Thursday, September 19, 2013
A soon-to-retire colleague at graduation phrased it well. "Once the students looked young. Now the parents look young."
CCs were full of adjuncts, as were lower division classes at university. Some adjuncts were cheap because of the PhD glut and unemployment problem in science and math circa 1970. The t-t profs were cheap, too, because they were all young. I believe that t-t Uni faculty teaching loads were higher and pay comparatively lower, but I can't prove it. (One complication is that the university in question has become the more elite and more selective research flagship it was trying to become back then, so it considers its former self unworthy of comparison. That is the biggest part of the cost difference, IMHO.) I can prove that the admin overhead has grown explosively. Just count offices and admin buildings on a campus that still has the same number of students.
PS - The 83 year old adjunct who died HAD single-payer insurance. You can't use that argument in her case, just as people struggling to get by as adjuncts would not be helped if we encouraged universities to keep full time professors well into their 80s.
On the other hand, single-payer systems lead to shortages and rationing.
Everyone agrees that the current system doesn't work very well—my favorite take is "How American Healthcare Killed My Father"—but the single-payer alternatives won't necessarily improve the situation for many people.
In the short term, I'd like to the feds allow the sale of insurance across state lines and, more importantly, mandatory price transparency. One huge problem with the system is the absence of meaningful prices. Solve that we may see a lot of other components fall into place.
I'd like to see a move towards a single-payer catastrophic system and some kind of mandated HSA-style system, but that's as politically unlikely as a single-payer system.
I wonder how much of this is the "death of a thousand cuts" where each individual increase in administrative overhead is justified (and even desirable) but the cumulative effect is a problem? This gets even worse when you try and cut admin, as the regulatory, tracking, and IT expectations are completely different. This makes it hard to actually identify clear waste, even if the net effect is a bit of a problem.
I think about what amount of this is the "passing of a thousand cuts" where every singular build in managerial overhead is supported (and even alluring) yet the aggregate impact is an issue? This deteriorates when you attempt and cut admin, as the administrative, following, and IT desires are totally diverse. This makes it hard to really recognize clear waste, regardless of the possibility that the net impact is a touch of an issue.
IMHO even the cumulative administrative effect is not a "problem" at a flagship state R1. It is the much revered solution to increasing research productivity and grant income. Ditto for the drop in teaching loads for the tt faculty. The goal is to increase your ranking. Period.
The very large flagship R1 that I know well is not unique except that I know more about it at a particular point in ancient times. I know several others almost as well, but only for 30 to 35 years.
I must say that what really fascinates me the most is what the actual costs of registration were compared to today. It was hideously inefficient back then, but I suspect that the manpower was mostly "free" (staff, faculty, and adjuncts who would be doing something else the next week).
That was a nice "bot-like" job of almost not plagiarizing what Alex wrote. Looks like it went twice through Google Translate.
I know that flagships aren't all there is to public higher ed (I happen to teach at a non-flagship "comprehensive" school) but they're the ones that people pay attention to. More importantly, many "comprehensive" state universities do seem to have grown in the last 30-40 years, and some of them weren't even around then, whereas the flagships are (mostly) longer-lived and (mostly) more stable. Some of today's independent "comprehensives" were extension campuses or whatnot back in the day, whereas most of today's flagships existed in a roughly analogous form in 1970. So a 1970 comparison might be relevant.
We already have shortages and rationing - they just hit the poor and the sick hardest so no one cares. The problem with the current system is that we have the worst of both worlds - a costly fee for service system with no meaningful incentives for cost containment or preventative medicine and cut rate care that is offered at such low reimbursement that providers in high cost areas have trouble staying in business.
For all it's faults, Medicare has improved vastly the health of older people. Yes, there are holes in the system but it's pretty equal across the board and those with additional money can pay for additional coverage. We would be lucky if everyone in this country had coverage that met the minimum standards set by Medicare.
Sure, if you massively underfund them. Guess what other systems lead to shortages if you underfund them?
Single-payer still does the most with the least. The data is absolutely solid on this point. And remember, the US already spends more PUBLIC money per-capita than most single-payer countries. Plus the private money.
But I doubt that's DD's point, so he's wrong.