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There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we’re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet.

Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med’s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms.

In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised.
This is an essential read for understanding the current state of the health care system in America—and the steps urgently needed to create an environment of better care for all of us.

Resource Allocation in Higher Education describes how colleges, universities, and government agencies can use budgeting processes to improve program planning and productivity. Drawn from the contributors' direct experiences as well as research findings, it blends conceptual foundations with practical insights. Many resource allocation processes in higher education need reform, and this volume will stimulate and assist that effort. Beginning with the economic theory of nonprofits, the essays examine current budgeting systems in both theoretical and practical terms. Resource allocation systems from other domains such as health care are explored for relevant insights. Throughout, decentralization remains a major theme. Topics range from the eminently practical--how to establish a global accounting system or choose an endowment spending rate--to the more abstract--the theory of how various nonprofit enterprises balance academic values against market pressures. The volume ends by proposing value responsibility budgeting, which offers institutions a potentially better way of pursuing their academic values while remaining responsive to market pressures. Those within higher education institutions who are responsible for resource allocation, such as provosts, chief financial officers, or budget directors, will find much that speaks to them. While mostly in the domain of higher education economics, management, and planning, the essays are written for any serious reader concerned with the problem of reform in higher education. William F. Massy is Professor of Education and Business Administration at Stanford University.

Based on years of observation at a large state university, Wannabe U tracks the dispiriting consequences of trading in traditional educational values for loyalty to the market. Aping their boardroom idols, the new corporate administrators at such universities wander from job to job and reductively view the students there as future workers in need of training. Obsessed with measurable successes, they stress auditing and accountability, which leads to policies of surveillance and control dubiously cloaked in the guise of scientific administration. In this eye-opening exposé of the modern university, Tuchman paints a candid portrait of the corporatization of higher education and its impact on students and faculty. 

Like the best campus novelists, Tuchman entertains with her acidly witty observations of backstage power dynamics and faculty politics, but ultimately Wannabe U is a hard-hitting account of how higher education’s misguided pursuit of success fails us all.