by Mitt Romney
One of the biggest behavioral contributors to sickness and death is our big waistlines, and the cascading negative health impacts of that excess weight. In the 1960s, 15 percent of people aged twenty to seventy-four were obese. Today that figure tops 35 percent. And if you combine the obese and the overweight, it reaches a shocking 68 percent of Americans. And the problem extends to the youngest Americans as well. In the 1960s, 4 percent of six- to eleven-year-olds were obese. Today, over 15 percent are obese and an alarming number of kids are affected by the type of diabetes that just a few years ago appeared only in adults.
The obese are six times more likely to develop diabetes and almost four times more likely to develop hypertension. The World Bank estimates that 12 percent of our national health-care spending can be directly attributed to obesity—that’s 250 billion a year. According to an Institute of Medicine study, if the obesity trend continues for our children, the average life span of American adults will be cut by at least two to five years, which would mark the first time in history that our children didn’t live as long as their parents.
We know what causes obesity, and it’s not genetics. Our gene pool didn’t somehow suddenly gain weight. Almost everyone knows that obesity isn’t healthy, yet that hasn’t slowed the trend. Until someone invents a miracle pill, we’re going to have to solve the problem the authentic and realistic way—by eating less, eating better, and exercising more. And like most complex issues, solving our obesity crisis begins at home.
The good news is that the reforms I’ve described will help foster healthier living. With everyone insured, every citizen will have a doctor. And with doctors and providers paid a fixed fee for the primary care of each individual, they will at last have a big incentive to keep their patients healthy. As more and more individuals have their own permanent and portable health-insurance policies, they will be more likely to stay with the same insurer and provider system over an extended period of time, making it very much in the insurer’s and the provider’s interest to invest in their wellness. Pediatricians will be far less tolerant of parents who let a child become obese. Training and intervention systems will be developed to help guide and support parents. Providers and doctors will partner with schools and churches to encourage exercise and smart diet choices. A number of companies may well begin to offer discounted premiums to individuals and families who are not obese, just as they do today for nonsmokers. In fact, some already do. Perrigo Company, an employer of 7,500 people, provides health-insurance discounts to those who choose to make healthy choices such as having annual physicals and, for those who are overweight, getting into a program to take off the pounds. After implementing the discounts, the company’s health-care costs actually declined. Perrigo’s former CEO said that more than one employee has told him that the company’s healthy-living program had saved his life.
As we endeavor to reform health care in ways that will lower cost and improve patient care, we should not lose sight of the fact that America has the best health care in the world. Sometimes statistics are trotted out to attempt to refute that reality, but they are invariably incomplete, distorted, or tortured. When, for example, statistics show that the survival rate for our newborns may not be higher than for another single-payer nation, remember that our singularly advanced, extensive, and enormously expensive neonatal care system means that babies are born alive in America that could never have been born alive in other nations. These very high-risk newborns are in our statistics but not in theirs’.
My own experience is a personal testament to our health-care professionals. My boys, being boys, were in the emergency room so often that the nurses at Mt. Auburn Hospital knew their names on sight. One day Matt and Tagg climbed up on the counter in the kitchen to open the cabinet where the cookies were hiding. Matt hadn’t calculated that when he opened the door, it would send Tagg flying. That fall required only a few stitches. But many and more serious accidents and illnesses were treated with care and competence.
The fact that my wife Ann is still here to bless my life is because of America’s health-care professionals. A gangrenous cyst would have taken her had she not received emergency surgery. She has survived breast cancer, thanks to early detection by attentive radiologists, surgery by a skilled surgeon, and radiation by highly competent technicians. The pain from a herniated disc has repeatedly been kept in check by creative and caring physicians. And in 1998, we got our greatest scare and felt our greatest appreciation for caregivers. Ann felt numbness in her leg. She lost balance. And she felt unusually tired. Her condition was diagnosed by a neurologist with the help of an MRI—she had multiple sclerosis. In the years that have followed since her diagnosis, she has been helped immeasurably by traditional and nontraditional medicine, by pharmaceuticals and treatments invented by American innovators, and by people who are true healers. There is no other country on earth that could have done for Ann what America has done. It is one more reason why I love America.
Whatever we do to reform medicine, we must make sure that we do no harm.
Health-care legislation may be passed by Congress in 2009, but regardless, the work is far from complete and the battle over the future direction of health care in America is ongoing. At its core of this debate is the question of what creates better patient outcomes and more efficiency: free enterprise and consumer-driven markets, or government management and regulation? The proponents of a government solution point to the obvious failures of our current health-care system. But our current system is far from being a consumer-driven free market. In my view, the failures we encounter virtually every day are the result of features imposed on the health-care system that have distorted market incentives—tax benefits only for those who receive insurance through their employer, fee-for-service payments to providers, the monolithic scale of Medicaid and Medicare, and an oppressive malpractice liability system, to name a few.
