Medugrift: The Unsustainable Nature of University-Related Health Care

University-related health care has become a sprawling and increasingly unsustainable enterprise. What began as a mission to train doctors, nurses, and medical researchers in service of the public good has morphed into a vast, profit-driven complex. Tied to the branding of universities, the financial imperatives of Big Medicine, and the precarious economics of higher education, this “Medugrift” reflects many of the same dysfunctions we see across American higher ed.

The University as Health Care Conglomerate
Major research universities often operate sprawling medical centers that rival Fortune 500 corporations in both revenue and expenses. Academic health systems like those at Johns Hopkins, Duke, Michigan, or USC bring in billions annually. Yet despite this scale, their finances are increasingly fragile. They rely heavily on a combination of government reimbursements, philanthropy, and sky-high tuition from medical students—many of whom graduate with debt loads exceeding $200,000.

For universities, medical schools and hospitals serve as prestige engines and revenue streams, but they also drain resources, saddle institutions with debt, and expose them to scandals involving fraud, patient neglect, or mismanagement.

The Student and Worker Burden
The workforce supporting university health systems—residents, nurses, adjunct faculty, contract staff—often face long hours, low pay relative to the work demanded, and little job security. Meanwhile, students in health care disciplines are treated less as apprentices of the healing profession and more as revenue sources for both the university and affiliated corporations.

Many young doctors-in-training are funneled into a system where their debt and exhaustion make them more compliant with the corporatization of medicine. Universities profit from this cycle, while students and patients carry the costs.

Ballooning Costs and Broken Promises
Despite claims of providing cutting-edge care and serving communities, university health systems often contribute to the nation’s crisis of affordability. Hospital charges at university facilities are often higher than at non-teaching hospitals, reflecting not only the real costs of research and training but also the administrative bloat, marketing budgets, and executive compensation packages that mirror the rest of higher ed.

Patients face sticker shock, insurers pass costs to the public, and communities are left to wonder whether these “nonprofit” institutions are truly accountable.

Medugrift and the Future
The term Medugrift captures the contradictions: universities use the prestige of medical schools and hospitals to attract funding and political clout, but the system feeds on debt, underpaid labor, and inflated costs. It is not financially or ethically sustainable.

As university debt rises and student loan defaults grow, the Medugrift may become a central fault line in the higher education crisis. Already, some universities have been forced to sell or spin off their hospitals. Others double down, betting on health care revenue streams to subsidize declining undergraduate enrollments.

But this path cannot hold indefinitely. Like the broader higher education bubble, the university health care complex rests on fragile assumptions: endless student demand, limitless patient reimbursements, and unquestioned public trust. If those foundations crack, the consequences for both higher education and health care will be profound.

The Higher Education Inquirer: Six Hundred Thousand Views, and Still Digging

The Higher Education Inquirer has crossed another milestone, reaching more than 600,000 views over the past quarter. For a niche publication without corporate backing, this is a significant achievement. But the real measure of success is not in page views—it is in the stories that matter, the investigations that refuse to die even when the higher education establishment would rather they disappear.

Since its inception, HEI has taken the long view on the crises and contradictions shaping U.S. colleges and universities. We continue to probe the issues that mainstream media outlets often skim or ignore. These are not passing headlines; they are structural problems, many of them decades in the making, that affect millions of students, faculty, staff, and communities.

Among the stories we continue to pursue:

• Charlie Kirk and Neofascism on Campus: Tracing how right-wing movements use higher education as a recruiting ground, and how student martyrdom narratives fuel a dangerous cycle.

• Academic Labor and Adjunctification: Investigating the systemic exploitation of contingent faculty, who now make up the majority of the academic workforce.

• Higher Education and Underemployment: Examining how rising tuition, debt, and credentials collide with a labor market that cannot absorb the graduates it produces.

• EdTech, Robocolleges, and the University of Phoenix: Following the money as education technology corporations replace faculty with algorithms and marketing schemes.

• Student Loan Debt and Borrower Defense to Repayment: Tracking litigation, regulatory shifts, and the human toll of a $1.7 trillion debt system.

• U.S. Department of Education Oversight: Analyzing how federal enforcement waxes and wanes with political cycles, often leaving students exposed.

• Online Program Managers and Higher Ed Privatization: Investigating the outsourcing of core academic functions to companies driven by profit, not pedagogy.

• Edugrift and Bad Actors in Higher Education: Naming the profiteers who siphon billions from public trust.

• Medugrift and University Medicine Oligopolies: Connecting elite medical centers to systemic inequality in U.S. healthcare.

• Student Protests: Documenting student resistance to injustice on campus and beyond.

