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Tuesday, December 16, 2025

Violence, Safety, and the Limits of Campus Security: From MIT to Brown and Beyond

The Monday killing of MIT professor Nuno F.G. Loureiro at his home in Brookline, Massachusetts has shaken the academic community and reinforced a troubling reality already examined in Higher Education Inquirer’s recent reporting on campus safety and mental health: violence affecting higher education in the United States is neither isolated nor confined to campus boundaries.

Loureiro, a Portuguese-born physicist and internationally respected scholar in plasma science and fusion research, was a senior leader at MIT and director of its Plasma Science and Fusion Center. His death occurred off campus, yet it reverberated powerfully within higher education because it underscores how scholars, students, and staff exist within a broader national environment shaped by widespread gun violence, strained mental-health systems, and limited preventive safeguards.

Authorities have confirmed the incident as a homicide. At the time of writing, no suspect has been publicly identified, and investigators have released few details about motive. The uncertainty has compounded the shock felt by colleagues, students, and international collaborators who viewed Loureiro as both a scientific leader and a deeply committed mentor.

A Pattern, Not an Anomaly

Loureiro’s killing followed a series of violent incidents tied to U.S. college campuses throughout 2025, reinforcing that these events are not aberrations but part of a broader pattern.

Just days earlier, a deadly shooting at Brown University left two students dead and several others wounded when a gunman opened fire in an academic building during final exams. The attack disrupted campus life, forced lockdowns, and exposed vulnerabilities in building access and emergency response procedures.

Earlier in the year, Florida State University experienced a mass shooting in a heavily trafficked campus area, resulting in multiple fatalities and injuries. The suspect, a student, was taken into custody, but the psychological impact on students and faculty persisted long after classes resumed.

At Kentucky State University, a shooting inside a residence hall claimed the life of a student and critically injured another. The alleged shooter was not a student but a parent, underscoring how campus violence increasingly involves individuals with indirect or external connections to institutions.

In September 2025, violence took an explicitly political turn when Charlie Kirk, founder of Turning Point USA, was assassinated during a public speaking event at Utah Valley University. Kirk was shot during a large outdoor gathering attended by thousands. The killing, widely described as a political assassination, was unprecedented in recent U.S. campus history and raised urgent questions about security at high-profile events, free expression, and political polarization within academic spaces.

Together, these incidents — spanning elite private universities, public flagship institutions, regional campuses, and HBCUs — illustrate how violence in higher education now crosses institutional type, geography, and purpose, from classrooms and residence halls to public forums and nearby neighborhoods.

The Limits of Traditional Campus Safety Models

HEI’s recent analysis of U.S. campus safety emphasized a central tension: colleges and universities rely heavily on reactive security measures — armed campus police, surveillance infrastructure, emergency alerts — while underinvesting in prevention, mental-health care, and community-based risk reduction.

The events of 2025 highlight the limitations of these approaches. Even well-resourced institutions cannot fully secure campus perimeters or prevent violence originating beyond institutional control. Nor can security infrastructure alone address the social isolation, untreated mental illness, ideological extremism, and easy access to firearms that underlie many of these incidents.

Federal compliance frameworks such as the Clery Act prioritize disclosure and reporting rather than prevention. Meanwhile, the expansion of campus policing has often mirrored broader trends in U.S. law enforcement, raising concerns about militarization without clear evidence of improved safety outcomes.

Violence Beyond Active Shooters

While mass shootings and assassinations draw national attention, they represent only one part of a wider landscape of harm in higher education. HEI has documented other persistent threats, including hazing deaths, sexual violence, domestic abuse, stalking, false threats that provoke armed responses, and institutional failures to protect vulnerable populations.

Mental health remains a critical and often neglected dimension. Many acts of campus-related violence intersect with untreated mental illness, financial stress, academic pressure, and inadequate access to care — conditions exacerbated by rising tuition, housing insecurity, and uneven campus support systems.

For international students in particular, exposure to U.S. gun violence and emergency lockdowns can be deeply destabilizing, challenging assumptions about safety that differ sharply from conditions in other countries.

An Urgent Moment for Higher Education

The deaths of individuals such as Professor Loureiro and Charlie Kirk, alongside students at Brown, Florida State, and Kentucky State, underscore a central truth: American campuses do not exist apart from the society around them. No amount of prestige, branding, or technology can fully insulate higher education from national patterns of violence.

