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Sunday, October 27, 2013

Sunday, October 27, 2013
The problems besetting Cal athletics keep multiplying.  In addition to the evidence that central campus resources have been used to subsidize Intercollegiate Athletics it has now become clear that the Athletics department has not been fulfilling its responsibilities to its student Athletes in major sports.  A recent NCAA report shows that the graduation rate for Cal Football and Basketball are among the lowest of any University participating in the major sports.  In football, Cal has the lowest graduation rate among the 72 schools listed, while in Basketball Cal has the 4th lowest amongst teams in the major conferences.  These results are occurring at a moment when graduation rates across the country's athletic programs appear to be rising.

Although the Cal Athletics department argued that the figures did not represent present coaching staffs it is hard not to see this as a deep-rooted institutional problem.  Nor can Berkeley insist that its numbers are lower because of the difficulty of its academics.  Stanford on the other hand ranked 5th in graduation rates.

Berkeley has been diverting resources away from the general campus population in favor of their elite athletes. Now it seems, they are failing to meet their obligations to those athletes as well.

Monday, October 21, 2013

Monday, October 21, 2013
The best recent book about British higher education, Andrew McGettigan's The Great University Gamble,  was the subject of two long reviews last week. I wrote one of them, which appeared in the LA Review of Books under the title “The Counterreformation in Higher Education.”  The other, called “Sold Out,” was written by the eminent essayist and Cambridge literature professor Stefan Collini, and appeared in the London Review of Books.  The essays have US and UK audiences in mind, respectively.  I try to provide enough background on both UK universities and the Conservative government’s changes for non-British readers to see just how huge and irreversible the British changes have been—and how relevant that are to the U.S. If you don’t have time to read the reviews and this post, then stop reading here and cut to the reviews (LARB & LRB). 
There are two broad schools of thought in the Anglophone world about the permafrost austerity and the deep cuts that have been applied to public universities. One is that they reflect reform, and that the suffering is temporary, the pain transitional, and the outcome cost-effective improvement.  The other school of thought is that they produce decline, and that both quality and efficiency are being reduced by systemic cuts and related changes.  Drs. Collini, McGettigan and I are declinists, though also optimists in the narrow sense of thinking there is nothing inevitable or necessary about the changes that are harming public universities. 

Thus the work of the book and the reviews is to persuade the first school that changes like the Cameron government’s sudden 80% cuts in the UK university teaching budget are in fact both unnecessary and destructive—that the replacement income of tripled fees and other market-oriented measures create losses rather than gains.  Persuasion will be in the eye of the careful reader, and I hope the McGettigan book attracts quite a few. He shows that Tory talk was one thing and Tory deeds something else altogether. The Great University Gamble will be especially valued by anyone interested in what the broad concept of privatization really means in technical practice.  How you really do that is fully explained in the long-play version, with the nuance required to see the operating system behind Tory beliefs.

The declinists are in turn comprised of various groups.  One might be called the fatalists, who are deeply unhappy about what is happening to their universities but who don’t see intentionality or design, at least ones that could be blocked or redressed. Another are depressives, and this is a psychologically interesting position that I can’t go into here.  A third are anti-commercialists—not anti-commerce in a general sense but anti-commercialism, where commercialism is an ideology that deals with economic adversity, turbulence, injustice, and confusion by saying commercialize everything. 

Prof. Collini and I could be classed as opposing this master narrative, often called neoliberal, and as you read the two reviews you will see a shared sense that behind the assurances of efficient budgets and increased quality lies the goal of commercializing universities all the way down, norming their goals and practices to those of for-profit firms. 

Anyone writing from this position needs to master technical detail for the purpose of constructing arguments that will appeal both to allies and to opponents.  My own method in the LARB review is to use Dr. McGettigan’s formidable research to deduce government motive from government policy implementation, crossing off one declared goal after the other until we get to what is really going on. I also say a few things about why commercialization is bad, since the dominant school sees it as a liberating breeze that brings a vital glow to the excessively cloistered academic cheek. Even commercialization is not, as I see it, the final Conservative goal. But to see how this works you’d have to read through to Sections V and VI of the piece.  

My title alludes to my sense that those who say they favor reform are not rightly called reformers but counterreformers, and that they are not adapting ad hoc to a changing situation but aim at a full counterreformation, which I outline there. The main way today’s conventional wisdom deals with such arguments is to cast them as resistance to inevitable change, but even sympathetic skeptics about the declinist analysis reasonably ask, what do declinists favor? What are declinists for?

