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EduHealth CationCare

See if this description of a major public policy debate sounds familiar:

- A major public service and its related public policy area need serious reform
- The current industry providing the service has a monopoly over the service. To the extent that choice within the industry exists, it exists only among extremely similar establishment institutions that are markedly similar in the structure of their systems and in their incentives.
- One political party believes that a necessary component to fixing the public service is to break the existing industry monopoly over that service by creating or empowering a new kind of service provider to compete with the establishment
- The other political party believes that creating or empowering such a new service provider would spell ruin for the industry and the American public as a whole.

What issue am I talking about? If you thought "education" - you're right. And if you answered "health care" - well, you're also right. But something weird happens depending on which issue you're talking about: the two political parties completely flip sides of the debate.

In the health care arena, Democrats these days are pressing the argument that the "establishment" health care provider--health insurance companies--are doing a shoddy job and that the system is broken. In education, it's conservative Republicans who say that the establishment education provider--traditional public schools--are broken.

In health care, the Democrats want to inject competition as a way to hold the inefficient health insurers accountable--and they see a government health care plan as the most effective competitor. In education, it's the opposite: Republicans want the private sector to compete with the government schools, most commonly through voucher programs to subsidize the cost of private education. What's important to note is that there already is competition in both arenas--competition among various health insurance companies and competition among public schools and charter schools within a given locale.

But both parties argue that this kind of competition is not good enough, as evidenced by spiraling health care costs with little public health benefit and unacceptable levels of student achievement and graduation rates What they want is a paradigm shift in the kind of competition--not just competition within the industry provider but competition between the industry as a whole and a completely different kind of provider (a government health plan in health care; private for-profit schools in education).

So what should we make out of this strange role reversal?

One conclusion is that both political parties are simply logically incoherent. If the Democrats really think that competition and choice between the private sector and government is good in health care, shouldn't they think the same thing about education? And if Republicans really support competition between private schools and public schools, shouldn't they also support competition between private health insurers and a public option in health care? The fact that both parties change their minds might mean that what's really driving their policy preferences is naked political gain: health insurance companies largely fund GOP candidate campaigns while teachers unions typically support Democrats.

Or maybe it's not so simple as that. Maybe both parties are being logically consistent, not about choice and competition, but about the role of the government versus the private sector writ large. Maybe Democrats really think all of health care should be government run, just like all of education--and maybe Republicans think both services should be exclusively privatized. If that's the case, all of this talk about "choice" and "competition" is just a front; neither party could care less about government and private industry battling to do best by customers. But if that's the case, recognize what it means: the government health care option may really be a wolf in sheep's clothing designed to eliminate private health insurance altogether in a slow, steady march to a western European health system. And Republican pushes for charter schools and vouchers may represent an attempt to torpedo public education as we know it.

But neither party has the political capital to go as far in either extreme--some members of each party wouldn't even go that far. So what we're left with is this strange political reality where Republicans believe choice and competition is good for Kennedy Elementary School but not for Kaiser Permanente, and where Democrats think the opposite.

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