THE HEALTH CARE DEBATE ECHOS PAST PUBLIC EDUCATION DEBATE
By Daria M. Brezinski, PH.D
Is the public option in Education a comparative forerunner for the Health Care debate? The Public Education debate spanned nearly 300 years! For decades, individual states—rather than the federal government—had primary authority over education in the United States. The Puritans and the Congregationalists during the 1600s in the New England colonies of Massachusetts, Connecticut and New Hampshire, established private, religious schools. By the 1700’s, Thomas Jefferson believed that education should be under the control of the government, free from religious biases, and available to all people irrespective of their status in society. Jefferson attempted to mandate education for the young nation but in spite of his efforts was unable to lead the country to affirmative action for free schools. In the 1840’s, Horace Mann started the Common School Journal, which took the educational issues to the public. It wasn’t until 1870 (when the 1870 Education Act was passed in England) that the first Superintendent of Schools was appointed in the US to set up a tax-funded uniform system for Public Instruction (but long held prejudices stalled the program nationally until 1940). The long-term effects of the educational debate and the individuals who enacted legislation (who lacked the knowledge and expertise to determine what was appropriate and practical for learning) were not clearly thought through but rather a medley of divergent trends crystallized into a product that no one had expected and nobody wanted. Hopefully, health care reform will learn from the past, have less obstacles, bias and be incorporated in a lot less time!
This Health Care debate is related to Public Education in the following categories:
1) DEFINNG OBJECTIVES: Not unlike a clear, concise business plan, one of the greatest obstacles to beginning any endeavor is to specifically designate what is to be accomplished- the end results, actions or objectives. If 100 individuals were interviewed, each would elucidate the role and function of health care and/or education within personal parameters, perspectives and needs. Arguments include: What constitutes a ‘good education’? What is the purpose of education? Is it job preparation and training, income earning potential, passionate personal pursuits, following the “American Dream” (whatever that is), becoming a productive, tax paying member of society or proficiency in test taking? In this Health Care debate, the argument is comparable. Is it coverage for all, on-going prevention, curing disease, eliminating pain and suffering, supporting reactionary medicine, being fiscally responsible, taking insurance companies and medical professionals to task, emphasizing ‘care’ as opposed to ‘defensive’ medicine or something else? The issues defining this discussion are relative to the various experiences of constituents. In health care, wrangling occurs between those who have medical care from employers, those who pay for their own, those who have none, those who have been ill, those who have not, those who are young or old- all of which determine perspective and perception as much as need and want. Until a majority agree and define the goals or someone takes the lead, the path and process of achievement will remain obscure. A public option would enable the differences to be accommodated over those satisfied with private coverage.
2) GENERATING TRANSPARENT CHOICES: Public and private choices in education have remained options throughout. For the most part during Jefferson’s time, designated plantation, black or white private schools were supported and maintained by upper class families or local communities while early Puritans had private religious schools for their own. Today, public, private, alternative and home schooling options are transparent, open and, for the most part, information is readily available to formulate comparisons on personnel requirements, pupil preparation, methodologies, ideologies, ranking and affordability. By contrast, as the sick have no time for comparison shopping, the mysterious health care industry whose physicians, hospitals, procedures and insurance companies obscure, complicate, confuse, deter, and are outright deceptive about incomprehensible data for procedural necessities, physician and hospital pricing, types of services rendered, disciplining in-house infractions (serious or otherwise), ratings, preparation of professionals, professional privacy and costs. This obliterates informed choice and makes the patient susceptible to fraudulent billing, unscrupulous and untrustworthy practices (like the overdose deaths of movie stars through prescription drug enablers). After the fact, upon the arrival of the bill, the patient’s inquiry skills must penetrate the procedural maze by meandering to physician’s office, billing office, accounting office for answers. The insurance companies are designed and utilize deterrent strategies such as waiting on hold for long periods, unclearly defining appropriate departments, lack of return calling, and discouraging or intimidating patient questions. In frustration, those who are ill, exhausted and fearful in the first place, ‘give up’. It often seems the purpose of health care industry is ‘hide, duck or defer’ rather than confront. A public option would weed out the deception.
