Student debt crisis

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Sen. Lamar Alexander listens as Department of Education Secretary Betsy DeVos speaks to students at Sevier County High School, Tuesday, Nov. 13, 2018, in Sevierville, Tenn. The pair spoke about the newly launched myStudentAid mobile application. (Robert Berlin/The Daily Times via AP)

Sen. Lamar Alexander listens as Department of Education Secretary Betsy DeVos speaks to students at Sevier County High School, Tuesday, Nov. 13, 2018, in Sevierville, Tenn. The pair spoke about the newly launched myStudentAid mobile application. (Robert Berlin/The Daily Times via AP)

DeVos warns of crisis amid ballooning student debt


Associated Press

Tuesday, November 27

WASHINGTON (AP) — Education Secretary Betsy DeVos said Tuesday that ballooning student debt has caused a “crisis in higher education,” and that the traditional path to college might not be the best choice for all students.

DeVos made the comments in Atlanta at a training conference for the Education Department’s Federal Student Aid division, which oversees student loans awarded by the federal government. The department released a text of her remarks.

“Our higher-ed system is the envy of the world, but if we as a country do not make important policy changes in the way we distribute, administer and manage federal student loans, the program on which so many students rely will be in serious jeopardy,” she said.

DeVos said the federal government holds $1.5 trillion in outstanding student loans, a threefold increase from 2007 and a $500 billion increase from 2013. She said Federal Student Aid’s loan portfolio now accounts for nearly 10 percent of America’s national debt.

She blamed the Obama administration and its 2010 takeover of federal student loans, which stopped private banks from giving out federally subsidized student loans. DeVos says the decision encouraged colleges to hike their tuition rates.

“When the federal government loans more taxpayer money, schools raise their rates,” she said. “FSA financing accounts for 80 percent of the actual tuition and fee revenue received by schools.”

She said most of the loan growth since 2010 is tied to individuals taking on more debt, rather than a growing number of students taking out loans. She said 70 percent of the growth is tied to increases in individual debt, while 30 percent is driven by growing numbers of borrowers.

As a result, she said, many students are struggling to pay off their debt, with 43 percent of all loans considered “in distress” by the federal government.

“The parade of programs, repayment options and complex rules serves no one well,” she said. “Everything has become more cumbersome and confusing for everyone. The government monopoly has proven costly to taxpayers and it hasn’t been a panacea for students either.”

DeVos didn’t propose specific changes but laid out “core principles” that she said must guide changes to the student loan system. Chief among them is an emphasis on helping students find “the education that’s right for them,” even if it isn’t a traditional four-year university.

She also pushed for greater innovation in education, and better information to guide families and policymakers.

DeVos said the federal government must become a “more responsible” lender, but also said schools and families should bear greater responsibility as the nation tackles its student debt woes.

“Students — our human capital — must equip themselves to be responsible consumers of education with a serious commitment to their own success,” she said. “They need to have the best possible tools, data, advice, and support. And then they need to understand the implications of their decisions.”

Follow Collin Binkley on Twitter at

Opinion: Toward Humility in Health Care

By Robert Graboyes

Modesty is an essential ingredient of good medicine and good policy.

I’ve taught the economics of health to hundreds of physicians, nurses, therapists, administrators and other professionals. There’s no telling how many tens of thousands of lives they’ve saved. Though lecturing to such students is profoundly humbling, one of my principal goals is harnessing economics to teach humility to those who have much reason for pride.

In the 20th century, physicians attained godlike stature, a process described in Paul Starr’s book “The Social Transformation of American Medicine.” But the border between pride and hubris is porous, and hubris is a dangerous tonic.

My job is mostly to ask questions and poke holes in conventional wisdom — not to provide answers. Four documents described below help me in this effort.

“Determinants of Health” is a complex, but comprehensible, graphic produced by Edwin Choi and Juhan Sonin of GoInvo (a digital studio focusing on health care). It asks, “What explains differences in health across individuals?”

For providers, it’s sobering to see that medical care explains only 11 percent of the variation. Individual behavior (alcohol, drugs, diet, etc.) explains 36 percent; social circumstances (literacy, occupation, family circumstances, etc.), 24 percent; genetics and biology, 22 percent; and environmental factors, 7 percent.

This doesn’t mean medical care is unimportant. It might suggest that in pursuing health, one might spend the next million dollars on something other than medical care. It might suggest that health care isn’t to blame for America’s somewhat foreshortened average lifespan. The key is “might.”

