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Health Care and an Educated Citizenry
To understand the debate, one must possess an enormous amount of background knowledge.


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Chester E. Finn Jr.

What kind of education would one need to make sense of the current health-care debate? As the U.S. rethinks its academic standards and international competitiveness, this is not a bad time to ask what American citizens, voters, and taxpayers need by way of knowledge and skills to form reasonable conclusions about the hottest domestic policy issue of the day.

Today’s elites seem certain that John Q. Public is irremediably ignorant about, and perhaps oblivious to, the health-care debate, and thus susceptible to being misled, brainwashed, or cowed. Some Democrats are convinced that the insurance industry is creating “movements” bent on misleading and confusing people and planting suspicion in their hearts, while at least one GOP congressman and more than a few conservative pundits and talk-show hosts say President Obama is lying. All these folks seem to assume that the masses cannot possibly understand the debate. But must we accept that as a given? What would it take to comprehend the health-care battle?

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Basic literacy and math skills obviously come first. Lots of numbers, cost projections, and ratios are being tossed around, and so are many sophisticated words, phrases, and concepts. Some“21st-century skills” are called for, too (even if one believes, as I do, that these skills were just as important in earlier centuries). One must, for example, 1) be able to get behind the words, slogans, claims, and counterclaims to discern motives, rhetorical strategies, etc.; 2) be able to distinguish among fact, conjecture, opinion, propaganda, and so on; and 3) be able to gauge the impact of a given proposal on one’s own situation or that of one’s family and friends.

What I’m most struck by, however, is the enormous amount of background knowledge — across multiple disciplines — that one must possess in order to understand this debate. It’s almost a litmus test of cultural literacy. Consider, for starters, just three short paragraphs from President Obama’s address to Congress last week:

I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.

We are the only advanced democracy on Earth — the only wealthy nation — that allows such hardships for millions of its people. There are now more than thirty million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone. [Emphasis added throughout.]

I’ve marked a few of the many terms, concepts, people, and formulations that demand background knowledge.

What is “health care reform,” and what’s the significance of adding the word “comprehensive” to that phrase?

Who were Theodore Roosevelt and John Dingell Sr. (and Jr.), and what’s the relevance of their past experience to our present debate? How does the past shape the present?

What are key differences between Democrats and Republicans? Why did Obama invoke both? Is it coincidental that he also named Roosevelt and Dingell?

How does “insurance” work? What do insurance companies do? What do employers do in this realm? What does it mean to be “self-insured”? What is “coverage”? “Bankruptcy”?

What’s an “advanced democracy”? How many are there? What are some others? What’s the point of Obama’s comparison of the U.S. with other countries?

Some other essentials: What are Medicare and Medicaid? Where did they come from? How do they work? Who is covered by them?

What’s the federal deficit, and why are some people concerned about its size?

What is the congressional legislative process, and why is it unusually complex in this instance?

As is obvious, history, civics, and economics converge here. If you don’t possess a good amount of background knowledge in these fields, how could you expect to be even a knowledgeable observer of the health-care debate, much less an active participant in it? And if you are not knowledgeable yourself, what are the consequences? In the end, you could end up with some unpleasant (or perhaps pleasant) surprises. More immediately, you are — just as the elites say — vulnerable to rhetorical tricks, scare tactics, and propaganda, and you are apt to abdicate your civic role to others, whether you like it or not. Those others may be elected officials, or they may be interest groups and lobbyists. Perhaps they will serve you well. But you’re not likely to be able to determine whether that’s so, because you simply don’t know enough.

Perhaps you don’t need to know these sorts of things to succeed in college or the workplace (which seems to be the litmus test for today’s standards-writers and education reformers). But you really do need to know them to be a constructive participant in modern American life. Who is going to ensure that our schools teach them?

– Chester E. Finn Jr. is a former assistant U.S. secretary of education, a senior fellow at Stanford’s Hoover Institution, and president of the Thomas B. Fordham Institute. His latest book is Reroute the Preschool Juggernaut.



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