For administrators and policymakers, the lesson is not simply to harden security, but to rethink safety holistically — integrating physical protection with mental-health infrastructure, transparent accountability, community engagement, and policies that address deeper cultural and structural drivers of violence.

As Higher Education Inquirer has argued, campus safety is inseparable from broader questions of public health, social policy, and institutional responsibility. Without sustained attention to these connections, tragedies across U.S. campuses will continue to be framed as shocking exceptions rather than symptoms of a deeper and ongoing crisis.

Sources

Associated Press reporting on the MIT professor killing
Reuters coverage of campus shootings in 2025
Reporting on the Brown University shooting
Coverage of the Florida State University shooting
Reporting on the Kentucky State University residence hall shooting
PBS NewsHour and national reporting on the Charlie Kirk assassination at Utah Valley University
Higher Education Inquirer – Understanding U.S. Campus Safety and Mental Health: Guidance for International Students

Saturday, April 19, 2025

Why College Matters: Out of Touch with Social Class Realities

Serve Marketing's Why College Matters media campaign stacks the deck in favor of higher education and expects consumers to believe the story they tell. The problem with this campaign, and its anonymous funders, is that for many folks, college (and life after college) is problematic at best and oppressive at worst.

The Higher Education Disconnect: What Survey Results Miss About Americans' Real Concerns

The Why College Matters campaign presents data suggesting Americans' perceptions of higher education can be positively influenced through messaging. However, when compared with broader research on Americans' attitudes toward higher education, significant disconnects emerge. This analysis examines the gaps between the campaign's focus and the well-documented concerns Americans have about today's college experience.

The Financial Reality Gap: Debt and Affordability Concerns

The Why College Matters campaign notably avoids addressing one of the most pressing issues facing Americans considering higher education: the financial burden. This omission creates a fundamental disconnect with public sentiment.

Student Debt as a Life-Altering Burden

Recent research shows that 70% of middle-income Americans believe student loans are impacting their ability to achieve financial prosperity5. The psychological burden is equally significant, with 54% of student borrowers experiencing mental health challenges directly attributed to their debt load, including anxiety (56%) and depression (approximately 33%)8.

The campaign's focus on abstract benefits like "growing America's economic prosperity" fails to acknowledge that for many individuals, the immediate economic reality is far less promising. Student borrowers report delaying major life milestones including starting families, purchasing homes, and pursuing careers they're passionate about due to debt constraints8.

The Middle-Class Squeeze

While the campaign targets adults without college degrees as a key demographic, it misses that middle-class families face particularly acute challenges. These families often find themselves in a precarious position - too wealthy to qualify for significant need-based aid but not wealthy enough to comfortably afford college expenses13. This "middle-class squeeze" represents a significant disconnect between survey messaging and lived experience.

The Employment Reality Disconnect

Perhaps the most striking omission in the campaign's framing is the reality of post-graduation employment outcomes, which directly contradicts the economic benefit messaging.

Widespread Underemployment

Research from the Burning Glass Institute reveals a sobering statistic: 52% of recent four-year college graduates are underemployed a year after graduation, holding jobs that don't require a bachelor's degree14. Even more concerning, 45% still don't hold college-level jobs a decade after graduation14. This creates a fundamental disconnect when the campaign emphasizes workforce development without acknowledging this reality.

The "First Job Trap"

The survey frames higher education as broadly beneficial for workforce development but fails to address what researchers call the "first job trap." Data shows that 73% of graduates who start their careers in below-college-level jobs remain underemployed a decade after graduation14. This presents a significantly different picture than the campaign's simplified message about maintaining a skilled workforce.

Credential Inflation: The Devaluing Degree

The campaign messaging presumes that increased educational attainment inherently produces positive outcomes, without addressing the phenomenon of credential inflation that undermines this assumption.

Degrees as Diminishing Returns

Credential inflation refers to the declining value of educational credentials over time, creating a scenario where jobs that once required a high school diploma now demand bachelor's degrees, and positions that required bachelor's degrees now require master's or doctorates11. This creates a paradoxical situation where more education is simultaneously more necessary yet less valuable - a nuance entirely absent from the campaign narrative.

Opportunity Costs Unacknowledged

The campaign frames college primarily through its benefits, without acknowledging significant opportunity costs identified in research. These include delayed savings, fewer years in the workforce, postponement of family formation, and accumulation of debt11. This one-sided framing creates a disconnect with the lived experience of many Americans weighing these very real tradeoffs.

