Never, ever leaving the news
On "Groundhog Day", funding for local hospitals, and the inevitability of certain contested disputes in public policy
The University of Nebraska is a partner in a large health system called Nebraska Medicine, and they’re in the messy process of separating from one partner institution and adding another. But behind the story, there are two issues that are never, ever leaving the news: Funding for higher education and funding for health care.
■ Anyone who wants to understand why both stories are going to come back perpetually, “Groundhog Day”-style, needs to read William Baumol’s book “The Cost Disease”. Right behind death and taxes comes the certainty that higher education and health care budgets will remain large, growing, and contentious from now until the end of foreseeable time.
■ To condense the argument to its essence, demand for both health care and education seems poised to grow indefinitely. Meanwhile, the supply of each is tightly constrained by the need for lots of human-centered, person-to-person interactions, from diagnostic counseling to reading stories written by second-graders. Unless a substantial number of patients want to sign up for do-it-yourself blood draws or emptying their own hospital bedpans, these constraints are inevitable.
■ On the surface, it’s a little grim to say, “These problems are both intractable and virtually certain to get worse with every passing week”, but it’s much worse to approach them as if they are solvable in the sense of “If we just apply enough brainpower and effort, we can find a permanent answer”.
■ The problem is that both health care and education are hugely influenced by public policy and public funding, which invariably draws them into an arena of discussion where patience, strategic thinking, long-term viewpoints are especially hard to sustain. This means every resulting policy discussion is more or less bound to involve wishful thinking, impossible promises, and frothy arguments among highly interested parties. And that’s exceptionally unlikely to change in anyone’s lifetime today, even when all parties involved are of good character and mutual goodwill.