Fortunately, Stefan Collini has written an entire book called What Are Universities For? A complex answer lies therein.  One way to think about it in a policy context is as the a strong public good understanding of education. This is an economic discourse that is woefully underdeveloped if not falsified in standard economics. This abstract discourse of the public good—or common, or commonwealth—is embodied in Prof. Collini’s book as the limitless pursuit of human knowledge. 

This discussion emerges in his uncomfortable relationship to the humanism of Cardinal Newman, and I quote him (Prof. Collini) in part.

A better way to characterize the intellectual life of universities may be to say that the drive towards understanding can never accept an arbitrary stopping-point, and critique may always in principle reveal that any currently accepted stopping-point is ultimately arbitrary. Human understanding, when not chained to a particular instrumental task, is restless, always pushing onwards, though not in a single or fixed or entirely knowable direction, and there is no one moment along that journey where we can say in general or in the abstract that the degree of understanding being sought has passed from the useful to the useless. In other words, it is not the subject-matter itself that determines whether something is, at a particular moment, classed as ‘useful’ or ‘useless’. Almost any subject can fall under either description. Rather, it is a question of whether enquiry into that subject is being undertaken under the sign of limitlessness – that is to say, not just, as with the development of all knowledge, subject to the testing of hypotheses or the revision of errors, but where the open-ended quest for understanding has primacy over any application or intermediate outcome.

This is the tip of the iceberg of the impact of the university on public or common knowledge, where the university is one place devoted, in theory, but utterly, to maximizing the power of human thought to save us from ourselves.  Limitless knowledge is a central public stake in the contemporary battles for the university, and the book and these reviews are written in the knowledge that commercialism doesn’t have what it takes to support this work.

Tuesday, October 15, 2013

Tuesday, October 15, 2013
By Berkeley Anonymous

Previous posts have identified problems with UC Care for employees at non-medical campus and a particular problem with the coverage around UCSB.

But there are broader problems with replacing Anthem’s Blue Cross Plus Program with UC Care. 

Anthem Blue Cross Plus had three tiers including an HMO which I guess most people used most of the time.  But it also allowed flexibility to get out-of-HMO care if needed

UC Care purports to be similar with three ostensibly corresponding tiers 1 - UC Select, 2 - PPO network, and 3 - out-of-network.  But as we heard before, the UC Care Select network excludes many doctors in the Anthem Blue Cross Plus HMO network.  Even the broader UC Care PPO omits some that were part of the PLUS HMO (including one of mine).  Going to Tier3 out-of-network means you’ll probably pay a majority of the cost out of pocket.  UC Care also seems to cover fewer prescriptions; specialty drugs cost some fourfold more.

Perhaps the biggest difference is that one could meet all medical needs using the Anthem Blue Cross Plus HMO -- never needing to pay deductible or co-insurance, even for some out-of-network consultations with specialists and while traveling.  Alternative medicine (acupuncture and chiropractic) were also covered at fixed co-pays without deductible.  Vast swaths of HMO medical expenses were free.  These included: laboratory tests & X-rays not at a hospital, outpatient ambulatory surgery, home health care, medical equipment & devices, hospice care, skilled nursing facilities, home infusion and nurses, emergency physician services, and ambulance.  Free!

UC Care is different.  The UC Care Select tier doesn’t cover most of those free services at all.  Instead, most are bumped to the PPO tier (along with alternative medicine), requiring deductable and co-insurance.   If the type of specialist you need isn’t in UC Care Select, you must go to the PPO tier.  Even some physician services at UC Care Select facilities seem to be billed as co-insurance.  It seems some illnesses will require some PPO tier treatment, with its substantially greater costs.

In short, Anthem Blue Cross Plus mixed low HMO co-pays with out-of-network flexibility when needed.  UC Care is just a PPO with deductibles and co-insurance, except for some Select types of coverage with Select doctors.

* * *
In light of this it is worth looking at the other UC PPO option.  At the bottom of the totem pole in the UC insurance world is the Core plan, the only choice for employees who do not work enough hours to qualify for full or mid-level benefits. However, the costs and benefits of the new UC Care plan make the Core plan look comparatively attractive.
The Core plan has a $0 employee premium.  Though it has a $3000 deductable and co-insurance on drugs, its _maximum_ out-of-pocket cost of $6,350 is not vastly higher than -- or even lower than -- the employee family premium alone for the UC Care program ($4,392 in IncomeBandII, $6,917 in IncomeBandIV -- though bear in mind that premiums are pre-tax).  Its out-of-network benefits look better than UC Care.

So, the Core plan could be the most cost-effective plan for many families, considering premium plus out-of-pocket costs.

