Everyone’s talking about reform. Especially right now. Jim Gomes offers a provocative way to look at the healthcare and education systems in this country in yesterday’s Boston Globe.
Gomes offers the question: What if public education worked like our healthcare system?
Here, he looks at employer-based education:
First, children’s education would depend on where their parents worked. If the employer provided it as part of a benefits package, kids would receive an education. Some employers would offer high-quality educations to their employees’ kids, while others would offer stripped-down schooling that omitted whole subjects or stopped after sixth grade. Students would bring daily co-payments to school with their lunch money.
America would also have a program for poor children whose parents did not have jobs or had jobs without education benefits. However, the quality of education would vary widely depending on how much funding each state provided. One child in seven would have no education plan at all, although they could receive instruction on an emergency basis – for example, just before the SAT exams.
Teachers would be paid by peicework; the budget would determine coverage for particular subjects (not everyone needs reading and writing!)
Our health care center would be based on real estate and our ability to afford a home in a town with decent health centers and hospitals. At some point even the best and brightest doctors wouldn’t be able to pass their periodic recertification and licensing exams (but who cares?!)
We wouldn’t allow these systems to function if they were reversed like this, but looking at them this way allows us to look at flaws in a new way.
Access may be universal with our education system but there still exist grave disparities in content and preparation for higher education and the workforce. Health care is top-notch, but still important issues concerning disparities regarding access, insurance coverage and cost exist.
With systems like this, the most vulnerable are at greatest risk: children.
This is not a world we want to live in, yet we’ve accepted it and despite calls for reform for decades- have we ever really seen any? Will we ever see any?
or clothing or automobile ownership or spouse… Or are they just the next thing on the list of making everyone the same? Is healthcare a “Constitutional right”?
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p>When our own Senator Kennedy was first hospitalized with his brain condition, he was heliported from the Cape to MGH. Then he was flown to NC to be operated on by one of the world’s finest brain surgeons. Are you saying this type of thing should not be done or that everyone should have this option?
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p>Can’t you come up with another sob story as to why every child should not have a home, with a yard and a dog and how they should have plentiful clothing and dolls and toys… I personally do believe in every child having this… but based on the blood and sweat of their parents working for it and not handed to them by the US Government from the pockets of tax payers.
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p>And certainly Doctors care about children so why don’t they voluntarily work in the areas where people need help the most? They must have bills to pay as well.
I came across this post on Alternet a while back that takes a look at the question of whether universal healthcare is better considered an right or a moral responsibility. It refers to a blog post written by an ER doc who presents a quite compelling case for reframing the discussion in terms of the latter. Definitely worth a read.
The afore-mentioned ER doc is referenced in a general way but it should be known that he makes this statement;
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p>The actual Alternet post is written by Maggie Mahar, a policy wonk who authors the very good HealthBeatBlog at http://www.healthbeatblog.org/… She goes on to say
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p>Hear, hear. They are “rights” nonetheless.
In a wealthy, industrialized–and hopefully, a civilized nation–why shouldn’t we collectively decide that a safe roof over one’s head, adequate food to eat, and clothes on one’s back are things that the good people of a civilized nation GUARANTEE TO ALL ITS PEOPLE. (Note to JohnD: check out what more mature societies such as those in Europe do. And btw they see it as a natural moral obligation to one’s fellow human beings). Most people will attain these things on their own as they do now, provided they have equal access to quality education, jobs, and such.
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p>Hey, Check it out! This just in featuring President-elect Obama on health care reform, in my email In Box:
http://healthcareforamericanow…
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p>P.S. to place JohnD’s comment in context, I’ll remind you of his self-described BMG profile as a “Conservative Republican..”
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p>P.P.S. I agree with the poster’s concerns about public education; I have one child in BPS 3rd grade and another heading to BPS soon… there’s lots of room for improved policies, for sure, and as parents my husband and I are trying to be part of making these happen (e.g. by having our child in BPS, attending BPS re-org meetings, meetings re improving 6-8 grade options etc)
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p>As stated so eloquently many years ago, I like paying taxes. With them I buy civilization.” — Oliver Wendell Holmes
Education
Housing
Healthcare
Food
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p>These are the basic tools everyone needs to pursue further opportunities. They can but the more materialistic things. As another commenter mentioned our European friends are much better about the idea that a function of society is to take care of its people.
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p>As for the Senator Kennedy example, geography might get in some people’s way, but insurance unwillingness to cover a procedure shouldn’t.
I think we should consider internet access a right, including free government email accounts for every citizen, a free bank account, and privacy and security should be a right, too.
but I’d be a bit concerned about Big Brother watching…can you really ever have privacy and security in this country (or world for that matter?)- especially with government email accounts and free bank accounts?
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p>So much for all those FW:FWD:FW: emails going around during the election periods.
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p>Internet access is quickly becoming a hot-button issue for pols in disadvantaged communities, including places in Boston, Cambridge, etc. Not just rural areas or developing nations.