The Growing Generational Divide

The campaign's focus on adults aged 35-64 misses a critical demographic: younger generations who express the most skepticism about higher education's value.

Gen Z's Value Perception Crisis

Only 39% of Gen Z respondents in one study said advancing their education is important to them, and 46% don't believe college is worth the cost15. This represents a fundamental shift in attitude that the campaign's methodology doesn't capture, creating another disconnect between messaging and emerging social reality.

The Civic Disconnection Context

Research on youth disconnection shows broader trends of civic disengagement, with young Americans becoming less connected to community institutions generally1 9. The campaign's framing of higher education as building community connection happens against this backdrop of declining civic participation - context that provides important nuance missing from the survey design.

Mental Health Concerns: The Hidden Cost

Perhaps the most significant omission in the campaign's messaging is the documented mental health impact of the higher education experience, particularly related to financial strain.

Student Debt as Mental Health Crisis

Research demonstrates clear links between student loan debt and mental health challenges. Beyond anxiety and depression, the financial burden of education impacts overall wellbeing in ways unacknowledged by the campaign messaging8 16.

Postponed Lives and Dreams

The psychological impact of delayed life milestones due to educational debt creates stress that extends far beyond graduation. Student borrowers report putting their lives on hold - a reality that contradicts the campaign's emphasis on "keeping alive the American dream"8.

Ideological and Cultural Concerns

The campaign notably avoids addressing concerns about campus culture and ideological homogeneity that research shows are significant factors in changing attitudes toward higher education.

Faculty Ideological Imbalance

Research from Harvard University reveals striking ideological homogeneity among faculty, with 37% identifying as "very liberal" and just 1% as "conservative"12. This imbalance contributes to perceptions of higher education as disconnected from the values of many Americans - particularly explaining why the campaign struggled to persuade conservative Americans that "higher education plays a critical role in maintaining a healthy democracy."

Conclusion: Bridging the Perception Gap

The Why College Matters campaign demonstrates that positive messaging can improve abstract perceptions of higher education's value. However, for these improved perceptions to translate into meaningful change in Americans' relationship with higher education, campaigns must address the substantive concerns documented in research.

The disconnects identified here - regarding debt, employment outcomes, credential inflation, generational attitudes, mental health impacts, and ideological concerns - represent real issues that significantly impact Americans' decisions about higher education. Any campaign seeking to genuinely improve perceptions of higher education's value must engage with these realities rather than focusing solely on abstract benefits.

Simply improving "feelings" about higher education without addressing concrete problems risks further widening the gap between institutional messaging and public experience - potentially eroding rather than building trust in higher education as an institution.

Citations:

Sunday, November 23, 2025

What America’s Declining Happiness Means — and How Higher Education Fits In

A recent report has sounded an alarm: happiness in the United States is falling more sharply than in almost every other developed nation. According to coverage by CBS News, Americans increasingly report loneliness, deep political division, and diminished life satisfaction. While this trend is worrying in itself, a closer look shows that it’s not just a problem of individual melancholy — it reflects a broader weakening of social structures, civic trust, and community cohesion. Historically, these phenomena have been central to the nation’s sense of coherence; now, they may be eroding.

Historical Roots and the Social Capital Framework

To understand the scale of what’s happening, it helps to go back. Over two decades ago, Robert D. Putnam’s seminal Bowling Alone documented a dramatic decline in American “social capital” — the network of associations, civic participation, and interpersonal trust that undergirds a functioning democracy. Putnam traced declines in everything from civic organizations to informal social gatherings, arguing that this fraying of social infrastructure had profound consequences.

Social capital theory provides a useful lens here: trust between citizens, engagement in local institutions, and time spent in shared civic life are not just feel‑good extras, but foundations for collective resilience.

Later empirical work has revisited these concerns. Weiss, Paxton, Velasco, and Ressler (2018) developed a newer measure of social capital and found evidence that the decline persists. Inequality also appears to play a role: as income gaps widen, interpersonal trust tends to decrease. In research published in Finance & Development, economists found that rising inequality explained a substantial portion of the decline in social trust in the United States.

More recently, political scientists have documented how perceived political polarization erodes social trust. In a nationally representative panel study, Amber Hye‑Yon Lee showed that when people believe their country is deeply divided, their trust in fellow citizens drops — even beyond partisan loyalties. Pew Research Center data further illustrate this generational shift: younger cohorts, raised in a more polarized and atomized society, report lower social trust than earlier generations.

