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.