America's Twin Crises: Education, Health Care

By , Pat M. Holt, former chief of staff of the Senate Foeign Relations Committee, writes on public policy from Washington.

A POPULAR pastime these days is to compare the United States unfavorably with other industrialized countries. The figures are rightly a cause of concern, especially with respect to education and health care. Too many teenagers are dropping out of high school. Even among those who finish, too many have not mastered the simplest skills that would make them useful to employers. American students regularly do worse on standardized achievement tests than their peers in other industrialized countries.

Given these circumstances, how can the US compete in the world economy? The answer is that it can't until Americans take these problems more seriously.

Similarly, the people in many other countries are healthier than Americans. They have lower infant-mortality rates and longer life expectancy. And they spend less money on health.

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It is tempting to bash the public schools and the educational establishment as a bunch of bungling bureaucrats. Or, on the other hand, to point to parsimonious politicians who have starved the public schools for funds to pay teachers and buy equipment. There is some validity in both points of view, but this is a sterile argument.

With respect to health care, doctors and hospitals are commonly thought to charge too much, but hospitals are going broke. Congress watches in helpless frustration as Medicare and Medicaid costs go through the roof while large numbers of people remain uncared for. There is some validity in all of these points, too.

It is not fair either to American schools or to American medicine to lay all these problems on their doorsteps. It is a serious matter that schools are turning out less-prepared students than schools in other industrialized countries, and we need to give urgent attention to correcting it. But we also need to recognize that the challenges American schools face are far greater than those faced by schools in Japan or Germany or Great Britain.

What is different is that American schools are dealing with an extraordinarily heterogeneous student population. A school system may have students who speak a Babel of languages at home and then try to switch to English at school.

This heterogeneity affects international health statistics, as well. One would expect a country such as Sweden, for example - with a homogeneous population and a high standard of living - to have healthier people. American medicine also has to take care of large numbers of immigrants, many of them illegal - the "poor, huddled masses" for which the Statue of Liberty has for so long been a beacon of hope and welcome. It is a serious matter that the health of Americans is not better, but it should be recog n

ized that the US medical establishment faces a bigger challenge than doctors in many other industrialized countries.

PART of the problem in both education and health is that schools, doctors, and hospitals are expected to perform social as well as professional or technical functions. When there is no father at home, it helps if there is a surrogate, or at least a role model, at school. This doesn't have much to do with learning algebra, but it may have a great deal to do with staying in school. When there is nobody at home, hospitals perforce are transformed into orphanages for the newborn.

That things have come to this state is a consequence of how badly distorted our national priorities were during the 1980s. Those priorities must be readjusted before significant changes can be expected. In the meantime, the government has no money. Here is one radical suggestion of how to get some for medical care (and at the same time reduce the cost): Make insurance payments for health care taxable to the beneficiary. For example, if Joe Smith's insurance company pays Joe's doctor $1,000, Joe adds $1, 0

00 to his income on his next tax return and pays tax on it. Joe might be less eager to have every known test.

Fundamentally, the American position in the world depends on the strength of the American economy and the American people. We cannot prosper if we try to build walls to keep out imports made by cheap labor. We have to be smarter and make something better. We cannot do that if we are half literate and half sick. To say we are not doing as badly as some charge is not to say we are doing well enough.

Recognizing this does not solve the problem of restoring American leadership in health and education, but it might at least make the argument about how to do it more relevant.

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