As a Dean, I am committed to higher education, both in the public and private sectors. As a parent, I have spent a small fortune on tuition to educate my three children at “elite” private universities. I understand the cost structure of higher education, both as a provider and a consumer. Perhaps this is why I find myself very concerned about the little-known connection between paying for health care for the poor (Medicaid), and the cost of higher education.
According to The Wall Street Journal (Dec 14, 2012), state subsidies for higher education fell 21% between the school years of 2001 and 2011. In that same period, tuition at four-year public universities has risen nearly 45% and now averages nearly $9,000 per year.
The WSJ story goes on to site several prominent educational policy experts who admit that states have to focus on Medicaid first, prisons second, and that universities are further down the list. Now, connect these dots with Sara Rosenbaum’s recent piece in the New England Journal of Medicine (Threading the Needle – Medicaid and the 113th Congress; December 20, 2012), where she says essentially that Medicaid spending, under Health Reform, will continue to expand.
Rosenbaum hopes that the proposed “organizational changes” under the ACA, like Patient-Centered Medical Homes, Accountable Care Organizations, and other topics previously covered in my blog, could possibly stem the tide of red ink for health entitlements before Medicaid undergoes a severe budgetary reduction by lawmakers.
Here is my view: We are in a total jam and most persons don’t recognize it. We have a very difficult choice ahead. Continue to pay for the care of the poor – especially poor children – or, raise public university tuition to the point that the middle class will be priced out of a college education.
I surely don’t want to pit higher education against health care! I just want to make sure that we all understand that current spending for health care is unsustainable. Higher education will become another casualty if we are not careful. What should health care deans do?