CORRECTION:  http://atyourservice.ucop.edu/oe/medical/core.html says “Annual out-of-pocket maximums ($6,350 per member) limit what you pay.”   In my original post I assumed “member” meant employee or family.  However, it turns out that “member” means “family member;” i.e., the out of pocket is $6,350 per person, and for a family the maximum is $12,700.  This is listed in the new detailed plan description, at https://www.blueshieldca.com/sites/uc/documents/2014-OE-Brochure-Non-Medicare.pdf (page 12).   Given this, it turns our that Core will not be as appealing as I previously suggested.

UPDATE: Also, there is a confusing statement at http://atyourservice.ucop.edu/oe/tools-resources/discontinued-plans/anthem-plus-plan.html which says:

"If you do nothing
 You will be enrolled in the new UC Care plan, with the same dependent coverage you have now. UC Care has the same in-network and out-of-network coverage you have now, with much more."

This statement on the UCOP website is only true if "with much more" is interpreted to mean "with more out-of-pocket expense, for deductible and co-insurance charges."

Saturday, October 12, 2013

Saturday, October 12, 2013
In his two posts (here and here) Chris has raised a series of issues concerning the failure of UCOP to ensure that all campuses have access to Tier 1 coverage in UC Care.  Although his focus has been on the Santa Barbara case, there are indications from other non-medical school campuses that there are tremendous concerns over access and costs.  But the issues do not stop there.  I want to raise here a few issues concerning the impact of the health insurance changes even at the Medical Center campuses and then raise some questions which it seems to me is incumbent on UCOP to answer--and to answer with real data and reasons.

I should say that my first thought on the changes was that it would make little difference to those on Medical Center campuses.  But as I looked into the issues a little more I began to doubt that.  Given that we have not yet had a full accounting of the details of the new plan these concerns are somewhat tentative.  But I think faculty and staff need to look into this issue with some care--and not just with UCcare.

Just so we are all on the same page I am basing this discussion on three documents available at UCOP.  They are descriptions of the benefits for Anthem Blue Cross Plus, Anthem Blue Cross PPO, and the new UC Care.  If I am reading these documents correctly (and I am happy to have others correct any errors) then the following is the case.

If you have the Anthem Blue Cross Plus AND you are already in a UC Medical group your changes will be relatively small.  In fact, if you are able to select a Tier 1 physician your co-pays will drop slightly, and your yearly co-pay max is the same.  That is true with specialists as well so long as they are at a UC medical center (I am assuming that the sort of intervention that occurred at UCSC to obtain a non-UC Tier 1 provider is off the table since that would defeat the whole purpose of the shift).  Your fees for physician services in emergency rooms apparently will go up although not the hospital fees. (compare pg,5 with pg.2)  It is less clear to me about the costs and availability of medications since I have not located those lists.  Nor is it clear whether or not the shift to an HMO type plan for Tier 1 will affect the pressures on doctors in terms of referrals or procedures.

But if you were in Anthem Blue Cross Plus and you ARE NOT already in a UC Medical group then things look quite different.  For one thing, it isn't clear that there are enough spaces at the Medical Centers to accommodate people shifting in.  And second if you wish to keep your non UC doctor they will now be in Tier 2 (even if they had been considered "in network" for the purposes of Anthem Blue Cross Plus).  Vice-President Duckett indicated that there would be a high overlap in doctors between the old system and the new.  But the only way that I can figure out for that to be true is if he means that doctors who were formerly "in-network" (the de facto equivalent of UC Care's Tier 1) will now be available in TIER 2.  In THAT case employees co-pay and costs will go up considerably.

If on the other hand, you were in the Anthem Blue Cross PPO, your Tier 1 or Tier 2 costs and access should not be strongly affected.  On the other hand, your costs outside of the network will go up for any specific event although your yearly maximum contributions will go down somewhat.

To sum up, despite the focus that UCOP has placed on premiums if you are at one of the medical center campuses it is looks pretty clear that access AND cost will not be maintained for those in the discontinued plans unless you are able to move into a UC medical center for your health care.

If this is the situation I think that it raises a series of questions:

1) Vice-President Duckett reportedly indicated that this transformation was instigated by the Medical Centers themselves.  It would be good to have a fuller accounting of this process.  I understand that UC might be interested in being able to retain its revenues within itself rather than having to release them to the outside.  But in this case, it seems as if the interests of the majority of faculty and staff are being subordinated (in some cases sacrificed) to the interests of the medical centers.  Vice Presidents Taylor and Brostrom have claimed that the University will secure important savings from these changes.  If that is the case how are those savings going to spent?  If UC faculty and staff are going to be pushed into the medical centers where is that revenue going to?  For what? Taylor and Brostrom speak as if these changes benefit everyone.  But how exactly?

