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Give power, choices to individuals, not government systems
by Craig Westover
'High quality, low cost and universal access" is the nirvana of health care reform. Enlightenment, say reform gurus, lies in a government-managed system. Just a thought: Don't we have a government-managed public education system with universal access? How's that high-quality, low-cost thing working out?
Not very well, it seems.
Last week, 67 percent of Minnesotacommunities passed levy measures, voting to increase or sustain property taxes to fund local schools - despite that 40 percent of the state general fund is already dedicated to K-12 education. But while Minnesota students going on to college score among the best in the nation on ACT and SAT tests, the number of Minnesota schools failing to meet federal "adequate yearly progress" standards is increasing. And state test scores in reading and math proficiency show steady decline as students progress through the system.
It's not surprising that a single-system education model hasn't gotten us to the Promised Land; don't count on a single-payer health care plan to get us there, either. To be sure, there are differences between education and health care delivery, but the big three - quality, cost and access - are inescapable elements of both that necessarily require tradeoffs. A single system - be it an education system or a health care system - cannot be all things to all people.
Let's take a closer look at the big three.
Quality. It's not hard to achieve "quality" when one gets to define it. In education reform, we get "QComp," ostensibly a pay-for-performance plan that actually rewards teachers less for student achievement and more for improving teaching techniques and conforming to "best practices." In health care, we get pay-for-performance plans that financially reward doctors for following "best practices," which are based on statistical outcomes, not scientific applications applied to individualized patient care.
What of children and patients?
Under a government-managed system, students actually acquiring knowledge and skills or patients improving their health becomes secondary to measuring the system. Dedicated teachers will still inspire individual students, dedicated doctors will still practice individualized medicine; but in doing so, they will be acting contrary to the incentives of the system.
Cost. If we take the quality question to the next level, the commonality is that the definition of "quality" is imposed by the third party paying for education or health care but not actually receiving either. Although the money comes from taxpayers, the state controls education funding, so the state determines "best practices," "quality outcomes" and the definition of "value." Although insurance premiums are paid by patients, it is insurers and government agencies that determine "best practices," "quality outcomes" and "value."
Thus, in an Orwellian sense, the 40 percent of the state budget spent on education is a bargain bordering on the inadequate. We ought to "invest" more (note the language) to get even better "value" for our educational dollar. By the same logic, expanding the number of people covered by health insurance is a good "investment," because the "value" comes in lower health care costs down the road. However, the costs down the road will be determined not by the actual health of patients, but by what the government-managed system decides to cover and what cost.
In both cases, there is no check on costs motivated by the needs and desires or reason for self-control on the part of people actually being educated or seeking health care. The people controlling the costs are the ones defining the services provided and to whom they are provided, which brings us to the question of access.
Access. Universal access to education is a good thing. So is universal access to health care. But how universal access is achieved is as important, if not more so, as simply achieving it.
Providing universal access under the illusion that education and health care are "free" artificially increases demand for more service, which in turn either drives up costs (to provide more service) or limits service (to drive down costs). Unless, as we've seen, one distorts the definitions of "quality" and "value," there can't be any other outcome.
So what is the answer? The key is putting purchasing power into the hands of the people receiving service and allowing them to determine the quality, cost and value of the education and level of health care they are willing to pay for - it's not the same for all people.
There may be a role for government to "invest" in education and health care, but that investment should be in people, not the government system. More dollars for ill-functioning systems is not the answer. If we really started thinking progressively, we'd be investing in people, in involving individuals in free-market education and health care systems, not waiting for more money to prop up the status quo.
Craig Westover is a contributing columnist to the Pioneer Press Opinion page and a senior policy fellow at the Minnesota Free Market Institute (www.mnfmi. org). His e-mail address is
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This commentary originally appeared in the St. Paul Pioneer Press, November 15, 2007. |