At the same time, the digital revolution hasn’t necessarily filled the gap. Sabatini and Sarracino (2014) found that while people are more active on social media, this does not compensate for lost in-person connection — and may even undermine trust. During the COVID-19 pandemic, researchers observed increased remote communication, but also stronger political echo chambers: in a study of 41,000 Americans’ social networks, political homophily (interacting mostly with those who share one’s partisan identity) increased.

Well-Being, Health, and Mortality

The decline in social trust and cohesion is not just a sociological problem — it is deeply linked to health. A growing body of epidemiological research ties subjective well‑being to longevity and mortality. For instance, a widely cited study by Lawrence, Rogers, and Wadsworth found that lower happiness is associated with higher all‑cause mortality risk in U.S. adults. In another longitudinal study, researchers followed more than 30,000 adults over 14 years and found that individuals with low life satisfaction lived, on average, 8–10 years less than those with high satisfaction — even after controlling for sociodemographic and behavioral variables.

These findings suggest that declining happiness is not just a matter of mental distress or cultural malaise — it translates into concrete health inequities and life expectancy gaps.

Recent Trends and the Global Context

Over the past decade, the United States has slid in global happiness rankings, according to the World Happiness Report. Some analyses suggest that the U.S. now falls behind peer nations on measures of life evaluation, meaning that Americans are increasingly less satisfied with their lives in a broad, reflective sense.

Meanwhile, epidemiological studies of happy life expectancy — the number of years people spend in a state of subjective well‑being — show that although well-being improved from 1970–2000, gains were uneven by race and gender. The recent reversal or stagnation in happiness is thus especially alarming in light of these prior gains.

The Role of Higher Education: Past, Present, and Potential Futures

Given this historical and empirical context, higher education institutions have a complex and potentially pivotal role in responding to declining well-being.

On one hand, universities could help rebuild social capital. Institutions of higher learning have unique capacity to foster cross-partisan civic engagement, to embed community-building in pedagogy, and to support students’ social and emotional development. By investing in mental health infrastructure, peer networks, and service-based learning, colleges could act as local laboratories for restoring trust and social cohesion.

Higher education also has a research function: universities can produce evidence about what strengthens well-being, what interventions mitigate loneliness or political fragmentation, and how different models of community engagement impact long-term health outcomes. Through partnerships with public policy institutions, universities can help translate these findings into programs that bolster social infrastructure outside campus walls.

However, higher education also runs risks. If institutions remain fragmented, politically polarized, or focused on prestige rather than public mission, they may contribute to social fragmentation rather than healing it. Elite universities, in particular, may be perceived as disconnected from broader communities, undermining trust rather than reinforcing it. In such a scenario, higher education may reproduce the very inequalities and isolation that are driving declining well‑being.

Moreover, without deliberate strategies, campus networks may reinforce echo chambers: social connections among students may mirror broader partisan divides, especially in environments where political homogeneity is common.

Health Equity Implications

The decline in American happiness intersects directly with issues of health equity. Lower well-being and eroded trust disproportionately affect marginalized communities — those with fewer economic resources, less social support, and weaker civic infrastructure. When universities take an active role in promoting well-being and rebuilding social capital, they not only support individual students but may contribute to reducing structural health disparities.

Conversely, if higher education plays a passive role, or if access to supportive, socially rich campus environments is limited to privileged groups, the decline in happiness may deepen existing inequities. The gap in life expectancy tied to subjective well-being suggests that we cannot ignore the social determinants of happiness: economic inequality, community fragmentation, political polarization, and institutional trust all matter.

A Call to Action

To address this crisis, higher education leaders, policymakers, and public health practitioners should consider the following:

Reinforce community-building: Colleges should invest in programs that promote cross-group interaction, civic participation, and social trust.
Prioritize mental health: Expand counseling, peer support, and proactive well-being initiatives, especially for students who might otherwise fall through the cracks.
Align research with public value: Fund and promote research on social cohesion, well-being interventions, and the relationship between trust and health, and ensure that findings inform public policy.
Foster institutional humility and outreach: Universities should engage with local communities, not as isolated centers of prestige, but as partners in building social infrastructure and resilience.
Measure what matters: Beyond graduation rates and research output, institutions should track well-being metrics — social trust, belonging, mental health — as central indicators of their impact.