3) STANDARDIZING THE TANGIBLES: In 1894, The Committee of Twelve, constituting the 12 university presidents in the US, decided that a standard was necessary for the 15% (who didn’t necessarily graduate) of college bound students (now 25% receive Bachelor’s Degrees) who demonstrated a wide diversification of knowledge. Without research, investigation or determining the long term consequences for the children under 18 years of age, they adopted the Five-Core Curriculum- science, Social Studies, math, Language and English. In Jefferson’s era, one teacher emphasized language and spelling (because that area of the country needed it) while in another school, the teachers’ interest was history or geography. When a child graduated, competence ran the gamut of the amount and specificity of subject matter. So combined with the Carnegie Units which segmented the day into ‘time-spent units’, incorporating the notion of child as ‘machine’ (the combined stimulus-response plus Cartesian notions of the times) to be measured and controlled, severing body from mind, standardization emerged to unify the nations schools. Today, an infrastructure, designed for a minority of the population, the elite attending higher education, denies the majority of students, who are not college material, a good free public education because instead of receiving technical and job training in high school (which most youths need in life), they must go to Community College or college for career placement (putting students in debt before vocation)! Although medical training is standardized, the critical factor in Health Care is accountability, responsibility and reconcilability of services and products across the nation. Wouldn’t it be better if products and services, costs and plans were standardized instead of minds (knowledge) and hearts (emotions), spirits (passion) and souls (personal purpose)?
4) The dignity of all humans must be inviolate: Vulnerable children are prey to predators. Although the infrastructure or content delivery system of education might not be considered humane , a modicum of protection, safety and security (as can be achieved in massive environments) for all children throughout the school day (with the exception of gangs, cliques and bullies) is achieved through parent, professional and community cooperation, which inherently values the dignity of human life. The sick and infirm (especially those who are alone) are also vulnerable but unlike a child in school, the tired, weathered, fearful, frightened and weak patient is at the mercy of the medical- insurance infrastructures while dealing with life and death issues without a voice among the soothsayers. The safety factor is questionable because as a for-profit entity, the bottom line can be more important than the welfare of the patient. Thus the patient would be susceptible to unneeded procedures, specialists, prescriptions, surgeries, shuttled from one specialist to another and out-right torture. By decree of insurance companies billing practices, patient visits with a physician last 15-20 minutes. If physicians were able to communicate and listen, spend time with patients, perhaps costly procedures and testing (the dehumanizing processes) would be unnecessary. Most people want to be ‘heard’, to be cared for not to be corralled, poked, prodded, opened, invaded and violated. Many are lonely and isolated from human contact. Virtually untrained in patient care, physicians are more acclimated to patient diagnosis and treatment. Ironically, a more expeditious delivery system can be obtained when patients are treated with dignity and respect rather than as diseases and symptoms needing cures.
5) COMMUNICATING SIMPLY: The formalization of curriculum is next in education. Prior to the McGuffy Reader and New England Primer, the Sears Roebuck Catalogue was the first textbook in addition to the Bible and works of poetry, prose and morality. What subjects were important to an industrialized, growing nation? With immigration at its heights, people relocating from all over the world, a standard vocabulary was necessary for communication. English became the vernacular because the British were the predominant group, knew the lay of the land and held positions of power and authority. Although students in school learn basic forms of language and grammar, what generally occurs in modern professions is lingua fracas, a jargon foreign to the public and known, understood and availed only to those in the profession. Although the adept converse, the public does not comprehend, leaving the professional carte blanche to find agreement within the ‘club’. In the health care debate, the discourse from physicians to insurance plans is obscured as well so that the average person has no idea what is expected of them or what is available to them much less what they suffer from. This leaves the patient ‘without a voice’, unable to communicate, understand (especially the elderly), ask appropriate questions or coherently respond to a situation. Isn’t there a simplistic way to communicate?
6) DISCOURAGING SUBLIMINAL UNDERTONES: The inception of public education had a subliminal undertone. As an industrialized nation, certain vocations demanded specific skill sets. For the most part, soldiers, farmers, factory workers, coal and steel miners, and good tax paying citizens would constitute the majority of the population. The prerequisites for this group became enculturated through the ‘social science’ curriculum and throughout the content of all reading matter! The curriculum (and infrastructure) in education has long held a socialist, sexist, bigoted, white male philosophy subliminally by design. Although the content is changing, these still exist in places. Health Care, hospitals, stockholders, and the like, instead of the health and well-being of citizens, are driven by spreadsheets and profit margins. When the ‘bottom line’ is fundamental and health care is a business model, what compels the infrastructure to be patient driven? For this reason, a public option would be desirable.
