A focus on science and math education in secondary education discriminates
against children who never had the need for such education, since half
never got to such courses.

A focus in the US on expenditures for chronic disease such as in 75% of
Medicaid has clearly paid for care that used to go for children and young
people.

For populations that have a life expectancy of 50 years, these efforts are
also discriminatory since they will not share in the expenditure.

The arguments for children are at least 2 in number
1. it is best to invest in a way that will benefit all, not just those that
live longer or who fit certain criteria such as test taking ability
2. efficiency, sheer efficiency

A third argument is emotional not rational since it is difficult to turn
down needy children. Such arguments are why we spend a fortune in prenatal
areas and invasive testing to the nth degree where we should have spent
these extra health dollars outside of the health black box in efforts in
education, antismoking, antidrugs, etc. It just happens to be tough when
the ob-gyn docs dramatically present the stats on lost children or the rare
lost mom because of lack of sufficient invasive efforts, more testing, etc.

Health care is really good about emotional, dramatic, laser guided, but
soft on efficient use of funds.

Education and efficient use of funds are an entirely different matter.

1. education, especially education for poor children, represents a direct
needed effort that may improve levels of teachers and their support and
their retention in the schools that most need them.
2. such investments are also in schools and teachers and represent cash
flow and economics to poor areas
3. If you invest in the earliest ages in children and their development,
much disease, behavior problems, and future school problem can be avoided
or minimized.

Estimates in the US are that 40% more expenditures in the earliest grade
levels can equalize outcomes for disadvantaged students. Much the same can
be accomplished by moving the best teachers to the earliest grades. However
preschool efforts may have even greater value than early education.

Middle class and professional families speak thousands more words a day
than lower income types. Verbal ability is markedly different in only a few
years.

You can pick education, abuse, abortion, or any of a number of areas and
those with lower education suffer at higher rates.

We also live in an era where gaps get wider because of changes in
information and techonology. Left behind a little soon means left behind a
lot with menial low paying labor, less benefits, and little hope for
yourself or your children.

I won't repeat the efficiency arguments and stats but the efficient states
have a .6 and above correlations with significant cost areas and with
significant investments in health and education. You can argue that states
such as California, Texas, and Florida have problems with greater
diversity, but these states have also made choices not to invest their
great wealth efficiently. Other states such as West Virginia face greater
challenges and lower levels of income yet make infestments in children and
health. They are moving toward efficiency.

The major questions in systems such as education, health, and distribution
of income involve efficiency, not rich or poor.

The most efficient nations will have fewer who are extremely rich and fewer
who are extremely poor.

The differences been these arguments and the bean counters who pick out
programs to cut are that bean counters are looking at the big ticket items
that may or may not be good expenditures (drug costs, copays). They also
look at the politically expedient items and avoid targeting the powerful
elderly lobbies.

Looking more globally at entire programs or budgets or expenditures is
important. Cutting drug costs means little if it results in more ER,
hospital, institutionalization, and other costs in other areas.

There are few arguments to investing at early ages and building an
education and health infrastructure and sufficient job skill development.
There are few arguments against investing in those who are most poor,
unless these expenditures impact future generations or the development of
education and economics in a nation. When expenditures begin to erode basic
infrastructure, then there is little hope for the young, the poor, and the
elderly, or the environment or animal rights or human rights.

Robert C. Bowman, M.D.
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