned to attend school and class waiting to be taught by the teacher. Instead, they go to school at that young age still carrying their natural learning with them. After a few years they do learn otherwise, that school really isn’t about their learning, and they become disillusioned and for good in some cases, and for bad in others, look elsewhere to learn other things not taught in the schools.