It Doesn't Have to Be This Bad

The decline in happiness across the United States is not a passing phase or a matter of individual pathology. Rather, it reflects deep shifts in social trust, political cohesion, and community infrastructure. Historically, scholars like Putnam sounded the alarm on social capital’s erosion. Today, health researchers warn that falling well‑being shortens lives and exacerbates inequalities.

Higher education, if reoriented toward building connections, purpose, and trust, could play a vital role in reversing this trajectory. But if universities remain inward-looking or inequality-driven, they risk accelerating the very forces that undermine societal well-being. The stakes are high — not only for individual students, but for the future health and cohesion of the nation.

Scholarly Sources:

Lee, Amber H. Y. “Social Trust in Polarized Times: How Perceptions of Political Polarization Affect Americans’ Trust in Each Other.” Political Behavior, 2022. PMC
Weiss, Inbar, Pamela Paxton, Kristopher Velasco, and Robert W. Ressler. “Revisiting Declines in Social Capital: Evidence from a New Measure.” Social Indicators Research, 2018. PMC
Lawrence, Elizabeth M., Richard G. Rogers, and Tim Wadsworth. “Happiness and Longevity in the United States.” Social Science & Medicine, 2015. PMC
Study on life satisfaction and mortality (14-year follow-up): PMC
Research on income inequality and trust: “In Equality, We Trust” (IMF / Finance & Development) IMF
Study of happy life expectancy, 1970–2000: PMC
Putnam, Robert D. Bowling Alone: The Collapse and Revival of American Community. (on social capital history) Wikipedia+1

Saturday, July 19, 2025

What the Numbers Say About Anxiety in America

Anxiety is a word we hear a lot these days—online, in classrooms, at the doctor’s office, and in everyday conversations. But how many people actually experience it? And how much has it changed over time?

If you’re between the ages of 16 and 35, chances are you or someone close to you has felt overwhelmed, tense, or stuck in worry. Some people call it stress. Some call it burnout. Others use clinical terms like Generalized Anxiety Disorder. Regardless of the label, it’s clear that anxiety is more visible—and more talked about—than ever before.

So what do the facts say?

Different surveys and studies give different numbers for how many people in the United States are dealing with anxiety. That’s because they don’t all define or measure anxiety in the same way. Some studies ask people how they’ve been feeling lately—whether they’ve felt nervous, on edge, or unable to control worrying. Others ask if someone has ever been diagnosed by a doctor or therapist with an anxiety disorder.

In 2008, about 5 percent of U.S. adults reported feeling anxious on a regular basis. By 2018, that number had increased to nearly 7 percent. The increase was even sharper among young adults. For people ages 18 to 25, anxiety nearly doubled during that time.

Then came the COVID-19 pandemic. In early 2020, anxiety levels in the U.S. shot up dramatically. In April of that year, more than one in five adults said they felt anxious most of the time. Since then, anxiety levels have come down somewhat, but they have not returned to pre-pandemic levels. Today, depending on the survey, roughly one in three adults under 35 report having frequent anxiety symptoms.

The differences in these numbers can be confusing. Some headlines say 10 percent of people have anxiety. Others say it’s closer to 40 percent. The truth is, it depends on how anxiety is defined, who is being asked, and when the data was collected. Studies based on formal diagnoses usually report lower numbers. Studies based on self-reported symptoms often report higher ones. Surveys during the height of the pandemic found much higher rates of anxiety than those done before or after.

Despite the differences, the overall trend is clear. Anxiety has been rising in the U.S., especially among younger people, over the last 15 years.

As for why anxiety is rising, there’s no single answer. Many researchers point to several factors that affect mental health today. These include the constant use of social media, the pressure to stay connected and productive, the rising cost of living, student debt, uncertain job prospects, climate anxiety, political division, and the disruption caused by the COVID-19 pandemic. Longer screen time, less sleep, fewer in-person friendships, and less access to nature may also be part of the problem.

At the same time, it’s not all bad news. Talking about anxiety is less taboo than it used to be. Many people, especially younger adults, are more open to discussing mental health. That openness can make it easier for others to speak up, find help, and feel less alone.

Colleges and universities have expanded access to mental health services, including online counseling and peer support groups. Public health campaigns have helped raise awareness. And new tools like therapy apps and mindfulness programs have made mental health support more accessible.

