The following sentence, concerning the attorney general’s scuttling of a hospital merger deal, from Ted Nesi’s weekend roundup column brought to mind a different industry:

Yet in the end, their plans were derailed by a concern raised on day one: how could a hospital group with roughly 80% market share be stopped from abusing its dominant position?

Why is abuse of a dominant position a matter of concern in healthcare but not in education?  Not surprisingly, Erika Sanzi had the same thought:

Listening to @AGNeronha convincingly explain to @TedNesi and @TimWhiteRI how handing 80% of health care market share over to one entity would decrease quality and increase costs.

Exactly the same with our current K12 system but somehow that’s just fine?

Left-wing podcaster Bill Bartholomew, however, doesn’t get it:

not sure I follow the logic here from blogger/columnist Erika Sanzi, who compares fundamentals of @AGNeronha decision on proposed hospital merger to the status quo of public k12 education in RI. What am I missing?

And outgoing teachers union director Bob Walsh pretends not to get it:

I guess if we ever try to merge the current 66 separate local education agencies in Rhode Island, and the numerous private and parochial schools, into one entity we might face an objection. Or maybe it’s just a totally invalid, politically motivated, dark-money financed statement

Look, this isn’t complicated.  Even a merged company has divisions with distributed decision-making.  Monopolies are bad, but even so, a single company running every hospital in the state wouldn’t require every decision to go up to the central office.  Indeed, necessity would demand that most day-to-day decisions would be made by each hospital in much the same manner as independent organizations.  The differences would be in things like uniform employment arrangements, consistent rules for particular procedures or treatments, centralized bill collection, redistribution of resources across the system as managers deem necessary, and so on.

The problem with monopolies is that anybody who doesn’t like any of those one-for-all rules, whether as an employee, a customer, or a vendor/supplier, has no options.  That person is trapped.  This is particularly problematic in healthcare, because many of the services we buy are not really optional, and (although holistic medicine believers may disagree) self-treatment isn’t always feasible.

This is very much the situation we have in education.  Even were they inclined to be neglectful, parents are required by law to see that their children are educated.  The “choice” between districts requires the massive disruption of moving.  And the combined force of state mandates and statewide labor unions operating across districts imposes some substantial uniform policies throughout public schooling.

As for the control of the market, when I built an economic model to project the effects of school choice policy using 2012 data, I found that district schools controlled 85% of the enrollment market, with private school and homeschooling taking about 12% and charter schools and other independent public schools claiming the remaining 3%.

Remember, also, that left-wingers like Bartholomew and Walsh tend to want more centralization of policy and resource-redistribution across the system than we already have!  They also tend to want to limit access to the alternative 15%, while also extending more centralized policies to them.

So, back to Sanzi’s question:  If monopoly on this scale isn’t acceptable for healthcare, why is it for education?

Featured image by MChe Lee on Unsplash.