I've started working on the implications of the health care/higher ed analogy. Assuming that our political culture is too far gone to embrace the obviously correct solution (use progressive taxation to fund single-payer health care, and use some of the savings to beef up basic research in the universities), what I think may happen is the emergence of something like HMO's in higher education.
Since our culture treats these things in a bass-ackwards way, let's assume that the rage for 'cost control' that gave rise to 'managed care' spawns similar offspring for higher ed.
Take the next step. Given the rise of distance ed, and the recent move away from charging out-of-county students a premium (gotta get those enrollments up somehow!), what's to stop some enterprising capitalist from starting an Efficient Degree Organization that compiles data on the cheapest and most convenient ways for students to put together degree programs? Take these Smith County College courses via the web, add a few Jones CC courses, transfer the batch to Midtier State, and pay the EDO either a flat fee or a percentage of the money saved.
Take the next step after that. Assume the EDO gets big, which it might. What's to stop it from negotiating group discounts? After all, if every community college in the state offers English Composition on the web, and the EDO has an impressive number of students, the incentive for any given college to cut it a break is substantial. We've entered what manufacturers call "commodity hell," in which the only way to compete is on price. After all, if the program is knit together from a pile of different schools, the prestige variable has been more-or-less tabled. What's left is price.
None of this would have been realistic before the emergence of internet courses, since physical distances would have been prohibitive. Nor would it have made sense when the public picked up more of the tab for higher ed, because tuition was low enough that any savings would have been too small to bother. Now, distance is irrelevant, and tuition is climbing fast.
If the EDO gets big enough, there might be some counter-pressure from the academic side, claiming that quality control has become untenable. The obvious legislative response would be...wait for it...drum roll, please...standard, external exams! Outcomes assessment, taken to the next level! The relation of colleges to degrees would become closer to the relationship between law schools and the bar exam.
It's not really all that otherworldly, if you think about it. Universities have already effectively outsourced their personnel decisions to publishers. (No book, no tenure.) Why not outsource degree decisions, too? Colleges would become something closer to Stanley Kaplan test prep centers.
Substantively, this is a terrible, horrifying idea. Academic freedom would wither away, good luck defining criteria for the exam, etc. Still, while nobody would advocate a system defined this way from the beginning, it could easily take shape in the interstices, while everyone just whines about cost.
(No sooner had I polished off this missive than the latest Chronicle of Higher Ed arrived, featuring an article by Dick Armey suggesting…say it with me, now…replacing subsidies to public colleges with tuition vouchers for students! My goodness, these people are predictable.)