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p>Thanks for raising that issue, they.
is to ensure privacy and security. The Big Brother fear would have to be overcome by convincing people that it increases security and privacy and control over who has access to what information. We’d need the Open Source community and the Electronic Freedom Foundation to approve of the project and oversee that it was the most secure system possible.
I’m not sure I would list Internet access per se as a fundamental right. I do however assume that any public school or public library worth its salt would have Internet access available.
Having it in your home is a million times more valuable. But even if we don’t get broadband access to every person and settle for free access at libraries and coffee shops, there is still the matter of security and privacy on line, from every access point. That should be a right, too, and fool-proof.
to any specialist in the country if I want it?
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p>Also regarding your right to food… does that mean you should get food (chicken, rice…) or should you get access to the very best food money can buy (steaks, lobsters…)?
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p>I do wish we would stop comparing ourselves to Europe until our society looked just like Europe. I was just reading the violent crime statistics for MA and there was nothing “European” about them. Until then comparisons aren’t valid.
If it is absolutely essential to transport long distances due to lack of availability of services locally then yes, but if great service is available locally than no need. I don’t know all the details of the Kennedy situation, but it semms we are blessed to live near Boston, especially MGH which consistently ranks in the top three nationwide in just about every specialty.
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p>If the government is going to provide access to food then anything that provides balanced nutrition would suffice. File under beggars can’t be choosers, but prople need to eat. Besides, this isn’t original; that’s what food stamps are for.
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p>As for Europe, my response to your crime comparison is “duh!” If we could not be quite so reluctant to regulate firearms (JUST LIKE EUROPE!) maybe that situation would improve as well. Point is, other countries have largely figured this out. Here we are supposedly the greatest nation on the planet, yet we lag behind in some obvious and frankly stupid ways.
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p>I don’t have all the answers to all the details of how to put these into practice. My larger philosophical point is that one way or the other people should be taken care of. That is the decent and civilized thing to do, so let’s find the solutions rather than suggesting it can’t be done.
I am 100% behind providing food for people to eat and healthcare to everyone. The difference may be in how we do this. I feel the same way about education.
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p>The hard part comes when the powers to be decide on the implementation to these needs (not rights). You mention food to “anyone” being of balanced nutrition would suffice. I agree to that and I don’t think even the most anti-social program person out there would disagree. But that isn’t what happens with food stamps and other programs. If that were the case then food stamps would only be valid for purchase of chicken, rice and beans… as opposed to everything purchased with them now.
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p>The same is true with education… a classroom, a teacher and books would suffice and again be supported by just about everyone out there. But what happens is lower income towns or cities want what the well-to-do towns can afford for themselves.
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p>And then healthcare… who would deny that a sick person should not get treated and currently a sick person does not get turned away from healthcare. I’m not an expert but I think it is A) Illegal and B) unethical for Doctor/Hospital to do this. Again the debate is how this happens and how east we make it.
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p>So in summary, people without the means do have access to food, they do have access to education and they do have access to healthcare. But what the other side would say is everybody should be able to get healthcare at any Doctor o hospital they chose, that students in the poorest areas should get the same access to teachers/schools/buses/sports programs in school that the most affluent towns get and hungry people should be able to get free food just like people who pay money get. Next will be Armani suits, Wii systems, 52″ Sony flat panel TVs, Gucci bags and 3 bedroom Colonials for all (almost forgot… a summer place down the Cape).
Food Stamps are part of the Farm Bill. The Farm Bill subsidizes farmers. Farmers are getting subsidies for cash crops, like corn. Corn is in everything, which is why foods covered under Food Stamps run the whole gamet, because Corn Chips (like Fritos) are corn.
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p>WIC is also under the Farm Bill. The items eligible for purchase under WIC are way more limited, but are not necessarily the healthiest options available anymore.
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p>Just because people have access to food and education, it is quite evident that it is not the same quality. I think it is somewhat ignorant to then make the jump to Gucci bags and second homes, etc. when many families I know are barely surviving, working hard, and are walking the fine line of eligibility for things like Section 8, food stamps, MassHealth, etc. And many families who live in these wealthier towns are not of the wealth.
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p>The parameters put around the eligibility does not guarantee that someone is able to live above the poverty line, just because they are making too much money for their family of 2 or 3 to be able to qualify for government assistance in a whole realm of areas.
I believe that no insurance company or bureaucracy should automatically shut the door on certain doctors, hospitals, or treatments. That is basically for the patient to decide although in practice other factors may come into play. I want annual physicals, vaccinations, unplanned procedures, prenatal/maternity care, and ER visits for true emergencies to be completely free and a copay schedule for other things.
