Alan et al:
Speaking of conspiracies against the public -- we academics should know
something about that topic. See below.
As my late colleague Marion J. Levy Jr. put it in his LEVY'S ELEVEN LAWS
OF THE DISILLUSIONMENT OF THE TRUE LIBERAL, "To know thyself is the
ultimate form of aggression."
By all means let's help make the health care sector economically and
clinically responsible. That done, let's then turn our vigor for
socially responsible conduct on ourselves. There is much to do.
Best,
Uwe
------------------------------------------------------------------------
----
THE NEW YORK TIMES, SUNDAY OPINION, PAGE 9.
August 14, 2010
Academic Bankruptcy
By MARK C. TAYLOR
WITH the academic year about to begin, colleges and universities, as
well as students and their parents, are facing an unprecedented
financial crisis. What we've seen with California's distinguished state
university system - huge cutbacks in spending and a 32 percent rise in
tuition - is likely to become the norm at public and private colleges.
Government support is being slashed, endowments and charitable giving
are down, debts are piling up, expenses are rising and some schools are
selling their product for two-thirds of what it costs to produce it. You
don't need an M.B.A. to know this situation is unsustainable.
With unemployment soaring, higher education has never been more
important to society or more widely desired. But the collapse of our
public education system and the skyrocketing cost of private education
threaten to make college unaffordable for millions of young people. If
recent trends continue, four years at a top-tier school will cost
$330,000 in 2020, $525,000 in 2028 and $785,000 in 2035.
Yet most faculty and administrators refuse to acknowledge this crisis.
Consider what is taking place here in New York City. Rather than
learning to live within their means, Columbia University, where I teach,
and New York University are engaged in a fierce competition to expand as
widely and quickly as possible. Last spring, N.Y.U. announced plans to
increase its physical plant by 40 percent over the next 20 years; this
summer Columbia secured approval for its $6.3 billion expansion in Upper
Manhattan. N.Y.U. is also opening a new campus in Abu Dhabi this fall.
The financial arrangements for these projects remain obscure, but it is
clear that they will not be completed without increasing the
universities' already significant and perhaps unsustainable levels of
debt. Last year Columbia reported $1.4 billion in outstanding debt
against a $5.89 billion endowment. N.Y.U. had a staggering $2.22 billion
debt with a relatively modest $2.2 billion endowment - one that had
shrunk by more than 11 percent over the previous fiscal year. For
universities, as for banks, the question is not only the value of
current and projected assets but also the availability of liquidity so
they can pay off interim debt obligations during a time of financial
instability.
There is a similarity between the debt crisis on Wall Street and what
threatens higher education. Just as investors borrowed more and
increased their leverage in volatile markets, many colleges and
universities are borrowing more and betting on an expanding market in
higher education at the precise moment their product is becoming
affordable for fewer people.
Financial aid is drying up and government support is not keeping pace
with the rising cost of college, so students and parents are being
forced to borrow more heavily. For decades, admissions offices have
marketed themselves by promising a significant return on the investment
in the form of higher lifetime income. But with the cost of an
undergraduate degree well into the hundreds of thousands of dollars,
this argument is no longer persuasive. Students and their parents are
carrying unsustainable levels of debt, which is likely to lead to a
crisis that will mirror the collapse of the subprime mortgage market. To
make matters worse, student debt is even more toxic than a soured
mortgage, because it is nearly impossible for a person to legally walk
away from student loans the way a homeowner can walk away from a
mortgage.
The competition between Columbia and N.Y.U. is an example of what
educational institutions should not be doing. Universities should be
looking for new ways to provide high-quality education to more students
at a lower price. In today's world, it no longer makes sense for every
school to cover every subject.
For example, it is absurd for Columbia and N.Y.U. to be have competing
philosophy departments at a time when there are few jobs for philosophy
academics. Instead, they could cooperate by forming a joint graduate and
undergraduate program, which would reduce costs by requiring fewer
faculty members and a more modest physical presence, while at the same
time increasing course choices for students. And in our wired world,
universities on opposite sides of the globe could find similar ways to
collaborate.
American higher education has long been the envy of the world, but today
our institutions are eroding from within and are facing growing
competition from countries like China and India, which are developing
ambitious plans to enter the global higher education market. Capital can
be intellectual and cultural as well as financial; it is vital that
American higher education remains the reserve currency of the global
educational system. No less than Wall Street, our colleges and
universities are in dire need of reform.
Mark C. Taylor, the chairman of the religion department at Columbia
University, is the author of the forthcoming "Crisis on Campus: A Bold
Plan for Reforming Our Colleges and Universities."
-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Maynard, A.
Sent: Sunday, August 15, 2010 6:01 AM
To: [log in to unmask]
Subject: Re: On the Mend
Thanks Bob
Wow! "Lean" may hit the US hospital sector over 50 years after Demming
and others developed this in the reconstruction of Japan. Europe is
already "infected"!
The nice issue is why has it taken so long to streamline systems and
reduce the variations endemic in health care systems, public and
private?. Could it be that George Bernard Shaw was right and that
professions are" a conspiracy against the laity". Reading Shaw's play,
the "Doctor's Dilemma" from 1906 still seems very pertinent! For those
preferring Chicago to the Fabians, Milton Friedman argued that
occupational licensure reduced the volume and quality of care in his
"Capitalism and Freedom" in 1962. Managing better the "crews" of health
care systems would of course redistribute power and money and is
therefore unacceptable!
Has much changed in the last 100 years?
Have a nice day!
Alan
Bob Pyke Jr.,RN,CPNP wrote:
> John Toussaint and Roger Gerard have published a book entitled On the
Mend: Revolutionizing Healthcare to Save Lives and Transform the
Industry. Ordinarily, you would be well advised to be skeptical of
anyone promising revolution and transformation, but not here.
>
> Here's an excerpt from the introduction:
>
>
>
> With few exceptions, [government policy] debaters assume that
healthcare costs are fixed, that America's proud history of medical care
and innovation comes with a staggering bill.
>
>
>
> We know different.
>
> http://goo.gl/b/uhyl
>
> Bob,
>
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