7) DETERING SPECIAL INTERESTS: Education has a tradition of allowing and enabling ‘special interest entities’ who entice with additional funding carrots, with propaganda (whose sole purpose is to create lifelong consumers), with ‘instructional objects for classroom use’, with ‘free’ guest speakers and the like to invade the infrastructure with disastrous effects (and still has not learned). For example, in Jefferson’s time, mathematics was a practical system, teaching students the basics of ‘business math’ for everyday use on farms, mercantile and otherwise with high levels of mastery. Today, the modern ‘dumb down’ curriculum with spoon-feeding techniques has degraded the school experience driven by special interest groups to accommodate the bottom end of the spectrum and textbook companies. In addition, during the 1950’s enticed by free ice cream and free teacher materials (posters, stickers and hand out sheets), no greater interest group penetrated the schools and hence, the national psyche (and caused generational damage) than the Dairy and Cattleman’s Association incorporating the (now outlawed) notion that milk and beef were predominant in the Food Pyramid. NO scientific inquiry was ever conducted substantiating the truth in this claim. Today, fifty years later, generations of life long consumption of fats has led to overweight populations whose neurophysiology is wired to crave these foods. Innocent children were turned into lifelong consumers. Add to this soda and snack vending machines, sale of nutritionally deficient foods to cafeterias, the ‘flashy’ visible exterior or textbooks rather than content quality, even computers for underdeveloped brains in the classroom and the results of ‘special interests’ can be devastating for future generations. The health care system has examples in much the same way including politician’s campaign funding, taking junkets and driving vehicles sponsored by lobbies that would benefit from legislation (medical association, pharmaceutical companies, insurance companies- all of whom have billions to spend in exchange to receive billions more down the line through legislation). In return, politicians skew the information to the public, with lobbies in mind, regarding every facet of health care and/or reform. The airwaves are full of misinformation (as Freedom of Speech requires no specification on truth). Even education is targeted with insurance company representatives lecturing in upper grades, pharmaceutical companies using scare tactics so school children must be vaccinated or medicated from menstruation to depression to overweight as well as every known ailment (without determining the long term effects on immune suppression or internal organ compromise.) Has any one ever conducted an investigation as to the rising disease among children and the use of prescription drugs or its long-term effects on adults? No one questions powerful special interest groups with deep pockets or a very loud voice (the squeaky wheel). Again, a public option would help!
8) LOOKING ELSEWHERE FOR EXAMPLES: The politicians who sought a unified system of education fortified with the desire to create soldiers, factory workers and good tax paying citizens, advanced overseas to a nation that had long incorporated a successful educational model- Russia- implemented by Catherine the Great. The one-room-school house in the US succumbed to the conglomerate school district for reasons of ‘efficiency’ and ‘socialization’ in order to unify the nation but degrade the local community. The better model would have been the Reggio Emilio Schools of Italy founded by Loris Mamaguzzi where “a school is a place for all children not based on the idea that they are all the same but that they are different.” After World War II, single women impregnated by infiltrating soldiers, banished from shammed families, started a community literally out of the rubbles of war where children are revered, respected, honored and celebrated for their gifts and talents. The health care debaters look to other countries to find the answers and cures – Canada, Mexico and Europe. But the ‘powers that be’ equipped with agendas, are again attempting to undermine the benefits of successful systems with untruthful frightening propaganda. No system achieves perfection. However, the pros and cons of every viable alternative that would successfully comprise the essential issues of this nation must be injected in a healthy debate.
9) THROWING OUT BABY WITH BATH: The one-room-school houses achieved substantial triumphs throughout the nation from the mundane training of young girls as literate wives and mothers or promising careers for boys to literacy among African slaves. More importantly, the quality of training for creativity, imagination, depth, communication and relationship competency was remarkable. Brilliant, innovative thinkers were cultivated in one-room-schools- Abraham Lincoln, George Washington Carver as well as Lady Astor! The benefits were innumerable a) children of all ages co-operated in the process with one another b) progression was not by age or grade but by knowledge acquired c) the astute overheard the lessons of older children d) family and community interrelationships were propagated instilling an atmosphere of belonging, nurturing e) an education was considered a privilege not a right elevating its status as a valuable commodity f) values, morality and competence supercede the agendas of large publishing companies or politicians. g) The schoolhouse, a multiuse facility and as heart of the community rather than laying vacant and padlocked, accommodated community activities from Sunday socials to weddings and funerals f) students and communities participated in the design of curriculum. In this Health Care debate, is it imperative to elucidate the triumphs from representative models (whose lists are absent from the rhetoric) and integrate them into a prototype (or improbably throw it all out and begin anew)?
