Sunday, December 30, 2012

Clear and Present Dangers 7

In my latest reading of M. Stanton Evans' Clear and Present Dangers: A Conservative View of America's Government (copyright 1975), I read the chapters on education and inflation, and I started the chapter on health care.  I have three items.

1.  In the chapter on education, Evans disagrees with the liberal view that more government spending on education will improve educational quality, and he also argues against school busing.  In this item, I'll focus more on the busing issue.  Evans discusses the work of a scholar, James Coleman, who contended that African-American students would do better academically if they were removed from their own impoverished community and put around white people, and that became the rationale for busing African-American children for long distances to public schools that are largely white.  When I read that, I thought about Robert Reich's argument in I'll Be Short that students who are around other students who don't plan to go to college will probably themselves lack the aspiration to go to college (see here).  Reich there was not arguing in favor of busing, nor was he suggesting that it's awful for African-Americans to be in their own communities.  But I was reminded of Reich because both he and Coleman (as Evans describes him) make the point that one's social environment can affect one's educational achievement and aspirations.

Evans contends that school busing has failed, for it has not resulted in higher academic achievement among African-Americans, and it has exasperated rather than improved race relations.  Evans also quotes the 1964 Civil Rights Act in arguing that busing is a violation of that law.

Evans may have a legitimate point that school busing was problematic.  As I mentioned in my post here, I once talked with an African-American woman who said that busing was a bad idea because it removed African-American children from their neighborhoods.  Prior to busing, she said, an African-American doctor could mentor an African-American child in his neighborhood who wanted to be a doctor.  With busing, however, this was less likely to occur because African-American children were removed from their communities for long periods of time each day.

Where I differ from Evans, however, is that he does not seem to think that unequal schools were much of a problem.  Evans appeals to "a compilation of papers derived from a Harvard seminar on the Coleman Report, edited by Frederick Mosteller and Daniel P. Moynihan" (page 179), and he says that scholars in this study found that "in many respects the level of spending on Negro schools is higher than that for schools that are chiefly white, and that where discrepancies exist in favor of whites they are less discernible in the South, not more", and also that "variation in school facilities has little to do with variation in achievement" (Evans' words on page 180).  I don't have the time or the energy right now to read the Coleman Report or to do a research project to refute what Evans is saying----but see here for wikipedia's documented description of the Coleman Report.  I will say this, though: I'm sure that there are a number of scholars who have arrived at conclusions different from what Evans is arguing.  Moreover, I should note that even Republicans, such as George W. Bush and Dick Cheney, argued that there was an achievement gap between whites and minorities, which (according to them) No Child Left Behind helped to close.

2.  In the chapter on inflation, Evans argues that the wage and price controls of the 1970's did not work because they resulted in shortages, for they discouraged people from making products because the price controls would inhibit them from charging enough to make the profit that they desired.  Evans locates the problem of inflation in the increase in the money supply, and he contends that deficit spending makes this problem worse because the government prints money in an attempt to satisfy the growing government budget, while avoiding increases in interest rates and the tax burden.

I'm sure that there's something to Evans' arguments.  At the same time, I wonder: How have inflation rates managed to be low, when government spending continues to rise?  See here.

3.  I started the chapter on health care.  Evans argues that there is not much of a health care crisis in the U.S., for the U.S. has reduced infant mortality, plus there are more doctors per patient in the U.S. than exist in a number of other countries, and Evans argues that there are long lines to receive medical care in Great Britain.  But Evans acknowledges that the cost of health care is rising, and he believes that Medicare and Medicaid are contributing to that, for treating people for free requires higher costs for the people who pay.  In a sense, Medicare and Medicaid patients are not treated for free, for their care receives a reimbursement from the government.  But there have been concerns that the reimbursement is not adequate, and so a number of physicians either choose not to see Medicaid patients, or they pass costs on to others.

I think that Evans' critique of the Swedish system is worth quoting.  On page 207, Evans states: "Since nobody [in Sweden] has any incentives to control costs, patients come to hospitals for the most minor or imaginary ills and hospital stays are protracted.  Private practice of medicine on an outpatient basis has been discouraged, although steps are afoot to alter this.  In addition, the Swedish system has discouraged entry into medicine by new physicians, and it is noteworthy that the doctor-patient ratio is considerably lower than in the much more populous United States."

I don't think that a person should be afraid to see a doctor, for even "minor or imaginary ills" may indicate that something is seriously wrong with the patient.  At the same time, there should be efforts to control costs----to ensure that doctors are not ordering unnecessary tests to get more money, to focus on results, to value preventative care as a way to prevent more expensive emergency care from being necessary down the road, and to seek cost-effective ways to meet patients' needs.  In my opinion, Obamacare either does these things, or is moving the health care system in the direction of doing these things.

I agree with Evans that the doctor-per-patient ratio is important, for a greater supply of health care facilities can result in lower prices.  Otherwise, you probably would have long lines to receive medical care!  In my opinion, newer physicians should be encouraged to enter the field rather than discouraged.  Regarding how the U.S. compares with other nations on this, there are countries that have the sort of system that Evans opposes----a single-payer national health insurance system----that have better doctor-per-patient ratios than the U.S., and there are countries with a single-payer system (such as Canada) that have worse ratios than the U.S. does.  See here.  In my opinion, a single-payer system is compatible with a decent ratio of doctors to patients. 

There has been concern, however, that Obamacare is scaring people from the medical profession or is encouraging doctors to leave the profession early.  I think that the government should take steps to encourage people to enter the medical field.  One professor I had suggested that people who decide to enter medicine should receive their college education for free.  Maybe that would be costly, but it could also bring down the cost of health care.

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