The Gap Between Spending and Results

This subject was discussed on December 23, 2013.

One of the key “talking points” used in the debate over the Affordable Care Act has been the fact that the U.S. spends substantially more than virtually any of our international “peers,” but has lagged those same peers in terms of health outcomes.  Similarly, the U.S. education system spends more per pupil than almost any other country, yet our students perform poorly on tests of reading, math and science skills. We could probably identify many similar situations…high spending, low outcomes…if we tried.

What is driving this enormous gap between financial commitment and results? To what degree does it have to do with:

  1. The role of Federal and local governments in education and, increasingly, in health care?
  2. Our expectations that, given our success of the last 50 years, we are somehow “entitled” to continued success?
  3. The changing roles and attitudes of our people, whether parents, children, healthy or infirm?
  4. In short, is this more a problem with the “system”…teachers, doctors, health care companies and administration…or with our “culture”?

One thought on “The Gap Between Spending and Results”

  1. I doubt that there are a great many citizens out there who feel entitled to anything more than freedom, privacy, and the opportunity to pursue whatever they may perceive as the American Dream. There is, however, a small but growing number of people who feel exploited by the “system” (e.g. jobs at service employers that are so poorly paid that the workers need assistance for basic needs; near-constant wars, often multiple, fought almost solely by volunteers, who may be sent on several tours.). In the professions, there are also growing disparities–teachers’ salaries are so low now that fewer and fewer talented and idealistic people will sign up. At many colleges, academic programs are cut so that larger sums can be used to support athletic teams and coaches. Often, some college administrators, as well as some coaches, are paid three or four times the salaries of professors. In health care, it is common for administrators to be paid several times the salaries of vital employees, such as primary care physicians and IC head nurses. Academics and physicians, though still highly respected by much of the populace, are increasingly feeling their financial and scheduling needs to be ignored by the folks who set their working conditions. I have no issue with hard-working people becoming very rich (wealth is an important part of most people’s American dream). BUT certain athletic coaches, medical administrators (who, unlike doctors, do not have to make life-or-death decisions in the middle of the night), and public college presidents are paid in excess of one million dollars a year? And they will generally see to it that their colleagues and successors will be paid similarly. Bureaucracies beget bureaucracies. In the face of the intensification of that ancient principle, how can parts of these systems be reformed? Seems a very steep uphill battle. But the only way for results to get better is to use resources, especially public money, much more wisely.

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