“The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century” is a 1977 research paper by John and Sonja McKinlay. For my physician-students, a showstopper is the McKinlays’ graphs showing massive declines in deaths from measles, scarlet fever, tuberculosis and typhoid after 1900. Perplexingly, all four show effective medications (vaccine, penicillin, isoniazid, chloramphenicol) were introduced after the mortality declines, not before. What does this mean for health care? You decide.

Nobel economist Robert Fogel sought to explain why human mortality declined precipitously over the past few centuries. His 1996 paper “New Findings about Trends in Life Expectation and Chronic Diseases” mined centuries of data on agriculture, calories consumed in labor, military recruits’ height, incidence of bad teeth, and more. He found that medical care, public health and other conventional answers couldn’t explain the decline. The likeliest explanation, he found, was the decline in malnutrition during the first few years of life (including the months in the womb). No matter how well one eats later in life, poor nourishment in those early years, it seems, make organ failure and early death likely decades later.

A powerful implication is that in our well-nourished era, Americans may live longer than managers of pension funds (or Social Security) assume. Financial trouble ahead?

Finally, James A. Maccaro’s 1997 article “From Small Beginnings: The Road to Genocide” contrasted humility and hubris in mid-century European medicine. Leo Alexander, an American psychiatrist (and expert at the Nuremberg Trials) investigated why German doctors didn’t do more to stop the Nazis’ program of genocide and barbaric medical experimentation. He discovered they didn’t do more to stop the horrors because they were instrumental in creating them.

German doctors enthusiastically volunteered for servitude to, and leadership within, the Third Reich. Deputy Fuhrer Rudolf Hess declared Nazism “nothing but applied biology,” and many German doctors apparently agreed. They collectively decided that medicine’s primary purpose was building an economically productive populace — an emphasis that opened the floodgates for atrocities.

Dutch physicians, Alexander found, unanimously rejected this assumption after the Nazis conquered the Netherlands. They viewed their role as healing and comforting the sick and dying. Though threatened with punishment and death, humility assured that no Dutch doctors participated in the Holocaust.

Finally, let’s ponder the notion of humility with two fitting quotes: “Some of the biggest cases of mistaken identity,” economist Thomas Sowell wrote, “are among intellectuals who have trouble remembering that they are not God.” Novelist N.K. Jemisin once cautioned, “We can never be gods, after all — but we can become something less than human with frightening ease.”


Robert Graboyes is a senior research fellow with the Mercatus Center at George Mason University, where he focuses on technological innovation in health care. He is the author of “Fortress and Frontier in American Health Care” and has taught health economics at five universities. He wrote this for

At-home HPV tests could be powerful tool for hard-to-reach U.S. women

Pilot study found 80 percent of participants used the tests

COLUMBUS, Ohio – Screening women for HPV, or human papillomavirus, is a promising way to help detect cervical cancer early, but many at-risk women go without screening for the virus and without Pap tests that look for abnormal cells on the cervix.

A new study from The Ohio State University found that mailing at-home HPV tests to hard-to-reach women may be a viable approach, one that could be especially helpful in regions such as Appalachia, where access to women’s health care can be limited.

The study, which appears in the journal Sexually Transmitted Diseases, found that almost 80 percent of women who received the kits used them and sent them back to the researchers for testing. About a quarter of them tested positive for a cancer-causing type of HPV.

Women were first contacted to gauge their interest in participating in the study, then sent a screening kit to return by U.S. mail. The kit included a device called an Evalyn Brush that has a small brush on its end that a woman inserts like a tampon to collect cells from the cervix and/or vagina. Participants received up to $85 in gift cards for their participation, though they did not receive gift cards for returning their screening kit.

“The return rate was so much higher than we expected – we thought maybe 30 or 40 percent of the women would send the tests back, based on experiences in other countries,” said Paul Reiter, an associate professor of health behavior and health promotion at Ohio State.

“There’s a lot of interest in exploring more widespread use of these tests in the U.S., particularly to increase screening rates among women who aren’t getting regular care,” said Reiter, who is part of the cancer control research program at Ohio State’s Comprehensive Cancer Center (OSUCCC).

HPV is a very common virus; about one in four adults in the U.S. are infected with a cancer-causing type of HPV, according to data from the Centers for Disease Control and Prevention, which collaborated on this study. Most infections clear without causing health problems, but in some cases they lead to cancer of the cervix, vulva, vagina, penis, anus or throat. Almost all cervical cancers are caused by persistent HPV infection.

