Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-06T07:55:41.014Z Has data issue: false hasContentIssue false

Health and Education: A Tale of Two Crises

Published online by Cambridge University Press:  01 January 2021

Extract

This is a tale of two social structures, health care and education. Both systems are undeniably critical to our social fabric, and even to our national prosperity. Both systems also provide services that are uniquely personal and vital to individual well-being. And both systems are now widely perceived as being in “crisis,” as needing “fundamental reform.”

At the same time, there are fundamental differences in the ways the two sectors are organized and understood. Health care is essentially a system of private relationships; education a system of public responsibilities. Although each system is extraordinarily complex and contains elements that defy neat categorization, by highlighting the contrasting visions and structures of the two, one gleans useful insights both into the distinctive failings of each and into potential directions for reform.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Iglehart, John K., “Health Policy Report: The American Health Care System: Medicare,” New England Journal of Medicine, 327, no. 20 (1992): 1462–72; and Iglehart, John K., “Health Policy Report: The American Health Care System: Medicaid,” New England Journal of Medicine, 328, no. 12 (1993): 896-900.Google Scholar
United States Bureau of the Census, Statistical Abstract of the United States: 1992 (Washington, D.C.: U.S. Government Printing Office, 1992), p. 321 (No. 497).Google Scholar
Emergency Medical Treatment and Active Labor Act, 42 U.S.C. § 1395dd.Google Scholar
Starr, Paul, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 379449.Google Scholar
See Thro, William E., Note: “To Render Them Safe: The Analysis of State Constitutional Provisions in Public School Finance Reform Litigation,” Virginia Law Review, 75 (1989): 1639–79.CrossRefGoogle Scholar
See Statistical Abstract of the United States, supra note 2, at 141 (No. 215).Google Scholar
Id. at 141 (No. 214).Google Scholar
President Clinton's Address to Joint Session of Congress, Sept. 22, 1993.Google Scholar
Pear, Robert, “Fewer Are Insured for Medical Care,” The New York Times, Dec. 15, 1993, sec. A24.Google Scholar
Editorial, “Shrinking Health Coverage,” The Washington Post, Oct. 11, 1993, sec. A30.Google Scholar
In fact, education may be the key determinant to health status. Adler, Nancy et al., “Socioeconomic Inequalities in Health,” Journal of the American Medical Association, 269, no. 24 (1993): 3140–45; and Pear, Robert, “Big Health Gap Tied to Income Is Found in U.S.,” The New York Times, July 8, 1993, sec. A1.CrossRefGoogle Scholar
Celis, William, “Study Says Half of Adults in U.S. Lack Reading and Math Abilities,” The New York Times, Sept. 9, 1993, sec. A1.Google Scholar
Testimony of Laura D'Andrea Tyson, Hearing of the Health Subcommittee of the House Ways and Means Committee, Nov. 4, 1993.Google Scholar
Rosenbaum, Susan, “Programs Combating Increase in Illiteracy,” The New York Times, Jan. 14, 1990, sec. 12 (N.J.) at 1.Google Scholar
White House Domestic Policy Council, Health Security: The President's Report to The American People (New York: Simon & Schuster, 1993), pp. 711.Google Scholar
Hilts, Philip J., “Doctors' Pay Underestimated But Resented Just the Same,” The New York Times, Mar. 31, 1993, sec. A21.Google Scholar
National Center for Education Statistics (U.S. Department of Education), The Condition of Education 1992 (Washington, D.C.: U.S. Government Printing Office, 1992), p. 335.Google Scholar
Id. at 338.Google Scholar
See Statistical Abstract of the United States, supra note 2, at 151 (No. 233) (citing National Education Association, Estimates of School Statistics).Google Scholar
Id. at 151 (No. 234).Google Scholar
Elam, Stanley M., Ross, Lowell C., Gallup, Alec M., “The 23rd Annual Poll of the Public's Attitudes Toward the Public Schools,” Phi Delta Kappan, 73, no. 1 (Sept. 1991): 4156; and Elam, Stanley M., “The 22nd Annual Gallup Poll of the Public Attitudes Toward the Public Schools,” Phi Delta Kappan, 72, no. 1 (Sept. 1990): 41-55.Google Scholar
Woolhandler, Steffie, Himmelstein, David U., Lewontin, James P., “Administrative Costs in U.S. Hospitals,” New England Journal of Medicine, 329, no. 6 (1993): 400–03.CrossRefGoogle Scholar
See Hubbard, Catherine, “Study Finds Health and Education Largest State Costs in 1992,” State Tax Notes, 4, no. 18 (May 3, 1993): 1036.Google Scholar
See Morain, Dan, Banks, Sandy, “State Voters Reject School Vouchers,” The Los Angeles Times, Nov. 3, 1993, sec. A1; and “School Voucher Movement Survives California Massacre,” St. Louis Post-Dispatch, Nov. 5, 1993, at 1C.Google Scholar
H.R. 3222, 103d Congress, 1st Sess. (1993).Google Scholar
S. 1757, 103d Congress, 1st Sess. (1993).Google Scholar
Congressional Budget Office, Estimates of Health Care Proposals from the 102nd Congress (Washington, D.C.: U.S. Government Printing Office, 1993), p. 18.Google Scholar
Kronick, Richard, Goodman, David C., Wennberg, John, “The Marketplace in Health Care Reform,” New England Journal of Medicine, 328, no. 2 (1993): 148–52.CrossRefGoogle Scholar
Consumer sovereignty may be further reduced because open enrollment periods only will occur annually. They will seldom occur at the precise moment, in the course of treatment, that a patient is dissatisfied with the care received.Google Scholar
Rice, Thomas, Brown, E. Richard, Wyn, Robert, “Holes in the Jackson Hole Approach to Health Care Reform,” Journal of the American Medical Association, 270, no. 11 (1993): 1357–62.CrossRefGoogle Scholar
See Reinhardt, Uwe E., “Managed Competition in American Health Care Reform: Just Another American Dream, or the Perfect Solution?,” Paper Delivered at the 1993 Annual Meeting of the American Society of Law, Medicine & Ethics, Arlington, Virginia, Oct. 22, 1993. While the plan will require health alliances to prohibit discrimination on the basis of race, geography, or employment status, in fact there are many ways in which insurer networks can fashion the market they desire. For example, by not including leading infectious disease specialists in their physician panels, networks can deter HIV patients from joining.CrossRefGoogle Scholar
See, e.g., Smetanka, Mary Jane, “Most Minnesota Reforms Met with Opposition at First,” Minneapolis Star Tribune, April 25, 1993, sec. A18 (discussing structural reforms in Minnesota); Skeen v. State, 505 N.W.2d 299, 319, and note 12 (Minn. 1993) (discussing fiscal reforms in Minnesota); and Howe, Peter, “Questions on Extent of School Reform,” The Boston Globe, June 7, 1993, p. 1 (discussing fiscal and structural reforms in the 1993 Massachusetts Education Reform Act, 1993 Mass. Acts c.71).Google Scholar
Some reform efforts have failed to appreciate the importance of equalizing resources before permitting parental choice, and some have structured the choice systems in ways that significantly favor wealthier parents over poorer ones (especially by failing to cover the costs of interdistrict transportation). These failings raise the threat of the same sorts of invidious segmentation posed by voucher systems.Google Scholar