2) Given this first set of questions I think it is fair to ask about the general relationship between the medical centers and the campuses.  I should make clear that I think that medical education is an important part of the UC system.  And I know that there are important synergies between the medical faculty and the campus faculty at least at UCLA.  But we know from its own statements that UCSF is facing a difficult future, no one seems to know about the financial future of the medical centers after ACA, and as Dan Mitchell has tirelessly pointed out in his analyses of the sometime-in-the-future-who-knows-when hotel convention center at UCLA the medical centers can have enormous effects on UC's spending priorities. 

3) There is also a question of the timing of all of this.  I recognize that this actually took a while to develop.  But in the event we have learned that the new system could not complete a successful negotiation for the faculty at UCSB and only did so through outside intervention at UCSC.  Berkeley people are complaining about the effects.  And I am not sure what is going on with either Riverside or Merced.   Why exactly UCOP was willing to do this when there was so much uncertainty for so many campuses is a fundamental question.

I remain proverbially naive about the Academic Senate.  But from my vantage point it seems to me that the least the Academic Council can do is insist on answers to these questions and plans for the rectification of the obvious problems.  This issue is a large one for Faculty Welfare after all. 

Of course UCOP makes the decisions here.  Vice-President Taylor is constantly insisting that UCOP is incredibly transparent.  This would be a fine issue to provide some evidence of that claim. 

UPDATE: In conversation with different faculty it appears that there may be some non-UC doctors who will fall into Tier 1 status.  As a result I would urge people to check carefully the status of their various doctors.  We are hoping to be able to provide more information and analysis as time goes on.  And feel free to use the comment sections if there are clarifications that you can provide.

Thursday, October 10, 2013

Thursday, October 10, 2013
The Chronicle of Higher Education has now run Don Troop's story on the UC health care changes, "Changes in U. of California's Medical Plans Worry Some Employees."  The piece reports information from UCOP finance head Peter Taylor that may be new to most people--it was to me at least. 

Mr. Taylor is quoted as saying that offering UCSB employees the same plan (UC Care Tier 1) "'would raise individual premiums systemwide by $323 a year. That's asking 18,400 non-UC-Santa Barbara employees to pay out of pocket tremendously so that about 600 Santa Barbara employees would have access to this,' he said. 'We're trying to find a balance. We don't have an inexhaustible supply of money, and yet we want to provide a solid benefit to our faculty and staff.'"

Does this mean that Cottage Health Systems wanted $5.94 million more than UC and Blue Shield were willing to pay? This comes to about $10,000 extra per affected employee.  Does it mean that actuaries expect that each of the 600 UCSB employees will need an extra $10,000 a year apiece to cover the difference between the Tier 1 care available apparently everywhere except at the Santa Barbara campus and the Tier 2 that they will have?  I will ask.

We do seem now to have a quantification of the gap between Cottage and the University.  We also have a somewhat different tone regarding the Santa Barbara campus.

Mr. Taylor's comments seem to recast UCSB employees, who defined themselves as seekers of a cross-campus equity of which they have been deprived, as demanders of subsidies from their UC colleagues elsewhere.  I pointed out in the post that cross-campus equity is not a subsidy, since UC Care is being underwritten by UC medical facilities and personnel in ways that are complex in accounting terms, and because UC has "subsidized" other non-medical campuses in providing them with local Tier 1 facilities.  Any framing of UCSB as seeking special privileges is inaccurate. 

This framing also misstates the nature of insurance pools, which are all about the mutualization of common costs.  This was a driving principle behind the Affordable Care Act, which outlaws the exclusion of people on the basis of a "preexisting condition."  Insurance providers are now not allowed to throw less healthy people out of health care pools because they've identified them as having higher individual costs.  Similarly, UC shouldn't throw a campus out of UC Care Tier 1 because their local health facility has higher costs.  

The framing in which UCSB is seeking a subsidy is also at odds with UC budgetary history: UCOP distributes to UCSB  lower funding per student than it gives to any other UC campus (see the Rebenching report, Appendix A for a table and Appendix B for a bar graph).  We've commented on campus inequities in this space before.  To state the matter somewhat pointedly, UCSB is a long-term net subsidizer of the UC system as a whole.  Let's posit that this UCSB contribution to the UC system is a good thing in the "all for one and one for all" spirit of UC as One University.  This spirit leads directly to UCOP negotiating correct UC Tier 1 coverage at UCSB.

I hope that Mr. Taylor and Mr. Duckett redouble their efforts to fix this inequity.

