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February 1, 2016

Dealing with the Devil

In his recent speech outlining his proposed budget, Republican Kentucky Governor Matt Bevin called for prioritizing practical academic endeavors like engineering over subjects like “French literature.” Others are arguing that studying the humanities is essential too. Certainly, those who work in higher education should read European literature.

One suggestion is “The Tragical History of Doctor Faustus,” a play written by Christopher Marlowe, a contemporary of Shakespeare. The character Doctor Faustus is a scholar who, in exchange for selling his soul to Lucifer, is given special powers, prestige, wealth, and knowledge. A “Faustian bargain” is a deal made for a short term gain with a big, long-term downside.

Fifty years ago, in their own Faustian bargain, physicians exchanged the soul of their profession for the keys to the federal treasury. Physician salaries jumped considerably after the passage of Medicare and Medicaid, as did the monies flowing to every other entity and person involved in the medical industry.

Pumping money into an economic sector without regard to market fundamentals creates price distortions and bubbles. At your local hospital, a Tylenol tablet might cost twenty dollars. Other hospital charges usually have no market basis. Frequently, they can be settled for pennies on the dollar, yet with a profit. Patients without some form of insurance to bargain on their behalf are bankrupted.

Eventually, people paying tabs expect accountability. In medicine, government and insurance payers have instituted innumerable regimens to monitor for perceived fraud and bad care. This oppressive intervention has nearly ruined the practice of medicine. In his deal, Doctor Faustus received twenty four years to “live in all voluptuousness,” roughly the same amount of time it took before the federal government, its treasury being looted, began to claim the soul of medicine.

With Obamacare, hospitals and insurance companies made their own Faustian deal. They thought lobbying the government to force people to buy their products was gold, but they are now realizing their mistake. United Healthcare is now threatening to pull out of the Obamacare exchanges in the face of massive financial losses. Kentucky Health Cooperative has already failed.

The medical industry of today is the higher education industry of tomorrow. For decades, the government has also shoveled money at higher education through various grants and student loans, creating another bubble. As in the medical industry, campus salaries, non-teaching positions, construction projects, and tuitions have all ballooned. Like patients, few students actually pay the sticker prices, and, like uninsured patients, many are deeply in debt.

A twenty thousand dollar business loan from a bank to an entrepreneur requires collateral and a track record. Today, a teenager with no assets and no track record can get the same loan to go to college, few questions asked. That money then passes to his college, which may be busy building a campus that more resembles a resort than a place of learning.

First comes the coverage, then comes the control. Student loan debt now exceeds one trillion dollars. Taxpayers and politicians now reasonably question what it is they are getting for all that money. Even as it exacerbated the student loan debt bubble by nationalizing student loans, the federal government began turning the screws on higher education, particularly for-profit institutions like Corinthian College, now bankrupt.

Going forward, expect the government to demand more accountability for student retention and graduation rates. Expect colleges to be put at risk for student loan defaults. Expect universities to hire more adjunct professors. Expect tenured professors to teach more classes and to be told what to teach. Administrators can expect endless paperwork to prove that their institutions are “compliant” with government policy.

One sleeps in the bed one makes, and he who has the gold makes the rules. Government frequently ruins what it touches, yet the people, like addicts, ask for more. In the end, Doctor Faustus is dismembered and carried off to hell. To our friends in the business of higher education, we physicians can only say: “Hop in! It’s nice and warm in here!”

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