Before we go the way of socialized medicine, let’s bring to the health-care crisis the tools the American economy has perfected—innovation, productivity, cost efficiency, and quality through a consumer-driven free market.
No Apology: The Case For American Greatness
8
An American Education
I didn’t give my education much thought back when I was a child—it just seemed to unfold on its own. I guess I presumed that all mothers read to their children because that’s what my mom did with me. In retrospect, some of what she read was a bit out of the ordinary, like Alfred, Lord Tennyson’s Idylls of the King, which went on for hundreds of pages in iambic pentameter blank verse. The King Arthur legends claimed so much of my attention that I wasn’t aware that my mother was educating me as she read them—stretching my imagination and tuning my ear to the cadences of great writing.
I got two turns at kindergarten, first at Hampton School in Detroit and then, after we moved, at Vaughn School in Bloomfield Hills, so I had a solid head start. I still clearly remember Mrs. Vandenberg, who taught second grade. She liked me, or made me think she did, and from then on, that was my test for what it meant to be a good teacher. The following year, Miss Clark liked me a good deal less, but in the fourth grade, Mrs. Clouse made up for it by making me believe that I could learn anything.
I left public school in seventh grade to attend a nearby private school, just as my sisters and brother had. Of all the things my attendance at Cranbrook School did for me, the most important was to teach me to read well and to write with a degree of confidence. Virtually every weekend, each of us was required to write a theme: a poem, an autobiographical sketch, a brief television script, a short story, a one-act play, etc. Our teachers critically analyzed them, graded them, and sent the best of the lot to the Detroit News’s writing contest, in which Cranbrook students often won the lion’s share of the honors. Pushing nouns against verbs made the student at Cranbrook. If I could wave a wand over American education and get one result, it would be a national rededication to the practice of writing. (Those who read this book may quar
rel with the success of the Cranbrook writing program in my case. But at least I gained the confidence to give it a try.)
I didn’t get serious about my college education until I left it for a while. After my first year of college, I went to France to serve a two-and-a-half-year mission for my church, a custom in my Mormon faith and a long tradition in my family. A mission is about serving others, of course, but in my experience, it shaped the missionary as well. Like my fellow missionaries, I lived on a hundred dollars a month—about six hundred of today’s dollars—and that had to cover rent, food, transportation, and clothing. Accordingly, I lived quite differently than I had as the son of an American auto executive. Spending my days with French people in every sort of economic circumstance, I quickly came to recognize the value of a good education. Several years later, when I walked across a stage to collect my diploma, I understood that my parents and teachers had given me a gift of incomparable worth.
After Ann and I became parents, our highest priority became the education of our five sons, Tagg, Matt, Josh, Ben, and Craig. When I became a governor many years later, I wasn’t so much looking to find good schools as I was trying to help create good schools for the children of Massachusetts. In my life, education had evolved from being about me to being about my children and ultimately to being about bettering the lives of hundreds of thousands of children.
As I toured schools and spoke to students in Massachusetts, I often told them about a television show I watched as a boy called Let’s Make a Deal. Contestants were given a small sum of money, then offered the chance to trade it for the unknown contents inside a box. If the contestant opted to make the trade—and if the trade went well—she was given the opportunity to make another trade, such as for what was behind a curtain on the stage. Sometimes the hidden objects proved to be valuable—a car, appliances, dream vacations. Other times they were not—a crate of carrots or a box of balloons. People in the audience shouted for the contestant to go for the trade, because there wasn’t a downside for the spectators either way. Some contestants walked away overjoyed at their good fortune, and others saw the winnings in their hands evaporate when a booby prize was behind the curtain they chose.
Over and over again, I explained to audiences of Massachusetts students that life was a little like that television show of my youth. All of us necessarily make deals that have either fortunate or unfortunate consequences. But in life, you often know what lies behind the curtain before you have to make your choice. If you choose to stay in school and get a high-school diploma, for example, your lifetime income will be 400,000 greater than if you drop out. If you choose to go to college and get a bachelor’s degree, your income will be 1,700,000 greater. In fact, the average college graduate earns 2.7 times more over her lifetime than a high-school dropout. And there’s much more to education than money. A high-school dropout is more likely to go on welfare, become divorced, and spend time in prison. Of course, many million Americans overcome the disadvantage of having dropped out, but the effort and sacrifice to do so may be substantial.
Choosing education is a very good decision, not only good for the student, but also for our country. The United States was the first nation in history to recognize that public education for every citizen, regardless of class or station, was vital to its future, and over the centuries, we have devoted enormous resources and effort toward enrolling each successive generation in high school and college.
