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John Harvard's Journal

Frenetic Fall

November-December 2014

Rakesh Khurana

Rakesh Khurana

Photograph by Michelle Jay/Harvard University

The fall semester began with a lot of news, including capital-campaign developments (see “Capitalizing,” page 26); the annual endowment report (plus announcement of the investment managers’ new senior leadership—see “Close to Par,” page 32); and further discussion of divestment and climate change (see “Divestment Discussions,” page 35). Herewith, some additional opening-weeks highlights—including a cutback in Harvard employees’ benefits.

Freshman Convocation. The young Harvard tradition (b. 2009), held this year on a summery Labor Day, featured just-hatched College students and their freshly minted Harvard College dean, Rakesh Khurana, master of Cabot House—also masterful at self-deprecation. Khurana said he shared the students’ anxiety as well as their excitement, and joked, “I’m 46 now and I still think medical school might be my possible next step if this whole deaning thing doesn’t work out.” (A twenty-first-century dean, he maintains an Instagram account and conducted an Instagram-mediated scavenger hunt/campus tour for his new charges.)

In a serious vein, Khurana underlined the difference between what he called “transactional” and “transformational” experiences in the intellectual, social, and personal realms. In the former, “you are reenacting the script that in many cases has worked for you up to this point.” Transformation is “the harder route,” but “If we are to tackle our most important challenges as a society—poverty, environmental degradation, justice, and health—a more transactional approach will not get us there.”

President Drew Faust touched on diversity and inclusion, telling the members of the class of 2018, “You now are Harvard” (echoing minority students’ “I, Too, Am Harvard” campaign of last spring), and reminding them of a sight that had greeted them on move-in day: lists of individuals who had occupied their dormitories in years past. The very earliest names, she noted, were white, male New Englanders, but the rosters transform over time. Read more at harvardmag.com/2018-14 and harvardmag.com/hunt-14.

Morning Prayers. Faust amplified that theme at Morning Prayers the next day. For most students, faculty, and staff, she said, the University would be the most diverse community they ever encounter—and the 6,000 newly arrived students had chosen to join such a diverse place. “Our differences are the foundation of our greatest strength, enabling each of us to grow beyond who we could be alone,” she declared. “That is the ideal of the symphony. The orchestra would not sound nearly so good if it was just made up of 100 oboes.”

But coming together, Faust noted, is never easy. She cited conflicts around the world that “seem to be tearing peoples apart”—a nod to unrest in places as far away as Gaza and Ukraine, and as near as Ferguson, Missouri. Frictions felt by “those who have felt marginalized or unsafe” have played out even closer to home, she said. Enriching diversity “is not something that just happens—without effort, without practice, without difficulties. It is a commitment. It requires work. And the notes we play will not always be perfect.” On this first day of the new school year, Faust asked community members to rededicate themselves to “all together performing that Harvard symphony.” Read more at harvardmag.com/prayers-14.

Learning and Teaching. Speakers at the third Harvard Initiative for Learning and Teaching (HILT) conference, on September 16, considered student engagement and distance (both in being distanced from learning, and in distance learning). In an initial discussion of innovation, Mallinckrodt professor of physics Melissa Franklin said she aimed “to get the students to do their own synthesizing—we never show them how to put it all together.”

In one of seven pedagogy-focused breakout sessions, the faculty for a course on “International Humanitarian Response” described putting students in the woods for three days to teach crisis management by simulating a natural disaster in two sub-Saharan countries. Eighteen teams assumed roles that required them to provide medical services, water, or shelter. “That upped the tension,” explained HILT reseach fellow Selen Turkay. “Just-in-time teaching” included situations such as encountering a villager wounded by a land mine—object lessons in managing stress.

At lunch, Malia Mason, Gantcher associate professor of business at Columbia, talked about “mindshare,” demonstrating how much time they spend on social-media diversions, at the expense of discretionary tasks—like studying. HILT’s research director, Samuel Moulton, charted how attendance at lecture classes atrophied during the course of a semester, noting, “People vote with their feet.”

