A Free Market for Medical Care? It’s Been Tried

Alternative medical practitioners and Jacksonian populists found common cause in an open market for medicine, write Jacob Habinek and Heather A. Haveman

The Financialization of US Higher Education

Research on financialization has been constrained by limited suitable measures for cases outside of the for-profit sector. Using the case of US higher education, we consider financialization as both increasing reliance on financial investment returns and increasing costs from transactions to acquire capital. We document returns and costs across four types of transactions: (i) revenues from endowment investments, (ii) interest payments on institutional borrowing by colleges, (iii) profits extracted by investors in for-profit colleges and (iv) interest payments on student loan borrowing by households. Estimated annual funding from endowment investments grew from $16 billion in 2003 to$20 billion in 2012. Meanwhile financing costs grew from $21 billion in 2003 to$48 billion in 2012, or from 5 to 9% of the total higher education spending, even as interest rates declined. Increases in financial returns, however, were concentrated at wealthy colleges whereas increases in financing costs tended to outpace returns at poorer institutions. We discuss the implications of the findings for resource allocation, organizational governance and stratification among colleges and households.1. Introduction 2. Financialization and higher education 3. Data and measures 4. College endowments and financial revenues 5. College institutional debt and interest costs 6. Proprietary colleges and profits as the costs of equity investment 7. Student loan debt and interest payments 8. Quantifying the costs of higher education financialization 9. Conclusions Supplementary material Funding Acknowledgements References Supplementary dat

Professionals and Populists: The Making of a Free Market for Medicine in the United States, 1787–1860

In the early decades of the 19th century, physicians in the USA enjoyed unquestioned authority in medicine and increasing state recognition. But by mid-century, their monopoly had given way to a raucous free market for medical care. To explain the causes and consequences of this dismantling of a professional monopoly, we draw on political sociology. We argue that to maintain a monopoly, a dominant profession must defend its cultural authority against rival claims and preserve its institutional support from the state. A dominant profession can lose its monopoly if rival occupations mobilize to challenge its cultural authority and if populist political coalitions mobilize to repeal laws upholding professional monopolies. Our analysis, which covers all states in the Union by 1860, reveals that the dynamics of contention, both within the system of professions and in the wider political arena, can erode the foundations of professional monopolies.Abstract 1. Introduction 2. The politics of professions 3. The Evolution of US Medicine, 1787-1860 4. Research design 5. Results 6. Discussion and conclusion Funding Acknowledgements Footnotes Reference