Tuesday, September 08, 2009

Why Are College Tuition and Health Insurance so Damned Expensive?

The New York Times takes a look at "failure factories", those public universities that admit massive numbers of students as freshmen, only to have the majority of them drop out before graduation.

"At its top levels, the American system of higher education may be the best in the world. Yet in terms of its core mission — turning teenagers into educated college graduates — much of the system is simply failing."

First I have a gripe: I get a bit tired of these articles about how "the system" is failing, or "the universities" are failing, or "educators" are failing, when what we're actually talking about is students who are failing. If you're old enough to vote, start a career, get married, or join the Army, maybe you're old enough to bear some responsibility for your own successes or failures in life. I imagine, before long, we're going to be talking about how employers have "let down" and "failed" the employees they fired.

Secondly, we have to accept that some people aren't cut out for university. It's always been that way, and when it stops being that way, a university education won't be worth having. Public universities now admit almost everyone who applies- we can't expect all of them to graduate. And there is still a cultural issue here- working hard and kicking ass in school is not exactly celebrated in youth culture.

But, there are good reasons to flunk out- such as not being cut out for college. And there are bad reasons for dropping out- such as being unable to afford the tuition, or being too lazy and entitled to do the work. And, indeed, a lot of students end up leaving for the lousy reasons.

As for the culture of lazy entitlement- those students I would get every semester who would say to me, very indignantly, things like, "I'm sorry- do they really expect us to read a book in this class?!"- it's not that interesting. Those people will, eventually, grow up and get their lives in order. Or, they will be the sort of clueless adults who end up on Judge Judy complaining that it's unfair that their landlord kicked them out just because they didn't pay rent for four months.

Now, for the other problem: Tuition is too high and it's completely unjustifiable.

The Times:
"There is a real parallel here to health care. We pay doctors and hospitals for more care instead of better care, and what do we get? More care, even if in many cases it doesn’t make us healthier.
"In education, the incentives can be truly perverse. Because large lecture classes are cheaper for a college than seminars, freshmen are cheaper than upperclassmen. So a college that allows many of its underclassmen to drop out may be helping its bottom line."
Let's push the parallel further, shall we?

In both cases- health care and education- the service being offered is seriously overpriced.

In both cases, the customer is at a severe disadvantage because we have decided that only the experts with several years of education are qualified to say what the service is really worth.

In both cases, the customer is made to feel they "need" the service to have a happy life.

In both cases, the customer is made to feel stupid for questioning the supplier on price.

In both cases, the price also gets pushed up by the fact that the customer is not paying for the service: in the case of health care, the insurer is paying; in the case of education, the loan officer is paying. This makes it easier for the customer to ignore the price, but it also detaches the price from rational choice. Imagine if, when you went to the grocery store, a bureaucrat went along with you and haggled with the cashier about what they would be willing to pay for food! $100 for a loaf of bread? They're okay with that, and you'll be paying them back in small increments, so what's the problem? You have to eat. A bit irrational, isn't it?

Why does health care cost so much? Because the insurance companies will pay that much. Why does education cost so much? Because the loan officer will pay that much. Simple as that.

In both cases, the institutions justify the outrageous prices by telling themselves that the "customers" are still willing to pay, even though they're not actually the ones haggling over or paying the full prices.

In both cases, the institutions also justify the inflated prices by larding a bunch of add-ons to the original product- doctors run unnecessary tests. Universities hold "learning fairs" and build 24-hour gyms and luxury dorms to convince the students that it's worth paying a fortune to get an education. Universities also hire top notch researchers... and then have grad students teach the courses.

Therefore, in both cases, a good accountant with a red pen could cut the costs in half overnight. If you put me in charge of the budget at my university, in a month, I could cut tuition in half. There is so much unnecessary overhead it is obscene. The same holds true for hospitals and insurance companies, incidentally.

Here's the really taboo thing to say in America: neither health insurance or education are working particularly well on the for-profit model. In fact, both of them have become bloated, inefficient, bureaucratic, and have all-but-abandoned their original missions. Insurance companies do an increasingly shitty job of insuring people, and universities do an increasingly shitty job of educating people.

And, in both cases, the costs are reaching a tipping point. My father lives in a state where 30% of the population simply can't afford insurance, while premiums keep rising faster than the rate of inflation; if they continue to rise, within a few years, my father will also have to go uninsured; right now, he's holding on by his fingernails. And so, a man who gets up at 5 am and works on his lobster boat until 6 pm, every day, will be one of the "bums" without insurance. Considering the fact that insurance premiums are expected to double within ten years, if nothing changes, it is completely feasible that states like Maine will have a majority of their population uninsured. But then we will, no doubt, be told that the people who still have insurance rate it highly.

(Is it giving away too much to say that I have no hope at all that things will have changed in ten years time?)

Similarly, university tuition rates continue to rise faster than the rate of inflation, in the middle of a recession. Students go deeper and deeper into debt in order to receive an education whose value they're, rightly, increasingly skeptical about. What will most likely happen, of course, is that enrollment will reach a peak and then start dropping rapidly. At that point, the universities will crow about how personally enriched the lives of their students are. Families that can still afford to send their children to college rate the experience very highly! Nevertheless, a larger percentage of the population will simply be uneducated and uninsured. If that's a serious problem, or not, depends on your point of view, I suppose. Me, I'm glad I live in Canada.

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