• University Endowments and Opaque Funding Sources: Pulling back the curtain on how universities build wealth while raising tuition.

• Universities and Gentrification: Exposing the displacement of working-class communities in the name of “campus expansion.”

• Ambow Education as a Potential National Security Threat: Tracking foreign-controlled for-profit education companies and their entanglements.

• Accreditation: Examining the gatekeepers of legitimacy and their failure to protect students.

• International Students: Covering the precarity of students navigating U.S. immigration and education systems.

• Student Health and Welfare: Looking at how universities fail to provide adequate physical and mental health support.

• Hypercredentialism: Interrogating the endless inflation of degrees and certificates that drain students’ time and money.

• Veritas: Pursuing truth in higher education, no matter how uncomfortable.

These are the stories that make HEI more than just a blog—they make it a watchdog. As higher education drifts deeper into corporatization and inequality, we will keep asking difficult questions, exposing contradictions, and documenting resistance.

The numbers are gratifying. But the truth is what matters.

Baby Boomers Turning 80: The Flip Side of the 2026 Enrollment Cliff (#medugrift)

While COVID eliminated hundreds of thousands of older Americans from the dependency rolls, higher education experts have not expressed the profound effect that the Baby Boomers reaching their 80s will have on state budgets. In 2026, the year we expect an enrollment cliff, the first Boomers will turn 80. Transfers of wealth will enrich the upper-middle class and the rich, but working-class folks will be further devastated. 

Some of this should not be surprising. US birth rates have been declining for more than six decades. And US inequality began widening about a decade later. 

It should also be unsurprising that younger adults have chosen to have fewer children. Non-immigrants have even fewer--below replacement level. We may not see a population decline soon, but it does change the composition of the US age pyramid (see images below).

This demographic phenomenon, of more older people and fewer young people to care for them, will strain state budgets that need more money for nursing homes and other forms of long-term care. It is taken for granted (from a medical perspective) that with aging in the US comes years of disease, advanced disability, and large medical costs with expensive pills, procedures, hospitalizations, and institutionalization becoming the norm. "Eds and meds" are major employers in most US cities. And ageism, ableism, and sedentary lifestyles make the situation worse. 

The CDC estimates that 80% of adults aged 75 and older have at least one chronic health condition, and 50% have at least two. Some of the most common chronic health conditions among older adults include heart disease, stroke, cancer, diabetes, and arthritis.

According to the Alzheimer's Association, dementia among people in the US over 75 years of age is relatively common. In fact, they estimate that 6.2 million Americans aged 65 and older are living with Alzheimer's dementia, which is the most common form of dementia. Additionally, they estimate that 700,000 Americans aged 65 and older are living with vascular dementia, which is the second most common form of dementia.The risk of developing dementia increases with age, and people over the age of 75 are at the highest risk.

There are a number of ways in which people over 75 in the US differ from elders in other countries. Some of the key differences include:

• Health: Older adults in the US are more likely to have chronic health conditions and disabilities than older adults in other developed countries. For example, the US has the lowest life expectancy among wealthy countries, and the gap between the US and other countries widens as people get older.
• Wealth: Older adults in the US are more likely to be living in poverty than older adults in other developed countries. For example, an estimated 6.2 million Americans aged 65 and older live below the poverty line.
• Social support: Older adults in the US are less likely to have strong social support networks than older adults in other developed countries. For example, the US has a relatively high rate of social isolation among older adults.
• Access to healthcare: Older adults in the US are more likely to have difficulty accessing affordable healthcare than older adults in other developed countries. For example, the US has a high rate of uninsured and underinsured older adults.

Robotics and other less human strategies to manage elders may reduce costs. However, unless there are dramatic cuts in the US healthcare system, K-12 education, and prisons, community colleges and non-flagship state universities are likely to face more austerity.  Suzanne Mettler described this budgetary strain in her 2014 book Degrees of Inequality.  It's almost ten years later and little has been done to prepare for this wave. 

States with large percentages of poor elderly may be harder hit.  This may include New Mexico (13.3%), Mississippi (12.4%), Louisiana: (12.4%), New York: (11.8%), Rhode Island: (11.2%), Texas: (11.1%), Florida: (10.6%), and California: (10.5%). 

Changing the inverting pyramid would have economic and political consequences. Forcing girls and women to have children may be more likely in 2023 than it was in 1973, but that's not likely to improve the human condition. Allowing more immigration does not appear politically feasible. And adding population to the US means more global environmental destruction--the ultimate rate limiting factor.

 

(Source: PopulationPyramid.net) 

Related link:

"Let's all pretend we couldn't see it coming" (The US Working-Class Depression)

State Universities and the College Meltdown

Community Colleges at the Heart of College Meltdown