Friday, October 23, 2009

Contradiction: Healthcare and Education Reforms

It's pretty easy for conservatives to make negative comparisons between existing disliked or failing government programs and a greater role for governme. A litany of financially unsuccessful or socially misguided programs that have been enacted with good intentions - AMTRAK, the Post Office, Medicare/Medicaid, Social Security, etc - serve as cautionary tales to greater government involvement in health care. The lesson is that the government will spend, cover spending with taxes, and spend more if they are in control of a program that they do not want to give up.

However, there is one program that attracts equal dislike across the political spectrum (but especially by liberals): No Child Left Behind. It seems to be the one federal program both conservatives and liberals dislike. Teachers seem to dislike the law for it's interference with their ability to design their own curriculum. For most, it's harder to get into a much deeper defense of it than it was a law with good intentions. It was supposed to force states to create minimum standards of achievement, and then hold schools accountable. To conservatives, it was a step toward shifting control of education back to the states, creating standards that could hold teachers, administrators, and politicians accountable, and reducing education spending at the federal level.

Keeping in mind that this was a bi-partisan bill - Ted Kennedy sponsored it and 87 senators voted for it - serious problems emerged after several years. The framework and consequences for schools setting and meeting standards is rigid, and the timeline for remedying and complying with the standards is harsh and sometimes unrealistic. The consequences for failure to comply are daunting: additional requirements for potentially over-burdened schools if they don't meet the standards after the first year, dismissal of administrators if still the school is still non-compliant after the second or third year, and then closing the school if it is still not meeting standards after four years.

The problem with inflexible such inflexible guidelines is that many mitigating factors that could prevent a school from meeting the grade: teachers union protecting bad teachers, a community of disinterested parents, an unusual influx of special needs or disadvantaged students (or, a large group of overachieving students who require IB or AP classes that take up additional resources and budget space), as well as a dearth of capable administrators. No Child Left Behind certainly has good intentions, but it is a law that could only function properly in a world filled with average to above-average students (say, C- to B+), where a specific curriculum meets the needs of each districts and additional resources do not have to be allotted to slower or faster learners.

After considering the negative, unintended consequences of a well-intentioned, bi-partisan education bill (and all of the instances of exploding costs for government programs), why do liberals insist that a government-run framework for health care will solve the problem? Doing the same thing - adding government - over and over is not going to result in a different outcome. It's like Lindsay and Tobias experimenting with an open marriage:
Tobias: You know, Lindsay, as a therapist, I have advised...
[falls off the bed]
Tobias: ...a number of couples to explore an open relationship where the couple remains emotionally committed, but free to explore extra-marital encounters.
Lindsay: Well, did it work for those people?
Tobias: No, it never does. I mean, these people somehow delude themselves into thinking it might, but... but it might work for us.
A government option and mandated coverage may provide broader access health care, but, much like NCLB, the unintended consequences will be great:
  • small businesses dropping coverage because it's cheaper to pay the fine for not providing insurance,
  • low-income people being fined for not purchasing health care,
  • mandated minimum amounts of coverage eating up the savings of young, healthy people who may only want catastrophic coverage,
  • private premiums rising because of taxes on private plans that exceed the maximum mandated coverage,
  • increased taxes to subsidize lower middle and middle class people purchasing public option insurance,
  • sacrificing quality of coverage for access to a plan.
And on and on. This doesn't even touch on the failure to bring down costs - none of the current plans have an adequate plan for diminishing health care costs aside from rationing - or the problem of adequately reimbursing doctors if the public option acts like Medicare.

There is a solution that doesn't require complex, potentially disastrous government mandates. The "small bill" and other conservative proposals don't require willful ignorance of past government failures.

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