President Obama’s proposal of August 2013 to tie individual students’ financial aid to government ratings of the college they attend is perhaps the worst idea ever put forward for higher education by a sitting president. Two of the major proposed metrics — graduation rates and post-graduation employment and income — are inexorably bound up with the nature of the students that the colleges serve. Poverty, poor preparation, commuter and part-time attendance, and non-traditional adult age status are all highly correlated with lower completion rates.
Add the third major Obama proposed metric — affordability — and the administration has put an admirable set of non-profit educational institutions in the crosshairs. By history, mission and commitment, they serve student bodies disproportionately drawn from disadvantaged, underserved populations. These institutions, most of them animated by deep religious or social activist traditions, are neither as inexpensive as public institutions nor as successful by conventional measures as wealthy, selective, private institutions that by and large serve the children of the upper reaches of the social order.
If the Obama administration has its way, many good colleges could be marked for extinction, or driven to subvert their ideals by jettisoning at-risk students to lower their own risk of failing the ratings test.
This is not an abstract possibility. There is a telling historical precedent for the consequences of applying a well-intended rating system to a heterogeneous collection of institutions of higher education, with devastating consequences for those serving marginalized populations. In 1900, the United States had about 160 medical schools of extraordinarily variable quality, ranging from small storefront diploma mills to research institutions like Harvard and Johns Hopkins. There was also a developing consensus that medical education needed to better reflect the scientific revolution in medicine of the preceding century and to offer deeper clinical experience. A reform movement developed with the admirable aims of professionalizing medical education based on scientific research and tying teaching directly to hospital practice.
This movement succeeded. The quality of physicians improved immensely as a result — but in the process it cut the number of American medical schools in half and almost destroyed medical education for African Americans and women. By 1923, eight of the 10 Black medical schools that existed in 1900 were out of business. Only Howard and Meharry survived the purge, and then only barely and by special dispensation. Women’s medical schools did not fare any better. By 1930 six of the seven early 20th century women’s medical schools were extinct. Opportunities for medical education for African Americans and women were severely curtailed and did not recover until the social movements of the 1960s and 1970s forced fairer, more enlightened admissions policies.
Before this drastic change, the profession of medicine was accessible to motivated working-class individuals. After their implementation, it became a bastion of upper-middle-class White males and remained so for decades after. In addition to curtailing individual opportunity, this led to a major loss of physicians serving urban minority communities and rural areas, problems that still afflict American medicine.
A major catalyst for this social catastrophe was a rating system not so different from that proposed by the Obama administration. In 1907 the reform-minded Committee on Medical Education (CME) of the American Medical Association (AMA) developed a rating system to grade each existing medical school as “A” (acceptable), “B” (needing improvements but redeemable), or “C” (in need of complete reorganization). Criteria for good ratings included enforcement of entrance requirements, a coherent curriculum, and adequate library facilities.
