What if the solutions we are proposing – won’t help?

from The Great Stagnation: How America Ate All The Low-Hanging Fruit of Modern History,Got Sick, and Will (Eventually) Feel Better

For healthcare, insurance coverage may not improve anything:

The famous RAND Corporation study of the 1970s gave thousands of Americans 100 percent free medical care, while the control group had to face insurance co-payments for care, as under normal circumstances. The group with free care consumed 25-30 percent more medical services. Yet, except for the very poorest group, the free health care didn’t make people any healthier. Most plausibly, that outcome is because many factors besides health care influence our health. When it comes to surgical patients, the uninsured seem to have better health outcomes than do Medicaid patients, even after controlling for thirty different comorbid conditions and many other relevant variables. You can give this “non-result” a lot of different twists or reinterpretations, but still it is further evidence questioning whether extra medical spending is bringing huge value.

And for education, more money seems to have zero impact:

How has spending on education changed over the last forty years? Well, it has gone up a lot. The test scores haven’t risen since the early 1970s, but, adjusted for inflation, we’re spending more than twice as much per pupil. In 1970-1971, the per-pupil expenditures were $5,593, and in 2006-2007, those same expenditures are measured at $12,463.



U.S. spending on education, as a percentage of our economy, is well above the OECD average and, by one measure, is second only to Iceland. Yet at least at the K-12 level, we are not performing at a superior level compared to other countries, including our neighbor Canada.

32 Community Comments, Facebook Comments

  1. So we don’t have to…  Thanks, David.

    I already covered the education part of this under Libertad’s post, and don’t really feel the need to go there again.

    As for healthcare, do you really believe that keeping a large portion of our population uninsured is a Good Thing?  And why are you citing a study from the 1970’s to make the case, when things were quite different?

    • Car 31 says:

      It interferes with his whole black and white no shades of gray thing he has going on.  

    • DavidThi808 says:

      And you made some very good points. But if extra spending doesn’t improve the results, then I think we need to look at what we should do differently. Differently may mean more money. It could mean less. But we should definitely focus on making what we do more effective.

      Blowing off info like this as “Republican talking points” won’t change the results. And it does us no good to win difficult political fights if the results of the win don’t improve things.

      To (counter)paraphrase Car 31 – we should not paint everything in black and white where anything brought up by Republicans is dismissed out of hand.

      • sxp151 says:

        has been partly inspired by Republican ideas, and not one bill has even been proposed that didn’t start with an attempt to placate Republicans. And there has literally been no harsher critic of this approach on this site than you, whether on the jobs proposals or the financial reform package.

        You’re not a Republican. Although most Republicans are stupid, some have ideological points of view. You’re just a contrarian, for no other reason than because it’s a good way to draw attention to yourself. Anyone who ever seriously considers an idea you propose should realize you’ll immediately turn against it when you think it will score you two more hits on your blog.

        • DavidThi808 says:

          I think in a lot of things you’re correct that I’m a contrarian. But not because I automatically disagree with what either side proposes, but because I don’t see the standard answer from either side being an effective solution. When it’s a compromise between two ineffective approaches, the final result will generally be poor.

        • Aristotle says:

          … sorry to threadjack, but I just saw your sig line for the first time, clicked on it, got the “Sorry!” message (so it’s been deleted). Does that mean Mark G. got the boot?

          • sxp151 says:

            Steve Harvey got banned for jokingly using the word “cracker,” but nothing can get our local bigots banned. The comment was deleted but Mark G.’s account is still alive. Looking forward to lots more homophobia from him and his fellow Republicans.

            Apparently there are so few Republicans who aren’t racist, homophobic, misogynistic assholes that the only way we can keep a few right-wingers on the site is to change the standards for them. Affirmative action for bigots, as it were.

      • then I call you on them.

        There is no doubt we spend more than most other developed nations on a lot of things.  We also have a more open capitalist system than most nations, which means we don’t have as much central control over people’s income.  (This, it can be argued, is a Good Thing.)

        Take healthcare as an example.  The three main distinctions between our healthcare costs and other nations’, by some studies at least, are the obvious profit overhead, plus provider costs and (for federal programs) drug costs.  The first and the last would be easy to solve: single-payer healthcare and negotiated drug rates.  But telling hospitals and doctors – specialists in particular – that we’re going to have to cut their compensation goes against our capitalist nature, and without some change to those expenses we will probably never match the rest of the world in controlling health care costs.

        I think looking at Finland is a good start for education, though I don’t think it’s an endpoint for us here.  The main takeaways from their system for us are:

        1. Valued Educators: Every teacher has at least a master’s degree with educational training, is chosen carefully out of a large applicant pool, and is respected for their expertise.
        2. Driven to Excel: Finland’s political parties, people, unions – everyone – is driven toward the same goal: give the children the best education they can receive, because it’s good for the country.  This means not skimping on cash, working in co-operation and not opposition, and cultivating a positive attitude and engagement with the education system.

        These are things we don’t have here that we could change if we had the political and popular will to do.  I’ll leave it to rational deduction as to where the blockages might be…

        • DavidThi808 says:

          I saw it as a study of how America has progressed and how the fundamentals that progression was built on has changed. It’s a very interesting read.