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p>I have no problem with wealthier towns paying for better education either through taxes or fundraisers, but we do need to raise the baseline. Classrooms need to be no larger than 25 students, teachers should be paid high five-figure salaries and there needs to be enough textbooks, etc. for the students. I went to a private (Catholic) high school, which certainly was not on par with Philips Academy, but seems to me what every high school should be, minus of course the religion element. I believe that public school choice is acceptable.
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p>The examples in your last sentence are all clearly luxuries. I do not claim possession of those to be a right or that the government should provide them, nor have I heard anyone else suggest that.
To me health care SHOULD be delivered like public education is now, minus any residency requirements within a particular district. You just sign up and that’s that. Not that public education is perfect of course, but it’s better than no education at all. Just as there are private schools which may provide better education for those who can afford it, I’d be completely willing to allow private insurers to offer better services than the public system if there is a market for it.
Yeah, we have to allow people to pay more if they want better health care, we can’t force people to settle for the care we can afford to pay for if they have their own money, but how about if we taxed that extra spending? That way people aren’t content to have really sucky basic plans and just pay more to make them acceptable, they’d want the basic plan to be god enough so they don’t have to pay extra taxes. Just like how One Laptop Per Child is now making you buy two laptops in order to get one, and they give the other one to a poor child somewhere. That’s a good rate for out of pocket medicine: 100%
That really is a great way of making the point about employer-based health care being really sucky. Would any progressives here countenance an education plan that tied education to employment? Should we not be looking for a way to totally end that system, the quicker the better?
health care or education may have been good in theory, but in practice is it really all that great?
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p>I don’t completely understand why “progressives” are so scared of letting go of that system. They keep calling Massachusetts a progressive liberal place on health care, but a mandate for health insurance is not progressive in my opinion.
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p>Free access to basic and general needed care (especially preventive!) is progressive.
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p>Being stuck in a job because you are afraid to lose your health insurance is not a good- or healthy- way to live.
isn’t this a mark of an advanced post-industrial society?
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p>what is federal deposit insurance, if not a safety net? sure, there was a day when the gummint didn’t guarantee baseline protections for citizens in the financial arena. is anyone lamenting the days when putting your nest egg in a bank was your own personal gamble?
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p>if you’re one of those folks, then you should call out any government intervention that seeks to provide any sort of institutional consumer and citizen protection from devastating loss.
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p>however, if you believe that there should be a government administered safety net for citizens lives equal to that of their bank deposits, then how is the best way to guarantee that safety net?
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p>is it better (and more economically sensible) to assure access to quality preventative healthcare for all citizens? or is the smartest thing to do is to continue providing that safety net in emergency rooms via freecare services for maladies that were easily preventable and avoided through basic comprehensive (and guaranteed) primary care?
preventive care AND emergency rooms.
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p>And also I don’t understand why dental care is not mandated. Tooth decay can lead to problems with eating, speaking, learning, and working. Poor oral health is linked with increased severity with cardiovascular disease, diabetes, immune disorders and more.
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p>Dental care is like the afterschool option in Gomes’ example.
Primary care systems are really annoying, I have to feel really justified to bother my doctor, and not feel embarrassed that my symptom will be gone by the time of the appointment and I’ll seem alarmist about nothing. I’d prefer not having a PCP and just go to a hospital for more anonymous care, though of course only if they have access to my necessary medical records on line (this should be provided by the government for each person too, to ensure privacy and regulate access).
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p>But if I go to a hospital, I don’t like being treated like I have the Andromeda Strain or a bullet wound to my heart; I am just sick and want someone to diagnose and treat me. Those drug store “minute clinics” would be good, but if it turns out to actually be serious, I want to be at a hospital, not a WalMart.
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p>Solution: require hospitals to operate walk-in clinics alongside the emergency rooms, so that people go to the hospital and the admitting nurse decides if they turn left into the ER or right into the clinic. Hospitals need to be required to do this, because they’re perfectly happy admitting people into the ER and getting paid $2000 to take their temperature (that nurse would have to have some incentive to perform that job properly). Yes, they’d have to fit it in the building, but they could if they had to.
might be another option for preventative free care, but the only concern would be the alarmists who frequent them for every paper cut and cough.
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p>I keep trying to figure out we can be sure that free clinics like your proposal would not overburden the hospital/clinic staff.
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p>There are hospitals around the country that do have clinics, any idea of how they work?
And there’d have to be additional staff, yes. Maybe some would work in both settings, depending on demand, but I was envisioning separate staff. There wouldn’t need to be as many in the ER if many of the walk-ins went to the clinic instead.
…but I can’t wait to see what Goldstein would have to say about charter hospitals.
I’ll bite………..but only b/c your election predictions were good.
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p>Imagine if Childrens Hospital had a big signs:
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p>So if that were to happen, then charter hospitals would spring up — some doctors and nurses band together to organize something new to serve those kids.
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p>* * * *
Here I’ll even write your reply for you đŸ™‚
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p>Not bad eh?
And thanks for saving me the trouble of writing a reply.