10) RESEARCHING AND IMPLEMENTING DATA ACCURATELY: Even though there is a plethora of data from scientists in a variety of disciplines assessing the nature of intelligence, environments conducive to learning, etc, educational pedagogy and infrastructure lack any mechanism for metamorphosis to incorporate these results. Carl Pribrum and Howard Gardner, for the example, elucidate the various categories of intelligences- tactile, auditory, visual- yet learning is primarily visually systematized for instruction. The stimulus-response conceptualization also predominates assignments even though for most, it impedes intelligence. Physical activity for mid-brain conscience development, three-dimensional deficiencies from television and computer viewing, socio-emotional damage of infants in Day Cares are a few of the elaborate research statistics unassimilated into the infrastructure of instruction. Why do taxpayer- funded ventures of scientists and other professionals continue when implementation, especially in education, is virtually non-existent or takes long enough for the information to become outdated? Yet, the health care continuum, skewed by data that has been funded by the very corporations that benefit from the results- drug companies, hospitals, institutions of higher learning- continue to magically, instantly become fused into the system. For example, how can clarity, accurate data and lack of conflict of interest regarding prescription drugs, be ascertained when the drug company funds the research or co-funds with the NIH? When the media informs the public about research, it neglects to inform the source of funding for the study.
11) MODELING IS FLUID: Today’s public education option is in need of major repair with the drop out rate at 50% in many localities among whites and higher among Hispanics and Blacks because of irrelevancy. The curriculum has not changed since the 1900’s, even after a comprehensive study was conducted right before World War I. In 1943, The Nine Year Report, which condemned Core Curriculum and Carnegie Units, now shelved in the archives at the University of Tennessee, was lost to the public because of war. The infrastructure is so crystallized and institutionalized for an Industrialized Society (that doesn’t exist) and Federal legislation that everything new is leveled to the playing field of public schools. In addition, in some communities, buildings are deplorable or incapable of housing the number of students; schools do not keep pace with either the workforce requirements, international shortages, cultural essentials, student aspirations or everyday competencies because it is more theoretical than practical national than local and irrelevant to pragmatic realism, personal health, community needs and the pace of technology. Real Learning has died because of stagnation. Any health care model must construct fluidity within its framework in order to maintain relevancy and the velocity with which new ideologies, technologies and infrastructures emerge.
12) INTEGRATING SMALL AND LOCAL OR BIG AND NATIONAL: Studies have shown that successful schools- public or private- like the Alternative Community School in Ithaca, New York; Liberty School in Main; School for Applied Learning in Florida; Jefferson County School in Colorado; Montessori and Waldorf Schools; Sudbury Valley School in Massachusetts (whose model has been duplicated in Japan); have no more than 250 children; as many as the principle can remember by name. In these schools, the sense of belonging, self-actualization, and self-confidence is nurtured and differences are valued and encouraged because small is more manageable. Students have a vested interest, a sense of ownership and funding is often less than large school systems because management is more efficient, there are less top heavy management requirements, students participate fully thus eliminating some salaried positions. In addition, regions of the country educate for various industries that are housed in that locality such as Lynchburg, Virginia where community colleges offer the necessary tools for the preponderance of technical needs of local corporations or the Midwest with agricultural dominance. This mode of instruction should have been provided by the local public high schools. Health care must have some components of localization for national diversity requires it. What is effective in New York City is ineffective on the plains in Montana. For example, in Charlottesville, Virginia, the Free Clinic (medical-dental) stands as testament, a model for local assistance of the uninsured middle class while non-profit hospitals like Geisinger in Pennsylvania support working class families. All the more reason for a public option.
