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A Friendly Attempt to Balance Steve Mintz’s Piece on Higher Ed Hard Truths

Comparing the health care and higher ed systems.

January 16, 2023

Nothing that Steve Mintz writes in his piece “Hard Truths That Higher Education Has Evaded for Too Long” is wrong. I’m in complete agreement on all the areas in which he enumerates the shortfalls of the U.S. postsecondary system.

Steve points out that our higher education system reflects and exacerbates social inequality, privileges the privileged, consigns millions to crushing levels of debt, fails to adequately prepare graduates for the changing labor market, and is characterized by persistently low graduation rates. On Steve’s critique that universities have inadequately taken “into account the insights of the learning sciences” to improve teaching and student learning, I co-authored an entire book with this observation as a central theme.

All of us in higher education benefit from efforts like Steve’s to forthrightly own up to the shortcomings of the system in which we work. As we think about Steve’s list of systemic failures, it is important to contextualize the status of the U.S. system of higher education within a broader and more comparative narrative.

It can be equally true that the U.S. postsecondary system is severely flawed and is, at the same time, a comparative marvel. We can decry all that is suboptimal, unjust and downright insane about our higher education system while celebrating the system’s absolute and relative achievements.

Perhaps I’m more sanguine about higher ed due to my proximity to that other complex and contested system, U.S. health care. My wife is a pediatric subspecialist in oncology/hematology, chief of her section and a professor at the medical school at the college where I also work. Each day, I hear about the challenges of medicine and our health-care system. Living in a household with feet in both the academic and medical worlds, I can confidently report that health care is exponentially worse off.

Of course, you don’t need to be a medical professional (or married to one) to understand how badly health care in our country is screwed up. It is well known that the United States spends a higher proportion of national income on health care (near one in five GDP dollars) than any other country while simultaneously achieving some of the world’s worst comparative health outcomes.

The reason that health care in the U.S. is wildly expensive while producing relatively poor results has everything to do with how medical care is financed. Rather than focusing on preventive care and population health, hospitals and providers are incentivized to provide expensive care to patients with the best private (employer-based) insurance and public (Medicare) insurance. The U.S.’s bizarre combination of for-profit health care and insurance, poorly funded public insurance for the poor and kids (Medicaid), and more generous public insurance for the elderly (Medicare) has resulted in an inefficient and ineffective health-care system.

The U.K.’s National Health Service (where health care is universal and publicly provided) and Canada’s system (private doctors and universal public insurance) are not perfect. Still, both systems drive better population health outcomes at much lower costs than in the U.S.

Our higher education system in the U.S. may have many problems, but our colleges and universities are still the envy of the world. Each year, nearly a million international students come to study at U.S. institutions.

Again, this comparison between the higher ed and health care systems is not designed to exonerate the former. As Mintz points out, our higher ed system has big challenges. Top on my list would be public disinvestment.

The point that I want to make is that the current higher ed system is sound enough—despite all its flaws and shortcomings—that those working in the system can make meaningful improvements. Higher ed people have a range of agency and possibility that I don’t think is possible for anyone currently working in health care.

If you are a provider or administrator working in health care, you are working in a fundamentally broken system. At best, health-care workers can hold the system together, do their best to provide care amid deep and chronic understaffing, and then gather their strength to make it through another day. There is not much optimism among the nation’s health-care workforce. Everyone is mostly in survival mode.

This is not true of those of us in higher education. We believe that what is wrong with higher ed can be fixed if we are smart and diligent with what is right with higher ed. Yes, systemic changes are needed, but there is possibility. Colleges and universities are innovating, teaching and learning is improving, and solid policy and organizational ideas exist to increase access and lower costs.

Let’s keep talking about the issues Mintz raises while also adopting the comparative lens that enables optimism about our ability to improve and advance our higher education system.

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Joshua Kim

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