Healthcare and Education

Expanding my thinking about the impacts of current policies on the young adults, I see a pattern in both health care (in particular affordable care act) and education (in particular common core).

By young adults, I’m using my own definition based on my own experience that the period of age between 19 and 34 are qualitatively different in the way it defines a person’s place in society.   In the period before, development follows a relatively inflexible script both due to physical growing up and due to the programs to guide that development being imposed from outside.  In the period after, constraints return through ones biography (curriculum vitae for life as opposed to a job) and the narrowing of opportunities to pursue.

I think the most valuable resource of the nation is the young adult age group.  How we manage the opportunities available to this generation will determine the wealth (in terms of quality of life) of our nation in the future.

It is hard to describe past policies as explicitly managing the opportunities available to young adults.  While there were constraints about what not to do, we allowed a great deal of independence to allow people to define themselves.

What bothers me now is a change in policies.  In addition to defining what is not permitted, we are mandating what must be done.  This result of the economic opportunities that result from desired policies.  The policies distort the economy and this impacts the participants who are not the target of the outcomes of these policies.

The policy for pursuing universal and uniform delivery of health care is desirable for the segment of population that needs health care services where there is some fraction who can not afford it either initially or because the condition degrades to the point of becoming prohibitively expensive.  The majority of the targeted beneficiaries of this policy is older adults.

The policy for pursuing universal and uniform delivery of childhood education is desirable because the educational opportunities vary greatly depending on local economic conditions such as wealth of students and availability of skilled instructors.  The targeted beneficiaries are very young.

Both of these policies require industries that are extremely labor intensive.  There services are delivered to individuals at a time.  In order to deliver these services, there needs to be relatively small ratios of beneficiary to provider.  In both cases, there is a need for the laborer to devote substantial amount of time to each individual to determine the best approach for delivering the service.  The demand for uniform quality requires qualifications of specialized training and documented experience.  The scope of the policies requires specialization so that the work of the practitioner becomes very narrow in terms of scope of work where the variety of the work is only in the circumstances of the individual beneficiary.

In addition these two areas also have not enjoyed the dramatic improvements of productivity enjoyed in other disciplines.  Automation that does occur is offset by added burdens.  For example, computerized record-keeping is offset by the demands for additional more detailed records.  The core of these fields is individual delivery of services.  The services must be customized for each individual.  The services must also be customized for the immediate condition of the set of individuals: for example, medicine having to adapt to a recent outbreak of infectious diseases, or a teacher encountering a class of unusually disruptive students.

Both of these areas are under high pressure to control costs.  Due to the limited opportunities for productivity, the costs are controlled through low median compensation.  In general, these occupations provide low compensation and compensation with virtually no opportunity for growth in later years.

The bulk of the labor for delivering these services are the young adults who have to spend their early years in training and their later years in gaining experience.  At the end of their young adult-hood, they will enter the middle adult-hood being locked in by that experience.

This career path has always been true for these occupations.  There is no reason to believe this will change in the future.

What has changed now is that the demand for universality and uniformity has distorted the labor market so that these occupations will require the participation of a much larger fraction of the young adults.  In contrast to earlier times, more of these occupations will be filled by economic necessity instead of by individual motivation of those inclined for helping individuals.   In order to assure uniform delivery from unmotivated laborers, there will need to be constraints that constrain the ambitions of those who are motivated by individual attention to the beneficiaries.

Both affordable care act and the common core indirectly does a major disservice to our young adults and I believe this will rob the nation of future wealth and welfare.

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