If you’re feeling anxious on a regular basis, you’re not alone. There’s no shame in struggling. It can help to talk to someone you trust, whether that’s a friend, family member, teacher, or counselor. Taking care of your physical health—through sleep, movement, and good nutrition—can also make a difference. So can setting boundaries with technology and making time for offline activities.

It’s worth remembering that you’re not just a statistic. But the numbers do tell a story. And that story shows that many young people are dealing with a world that feels uncertain, overwhelming, and disconnected. Anxiety is part of the reaction to that reality—not a personal failure.

If you’re in crisis or need someone to talk to, you can call or text the 988 Suicide & Crisis Lifeline. It’s free, confidential, and available 24/7.

The Higher Education Inquirer covers the intersections of education, labor, technology, and justice. If you have a story to share, you can reach out to us securely and anonymously.

Friday, August 15, 2025

Ketamine Is Not the Cure We Need

Ketamine is having a moment. Once used almost exclusively as an anesthetic and known on the street as “Special K,” it is now being hailed as a cutting-edge treatment for depression, PTSD, and anxiety. Private clinics are popping up in cities and suburbs alike, offering infusions, nasal sprays, and lozenges for a steep price.

But behind the hopeful marketing lies a troubling reality: ketamine’s rise is less about public health than it is about profit.

Follow the Money

In the past five years, venture capital and private equity have flooded into the ketamine space. Chains like Field Trip Health, Ketamine Wellness Centers, and Klarisana have been buying up smaller practices and opening new ones at breakneck speed. Telehealth startups—some born out of pandemic-era deregulation—now ship ketamine lozenges directly to patients’ doors, bypassing in-person medical oversight.

The business model is simple:

Charge between $400 and $800 per infusion, often multiple times per month.
Encourage ongoing “maintenance” treatments to sustain fleeting mood improvements.
Package the drug in a spa-like environment to justify the premium price.

There is no insurance guarantee for most patients, making ketamine therapy a cash-based service—a dream scenario for investors who want high margins without dealing with insurers.

Science on Shaky Ground

While some studies show ketamine can offer rapid symptom relief, the effects often fade within days or weeks. The drug’s long-term safety for repeated psychiatric use remains poorly studied. Potential side effects include memory impairment, bladder issues, and dissociation.

Even the FDA has not approved ketamine for depression—it has only approved esketamine (a derivative, sold under the brand name Spravato) for limited use in treatment-resistant cases. Yet clinics aggressively market generic ketamine “off-label” to a far wider audience.

Selling a Chemical Band-Aid for a Social Wound

The deeper issue is not just that ketamine’s benefits are short-lived—it’s that the marketing of ketamine clinics conveniently sidesteps the structural roots of the mental health crisis.

The United States is facing rising rates of loneliness, economic insecurity, and chronic disease. People are working longer hours for less pay. Housing is unstable, communities are fragmented, and processed food dominates our diets. For-profit healthcare treats these conditions as secondary, focusing instead on profitable “treatments” for their symptoms.

Ketamine fits neatly into this paradigm: it promises quick relief without requiring systemic change. It turns social pain into a personal chemical problem, to be managed one expensive infusion at a time.

The Alternative We’re Not Funding

If we truly want to improve mental health, we need to invest in what actually works long-term:

Connection: Strong, face-to-face social networks.
Movement: Exercise as a cultural norm, not a luxury.
Nutrition: Access to fresh, whole foods—not just cheap processed calories.
Dignified Work: Jobs that pay living wages and offer stability.

These solutions don’t generate quarterly returns for shareholders. They don’t make headlines in glossy wellness magazines. But they build the kind of resilience no ketamine clinic can replicate.

The question is not whether ketamine can help some people in crisis—it can. The question is whether we are willing to accept a future in which our collective mental health depends on paying private companies to administer short-term chemical escapes, rather than creating a society where people don’t feel so broken in the first place.

Sources:

Schatzberg, A.F. (2014). A word to the wise about ketamine. American Journal of Psychiatry, 171(3), 262–264.
Moncrieff, J., & Cooper, R.E. (2022). “Magic bullet” thinking in psychiatry: The case of ketamine. BJPsych Bulletin, 46(5), 285–288.
CNBC. (2023). Ketamine therapy clinics see booming business, but experts urge caution.
STAT News. (2024). Private equity eyes ketamine clinics as mental health crisis deepens.

