Health Lessons from Schools

If Congress creates a public option in health-care insurance, will that inevitably lead to a single-payer system, with the government everyone’s insurer? And should that happen, would the single-payer system lower costs, enhance medical-service delivery and improve the health of all Americans, as its advocates promise.

Much can be learned about such questions by considering the history of secondary schools in America.

Universal public high school is relatively new in this country. As late as 1900, more than two-thirds of all US high-school graduates got their diploma from private schools; public schools were turning out only 62,000 graduates a year. In later decades, school districts expanded the “public option” in education; by 1960, 90 percent of high-school age students were enrolled. When something is free, people will use it.

Today, though, only about 10 percent of elementary and secondary students attend a private school. Private schools now attract only two kinds of families: 1) the well-to-do, who are willing to pay the high cost of private schooling; and 2) those seeking to preserve their religious traditions.

Anything available on the cheap will drive out the more expensive — except for those with hefty wallets or strong convictions.

So if the public-school analogy holds, the public option in health-care insurance won’t create a system of choice and competition, as the White House claims; it will slowly — or not so slowly — give way to a (nearly) single-payer system.

Will that lower costs and enhance medical quality? Here the lesson from public education is pretty clear. Since 1960, the per-pupil cost of public schooling has risen by 3½ times in real-dollar terms. Yet the percentage of students graduating from high school has slipped since 1970, and the performance of 17-year-olds in math, science and reading has remained unchanged.

True, the cost of medical services also has risen — but, in contrast to education, Americans today enjoy medical services unheard of a couple of generations ago — arthroscopic surgery, magnetic imaging, high-quality anesthesiology, bypass surgery, antibiotics galore, cholesterol-reducing medication, fertilization treatments and much more. Health has improved, and Americans are enjoying more years of active living — all without a general public option in health insurance.

In education, where the single-payer system remains solidly intact, productivity losses abound. Students are not learning, while costs mount.

Should we expect the same to happen in medicine? Yes, says the contractor who is replacing the roof on my house. He promises to choose the public option for his employees, as it will be the cheapest available alternative. “And so will every other employer,” he added.

A cheap public and expensive private options can’t exist side by side without damaging the quality of medical services and significantly raising costs.

This blog entry first appeared as an op-ed in the New York Post.

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