Wednesday, October 9, 2013

Wednesday, October 9, 2013
In the spring of 2011, my partner Avery, a semi-pro cook, was working in the kitchen of our house in Santa Barbara when she cut straight through an artichoke and into her hand, severing tendons and sending blood everywhere. I was still working in France, so she called 911 and the fire department came. They took a look and called an ambulance, which drove her from the house on the Eastside to Cottage Hospital, an 11-minute drive of 3.3 miles in length, for which she was later billed $1900.

At the hospital, the first question was, “Do you have insurance? The second question was, “what kind of insurance do you have?” Avery had Anthem PPO and presented the card with the hand that wasn't oozing blood. She was waved through to immediate treatment, and one night, one surgery, and many doctor and hand therapy visits later she was on the mend. The care was good and the out of pocket cost ended up being about $2000, for some reason under the $3000 annual (in-network) cap including $410 as her share of 11 minutes in the ambulance.

That is a very happy ending under American health care. Will this be possible under the new health insurance regime, as UC’s Office of the President replaces Anthem with UC Care?

The switch is causing an uproar at UC Santa Barbara, and major concern at several other UC campuses. The UCSB problem is that it won’t have the Tier 1 benefits that other campuses get, and some subset of employees will pay more out of pocket than their colleagues at other campuses.

At a well-attended town hall on campus last week (partial audio here), there was plenty of concern about interrupted health care, reduced care, costs getting shifted onto employees—and also an undertone of worry that as a perennial “younger campus” UCSB was being relegated to second-tier status. “The breaking up of the UC system continues,” one person suggested to me in an email. There’s also the steady erosion of “total compensation” for UC employees. Salaries have been below the comparison average for years. Recently, pension and benefits are going to the same place. One effect of UCOP’s recent financial strategy has been the end of UC’s comparative advantage for employees.

But first, the answer to the care question is yes it will be the same—if you’re willing to pay more. Under Anthem, when you cut your hand open, and regardless of your doctor’s status in Anthem’s network you paid 20% of ER costs, 20% of emergency transportation, and 40% of surgical and other fees—if performed by a non-network doctor. But once one’s insurance was identified, an in-network surgeon seems to have been procured, and hence the semi-manageable out-of-pocket costs described above.

UC Care will be different: an outline is here. There is more detail here (now Scribd here), where it’s easier to compare its 3 tiers. (October 9th replacement of that link is here.) If you are my blog partner, UCLA professor Michael Meranze, and you cut your hand open in your kitchen in Santa Monica, an ambulance takes you to UCLA Medical Center, you pay $100 for ER costs, 20% of physician costs, and $100 for the outpatient surgery. That is Tier 1 UC Care, and it is available at all UC Medical Centers and other designated hospitals. Cottage in Santa Barbara is not one of these.

So if next year I cut my hand open in my kitchen in Santa Barbara, I will pay 20% of the full cost of all of the above. That is under Tier 2 of UC Care, which is Blue Shield’s Preferred network. UC Vice President for Human Resources Dwaine Duckett assured employees at the UCSB town hall that Cottage and Samsum Clinic would both be available for UC Care Tier 2 patients. And they are still available to HealthNet patients as well under HMO referral conditions.

But why would Cottage look at my UC Care card and treat me as Tier 2? I don’t know for sure, but I assume that they would want to know if my regular doctor is actually part of the Blue Shield network. And the answer to this question would be no. In that case, I will be treated as a non-network person attached to “non-preferred providers,” in other words, as a patient from Tier 3. Then I will be paying 50% of all costs (except ambulance and ER at 20%) up to an annual cap of $5000 (for individuals, or $15,000 for families).

There’s also reason to think my case is typical rather than anomalous. First of all, people want to keep their doctors, and the right to do this has become a national political issue in the Age of Obamacare. The UCSB town hall heard harrowing testimony—one faculty member reported that two of his wife’s three surgeries for brain cancer would happen at Cottage, and then the third, which fell after January 1, was supposed to be with another surgeon at a different hospital 50 miles from where they lived? It’s not clear whether there are continuity provisions.

And second, Tier 2 consists of the Blue Shield Preferred network, which has to have doctors in it for you to see if you want to belong to Tier 2. I assume that being Tier 2 at Cottage would require that your doctor be Blue Shield and have admitting privileges. There are parts of California that have great Blue Shield networks. For example, a search for Blue Shield network providers in any specialty within 15 miles of 94301, Palo Alto’s zip code, yields 983 doctors. The same search for Blue Shield’s Santa Barbara network (any specialty within 15 miles of zip codes 93101 or 93110) yields 20 doctors. And 8 of them are pathologists.