13) EMOTIONALIZING REASON: During Jefferson’s era, emotional venting was a recurrent event as youths carried guns to school to settle grievances on the schoolhouse steps. Today, not only are guns not tolerated in schools, neither is emotion. Instead, children are drugged into complacency if demonstration of anything but sedate, lethargic behavior is observed because the infrastructure necessitates it. During this medical debate, anger and rage is often misrepresented in a culture that rationalizes feelings. Today, many people who are loudly voicing anger and fear at town meetings (much like those who shout at ball games and rock concerts) are exercising a need through socially acceptable venues to vent frustrations, anger and anxieties for other matters like lost jobs, savings and homes; bailing out banks and insurance companies; bigotry of the election of a black president; distrust and fear of large government or personal loses of loved ones for which they feel helpless and out of control. The expression of fear and anger often has nothing to do with the subject at hand but becomes the vehicle for release when the opportunity arises. It is important to cipher through volatile emotions and weigh the facts in this debate.
14) JOB DESCRIPTION: PROFESSIONAL OR PUBLIC SERVANT: In a one-room-schoolhouse, the teacher, as professional rather than public servant, maintained passionate enthusiasm about the subject matter, personally conceiving and fashioning the curriculum around the community and student population. Today, there is mass confusion whether the teacher is professional or public servant, and treated as the latter i.e. salary compensation, professional opportunities, decision making respect about classroom rather than mandated from principal, superintendent, school board to state and Federal legislature or text book and standardized testing companies. Teachers, if treated as professionals, would be expected to achieve levels of competency for defining and designing their own classrooms like the physician with his patients (who alone, by the way, makes life and death choices). Does anyone look over a psychologist’s, architect’s, chiropractor’s or lawyer’s shoulder after licensing as is done with teachers? A physician, bringing in a six figure income, would be terrified with the thoughts of becoming a public servant under a government run medical system, dictating salary, guidelines for patient care, and a barrage of regulations. But wait a minute, don’t the insurance and pharmaceutical companies already subliminally through reimbursements and freebees, define patient care, procedures, products and services? The major difference is compensation , which enables physicians to receive perks, daily lunches provided to medical groups and individuals, vacations, lecture tours, funding for research, not to mention salary. In the debate, whether it is educational or medical, the adept as professional or public servant must be clearly defined and if deemed professional, permitted to practice, unimpeded, their vocation.
Overall, the evolution of the educational system, laws, infrastructures, requirements and mandates embraced little investigation or research for long-term effects. As the debate regarding Health Care continues, can the nation juxtapose the wisdom gleaned from public institutions (Federal Employee Health Care, Postal Service, Medicare, NIH- National Institute of Health, state universities, defense, etc) to determine whether or not the government is capable of a public option? Can learning from the mistakes of other tax-funded institutions assist us in moving forward in health care? In a free society, citizens need choices in order to drive down costs and make things competitive. BUT, has that helped us in the past or the present? Are we really a FREE capitalistic system when governments bail out banks and insurance companies (rewarding them for bad behavior, speculating and incompetent regulations and regulators) because they are ‘too big to fail’? Who can easily grasp the mentality of Hedge Fund speculators who insure for failure? Maybe, just maybe, BECAUSE they are too big they DO need to fail. The same holds true whether the subject is education or health care.
Yet, the difference between the Health Care debate and education is that today there are clear, transparent choices in education (good or not)- private schools are diverse, home schooling is on the rise, charter, democratic, free schools (where one can attend with a scholarship) are prolific. The pricing and levels of competence are public knowledge. In health care, everything is obscure, obtuse and hidden from the public from pricing, coverage and profits to the language of contracts. How can Canadians or Kosko constituents pay so much less for drugs? The deception must end.
On a personal note, this author has never owned health insurance. Rather, a more preventative and holistic approach was instituted, maintained and coveted throughout life even through serious illness. Although allopathic medicine has been utilized for diagnostic purposes only, and a child’s stint in the hospital for broken bones, the overwhelming investigative information about allopathic health care was derived from close friends, now deceased, who navigated the system, obviously unsuccessfully.
A long time ago, The Pony Express companies were oblivious to the telegraph cables erected all across the country until their demise. Citizens need to wake up to the need for reform before it is too late and too expensive to make clear, honest, cogent choices available for all citizens. Then again…maybe everything is too big and should just be allowed to fail in order to start over again! Perhaps, just perhaps a Public Option is the answer for the major issues in both debates.
Respectfully submitted;
Daria M. Brezinski
Daria M. Brezinski, PH.D
Advocate in Health, Education for those without a voice