Are University-Run Medical Centers The Tail Wagging The Dog?
The entrance to the University of California San Francisco (UCSF) medical center in San Francisco. Getty Images  Universities have played a consequential role in the fight against the coronavirus that has swept the globe their research tries to prevent the disease or mitigate its effects, their classrooms and labs train the future physicians and others trying to save lives, and their hospitals and clinics try to heal those with not only this sickness but all sorts of other serious aliments afflicting humankind. About 100 institutions with med schools and hospitals are particularly critical. With all this is mind, I recently chatted with Dr. Harold Paz, Executive Vice President and Chancellor for Health Affairs at Ohio State (OSU), and CEO of its Wexner Medical Center. Dr. Paz has run university medical centers at Rutgers and Penn State as well, and was the chief health executive at Aetna for several years. He also has had close professional associations with several private schools, such as Rochester, Johns Hopkins and Yale. He is an articulate, bright individual. The health care component at massive universities like Ohio State, as measured by spending, now sometimes exceed 50% it is around $4.5 billion a year ($500,000 an hour) at OSU, bigger than all other parts of that huge school combined an institution with 60,000 or so students in Columbus alone. Dr. Paz spends 20 times as much as the athletic director overseeing OSUs superstar status athletic programs. I asked Dr. Paz if doing things like opening and running massive new ambulatory centers (with one million square feet of space) in the Columbus suburbs in competition with rival health care providers, or building a new nearly $2 billion skyscraper hospital, distracts from traditional goals like teaching French or accounting to college freshmen. I remember decades ago when a distinguished Duke economist (a former president of the American Economics Association) told me my university would rue the day when it started a medical school. Dr. Paz politely but strongly demurred from this type of thinking, suggesting the synergies of medical schools combined with other university operations make for an effective model, ultimately serving the good of society. Dr. Paz notes that health care spending in the U.S. is approaching 18 % of national output -much more than in most other nations, and he believes there are ways to reduce future costs through restructuring medical care. Big changes in health care delivery are ahead, if Dr. Paz is correct. He, however, did not comment on an observation of my own: a huge percentage of health care costs are related to end-of-life heroic efforts that are extremely expensive but prolong life usually only for a few weeks or perhaps months. It occurred to me this may be where university medical centers receive a large hunk of their revenue. If there is ever an area where trade-offs, choosing between alternatives, is especially important it is medical education. An aging population, low levels of economic growth, high levels of indebtedness -these are attributes of contemporary America. We arguably are overextended as a nation. Our extremely high health care costs need to be reevaluated and reform is no doubt needed, as Dr. Paz seems to think will come. University provision of both medical education and medical care will be part of that scrutiny in coming years. My latest book is Restoring the Promise: Higher Education in America.