About half of the 103 women in this study, called the Health Outcomes through Motivation and Education Project, had not been screened for cervical cancer through Pap testing in more than five years. Current U.S. screening guidelines call for a combination of Pap testing and HPV testing every five years for women 30 to 65 years old and for Pap testing alone every three years for women 21 to 29 years old.

Rates of cervical cancer screening are lower than average in Appalachian Ohio communities in the southeastern part of the state where the women in this study lived, and rates of cervical cancer deaths are higher.

Many people do not know what HPV is, or how common it is, Reiter said, adding that HPV testing in conjunction with Pap smears is a powerful tool because it can alert a woman and her health care provider to health problems and help prevent cervical cancer. Women who have infections can be monitored more closely.

The researchers partnered with federally qualified health centers in southeast Ohio to identify the women in the study, which was co-led by Mira Katz, a professor of health behavior and health promotion and a researcher with the OSUCCC.

Initially, some providers at the Ohio clinics that participated in the study were concerned about at-home HPV testing, fearing that women might forgo other health services, Reiter said.

“But the reality is that many of these women are not coming in regularly anyway. We think these at-home tests can help open the door to follow-up visits to a health care provider,” he said.

Women who sent in an HPV test were notified that their results were available and advised to make an appointment with their local health center to receive their results. In the study, only 11 percent had a follow-up Pap test to screen for cervical cancer, and Pap testing was most common among those women with high-risk HPV types detected in their sample.

“We appreciate the importance of figuring out how to get these women to come to the clinic. One of the things that we would need to think about moving forward with our research is minimizing the drop-off we saw,” Reiter said.

“Ideally, this testing should be a springboard for getting women into the health care system.”

One limitation of the research is that the women who received test kits knew they were coming in advance, and had already agreed to participate in the study. Because of that, the researchers do not have a clear picture of how a broader program outside of a research protocol would be received, Reiter said. He and Katz are hoping to conduct a larger study designed to more closely mimic how a home screening program would work in a real-world setting.

“We’re really interested in seeing if we’d see the same level of enthusiasm if we did this among a much larger number of women without contacting them prior to sending the home test,” Reiter said.

Previous surveys had found that some women were apprehensive about the at-home tests, worrying that they’d use them incorrectly or that the sample wouldn’t be good enough for HPV testing, so the Ohio State researchers also tested a set of instructions they developed that was designed to be more user-friendly, using fewer clinical terms, and written in more of a story format with several pictures.

But they found no difference between the group of women who received the manufacturer’s instructions and those who used the experimental Ohio State materials.

The at-home HPV tests are widely used in other countries, including Australia and the Netherlands, but they are not yet an approved or recommended screening approach in the U.S.

Other Ohio State researchers who worked on the study were Abigail Shoben and Electra Paskett.

Funding came from National Cancer Institute and from Pelotonia, a grassroots cycling event that has raised more than $184 million for cancer research conducted at Ohio State.

The Conversation

In Georgia’s gubernatorial race, Stacey Abrams’ strategy may make victory easier for future black candidates in the South

November 28, 2018


Andra Gillespie

Associate Professor, Political Science, Emory University

Disclosure statement

Andra Gillespie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Democrat Stacey Abrams was poised to become America’s first black female governor in Georgia during the 2018 midterms.

She lost by only 1.5 percentage points. Because of allegations of voter suppression, Abrams felt duty-bound to legally challenge potential voting irregularities before offering any type of concession. By the time she exhausted those legal options, she still had fewer votes than Republican Brian Kemp.

Even though she lost, I still think she – and future black candidates in the Deep South – won.

Abrams’ candidacy – along with the breakthrough candidacy of Florida’s Andrew Gillum – help to dismantle the implied fear of many Democratic observers that black candidates cannot be viable statewide candidates, especially in the Deep South.

Few black statewide elected officials

In general, despite the election of Barack Obama and the near proportional representation of blacks in the U.S. House of Representatives, blacks are underrepresented in statewide offices like governor, U.S. senator and state attorney general.

In the more than 150 years since Reconstruction, there have been only two elected black governors, 14 lieutenant governors, five elected U.S. senators and, until Election Day, four state attorneys general. On election night, four African-Americans won races to serve their states as attorney general and one African-American won a lieutenant governor’s seat.

Scholars attribute part of the current disparity to demographics. While there are congressional districts with large minority populations that have a history of electing black representatives, no state has a majority black population that would likely do the same.