          Those points weren’t raised to say do what the Republicans suggest. They were raised to say maybe neither side is proposing an effective solution and we need to take a clear look at what would be effective.

          It worries me when we get group think (from either side) and the whole focus is on implementing a system designed decades ago rather than looking at what would be the most effective solution.

          • Those talking points are directly out of the Republican book on ‘reforming’ education.

            I think it’s delusional to think that at least in the short term we can make major reforms to an education system that is lacking in so many ways without spending money.

            The title of the piece is, paraphrased, “Don’t worry, be happy”, and the conclusions I can draw from the bits you quoted are that we really should be listening to Republican do-nothingism because we don’t really have a problem aside from trying to get government to help.

            I strongly disagree on all counts.

  2. ScottP says:

    Changing the way healthcare is paid for isn’t going to make people any healthier. I’m not necessarily concerned about people’s physical health, it’s their financial health. I hate it that some people have to choose between living without pain and having food and shelter. I’m convinced that insurance, of any kind, causes costs to rise unchecked.

    On education, I don’t expect performance to be directly related to spending and I don’t know how to make educating both cheaper and better. Would more community participation make it better or worse?

    Dave, thanks for giving me something decent to argue about. The “You’re a smelly poopy pants” arguing is really REALLY getting old.

    • if by way of giving us something to discuss, he hadn’t started by presenting essentially the Republican POV as something he supports.

      • ScottP says:

        as long as it’s a halfway civil and informed discussion I’m happy.

        I would be THRILLED if respectful, intelligent conservatives posted more on this site. I know they exist! They seem to be few and far between, but they’re out there.

        Unfortunately we’ve been subjected to ArapGOP, BJ, Libertad and (shudder) Mark G for so long we now have a knee-jerk reaction to shout obscenities whenever a right-leaning opinion is expressed.

        • It’s frustrating more because it’s David, who should know better.

          • DavidThi808 says:

            My point is not that the Republicans are right. It’s that maybe we on the left are not proposing a solution that will improve things. Alcoholism is a problem but that didn’t mean the fight for prohibition accomplished anything effective.

            • If anything, I would suggest that Democrats are simply not being bold enough.  We aren’t proposing the sweeping improvements that mark the most successful nations’ education programs, but rather the minimal changes we think we can drive home past an obstructionist Right.

              As to the money issue…  We still have a crumbling school infrastructure.  We still have teachers buying supplies for their classes out of their own limited pocketbooks.  We still have a shortage of truly excellent teachers, because we vilify them at every other turn for not succeeding, and we pay them only slightly better than we pay the average corporate secretary.  Given these details, more money seems in order as a basic starting point.

              • DavidThi808 says:

                I think step 1 is figuring out what makes for effective teaching. That doesn’t mean we come to a complete halt elsewhere (I voted for 103). But it does mean we focus most of our efforts on figuring out what leads to improvement.

                • I was reading today that the Gates Foundation was in the middle of trying to figure that out.  Of course, I think their goals are a bit biased in most of their funding, so we’ll see how their study comes out – I don’t think it will be the be all and end all of the discussion.

                  Is there a way to reliably train excellent teachers that we don’t already use?  Perhaps more importantly, is there something we can do about our school organization to get more kids involved and excelling?

            • Aristotle says:

              … you have this reaction all the time because you don’t discuss your own interpretation of what you quote, or analyze it, or say whether you agree or disagree with it. In short, you throw it out there and don’t discuss it yourself.

              Diary authors have a responsibility to present their own ideas. It’s great if this stuff stimulated your thoughts, but it’s not great when you don’t share those thoughts right off the bat. You open yourself to the attacks and criticisms you decry when you do that.

              Just my 2Вў.

  3. Tom says:

    Health outcomes aren’t necessarily linked to how much money you throw at a problem– higher paid physicians and more expensive technology has a diminishing utility. On the other hand, it’s not cheap to make sure that everyone can have their health needs taken care of when they need it, especially under the current for-profit system.

    In the 1970s, it wasn’t unusual for people to handle healthcare entirely on a fee for service basis. That’s no longer an option as even basic healthcare has become too expensive for people with moderate incomes to handle without insurance.  It’s a matter of reforming the system– universal healthcare in a number of permutations tends to cost less for consumers and taxpayers than our current system.

    As for education- in my experience, funding has stupid strings attached. The current vogue is technology funding. In the rural school district that I worked at, they were busy buying digital whiteboards and projectors for classrooms that didn’t have enough seats for the number of students. The starting pay for a teacher in that district is $24k/year and many of the teachers held down second jobs. They were able to get state and federal grants for technology and curriculum development, but the roof leaks in the middle school and the heating system routinely breaks down. This piecemeal fad-driven way of directing school funding has made it very hard to justify more money because vast amounts of cash are sunk into whatever the latest New Thing in Education is, without keeping up with basic infrastructure and personnel costs.  

  4. Diogenesdemar says:

    so I just got to this diary.

    My unnecessary two cents:

    When I first read this diary title, I was kind of excited — thought may be the author had had some kind of epiphany about the wrongheadedness of some of his deeply cherished, and often writ, beliefs.

    Now, I’m more diasappointed — turns out the folks that have been wrong thinking are the collective “we” others, not the more personal, even royal, “we” that includes the author.

    Should have known . . . “we” been had.

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