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Reviews | Universities prioritize their health systems over teaching. This kills academic freedom.

One important reason – which has been completely overlooked but is becoming increasingly important – is the role that many universities play in our country’s health sector. Universities with health systems are best understood as health systems with universities. As such, they are heavily dependent on the graces and whims of policymakers, and their leaders are structurally constrained from asserting their independence or challenging the misguided policies of elected leaders. Ultimately, academic freedom is the big loser.

Window on higher education policy

It’s not just about Desantis, the Supreme Court and Congress. Many state legislatures have targeted higher education to advance their policy goals, and my state, North Carolina, offers a living microcosm of what might be called the new politics of higher education.

This Legislature, the state General Assembly has introduced a number of bills this year targeting academic projects on the University of North Carolina’s flagship campus, including a bill that would eliminate the tenure, an effort to prescribe how instructors should teach American history, and budgetary intervention aimed at promoting certain political ideologies.

UNC faculty protested loudly, as nearly 700 people signed a letter denouncing the state’s recent actions “that violate the principles of academic freedom and shared governance that underpin higher education in SC North and the United States. UNC administrators, however, did not protest. Instead, UNC leaders aggressively sought special favors for its health system. The crown prize was the North Carolina Senate’s vote, 48-0, to grant the UNC Health System immunity from federal antitrust laws (after public review, the measure was not passed). adopted by the House of Representatives).

Let’s be clear: Health policy experts — including researchers at UNC’s renowned Gillings School of Global Public Health — agree that this is a terrible policy move. Federal antitrust laws, designed to prevent monopolies and preserve competition, are absolutely necessary in health care (this was admitted during limited Senate debate), and extensive research has shown that hospital monopolies significantly increase costs. health care costs while reducing quality.

The mystery is not why the state considered implementing such a reckless policy, since legislatures routinely grant special privileges to privileged institutions. The real curiosity is why, with its academic integrity threatened and its independence at stake, UNC invested its limited political capital to ask for such a blatant political favor.

The finances of the university that became a health system

One answer – albeit a painful one – is that UNC, like many major universities, is really a hospital system with an academic appendage. UNC Health has a budget about $2.2 billion more than UNC’s entire flagship campus in Chapel Hill ($3.5 billion versus $5.5 billion). This is also true for private universities in North Carolina that operate health systems, such as Duke University, whose health system has a budget $1.1 billion larger than the rest of the university ($4.5 billion versus $3.4 billion). Additionally, both health systems are growing faster than the rest of the two campuses.

These facts are important because the financial health of hospitals depends heavily on political decisions. For example, the North Carolina General Assembly’s legislative session this year included debates over Medicaid expansion, which would pump huge amounts of additional money into the state’s health care sector, and on “certificate of need” rules that would determine whether current hospitals could prevent competition from new entrants. The Legislature – like all other state legislatures – also regularly makes decisions about insurance eligibility, the range of services health care professionals can provide (so-called scope of practice rules), and the tax-exempt status of many healthcare facilities.

So perhaps it’s not surprising that UNC leaders have prioritized legislation strengthening the financial security of its hospital system over measures to protect its Chapel Hill faculty. And perhaps it’s not surprising that the University of Pennsylvania, MIT, and Harvard — each of which relies heavily on government, foundation, and industry funding (UPenn Health System has a budget that is more than double that of the university) – seek presidents who demonstrate a cautious attitude. The effectiveness of business leaders, who can ensure cooperation with policymakers and compromise with ideologues, rather than visionaries who inspire determination and can mount an aggressive defense against Rep. Elise Stefanik (R-N.Y. ).

Florida and the Future of Higher Education

Of course, it’s not a happy story. If UNC’s recent experience is a reflection of what many major universities have become—institutions hamstrung in defending academic freedom and scientific inquiry—Florida shows how universities can fall prey to truly malicious attacks from ambitious politicians.

DeSantis’ scorched-earth approach to higher education could be one such campaign. This has certainly produced permanent changes in higher education. One is the dismantling of New College, Sarasota’s eclectic public liberal arts college, where DeSantis appointees fired the president, defunded departments and caused 40 percent of the faculty to leave. Another is on the University of Florida’s flagship campus in Gainesville, where — while the history department subsists on a $4 million budget — the Republican Legislature authorized $10 million in annual funds to build a center dedicated to “cancel culture and uniformity.”

Not surprisingly, these efforts have drawn sharp criticism from professors at both public universities. Legislative intrusions led to an exodus of faculty from the University of Florida. In contrast, university leaders largely complied with the decisions of their legislature. This could simply reflect the reality that the president was appointed by and reports directly to the governor’s political supervisors (“College presidents are not supposed to be puppets, but this is Florida,” said a UF faculty member). But there has been little resistance from academic administrators at the state’s major universities, including from the private University of Miami. And it’s worth noting that the University of Florida and the University of Miami both operate health systems that approach or exceed the size of their flagship campuses.

This could also explain why the UF president, while receiving criticism for his absence from campus (“Gone! Have you seen this man?” a poster with the president’s photo), nevertheless made a pilgrimage to Pensacola Beach, approximately 350 miles from campus. , to meet with the chairman of the Florida Senate Appropriations Committee.

Given the general acquiescence of Florida’s university administrators, the resistance of the New College community is remarkable. At an August board meeting, students, faculty, staff and alumni challenged DeSantis’ proposals, and a coalition of former New College leaders formed an alternative New College designed to protecting academic freedom with online educational offerings (in a particularly malicious twist, DeSantis appointees threatened to sue Alt New College for trademark infringement, forcing it to change its name from Alt New College to AltLiberlArts) . Of course, New College, a liberal arts institution without a hospital or medical school, had a total budget less than 3 percent of that of UF Health alone. It is the exception that proves the rule.

If Florida and North Carolina open a window on the political economy of higher education, it does not matter who is named president of the major universities: the political stranglehold is inescapable. Even after President Liz Magill resigned from the University of Pennsylvania, the state legislature voted against an appropriation for the university’s veterinary school to protest the school’s actions following the war between Israel and Hamas.

The long-term consequences are serious. If university leaders cannot speak up and defend academics because they are overwhelmed by the economic realities of running a hospital, and if the university’s research arm and scientific community are silenced or ignored through the industrial branch we will get bad public policies, demoralized academics and health problems. learning environments for all. Worse, failing to preserve the integrity of academic research – the curiosity, scientific rigor and intellectual freedom that have made America’s universities the envy of it – degenerates the very thing that fuels our economy and inspires our imagination.

The last month and last year have made us want to provide strong leadership in higher education, but getting back what we are losing will take more than new appointments.


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