#Education & #Healthcare (Part 4 in the series)
One of the areas of the healthcare debate that we don't talk a lot about is the education component. I suppose there are components - for instance, a single-payer like system would encourage more education around healthy living and physical activity (lowering the cost of health care delivery for diabetes, heart disease, and other maladies directly related to physical health), as well as more of a push to make smoking less glamorous (lung cancer is not cheap).
But here, I'm looking more along the lines of the cost to be able to provide care. Looking at becoming a doctor? Based on 2014 numbers, you're looking at taking on some debt - in the range of $170,000-$200,000, debt that will need to be repaid. With interest.
But it isn't just doctors that are seeing patients - the healthcare system is made up of so many pieces that are crucial to everyday care, emergency care, and research to advance technologies. From nurses (RN, BSN, MSN) to phlebotomists, radiology technicians to the people who check you in to the ER, there is a large swath that have varying education requirements.
In all, between public universities, community colleges, private universities, and technical schools, there is a lot of money being made on training people to provide various healthcare services. And we have set up, as a nation, a system that saddles many of these folks with significant debt. So it is no wonder that the cost of health care delivery is so high. On top of that, because we do fee-for-service, the best way to make more money and pay down those loans: do more services with a CPT code that bills higher. But that's a different conversation altogether.
Taking a look at other nations, the United States really is an outlier. In Great Britain, the cost of medical school can be less than $10,000.00. Germany is well-known for having tuition-free higher education. France takes a (free) approach that includes different tracks at different points in someone's higher education.
This tracks with our education funding and financing problem in the United States. This lack of adequately funding higher education at the federal level, and seeing further cuts at the state level when universities are set against social safety nets for limited funding, it's no wonder the cost of education is so high.
Of course, to adequately fund higher education, and put in place a system where a single payer plan could work for individuals' economies, does mean a need for more revenue. While I previously touched on the actual cost to insure all residents of the United States, and how that cost as a tax would likely be lower than the cost of health insurance through employer subsidized plans, education just needs new funding.
One easy area to target is, of course, military spending. But let's not kid ourselves into thinking that we're going to see reductions in spending on jets that will never be used anytime soon. Somehow we have managed to turn our country in a place where even discussing reductions in spending in the defense budget makes someone weak.
So, more taxes it is. Whether we move forward with plans that make college tuition free for everyone (the Sanders model), free for middle income and low income households, while still charging for high-earning households (the Clinton model), or some combination that also incorporates the cost of books, food, housing, etc. (which is vital if we want low-income students to succeed, and not expect folks to work full-time while attending college and acclimating to a world to which they are not accustomed) - these are all good conversations to have. At the risk of an angry email: I would say many points of view and end results on the topic are 100% valid, and no one person is "right" in the approach.
More importantly, however, as we continue to move forward with a path toward a single-payer system, we must also move forward with a path for education reform that makes it affordable to become a doctor. Especially if we are looking at "Medicare-For-All" (which is actually a pretty terrible idea), with very low reimbursement rates, as our model. Further, considering the folks who will be put out of work with massive (and needed) reforms to health care delivery and insurance, having in place a system so folks can get the vocational and higher education they need to survive is vital. Fun fact: insurance companies aren't just the assholes at the very top, but are all of the people who do the work at all levels, many of whom become immediately expendable with a single-payer-like system.