Health Care and Education

When thinking about Higher Education, I find thinking about health care as a parallel instructive.

Consumers don’t know always know what’s best for them in health care — studies show that they’ll rate inept doctors who are nice to them and give them what they ask for much better than doctors who actually cure them.

To the extent that health care gives consumers what they want and “acts like a business” prices skyrocket. The cure for high prices is actually anti-market solutions (e.g. single payer medicine) where the government only reimburses evidence-based practice.

So to some extent, I think the people that say “Why can’t you act more like a business?” to Higher Ed players are paddling the wrong direction. It’s acting like a business that *got* us here, via the system of subsidization that killed direct funding to public institutions and put consumers in control.

We have to compete in small class size, though we can’t discern the benefit in many cases, because that’s what consumers are asking for. We have difficulty pitching blended learning to some populations because parents see it as subpar. Take almost anything we do that is questionably expensive, and you’ll find a consumer-facing decision behind it. Consumers want education to look like it did for them as kids, and that’s what they get. They also want the most expensive-looking education their voucher can give them. And so it continues.

So follow the conservatives, and lower the voucher, right? Cut the subsidy and education will become cheaper, right? Not quite. You can lower the voucher amount that parents are walking around with, but that doesn’t change the main problem: that the patients are writing the prescription.

And it doesn’t change the even more dismal problem — we, the professionals, don’t always use evidence-based practice either, so it’s very difficult to ask for the prescription pad back.

In Praise of Factory Education

Yes, I know the title is a bit #slatepitches. But I really mean it.

As some of you know, I work at the same college I graduated from almost 20 years ago. I did a lot of stuff in between, but I ended up back here, in part because I really believe in state provided education.

Twenty years ago the marketing of Keene State was pretty minimal. My decision to go to Keene State was based on the town of Plymouth (our rival college) seeming too depressing and the major NH university having a lot of people heading to it that I didn’t like. My parents basically told me that with my grades (my high school record was not exemplary) I should pick a state school and try to make a go. I choose Keene State, which seemed nice enough. That was it.

My sister, who was head of her high school class, had a different experience. She went on college tours to the Ivys, to MIT, corresponded with folks at Carnegie Mellon. Even back then they had plenty of glossy material to send her, plenty of stuff to pitch the MIT way and Stanford Experience. She waded through the material trying to figure out what college best suited her personality and goals.

What I notice at Keene State now is how much we’ve become like the private colleges, relentlessly concerned with our brand. And there’s no way out of it, it’s necessity. Our bottom line is almost entirely based on enrollment. We spend far more money competing for students than we do on technology or course redesign. And we breathe our own marketing fumes along the way, deciding here and there that our outcomes must be somehow different than the national outcomes, that our methods must be built here.

Were my sister and I to be looking at schools today, our experiences would be indistinguishable. Education as consumer accessory has prevailed.

I know the reasons this has happened, the reasons why it’s necessary, and the reasons it’s unlikely to change. But in such difficult times it seems counterproductive to take this stance. Factory education was problematic in many ways, but I’m increasingly sure that consumer education is worse.