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Death by Degrees
19 JUNE 2012
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Our elaborate, expensive system of higher education is first and foremost a system of stratification, and only secondly — and very dimly — a system for imparting knowledge.
The original universities in the Western world organized themselves as guilds, either of students, as in Bologna, or of masters, as in Paris. From the first, their chief mission was to produce not learning but graduates, with teaching subordinated to the process of certification — much as artisans would impose long and wasteful periods of apprenticeship, under the guise of "training," to keep their numbers scarce and their services expensive. For the contemporary bachelor or master or doctor of this or that, as for the Ming-era scholar–bureaucrat or the medieval European guildsman, income and social position are acquired through affiliation with a cartel. Those who want to join have to pay to play, and many never recover from the entry fee.
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When we ask ourselves whether populist hostility should be directed against the rich or against the professional elite, the answer must be, "Yes, please!" From 1980 to 2007, the financial sector grew from 4 percent of GDP to 8 percent, but it's shrunk since and may shrink further. The medical sector, on the other hand, grew in the same period from 9 percent to 16 percent — and is expected to account for a full 29 percent of the economy by 2030. Goldman Sachs makes for an attractive monster, but the bigger vampire squid may be the American Medical Association, which has colluded in blocking universal coverage and driving up health costs since World War II.
If not earlier: the AMA owes its authority to America's most notorious robber barons, who invented philanthropy as we know it by establishing foundations capable of long-term, organized interventions in the country's political and cultural life. The first foundations poured money into medical schools — but only if those schools followed the example set by Johns Hopkins, which in 1893 had introduced what's now the standard formula: students attend four years of college, then four years of medical school. Institutions that didn't follow this model did not get donations, and they also got denounced in a 1910 report sponsored by the Carnegie Foundation. After the Carnegie survey published its "findings," scores of medical schools — schools whose students could not afford the additional years of study now required, and nearly all of the schools that admitted blacks and women — closed.
Today, we take it for granted that practicing medicine or law requires years of costly credentialing in unrelated fields. In the law, the impact of all this "training" is clear: it supports a legal system that is overly complicated and outrageously expensive, both for high-flying corporate clients who routinely overpay and for small-time criminal defendants who, in the overwhelming majority of cases, can't afford to secure representation at all (and must surrender their fate to local prosecutors, who often send them to prison). But just as a million-dollar medical training isn't necessary to perform an abortion, routine legal matters could easily, and cheaply, be handled by noninitiates.
The standardization of these professional guilds benefited undergraduate institutions immensely, a fact that was not lost on university administrators. College presidents endorsed the Hopkins model and the AMA's consolidation of medical authority for good reason: in the mid-19th century, bachelor's degrees in the United States were viewed with skepticism by the private sector, and colleges had a hard time finding enough students. The corporate-sponsored consolidation of the medical establishment changed undergraduate education from a choice to a necessity. Where once there was indifference, now there was demand: "I want to be a doctor when I grow up," the child in the PSA says. "I want to go to college."
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Intredasting points raised... Thoughts?