The Academic Buzz around Health Care

Being a young whippersnapper, it never occurred to me that health care policy was a relatively new field of study within our universities. But when Health Beat reader Bradley Flansbaum passed along the  Reuters story below to Maggie (original here)  and she passed it on to me, I gained a new perspective on the issue. It turns out that until very recently, health care used to just mean medicine. But today, thinking about health care demands thinking about  a lot of different things, like public policy, public administration, economics, politics, and even sociology.

This mixed bag is reflected in the diverse academic offerings at colleges and universities—as well as the swell of students interested in them. The Reuters story below suggests that there are three main motivations for the increased student interest: fascination, idealism, and profit. That sounds about right. You can either be genuinely interested in the complexities of health care or the politics surrounding it; want to fix the system for the greater good; or want to learn as much as you can about the system to better navigate it for GlaxoSmithKline.

There’s obviously a lot of good to be had from generations growing up understanding more about our insanely complex and counter-productive health care system. Teaching college students about the system now might instill a long-term openness to reform and improvement that wasn’t present in generations who never knew about health care until they got sick.

But I can’t help but wonder about the faddishness of it all. After all, health care isn’t the only broken system that could use some attention. Consider the criminal justice system. Back in the day, law and order meant being a lawyer or a cop. But today there are criminology and criminal justice programs around the world that focus on issues like incarceration, community policing, cost, risk management, and more. Yet the buzz surrounding these issues hasn’t been comparable to the much louder debate about health care—even though one out of 32 Americans is currently in the corrections system and a black male is more likely to have served time in jail than have a college degree. This too is a crisis.

Obviously there are some major differences between health care and criminal justice. All of us are guaranteed to come in contact with the health care system at some point, while very few of us directly engage with the criminal justice system (at least in a conscious, explicit way). And health care is on the lips of politicians and the media in a way that criminal justice isn’t. But—maybe most importantly—criminal justice is not seen as a market that holds attractive business opportunities. (Insofar as for-profit prisons have been tried, they haven’t been very successful)  No one thinks that learning about prisons will help them get a job.

In the years ahead, it will be interesting to see if employment in health care related fields gets a big boost, and if so, where those increases will be. For now though, health care is grabbing the ears and imaginations of college students. I just wonder how long this will last. The Reuters story follows below.

Health care challenges fire up students
Mon Dec 10, 2007 8:14am EST
By Joanne Kenen

WASHINGTON (Reuters) - One measure of the troubled state of U.S. health care is the hordes of idealistic young people lining up to fix it.

A generation ago, college kids interested in health would have become doctors or nurses. Some might have picked hospital administration as a career.

Now, with health reform in the headlines and countless families having their own health crises, students are pouring into health policy classes in economics, political science, history, and public health departments. Many plan on making health policy their career.

Aaron Chang, a senior at the University of North Carolina at Chapel Hill, tried one subject and then another before he heard a lecture on health policy by professor Jon Oberlander. Chang signed up for a course with him, worked as an intern on health in the state legislature, and now recommends 600-page tomes on health policy to his friends -- who go and read them.

"I tell some of my friends that are a few years younger then me, if they are interested in politics and what is going on -- take policy courses. Health policy is something that affects us and it's going to affect us in the long run," said Chang, who hopes to attend law school.

"If you offer a seminar or class on health policy or politics, you'll fill it up. We can't meet the demand," said Oberlander, echoing a view heard on campuses across the country.

Students are drawn by the political debate over how to cover 47 million uninsured Americans, the challenge of containing runaway costs, and the growing awareness that quality of care is often tragically uneven.

"There are fascinating economic issues, fascinating politics, fascinating cultural and social issues," said David Cutler, an economist who helped set up a popular new interdisciplinary health studies program at Harvard.

POLITICS OF HEALTH

The spike of interest is partly cyclical; the United States is embarking on another debate about health in the 2008 presidential campaign. A student entering college now was scarcely out of kindergarten when the last attempt to overhaul U.S. health care under President Bill Clinton -- and then-first lady, now-presidential contender Hillary Clinton -- fell apart.

The growing recognition of the quality gaps also motivates students. "More people within their own families experience the kind of life-altering events that make health hugely salient to them," said Mark Schlesinger, a health expert at Yale.

The surge in interest extends beyond political debate over cost and coverage. Public health programs in epidemiology, global health and environmental health are expanding as rich and poor countries alike face health risks ranging from bird flu and AIDS to bioterror and climate change.

Students also see health, which makes up about a sixth of the U.S. economy, as a business career.
"Pharmaceutical companies, hospitals, physician group practices -- they all need people to run their businesses. There are a lot of jobs out there," said Dennis Shea, who teaches health policy at Pennsylvania State University.

Idealism is also a motivator.

"If you are a 17- or 18-year-old interested in domestic social policy, you're going to study health care. It's the exciting area of social policy," said Sherry Glied, a policy expert at Columbia's Mailman School of Public Health. Glied and experts at other top schools said they also see more aspiring doctors studying policy alongside chemistry and anatomy.

Lindsay Kennedy Brown entered Johns Hopkins University in Baltimore knowing she wanted to go on to medical school but like scores of other Hopkins premeds she ended up specializing in public health.

"I still want to be a practicing physician but I want to incorporate public health research in my career," Kennedy Brown said. She spent last summer working with a Seattle surgeon developing breast cancer screening programs for poor countries; one of her classes this year will require a final paper analyzing presidential candidates' health platforms.

Outside of specialized public health schools, health economics is booming, as are health law and health business programs. Political science and history departments offer courses on health politics, and medical sociology is also expanding on many campuses.

"Anyone teaching any course about health care gets a ton of students," said Harvard's Cutler. "There are just so many political and social dimensions."

Comments

[Niko Karvounis]

Ddx, I think you've got it right--health care is equal parts higher calling and opportunism for those trying to figure out their future. The question, of course, is the balance between the two...unfortunately, its an unhappy marriage that has a pretty bad history in other fields. Law and medicine, for example, are similarly tailored to big ideas and big bucks--and few of us would say that, on the whole, these industries have managed not to compromise their higher callings.

The problem is, of course, that opportunity is opportunity--there is a slew of people who don't care how they make a buck, just that they do so. All it takes are for the openings to be pointed out, and as you say, there will be a feeding frenzy. Which means that the opportunists gradually outnumber the idealists, or even the socially conscious.

If younger people are learning, however implicitly, that the failings of our healthcare system are advantageous because they provide opportunities to profit, that's troubling. It speaks to a potential long-term problem that only gets worse the longer we delay reform: more and more people become invested in maintaining the broken status quo.

[Ddx:dx]

Could this somehow be considered an economic indicator of the "waste" or(potential) profit of a system? Predators circle schools of minnows,(protein and calories), but might strike off across the open sea for a bigger prize. Different strategies, but I think the motivation described is natural. A school of sharks makes you think meat is near.
But we are human.
As Maslow would smile, both the utilitarian function is served(income) and the "higher order" needs are met(helping people, service, noble cause, justice) for us human predators. And I'll bet they hand out grades like candy....