The UCSB UC Care situation seems to be this. UC Care has a lower monthly premium than Anthem did, but higher copays and caps for the non-network people who are the ones mostly likely to seek a PPO in the first place. Then, at UCSB there is no Tier 1, so the low-cost high quality option is not available at all in the area. UCSB does have Tier 2 access to the local hospital, but Tier 2 Santa Barbara—the Blue Shield preferred network-- barely exists. Tier 2 may wind up being Tier 3 for most SB UC Care people for most conditions, unless they can gear up for a 40-100 mile ambulance ride. The cross-campus inequities are obvious: what most campuses can get for $20 copays (or $100 per outpatient surgery) will push UCSB employees up towards their $5000 / $15000 annual caps.

How did Santa Barbara fall through the PPO cracks (along with, at least initially, Berkeley, Merced, and Santa Cruz)? UC Care was based on a UC med center tie in--Mr. Duckett said the medical centers came to UCOP wanting to bid for the UC employee health business—which put the non-medical campus at a disadvantage.

He also said that in the Santa Barbara case there wasn’t a failed negotiation between UC and Cottage, but between Cottage and Blue Shield. Blue Shield made bids, and Cottage “made the decision that we don’t feel as though we should be offering these types of discounts.” Cottage does have a health care monopoly in town, and seems to be holding out for more money—even if it risks losing much of Santa Barbara County’s biggest payroll to providers outside the area.

Mr. Duckett said his office would continue to lean on Cottage and Blue Shield, and that in the meantime UCSB folks should write letters to “anyone who will listen.” This strikes me as shifting responsibility onto people who didn’t create the problem and who have no power to fix it. UCOP is putting together an insurance network, and it needs to function normally across all the cities where its employees live. UCOP obviously needs to finish putting its network together.

In the meantime, there’s a simple way to restore cross-campus equity. UCOP could reimburse all UCSB UC Care patients for the difference between (a) what they are paying for the tier they are forced to use (Tier 2 at best, mostly likely Tier 3), and (b) what they would be paying if they had a local version of Tier 1.

For example, if the hand wound needs $55,000 of reconstructive surgery, the would-be Tier 1 patient would pay $1500 to UC Care, and UC would pay $3500 to UC Care to make up the $5000 of the UC Care charge to the patient, who at UCSB has to be in Tier 3. UC would make a similar payment to match the difference between a $100 outpatient surgery and the 50% of $55,000 which a UC Care Tier 3 patient would be obliged to pay.

This may seem at first like a subsidy to UCSB employees that other campuses don’t get. But in reality medical campus employees are already getting an equivalent to this subsidy from the university. And this arrangement would be temporary, while UCOP restores cross-campus equity.

On the other hand, if UCOP does no more than encourage Cottage and Blue Shield to settle, it puts UCSB at a recruitment and retention disadvantage in relation to other UC campuses, which weakens a UC system that is already struggling to keep up with its peers in other places.

UPDATE: Michael has found a 7 page list of UC Care TIer 2 providers (Blue Shield's Preferred network) in Santa Barbara, which I've posted here.  So please take my gloom about Tier 2 with a grain of salt. The UCOP patch would apply to a solid Tier 2 as well as to Tier 3.

Friday, October 4, 2013

Friday, October 4, 2013
The Chronicle of Higher Education ran a section this week called NEXT: The Future of Higher Education. Last year the future was Massive Open Online Courses. This year the future is something else. The shift can be visualized in this graphic, accompanying a piece by CHE Editor-at-large Jeffrey Selingo on a recent poll of professors and college presidents.

The orange bars represent faculty opinion, and the blue, that of the college presidents.  The opinion of both groups is now overwhelmingly negative towards MOOCs--at least as a mode of college education, and MOOCs will carry on and improve in the wider world. A solid majority of college presidents agree with 2/3rds of faculty that MOOCs are a negative force in higher ed, which is not something that I for one would have predicted even six months ago.

On the other hand, hybrid courses do well with both groups, particularly the presidents.  Adaptive and interactive learning technologies do pretty well too.  At a minimum, this poll suggests that nine of ten faculty feel that adaptive and interactive technologies in a hybrid environment will do no harm.  It shows fairly strong levels of faculty interest in learning innovation.  The 2012 MOOC wave had the virtue of getting instruction back on the agenda of many faculty, in large part by making teaching seem more like a site of research, where new discoveries occur and improvements are put in place. This poll confirms the momentum behind better learning. The first thing we can say about this year's CHE future is that it's focused on student learning.

