January 27, 2013
I was struck by these paragraphs in a recent NYT Economix column by Uwe Reinhardt, a first rate health care economist at Princeton:
[T]he total sum the United States spends each year on health services research is trivial if compared to total annual health spending. If one plots it in a pie chart, health services research is not a visible slice but just a line. Probably no economic sector in the economy performs as little operations research as does health care – and it shows in the sector’s performance.
For the most part, health policy in this country is based on accepted folklore, forged from the legislator’s personal experience or information brought to him or her by acquaintances or lobbyists.
I found myself asking whether what Reinhardt says about health care research could be said about higher education research. I think it could.
That is, the amount the United States spends each year on higher education research is trivial if compared to total annual higher education spending. So if Reinhardt is skeptical that we know very much with certainty about what works in health care, I think the same could and should be said about higher education. Most of what passes for knowledge is folklore and anecdote. And much of the research is potentially biased by what conclusions people hope to draw.
Reinhardt goes on to discuss the mass of financial data that is collected and analyzed each year about the performance of for-profit corporations, and voices skepticism about whether we can draw solid conclusions from that much more substantial effort. But, he acknowledges, at least people are putting effort into trying to understand what’s working and what isn’t.