Monday, June 24, 2024

The Future of Publicly-Funded University Hospitals (Dahn Shaulis and Glen McGhee)

There are more than 200 active university medical centers (UMCs) and 1,700 teaching hospitals in the United States. These institutions, tied to America's major universities, employ large numbers of medical professionals, administrators, and laborers. While UMCs have grown in size, dominating areas in major cities, locating facilities that are financially well, well-staffed, and adequately resourced has become more difficult.

Also known as academic medical centers or AMCs, UMCs feel the financial strain of a number of social issues: a growing elderly population, drug overdoses, mental health problems, gunshot wounds, victims of car crashes, children with severe illnesses, and numerous medical problems related to poverty. Some UMCs are trying to grow out of their financial problems by expanding their networks and buying up other facilities that may provide more profitability.

Private equity is also taking over hundreds of hospitals and clinics across the US, finding value where they can, however they can. Private for-profit hospitals, for example, will steer their most vulnerable patients to UMCs. And they will cut out programs they cannot profit from. Publicly funded university hospitals often cannot turn people away or dump patients if they cannot pay their medical bills--or if they are not covered by premium insurance.

While nurses and other medical laborers may be overworked and short-staffed, CEO pay is often $1M-$3M a year at larger institutions. And many medical centers, both public and private, are run with administrators focused more on cost containment rather than patient care and preventive care.

Simply adding money to these institutions without transparency, accountability, and reform not only makes the situation no better, it means less money for other areas of need, such as public health, K-12 education, safe and affordable housing, clean air and water, public transportation, and infrastructure.

Critical Condition

While the covid epidemic was horrifying for hospitals, the underlying conditions for many UMC's are a slow-motion disaster. University medical centers are facing financial challenges due to several key factors:

1. Rising costs outpacing revenue growth: Operating expenses, particularly for staff, facilities, and technology investments, are increasing faster than patient care revenue.

2. Reduced government funding: State support for academic health centers has been shrinking since the early 1990s. Federal and state funding for medical research and education has also stagnated or declined.

3. Lower reimbursement rates: UMCs are facing low reimbursement rates from Medicaid, Medicare, and commercial insurance. Cost-control measures introduced by the Affordable Care Act have also impacted revenues.

4. Legacy pension costs: Some UMCs are burdened with high fringe benefit costs inherited from state systems.

5. Increased competition: Many UMCs are too small to compete effectively in the current healthcare market against monopolies like HCA and Keiser. Their lack of scale gives them little leverage in negotiations for services and supplies.

6. Balancing multiple missions: UMCs must juggle patient care, research, and education. This can lead to inefficiencies, as physician time spent on research and teaching is less profitable than pure clinical care.

7. Infrastructure investments: UMCs need to make large investments in infrastructure and technology to maintain top-tier diagnostic and research capabilities

The main problem seems to be that the traditional financial model for academic medical centers is no longer sustainable in the current healthcare environment. Their operating costs are rising faster than their revenue sources can keep up, and they are struggling to maintain financial viability while fulfilling their multiple missions of patient care, research, and education.

Saving Lives is Unprofitable

Burn Units: Treating burn victims requires specialized staff and facilities, leading to high costs, while insurance reimbursements may not fully cover them.

Neonatal Intensive Care Units (NICUs): While essential, NICU care for premature or critically ill newborns is expensive due to the high level of support needed.

Trauma Centers: Trauma care often involves a high volume of resources and unpredictable patient conditions, making it difficult to predict or control costs.

Mental Health Services: Mental healthcare reimbursement rates tend to be lower compared to other specialties, making these programs less profitable.

The Bigger (Unhealthy) Picture

This strain at UMCs is under-girded by a dysfunctional and expensive healthcare system serving a population that is violent and unequal, and increasingly sedentary, unhealthy, disabled, elderly, and under psychological strain.

Around 40% of US hospitals are operating at a loss according to Kaufman Hall. And about half of all rural hospitals are running in the red. Obstetrics and delivery services are big money losers in these hospitals. Hundreds of these units, and their hospitals, are at risk of closing, leaving folks with longer travel times to get medical care.

In 2022, U.S. healthcare spending reached $4.5 trillion, or $13,493 per person. The cost of healthcare per person in other wealthy countries is less than half as much. Despite this enormous spending, US life expectancy is 3 to 4 years less than other OECD nations. For those with means, though, the US offers some of the best medical care in the world.

