Pay teachers more. Shrink class sizes. Upgrade classroom materials. These are the standard positions taken by teachers’ unions and their political allies on the left. The belief is that more school spending, especially on across-the-board pay raises for teachers, is essential to improving education.
These views are mistaken. Teachers are not underpaid, and total education spending — which has more than doubled in real terms since the 1970s, with little change in test scores — is wasteful and excessive. But that’s not the point I want to make here. What I really find striking is that the Left treats teachers in the opposite way that it treats doctors.
Liberal commentators frequently argue that the single-payer aspect of Medicare is a cost-saver because the government uses its concentrated purchasing power to negotiate lower prices from doctors and other health-care providers. Paul Waldman of The American Prospect put it bluntly:
The fact that [Medicare is] big means it has tremendous negotiating power, so it is able to keep many costs low. If you’re a physician or a hospital, you have to accept Medicare’s reimbursement rates or just not serve Medicare patients. As you can imagine, doctors don’t like this very much, but it serves the taxpayer.
Imagine arguing for public schools on the same basis: “The government should use its purchasing power to push down teacher salaries below market levels.” Public-school boosters would be horrified by that idea, and they would predict dire effects on education if it ever came to pass.
I’m not an expert on health-care policy, but there appears to be a serious inconsistency here. The Left’s education mantra is “pay teachers more to attract the best and brightest,” while its health-care mantra seems to be “pay doctors as little as we can get away with.” Do doctors not respond to financial incentives as teachers do? Underpaying for either occupation will have consequences.
The broader point here is that if paying below-market prices for education would be bad, what does that say about the “savings” generated by single-payer health care that the Left touts? I tried to answer that question in a piece for Forbes this week:
A single-payer healthcare system may succeed in using its monopsony power, as Medicaid has, to keep prices well below market levels. If that happens, we need not wonder about the effect on healthcare quality: Just ask public school enthusiasts about the dangers of education cuts, replacing in their response “teachers” with “doctors,” “schools” with “hospitals,” “textbooks” with “medical devices,” and so on.
Needless to say, the alleged low cost of single-payer health care is not a convincing argument in its favor.