Mr. Selingo identifies a further condition that would help make learning innovation more sustainable. Noting that large majorities of both faculty and presidents would like to see more change rather than less, he writes,
When it comes to driving change in higher education, faculty members overwhelmingly believe that while they should be leading the discussion, politicians were often the ones pushing the agenda. Somewhat surprisingly, presidents also said faculty members should be driving change, and agreed that it's often politicians who control the conversation.
The issues that politicians have driven are preserving access and cutting costs.  This is really one issue: what they want is the same or better access to equal quality at a lower per-student cost.  State politicians have no intention of reversing long-term cuts that left 2012’s (inflation adjusted) per-student appropriations at 70% of what they were in 1987 (Figure 3).   Many know that 1987-level state funding was what enabled the mass access to high quality that built the powerhouse knowledge economy they want to revive.  But they nonetheless can't or won't get to 2007-level public investment, to say nothing of the much higher 1987-levels.  They saw MOOCs as a way getting the quality without the investment.  What we might call the Koller Hypothesis, after the co-founder of Coursera Daphne Koller, was that MOOCs could achieve “a cost of effectively zero dollars marginal cost per student” (“Rebooting Higher Education,” p 3). In our transcript of this event, you can read Udacity’s Sebastian Thrun politely disputing Prof. Koller’s zero-cost hypothesis (p 29), but the idea that online technology could more than make up for all funding declines was firmly embedded in the political consensus--as MOOC business strategy required it to be.

In other words, when universities lose MOOCs as a budget solution, they lose the main source of hope that state politicians had for a free fix of the college cost problem for a less affluent, not wonderfully educated younger generation.  MOOCs were the austerity solution to the mass quality problem.  Without them, tempers will flare, fingers will point, and funding will not be restored. In the meantime, faculty are going to have to lead higher ed innovation anyway, and the good news is that post-MOOC-as-cure-all faculty don't need to focus on the technology to the exclusion of the “human side” of teaching and learning.

The Chronicle’s Next collection has fourteen essays on the subject, and I don't number among the most helpful the one co-authored by innovation guru Clayton Christensen.  His piece focuses on radical cost cutting through goal simplification, while the better pieces, in my view, focus on goal enhancement, which is student development.

But first we need to look at the Christensen innovation baseline. His key insight, in his classic books, The Innovator’s Dilemma (1997) and The Innovator’s Solution (2003), was that in contemporary capitalism truly “disruptive” innovation comes in the form of worse technology adapted to less sophisticated non-consumers. One of his early examples was Canon wrecking Xerox with its pokey, mediocre, home office copiers, which discovered a new market of people who couldn't use or couldn't afford a real Xerox machine.

The analogy with higher ed is obvious--every college charging $20,000-$50,000 a year are ripe to be picked off by innovative disrupters, except for the Harvard, Swarthmore, and Stanford-style premium brands.  Christensen's cure is always for the incumbent--especially in the middle tiers--to focus on “a critical job to be done” and stick to that. In The Innovative University (2011), the two viable types of college are Harvard and BYU-Idaho: the latter revived itself with a 4-season all-teaching faculty that created shorter, straighter lines to cheaper BA qualifications by dumping peripherals like sports teams, and ending traditional working conditions and teaching schedules to focus on modularized, highly sequenced programs in which all effort and investment is focused on highly programmed goals.

This is a perfectly fine kind of college to have, but it is cheap because teaching-only undergraduate programs with limited majors are indeed cheap. As many have pointed out, college doesn't cost so much because standard teaching costs so much: the costs are mostly elsewhere, and only some of them are unjustified in relation to the “critical job.” In reality, the university’s critical job is usually comprised of a complex bundle of jobs, all of which cost money.

If you define your “critical job to be done” as “creativity learning,” as I do for knowledge economies in general, and also as “public good research,” as public research universities must, then the cost savings of radical simplification are simply not available.  “Understanding” is a complex activity that requires a variety of inputs, and what we don’t want is even more stratification than we already have in which only expensive, selective, elite universities are allowed to teach complex thinking with the full range of needed practical implementations, while the children of the ex-middle class are given the mechanisms of lesser capabilities.

Higher ed needs a plurality of innovation modes—Harvard and BYU-Idaho and BYU-Provo and Michigan-Ann Arbor and Michigan Tech, etc., but not where plurality  means two or ten grades of cognitive skills. It also needs honesty about costs—doing research and intensive teaching with many small courses or “flipped classrooms” drive costs up--so that we don’t spend half our time defensively explaining why UNC-Chapel Hill will always cost more than Western Governor’s University.  

Prof. Christensen’s theory has been used to say that the 99% need always to scramble downmarket.  In fact, their institutions need differentiation and universal upgrading.  Let’s just say that he and his co-author try to call a truce around disruption, and look at the other articles without trying to force them into the mold of adapting to low-cost disruptors.