Zooming In

Financial problems and/understaffing and safety issues have been noted at:

University of Vermont Health Network (VM)

Nassau University Medical Center (NY)

CarePoint Health and Hoboken University Medical Center (NJ)
Rutgers Robert Wood Johnson Medical School (NJ)

George Washington University Hospital (DC)

Penn Medicine-University of Pennsylvania (PA)
University of Pittsburgh Medical Center (PA)

University Hospitals-Case Western Reserve (OH)
West Virginia University Medicine (WV)
University of Miami Health System (FL)

University Medical Center-LSU and Tulane (LA)
Detroit Medical Center-Wayne State University (MI)
Marquette University Health Care (WI)
Cook County Health-Rush University (IL)
University of Chicago Medical Center (IL)
Oregon Health & Science University (OR)

University of New Mexico Hospital (NM)
UCLA Health (CA)

University of California, including UC Davis (CA)

We expect to see more headlines about the declining finances at some university hospitals--and the downsizing that will follow. Fierce Healthcare has created a layoff tracker to monitor these events.

Related links:

Baby Boomers Turning 80: The Flip Side of the 2026 Enrollment Cliff

State Universities and the College Meltdown

American Hospital Association (AHA) Report: New AHA Report Finds Financial Challenges Mount for Hospitals & Health Systems Putting Access to Care at Risk (April 2023)

McKinsey & Company: Ensuring the financial sustainability of academic medical centers (July 2023)

PESP Private Equity Hospital Tracker

Tuesday, July 8, 2025

Share your stories about life and debt

Student loan debt in the United States has ballooned into a $1.7 trillion crisis, affecting over 43 million borrowers. Beyond the staggering figures, this debt exacts a profound human cost, influencing personal relationships, family dynamics, and long-term financial stability.

The Burden Beyond Graduation

For many, student loans are not just a financial obligation but a lifelong burden. A report by Demos indicates that an education debt of $53,000 can lead to a $208,000 lifetime loss of wealth. This financial strain often delays or derails significant life milestones. According to the Education Data Initiative, 51% of renting student borrowers have postponed homeownership due to their debt, while 22% have delayed starting a business.

Strained Relationships and Delayed Families

The weight of student debt extends into personal relationships. A study by TIAA and MIT AgeLab found that nearly one-quarter of borrowers reported that student loans have led to conflict within their families. Furthermore, the greater the student loan debt, the more likely borrowers are to delay key life events such as marriage and having children.

Multigenerational Impact

Student debt doesn't just affect individual borrowers; it reverberates across generations. Parents and grandparents often co-sign loans or take on debt themselves to support their children's education. The TIAA and MIT AgeLab study revealed that 43% of parents and grandparents who took out loans for their children or grandchildren plan to increase retirement savings once the student loan is paid off. This shift in financial priorities underscores the long-term impact of educational debt on family financial planning.

Mental Health and Emotional Well-being

Beyond financial implications, student debt significantly affects mental health. A study from Harvard Law School's Center on the Legal Profession found that 65% of borrowers reported that their total student loan debt or monthly loan obligation caused them to feel anxious or stressed. Over 70% of those with debts between $100,000 and $200,000 reported high or overwhelming stress levels.

Policy Shifts and Economic Consequences

Recent policy changes have further complicated the landscape for borrowers. The resumption of student loan collections, including wage garnishments and tax refund seizures, has placed millions at risk. As of early 2025, nearly one in four borrowers are behind on their payments, with over 90 days delinquent . This financial strain not only affects individual borrowers but also poses a threat to overall economic growth, as decreased consumer spending impacts broader economic stability.

Shredding the Fabric of Society

The student loan crisis is more than a financial issue; it's a pervasive force affecting the fabric of American life. From delayed life milestones and strained family relationships to mental health challenges and economic repercussions, the impact is profound and far-reaching. Addressing this crisis requires comprehensive policy reforms that consider the human stories behind the debt figures. Only then can we hope to alleviate the burden and restore financial freedom to millions of Americans.

Share Your Story

We want to hear from you. If you or someone you know is grappling with the weight of student debt, please consider sharing your story. Your experiences can shed light on the real-world implications of this crisis and help others understand they're not alone.

To share your story, please email us at gmcghee@aya.yale.edu with the subject line "Student Debt Story." Include your name, location, and a brief summary of your experience. We may feature your story in an upcoming article to highlight the human toll of student debt.

Together, we can bring attention to this pressing issue and advocate for meaningful change.

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