In 1940, less than one quarter of American adults had completed high school, but today 84 percent have a high-school diploma. Immediately following World War II, only 6 percent of adult Americans had a college degree, but the G.I. Bill propelled hundreds of thousands of returning soldiers into higher education, and today almost 30 percent of all Americans are college graduates. There is little doubt from our research that education and training are decisive in national competitive advantage [emphasis added], writes Michael Porter in his book The Competitive Advantage of Nations. America’s commitment to education helped build a base of human capital that was broader than any other nation’s. That human capital propelled our productivity, which in turn generated higher standards of living, economic growth, and world leadership. Without Americans’ collective commitment to education, America would not have reached the heights we have achieved.
There are serious warning signs about where education will take us in the future. The educational foundations of our society are presently being eroded by a rising tide of mediocrity that threatens our very future as a nation and a people, the National Commission on Excellence in Education reported in 1983. Now, more than twenty-five years later, scholars and think tanks are in unfortunate agreement that we’ve made virtually no progress in stemming that tide. And when it comes to our ability to compete around the world, the National Academy of Sciences goes so far as to conclude that America is on a losing path. Never have so many alarms been sounded to so little effect.
A recent education report commissioned by the OECD ranked American fifteen-year-olds as being twenty-fifth in math skills and twenty-first in science among the group’s thirty-plus developed nations. The cause of the low ranking was not because low-income, immigrant, or at-risk student scores pulled down the average. When the study compared only the wealthiest students among OECD member nations, our rank rose no higher than eighteenth. Stanford economist Eric Hanushek calculates that when the comparative tests over the last decade are combined, American students still rank no better than seventeenth out of the twenty-five OECD nations he examined. Having led the world in public education and human capital during the first three-quarters of the twentieth century, we have fallen dramatically below average in the twenty-first.
We still tie other nations in the percentage of students who obtain bachelor degrees, but others far surpass us in the proportion of advanced degrees awarded in science and engineering. In 2005, just 6.4 percent of advanced degrees awarded by American universities were in engineering, while in Japan and South Korea, the percentages were 38.5 percent and 32.3 percent respectively. That same year, advanced degrees in science accounted for 13.7 percent of the total in the United States, 38.5 percent in Japan, and 45.6 percent in South Korea. The lead we once held in science and engineering has long since vanished, and the consequences for an economy driven by innovation are sobering. The impact ominously extends to our national security—the Pentagon recently reported that our severe shortage of engineers and scientists will soon jeopardize our lead in military technology.
If Michael Porter is correct that human capital created via education and training is decisive, America’s economic future, military edge, and prospects as the world’s leader throughout the twenty-first century are in jeopardy.
Several years ago, I spoke with a prominent venture capitalist who argued that the quality of education of our brightest students is what matters most to America’s economic future, not the education level of the general population. He cited a study of manufacturing that showed that workers with limited education can be given on-the-job training that lifts their productivity to near world-class levels.
I deeply disagree with him. First, manufacturing is a smaller and smaller portion of our economy. And even in manufacturing, there has been a shift toward technical, managerial, and professional jobs that require higher education levels. In the economy at large, the trend has moved even more decidedly to positions that require greater education and literacy. In a flat world, as New York Times columnist Thomas Friedman observes in his books, the product of labor moves easily across national borders. If the American workforce receives inferior education and skills, it will necessarily be confined to inferior tasks that pay inferior wages, producing, in turn, an inferior GDP. Education matters, not just for the few, but for the many.
Education Is a Civil Right
What’s been labeled the achievement gap has been lamented for decades, but distressingly little has been done to combat it. African American and Hispanic American achievement in primary and secondary scho
ols falls far below that of Anglo or Asian American students—and that’s among those students who stay in school. About half of African American and Hispanic American students drop out before receiving a high-school degree. The result is that we are virtually assuring the creation of a permanent underclass. It is an inexplicable human tragedy when millions of American children barely attain a third-world education in the most prosperous nation in the world, one that offers all its citizens access to free public schooling. Our current failure to educate our minority populations is the foremost civil-rights issue of our generation.
The combined African American and Hispanic American proportion of the U.S. population is projected to rise from 26 percent today to 34 percent by 2030, and if the achievement gap and drop out rate among minorities continues, the average educational level of the nation’s entire workforce will continue to decline dramatically at the very time when increased educational skills are in critical demand. In addition to the ruinous human and societal costs, we therefore face a significant economic cost as well.
Our inexcusable national dropout rate isn’t limited to minorities. In absolute numbers, in fact, more Anglo students drop out of school than do minorities, and nearly 29 percent of all American children currently do not complete high school. For that 29 percent, it becomes nearly impossible to break out of poverty during their lifetimes. As the Educational Testing Service warns, Unless we are willing to make substantial changes, the next generation of Americans, on average, will be less literate and have a harder time sustaining existing standards of living. States and municipalities should launch emergency efforts to keep kids in school at least until they receive their diploma. These could include programs to better match a student’s interests with his or her curriculum, bonus compensation for teachers who are successful in keeping their students in school, and drawing on community heroes and mentors to counsel young people.