I read recently a remarkable article in The New Yorker by Atul Gawande called “Big Med.” It tried to outline where medicine might be going next.
Given spiraling costs, increasing demand, and lax quality controls, Gawande makes it clear that medicine will—and probably has to—go through a series of changes that will move it from being a craft industry to something that much more closely resembles a conventional industry. He outlines clearly the costs and benefits: “We’ve let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change. Some will see danger in this. Many will see hope.”
Perhaps we are starting to see something like this process of change taking place in American and British higher education, too. It is possible to see a new political economy of higher education coming into existence born out of the huge increase in students around the world, as well as boosts to university research funds and the prevalence of information technology that allows lower transaction costs and more syndication. Whether we like it or not, higher education will almost certainly follow something much closer to a mass-production model as it scales up even further. The only question to be answered is, what kind of industrial model?
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