That set up an observation by Peter Bol, vice provost for advances in learning, during the final panel. Students at MIT, he reported, initially objected to “flipped classrooms,” in which they watched recorded lectures before attending class and then participated in learning exercises—precisely because that made them show up for class. Bates College president A. Clayton Spencer (a former Harvard vice president) suggested the institutional stakes in the attention now focusing on pedagogy when she said that “the sleeping giant of the Research-1 university has just woken up and gotten interested in what we [small liberal-arts colleges] thought we did best: teaching. They are…throwing all they’ve got at this.” She added that “the liberal-arts colleges have gotten pretty lazy about the ‘Small is good’ idea. Large can be very good, very powerful, and very beautiful. Unless we get over ourselves in liberal arts, we’re in a heap of trouble, because we’ve lost our distinctive market niche.”

Read a detailed account of the day at harvardmag.com/hilt-14.

Changing Terrain for Employee Benefits. And in an early-September human-resources e-mail, faculty and nonunionized staff members learned that their health-insurance coverage would become more costly. Atop co-payments for office visits and prescriptions, they will, effective January 1, become responsible for annual deductibles of $250 per individual and $750 per family, and coinsurance (equal to 10 percent of costs), for hospital expenses, surgeries, diagnostic testing, and outpatient services. The individual out-of-pocket maximum for such expenses is $1,500 per year; for families, the ceiling is $4,500 (present limits are $2,000 and $6,000). Co-payments for office visits and prescriptions will count towards these thresholds, above which Harvard resumes paying 100 percent of the costs. (Preventive care remains covered at 100 percent.)

These changes align University health benefits for nonunionized employees more closely with national norms—but faculty and staff members have been accustomed to Harvard’s traditionally full insurance coverage. The University indicated that Harvard’s cost savings would be sufficient to reduce employees’ healthcare premiums in 2015 by about 2 percent (they were otherwise expected to increase by about 3 percent). But it declined to disclose either how much Harvard spends now on health benefits or the anticipated dollar savings from the change in coverage. The effect on employees will be buffered somewhat: Harvard will reimburse part of the new charges (as it does co-payments) for covered employees who earn less than $95,000 annually.

The changes touch on the national discussion of healthcare and employee benefits. In her message, vice president for human resources Marilyn Hausammann wrote that “benefits have grown to consume 12 percent of the University’s budget (from 8 percent) over the past decade.” A review of past financial statements suggests that shift was driven by changes in pension costs and accounting in fiscal year 2003—but there has not been much relief since. The University’s health coverage, in the view of faculty experts at Harvard Medical School and Harvard School of Public Health, has been very generous—and that coverage pays for care in a market with very high-quality providers, who charge some of the highest prices in the country.

The changes in coinsurance and deductibles don’t address those factors. As some of the faculty experts point out, high local costs are associated with academic medical centers: the very hospitals affiliated with the medical school. (There is research demonstrating that the costs vary a lot—and often far more than the quality of care, when provided by community hospitals, for instance, versus the most sophisticated tertiary-care hospitals.) Scholars have discussed how to provide health insurance in tiers, for service options carrying varying costs. But there is little appetite for insurance that is tightly tied to the medical “value” of care, or to provider networks with differing prices. Even the Harvard Union of Clerical and Technical Workers (whose members are not immediately affected by the changes, which are subject to contract negotiation), a sharp critic of Harvard’s approach of shifting costs to employees, has not proposed tiered insurance plans. The union did release a white paper outlining changes in medical services (better use of mail-order prescriptions, attempts to reduce emergency-room use for urgent care, and so on); it calculated savings of $5 million to $6 million annually.

Hinting at the large issues still looming, the union paper noted, “Current research suggests that the problem of unnecessarily high-cost hospital care is particularly acute for hospitals in the Partners HealthCare system. If a carefully-designed program could gently push Harvard patients away from Partners for routine care, without taking away the opportunity to receive appropriate care in areas where Partners hospitals are world leaders, the potential savings are great.” Treading delicately, it continued, “This is a complex…area both for the University (because Partners hospitals are Harvard-affiliated…) and for employees (because the quality of care at Partners facilities…is so highly regarded).”

It may take all the health-policy and -economics expertise at the University’s disposal to solve that problem, for Harvard and the wider U.S. healthcare system. A report on these issues can be found at harvardmag.com/health-14.