Americans spend almost twice as much on health care as other developed countries, but generally have poorer health outcomes, according to a study released in the Journal of the American Medical Association. The analysis of data from 2013-2016 compared the U.S. with ten high-income countries: Australia, Canada, Denmark, Germany, France, the Netherlands, Japan, Sweden, Switzerland, and the United Kingdom.

The study found that in 2016, the U.S. spent 17.8% of GDP on health care while other countries only spent 9.6% (Australia) up to 12.4% (Switzerland). All ten of the other countries essentially covered every citizen (99-100%) with health insurance. The U.S. covered 90% of citizens with health insurance and had the highest proportion with private insurance.

Americans easily had the highest rate of overweight and obese citizens (70.1%) and the highest rate of infant mortality. U.S. life expectancy is the lowest of developed countries at 78.8 years and for the first time in modern history, future Americans will live shorter lives.

However, many pet theories for this rapid escalation of American health care costs were disproved. Some had blamed Americans for going to the doctor too often, but the U.S. has roughly similar rates of utilization as the other countries. With 2.6 doctors and 11.1 nurses per 1,000, our workforce was roughly equivalent to the other ten countries. So why the higher cost?

Medical doctor salaries were much higher. U.S. general practitioners average over $218,000 per year while pay ranges from $86,607 to $154,126 in the other countries. Nurses in America are also paid more. Even more dramatic is the cost of pharmaceuticals, where Americans average spending $1443 per capita annually compared to $466 to $939 in other countries. A few procedures did emerge as perhaps over-used in America, mainly knee surgery and C-sections. We also use more MRI and CT scans.

But a really important difference was “administrative costs” that gobbled up eight percent of the U.S. health care bill compared to only one to three percent in other countries. This points the finger at our bureaucracy of private insurance companies and at the complex electronic coding and added personnel required to manage continuously-updated digital record-keeping.

However, all of these measurable factors only accounted for 60% of the added cost of American health care, leaving 40% yet to be explained.

I propose that the majority of the remaining excess cost of American health care can be attributed to the steady decline in science literacy.

What was not measured—and admittedly, it would be hard to measure—is the average citizen’s understanding of anatomy and physiology, our owner’s manual. Across the United States, only a few states train high school teachers in biology. Instead, most train one-size-teach-all science teachers who receive little or no coursework in anatomy and physiology. Even in Kansas where we do license separate biology teachers, the large research universities do not require human anatomy and physiology. As a result, you cannot teach what you do not know.

This is not the case in the other developed countries where science makes up far more of the K–12 curriculum. For instance, in Germany, an average citizen can self-refer to a medical specialist because they have studied human anatomy and physiology as well as basic microbiology and diseases. In China, a mere high school graduate has learned more science than U.S. elementary teachers learn by the time they graduate college.

The result is that we have a population that is profoundly ignorant about their health. This basic medical illiteracy in turn costs us in bad lifestyle choices and wrong health care decisions. In addition, medical illiteracy contributes to indirect costs in higher medical insurance due to ignorant jury decisions.
Until we add a year of basic anatomy, physiology and microbiology to our high school curriculum, train enough biology teachers, and start graduating knowledgeable patients, we will continue paying this stupidity tax.

John Richard Schrock is a professor at Emporia State University.

It seems like every few months we’re treated to the results of a new survey that has something dismaying to report about how young people approach free speech. Last fall, the Brookings Institute reported that college students have a number of misconceptions about how the First Amendment works — a significant percentage believes that it doesn’t protect hate speech, and that it requires that an offensive speaker at a public university be matched with another speaker with an opposing view. Last week, a survey conducted by Gallup and the Knight Foundation found that 37 percent of college students think that shouting down an offensive campus speaker is acceptable; even more troubling, another 10 percent said that violence is also an acceptable tactic for silencing an offensive speaker.

Findings like these always lead to a lot of hand-wringing about the intolerance of today’s youth, followed by a backlash of editorials pointing out that campus protests — especially at elite colleges — are over-covered by the news media, usually topped off by internet commentators decrying liberal snowflakes and at least one columnist reminiscing about the ’60s at Berkeley. I enjoy that as much as the next person, but let’s skip it for today. Why do college students have a shaky understanding of the First Amendment and an aversion to opposing or controversial views?

The problem starts in high school. I’m not just referring to the lack of mandatory civic education in public schools. Even in schools where students do learn about the First Amendment, many school administrators don’t particularly want their students exercising their freedom of speech once they’ve learned about it.

Take the school walkouts that took place across the nation on March 14 to protest gun violence. About a week before that, my colleague Gene Policinski and I wrote a set of guidelines for students, teachers and school administrators trying to figure out how to approach the event. We advised students to weigh their options carefully, as their First Amendment rights would probably not protect them if their school decided to discipline them for taking part in the walkout. (Public schools can punish students for speech that “substantially disrupts” the learning environment, and a walkout could very well do just that.) But we also advised school administrators to think twice before defaulting to disciplinary action — “Given that we live in an age where there is much concern that young people don’t understand the Constitution or support free speech, punishing them for exercising it, even if…school administrators [have] that discretion, seems counterproductive.”

That’s why it saddened me to read that a high school in Arkansas decided to punish the three students who participated in the walkout by giving them a choice between a two-day suspension and corporal punishment. (Fun fact: corporal punishment is still legal in 22 states.) All of the students chose corporal punishment; one of them wrote a fair-minded and eloquent account of the experience for the Daily Beast:

“The punishment was not dealt with malice or cruelty, in fact, I have the utmost respect for all the adults involved. They were merely doing their job as the school board and school policy dictated…I believe that corporal punishment has no place in schools, even if it wasn’t painful to me. The idea that violence should be used against someone who was protesting violence as a means to discipline them is appalling.”

Even a two-day suspension seems disproportionate to the offense of leaving your classroom for seventeen minutes.

It was also disheartening for me to talk to the two high school journalists who published a meticulously-researched story about a fired teacher — and ended up having their story censored by the administration and their newspaper privileges revoked. As one of the journalists, Max Gordon, said, “[T]he whole point of a student newspaper is to teach the students. We want to grow and learn and experience these things, but if the administration tries to shut down any form of outside-the-box thinking…it really hampers the growth by journalists.”

And when educators emphasize obedience and conformity over the free expression, they need to think about what lessons they’re actually conveying.

Lata Nott is executive director of the First Amendment Center of the Newseum Institute. Contact her via email at [email protected], or follow her on Twitter at @LataNott.