Lessons for Higher Ed from Health Care

August 4, 2013 | Blog

The New York Times has been running a terrific series helping to illustrate why costs of healthcare in this country are so incredibly out of control. Today’s story is masterful in the way it breaks down the cost of an artificial hip replacement in the U.S. versus Belgium.  The cost in the U.S. is over $78,000, while in Belgium it is $13,660.

The main cost differences lie in variation in the surgeon’s fee (about 16 times higher in the U.S.), the implant cost (more than 8 times higher in the U.S.) and the hospital room cost (about 8 times higher on a per-night basis).  These differences helped direct the reporters towards a story that unpacks the reasons for variation in impact and hospital costs, while unfortunately saying little about the differences in surgeon’s fees.

Imagine what we could learn from similar analyses of the costs of higher education in this country versus in others.   Time and again I hear that costs of education students at the postsecondary level are higher here than anywhere else, and it is very hard to believe that those costs explain our high (yet declining) ranking in terms of quality.

This quote in the Times article stood out to me as precisely the sort of thing we need to explore.  When an American traveled to Belgium for a far less expensive hip replacement, he entered a hospital and was initially concerned: I was immediately scared because at first I thought, this is really old.  The chairs in the waiting rooms were metal, the walls were painted a pale green, there was no gift shop. He flashed back to his recent visit to New York Presbyterian Hospital, which has comfortable waiting rooms, an elegant lobby and newsstands — along with much, much higher prices. But then I realized everything was new. It was just functional. There wasn’t much of a nod to comfort because they were there to provide health care.

Think about the last private college or public flagship campus you visited, and then think about your local comprehensive university or community college.  They are all there, purportedly, to provide education.  Yet the former are all about “comfort”– and their influence is leading other institutions with far fewer resources to follow that path.  The question is, at what cost?

Take a look at this recent transformation of Madison Area Technical College — which now calls itself Madison College. What if this happened to two-year colleges across the nation, most of which rely on underpaid college instructors for the actual educating? At what cost, and at what consequence?  Of course it’s always wonderful to spend your days learning new things in beautiful places, but what if it means your neighbors can’t afford an education at all?

Last year
This year

Sure, buildings and amenities aren’t the whole story– we really need the Times to unpack those discrepancies in surgeon fees.  We have to get to the bottom of our American obsession with equating amenities with quality in fields and services where the amenities are immaterial to the purposes.  And then we need to engage in appropriate comparative analyses to look for better solutions to our American higher education challenges.


  1. Reply

    Sherman Dorn

    August 5, 2013

    I obviously need to follow through on my intention to write about rhetorical allocations...

  2. Reply


    August 8, 2013

    MATC is an interesting example. The original building at Truax is anything but lush. It's bleak and industrial, known for a poor ventilation system. There are no study halls so study in the noisy hallways or in the dining room. But yes the new buildings are so artsy-upscale looking as to definitely invite criticism. But MATC, which ran quite over-budget building those buildings, didn't get anything like the hostility for going over budget thaf UW System did for being under-budget. Underneath the MATC hood though it looks like they dropped a lot of needed classes in order to cut costs.

    A crucial issue in this discussion of cutting costs is what is taught and how it is taught. Teaching trendy in-demand topics using expensive content and licenses is going to cost more than teaching basic ed. That's one of the disturbing things about the MOOC model. They don't use proprietary products in instruction, despite that non-free products may be far and away the gold standard in the field. For example, matlab is the product of choice in many engineering related areas but no MOOC can require expensive matlab licenses. Part of the elite experience is going to be using expensive content and software while the bargain hunters use free content. Unfortunately that may not work well for the bargain students.

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