How public education can learn from the health care reform debate

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Doug Tuthill is president of Step Up For Students, which helps administer the nation’s largest private school choice program (and co-hosts this blog).

Florida Gov. Ron DeSantis caused an uproar recently when he commented that all publicly-funded K-12 education services are part of public education. He was speaking about a proposed new education voucher program that, if it becomes law, will give low-income and working-class families public funds to help pay for private school tuition and fees. The assertion that education vouchers are part of a devious scheme to dismantle and privatize public education is undermined if publicly-funded vouchers are part of the public education system. Hence, the strong political backlash from education choice opponents to the governor’s statement.

My hometown paper, the Tampa Bay Times, immediately attacked the governor’s comment by quoting a line from the Florida Constitution stating that Florida is required to provide “a uniform, efficient, safe, secure, and high quality system of free public schools.” But the governor didn’t say all publicly-funded education services are part of public schools. And I don’t think he was making a legal or constitutional argument. He was simply stating the obvious. It’s in the public interest to understand that public schools, alone, can never meet the educational needs of every child because much of their education occurs outside of schools. And always will.

The Florida Constitution properly requires that we provide every child access to a high-quality public school. But sit in any teachers’ lounge and you’ll quickly hear that educators know that’s not enough. Especially for children trying to escape generational poverty, we need a concept of public education that extends well beyond public and private schools.

The criticisms of Gov. DeSantis’ comment illustrate an obstacle people of good will face when discussing how best to improve public education. We don’t have a common set of linguistic and conceptual understandings to facilitate our discussions. Consequently, we often talk past each other.

Conversely, debates about how to improve our nation’s health care system, while often contentious, benefit from commonly understood concepts. Perhaps applying some of these health care reform concepts to public education could help us clarify where we agree and disagree, and maybe help us find common ground.

The New York Times recently published this useful glossary of health care reform terms:

Single-Payer: A health care system in which the government pays for everyone’s health expenses.

Private Pay/Private Insurance: Individuals pay for their health care through their personal funds and/or a private insurance provider.

Public Option: Allows individuals who don’t qualify for the current Medicaid or Medicare programs to purchase health insurance from the government.

Socialized Medicine: A single-payer system in which the government owns the hospitals and employs the medical staff. The British health care system is an example of socialized medicine. The British government owns the medical facilities and pays the doctors and nurses. According to the Times, in the U.S., the Veterans Administration health care system is an example of socialized medicine.

Medicare for All: Expanding the current health care system for older adults to cover everyone. Some Medicare-for-All proposals are single-pay programs that cover all medical expense, while others include privately-funded co-pays and options for supplemental private insurance coverage. No current Medicare-for-All proposals include socializing the U.S. health care system by requiring doctors, nurses, and other medical personnel to become government employees.

Universal Coverage: Everyone is guaranteed access to health care.  This could be accomplished through a single-payer system, requiring everyone to purchase private insurance, or some combination of single payer, private insurance, and a public option.

I don’t speak for the education choice movement. But my sense is that the goal of most education choice advocates, using the Times’ health care reform taxonomy, is a single-payer public education system that provides universal coverage and allows educators to participate without having to be government employees. This approach is similar to Canada’s health care system and Sen. Bernie Sanders’ Medicare-For-All proposal.

Most ed choice advocates would also support weighted funding based on each student’s needs and allowing parents to supplement single-payer funding with private funds.

Education choice advocates are generally skeptical of socialized public education (and socialized medicine). They are fine with doctors and teachers working as government employees in government-owned VA hospitals and district schools, respectively. But they think doctors and teachers should have the freedom to choose whether they want to be in public or private practice. Doctors have this freedom today. Most teachers do not.

Our two primary public health care systems today, Medicare and Medicaid, provide a context for understanding what Gov. DeSantis might have meant when he equated publicly-funded K-12 education services with public education. U.S. doctors who treat both private- and public-pay patients are simultaneously participating in private and public health care systems. When doctors in private practice are being paid by private health insurance companies to treat a patient, they are in a private health care system; when they start treating a Medicare patient a few minutes later, they are participating in a public health care system. From one minute to the next, what determines whether private practice doctors are participating in a public or private health care system is who is paying the bill.

If we apply today’s health care reality to K-12 education, private practice teachers are in private education when they are being paid by private funds and participating in public education when they are being paid by public funds. Given Gov. DeSantis’ congressional background and his experience with the Medicare and Medicaid programs, it’s not unusual that he may see parallels between public health care and public education.

The history and politics of public education and public health care differ greatly, which is why Sen. Bernie Sanders and others on the Left strongly support a single-payer, universal coverage plan for health care, yet oppose a similar plan for K-12 education. But low-income and working-class families are increasingly flexing their political muscles and causing the politics around education choice in public education to change. Gov. DeSantis’ comment will eventually be seen as common sense, even by the Medicare-For-All political Left.