Custodes Futurifor the advancement of humanity

Economic factor, barrier 3 of 6

Unequal access to education and healthcare

When access depends on family income, talent goes undeveloped. Heckman's research (Heckman et al., 2010) shows early childhood investment produces some of the highest returns of any public spending.

Evidence

  • Perry Preschool Program. The annual social rate of return was about 7% to 10%, lower than earlier claims but above the historical return on U.S. stocks. The program was small (58 treated children), so generalizing its results requires caution (Heckman et al., 2010).
  • Early gaps. In the conference version of the inventor study, third-grade math scores account for less than one-third of the income gap in innovation. By 8th grade, test scores explain half, because low-income children fall behind over time (Bell et al., 2018, 2019).
  • Innovative colleges. At colleges such as MIT, students from low- and high-income families patent at similar rates. The authors conclude that childhood environment and exposure drive most of the gap, rather than lack of funding or aversion to risk (Bell et al., 2019).

Proposed and experimental methods

Methods that are proposed, under trial, approved in some places, or tried and then failed. Each shows a stage label and an evidence rating. A stage label shows how far a method has progressed, not whether it works. The stage labels are explained on the economic factor page.

  • Universal public preschool, long-term lottery evidence (Large trial, B). Builds on the early childhood entry in "Antisocial and self-serving traits" in the psychological factors with a newer, lottery-based test of a large city program. Among over 4,000 Boston children who entered public preschool lotteries from 1997 to 2003, winning a seat raised on-time college enrollment by 8.3 percentage points (18%) and SAT taking by 8.5 percentage points, with no detectable change in state test scores (Gray-Lobe, Pathak, and Walters, 2023, MIT Economics, 2023). Results may not transfer to programs of different quality (see the Tennessee entry below).
  • Guaranteed free tuition offered before students apply (Large trial, B). High-achieving, low-income high school students in Michigan were sent an early, unconditional promise of free tuition at the state's flagship university, without any extra aid beyond what they would likely have received anyway. Application rates were 68% versus 26% in the comparison group and enrollment 27% versus 12% (Dynarski et al., 2021). It is one trial at one university.
  • Universal basic services (Theoretical, C). Instead of cash, governments would provide free shelter, food support, local bus travel, and phone and internet access, on top of free healthcare and education. A UK costing put these at about £42.16 billion a year, about 2.3% of GDP, versus just under £250 billion for a full basic income of £73.10 a week (UCL IGP, 2017). The figures are static estimates and the package has not been tested as a whole.
  • Not shown to help: Statewide pre-K in Tennessee (Large trial, contested, B). In a randomized study of 2,990 low-income children who applied to oversubscribed sites of Tennessee's state pre-K program, children offered a place had lower state test scores in third through sixth grades, with the strongest negative effects in sixth grade, and more disciplinary infractions and special education placements (Durkin et al., 2022). Critics argued the program was weak by current standards, and the authors replied that its quality ratings were mid-range and that strong long-term evidence comes from older, smaller programs (Farran and Lipsey, 2022).
  • Not shown to help: Buying and forgiving medical debt (Large trial, B). In two randomized experiments, medical debt with a face value of $169 million was relieved for 83,401 people between 2018 and 2020. Relief caused a moderate drop in payments on existing medical bills but no effects on credit outcomes in most cases, healthcare use, financial wellness, or survey measures of mental and physical health (Kluender et al., 2025).

Sources cited on this page

  1. Heckman, J. J., Moon, S. H., Pinto, R., Savelyev, P. A., & Yavitz, A. (2010). The rate of return to the HighScope Perry Preschool Program. Journal of Public Economics, 94(1-2), 114-128. DOI C Limited: B for the original sample
  2. Bell, A., Chetty, R., Jaravel, X., Petkova, N., & Van Reenen, J. (2019). Who becomes an inventor in America? Quarterly Journal of Economics, 134(2), 647-713. Oxford Academic B Moderate: A for the measured income gaps
  3. Bell, A., Chetty, R., Jaravel, X., Petkova, N., & Van Reenen, J. (2017). Who becomes an inventor in America? Non-technical research summary. Opportunity Insights B Moderate: A for the measured income gaps
  4. Bell, A., et al. (2018). Conference version of "Who becomes an inventor in America?" American Economic Association B Moderate: A for the measured income gaps
  5. Durkin, K., Lipsey, M. W., Farran, D. C., & Wiesen, S. E. (2022). Effects of a statewide pre-kindergarten program on children's achievement and behavior through sixth grade. Developmental Psychology, 58(3), 470-484. link B Moderate
  6. Dynarski, S., Libassi, C. J., Michelmore, K., & Owen, S. (2021). Closing the gap: The effect of reducing complexity and uncertainty in college pricing on the choices of low-income students. American Economic Review, 111(6), 1721-1756. link B Moderate
  7. Farran, D. C., & Lipsey, M. W. (2022). Response to The Hechinger Report essay by McCormick and Hsueh. Peabody Research Office, Vanderbilt University. link B Moderate
  8. Gray-Lobe, G., Pathak, P. A., & Walters, C. R. (2023). The long-term effects of universal preschool in Boston. The Quarterly Journal of Economics, 138(1), 363-411. link B Moderate
  9. Kluender, R., Mahoney, N., Wong, F., & Yin, W. (2025). The effects of medical debt relief: Evidence from two randomized experiments. The Quarterly Journal of Economics, 140(2), 1187-1241. link B Moderate

Every source for this factor is listed on the economic factor page.