When we do, what do we find? Descriptions of all sorts of interesting programs that are student-centered in the best sense, while connecting university work to learning structures in the rest of the world.   The key premise appears in a piece on remaking career centers: a center at Franklin & Marshall College
has moved from the old-fashioned "transactional" model—which focused on helping students complete specific tasks, like writing a résumé—to a developmental model that works with students over time.
Learning is at bottom human development.  It is the most immediately transformative thing that universities (and their partners) can do. One example is the Olin College of Engineering, which offers a curriculum that is historically oriented, project-based, user-focused, and entirely personal.
Before they arrived at the workshop, participants interviewed students from their home campuses to create composite "personas," which described how different types of students approach their education, what they want from it, and where they encounter difficulty. That exercise was an example of how user-centered design could be applied to curriculum planning.
Two possibly-unacknowledged insights of ethnic and feminist studies-- the importance of experience and standpoint-- seem here to have joined with practice-based theories of technological innovation to create an undergraduate curriculum that is not behind, below, and apart from research, but is research itself.  Learning is research as research-learning. The practice of it makes it clear that it can and should be available to students regardless of the price and selectivity of the particular college.

Most of the articles have moments like this: the University of Delaware creating “preceptors” to mediate between lecture and lab and to help individual students create their own intellectual trajectories.  There are the “guide on the side” reversals of questions and answers at Southwestern University, the “start-ups for all” program at RIT that aims to help students author and “self-publish” their career trajectories, and even the rolling chairs that help make Michigan state classroom groups more flexible so that, as part of a complex chain of interactions, students will have better capabilities for “communication and teamwork and problem solving in areas they haven't seen before.”
Only two questions nagged me as I read these testimonials of all the interesting things all sorts of universities have put in place. First, basic research is nearly invisible.  How does that fit in at universities where it is a major focus?
Secondly, all these real innovations cost money. In public universities, our funders wanted free ones.  How will we talk them into the kind that the public will need to pay for?

Wednesday, October 2, 2013

Wednesday, October 2, 2013
As you know, the House Republican Leadership has decided to shut down the Federal Government in protest of losing the last Presidential election.  The effects on Higher Education and Research are already appearing.  Some scientific labs have been forced to either close or restrict operations.  NASA has curtailed its activities.  If the closure is short, the larger effects may be minimal.  But if it goes on who knows...

Two younger faculty reflect on the potential impact and significance:

Anonymous A:

Let's talk fucking privilege: A very small minority can do their jobs very fucking poorly, put millions of people, including elderly folks and veterans, at real risk, and not have to give up one dime of their own fucking salary or one ounce of their own fucking comfort, just because they're mad that they're not getting their way?!! Yet, if I and about 30 of my colleagues just stopped doing our fucking jobs and endangered our student constituencies with that stoppage, we'd be out of a job so quickly our fucking heads would be spinning for days. This outrage and status are brought to you by the letter "F" for fuck!!!

Anonymous B: 

I was an undergrad the last time the government shutdown. Under Newt's directive, it was shutdown for 21 days. I was an emancipated minor. I remember being terrified of the implications. I was already trying to pick up extra shifts, along with everyone else I knew, and trying to endgame workarounds to keep me enrolled at CSUF. I showed up the financial aid office early in the morning--6am (like poor people do, go ask a poor person why)--and they said just show up to classes. So that's what we did. At the time, we were either 58% or 68% first generation college students. I honestly can't remember. It rivals the affirmative action for rich people and legacies at elite colleges (though it's never really called affirmative action, is it?) I digress. I remember that as students we didn't know if our profs would show up. Why would they? They're not getting paid and they'll probably not get paid retroactively. We never did, and our people never did when they went on strike. Only it wasn't a strike. But that's where we were wrong. Capital was on strike. Not the workers. Our profs showed up. They taught. And for over two months or thereabouts (when a gov't shuts down, it takes more than an open sign to get it working) all fees and tuition collections were suspended. And they taught. I'm a professor now. I'm at a public school dependent on federal funds. I'll teach for as long as it takes for people to demand some sense. And when I give my diversity week talk on Wednesday, I'm giving it on public education and its vital importance to the democratic project, because where in the hell do you think this kind of jackassery is going to be felt the most? Those that already have the buffer and connections won't feel a thing. Even without the gov't shutdown I'm using the VERY little threat power (and let's be clear, by "threat" I mean "shame") I have to make sure veterans get their tuition paid and their seats secured in classes. Can you imagine if it lasts 21 days? I'm in the state with the third highest rate of unemployment and winter is here. This isn't CA where you can live on shit you steal from CSUF's arboretum (you think CSUF doesn't know this happens? They planted MORE farm/fruit crops because of this). Food doesn't just happen here. Neither does heat.

 Let us know if the Shutdown affects your work.