School Choice and Single Payer

(This post originally appeared at Forbes. I’m posting it here partly because I think it’s a consistent position to support both single-payer healthcare – something many progressives advocate – and single-payer education – something many libertarians advocate. When I say below that I am not an advocate of vouchers for all students this is not an all-encompassing statement. If done correctly it could be something I would support. I simply approach the idea with skepticism, especially given the current system. For-profits are simply too prone to corruption when they make their profits solely off of government.)

I am not a proponent of school vouchers for for-profit schools or for all students, but I do think vouchers for low-income students is a very progressive idea that has unfortunately been tarred with the “pro-corporate-reform” label. Ditto that for charters.

I think charters represent a fundamentally progressive idea that many progressives are worried about because they’re afraid of corporate influence and the language of competition and markets.

I’ve been thinking about how school vouchers differ from healthcare vouchers, and I think there is an important distinction. Fortunately, Paul Krugman’s response to this pro-voucher piece in the New York Times by David Brooks provides a good opening.

Brooks argues that a top-down approach like Medicare can’t control costs and that a bottom-up, competitive approach (i.e. vouchers) makes more sense. To which Krugman responds:

I’ve been getting requests that I respond to my colleague David Brooks’s column today. Actually, I’ll just outsource it. Read Ezra Klein, Jonathan Chait, and Jonathan Cohn. The bottom line is, sorry, the evidence is indeed dispositive: decentralized, “consumer-based” health care is worse, and far more expensive, than universal systems run by the government.

I’d also recommend reading Ezra’s piece last month in which he tried to get Ryan to respond to the fact that everyone else has lower costs than we do.

The fact is, as Kevin Drum notes, most systems are a mixture of top-down and bottom-up planning and competition. Even Medicare is not all top-down. After all, the government doesn’t employ the providers of medical services, or manufacture the pills and hospital beds. They just pay the doctors and pay for the prescriptions and so forth.

In a sense, Medicare is already like a voucher program in that the government simply foots the bill, while private actors provide the services.

This is a lot like what many school choice advocates want. They want government to foot the bill, but they don’t want them to provide the service, or at least not exclusively. This approach works for Medicare, and it could work for schools also. What we really need is single-payer education – not single-provider education.

Anyways, the point is that we think about these programs in somewhat inconsistent ways. Nobody (or very few people) are arguing for the provision of healthcare services to be taken over by the government. Even people advocating single-payer want to be able to go to a private doctor.

And yet, these same people are terrified of the government paying for education but not actively providing the schooling. You can still have 100% public education without 100% public schooling, just like you can have Medicare for all Americans and still not have socialized medicine. So perhaps our debate about these issues is a bit jumbled, and many of the terms (such as “corporate reform”) less than helpful.