Because no state has a majority African-American population, scholars and political analysts have opined about the likelihood that non-black voters would be willing to vote for black candidates statewide.

States like Massachusetts and Virginia, which have larger white Democratic populations, have elected African-American governors. However, this has been less likely to happen in the Deep South, where racially polarized voting is more stark and gives the advantage to Republican, typically white, candidates.

For these reasons, African-American Democratic candidates for statewide office in Georgia, as in other parts of the Deep South, have often faced skepticism.

Sometimes, they have run as the sacrificial lamb candidate – the one who has no chance of winning, but runs anyway to ensure Democratic representation on the ballot.

Other times, seasoned black candidates, such as former Atlanta Mayor Shirley Franklin, have chosen not to run for statewide office. They decided not to waste political capital on a race that would be hard for any Democrat to win.

In lieu of willing black candidates, Georgia Democrats have often nominated centrist white candidates such as Roy Barnes or Jason Carter. They hope such candidates will win back working class or suburban white voters who started leaving the party after the civil rights movement and first helped to deliver the governor’s mansion to the Republicans in 2002.

Usually, regardless of their race, both the white and black Democratic candidates ended up losing.

In this context, Abrams offered a new path – one that did not pay off in this election, but will likely reap dividends in the long run.

A new campaign template?

Abrams proposed expanding the Democratic Party base in Georgia through voter registration and intensive voter mobilization designed to drive up turnout.

Her campaign invested in canvassing and phone banking operations, taking to heart the lessons imparted by scholars like Don Green and Alan Gerber, who demonstrated how canvassing and live phone banking increases voter turnout.

Abrams radically asserted a strategy premised not on trying to woo back whites who had left the Democratic Party long ago, but focused on building a new base of voters of color, whose population in Georgia is growing.

Abrams was challenging the practice that political scientist Paul Frymer referred to as Democratic “electoral capture.” Frymer argues that Democrats assume that they do not need to target campaign messages to black voters because data show roughly 90 percent of them vote Democratic.

Instead, Abrams looked at the diversity of the Democratic base in Georgia and argued that because of their strong Democratic voting behavior, blacks deserved additional campaign attention.

A community no longer taken for granted

By focusing on minority outreach, Abrams turned the notion of electoral capture on its head, arguing that Democrats could yield more black votes if they campaigned in black communities.

Moreover, as a serious candidate of color, Abrams also challenged the idea that only centrist white candidates could put together a formidable campaign coalition in Georgia. By expanding the electorate through voter registration and taking painstaking care to remind new and longstanding voters to turn out to vote, Abrams earned more votes than previous Democratic gubernatorial candidates.

Proportionally, Abrams earned slightly more support among white voters than Jason Carter, the last Democratic gubernatorial nominee. Thus, she outperformed her white Democratic predecessors using a wide-ranging and inclusive strategy.

So, even though Abrams lost this election battle, she still won in many important ways.

To be sure, Abrams’ race and gender subjected her to particularly bigoted attacks. And when I say that she still won, I am not ignoring the ways that voter suppression may have dampened her support. However, Abrams’ performance shows that black candidates in the Deep South can run effective, highly competitive campaigns.

Democratic candidates still face challenges running in solidly Republican states, but Abrams has provided a template for showing how black Democrats can be competitive, even in parts of the Deep South.

As such, the results of the 2018 election demonstrate that the implied fears about nominating serious black candidates for statewide office in the Deep South are misplaced. While party is still a disadvantage for any Democratic candidate in Republican-leaning states, black candidates like Stacey Abrams and Andrew Gillum have shown how they can navigate racial landmines and partisan disadvantages to run competitive races. Instead of assuming that black candidates will underperform their white counterparts running for statewide office, perhaps we should focus our attention on rooting out institutional burdens that may make equal access to the ballot more difficult.

Sen. Lamar Alexander listens as Department of Education Secretary Betsy DeVos speaks to students at Sevier County High School, Tuesday, Nov. 13, 2018, in Sevierville, Tenn. The pair spoke about the newly launched myStudentAid mobile application. (Robert Berlin/The Daily Times via AP) Lamar Alexander listens as Department of Education Secretary Betsy DeVos speaks to students at Sevier County High School, Tuesday, Nov. 13, 2018, in Sevierville, Tenn. The pair spoke about the newly launched myStudentAid mobile application. (Robert Berlin/The Daily Times via AP)
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