Over the weekend, I caught parts of North Carolina’s 15-10 win over TCU in Dublin, Ireland and NC State’s loss to Virginia 34-8 in the ACC opener. All told, the NCAA Week Zero schedule included 8 games with few surprises but a welcome arrival to the sport’s avid followers including me.

As the NCAA commences its Week One schedule with 87 games Thursday thru Monday on tap, I find myself conflicted. I am a college football fan having watched religiously for years. Growing up in Chattanooga, Thanksgiving Day started with worship at Central Church of Christ, lunch at S&W Cafeteria downtown and Chamberlin Field in the afternoon to watch the University of Chattanooga Moccasins take on the likes of Southern MS and Furman. And News Year’s Day Bowl games were equally sacred: the Cotton, Gator, Orange, Sugar and Rose Bowls featured marque teams who’d survived to 10-game seasons and final rankings were determined by sports media. Pop would re-locate our second black and white TV to the den so we could watch 2 at once (provided the rabbit ears were aimed right). And Mimi made unhealthy Vienna sausage wraps so we never had to leave the room.

Those days are gone. That was before NIL (name, image and likeness) money poured in to lure elite athletes to the highest bidders. That was before the 5 major bowl games played on New Year’s Day morphed into 46 bowl games lollapalooza played over 45 days. That was when the Big 10 had 10 mostly midwestern teams (vs. 18 today including Oregon, Washington, USC and UCLA) and the SEC had 12 mostly southeastern teams vs. 16 today which include Teas and Oklahoma this year. And that was when a family of four could afford to attend a game: per StubHub, tickets for my most cherished contests this season will be $550 to $9093 for Texas-Ohio State September 12, and $434 for the “get in” seats to $4657 for the Michigan-Ohio State matchup November 28.

On Bill Maher Saturday night, Wesleyan University President Michael Roth answered the hyper- cynical host’ questions about the value of higher education and left-leaning faculty bias. Wesleyan is among the three “Little Ivies” (along with Amherst and Williams) where the curriculum is liberal arts, tuition is high, intercollegiate athletic competition is modest and politics is decidedly progressive—a “monoculture” per Roth. Maher questioned whether higher education today educates young adults to be informed, critical thinkers or indoctrinates leftist ideology. Roth countered that college faculty engage students to be thoughtful on issues otherwise overlooked/neglected.  Maher ended ‘it’s not working.’

Their dialogue might have been about healthcare. The health system, like higher education, faces a crisis of confidence and its future is being defined by its finances. The health system’s version of NIL centers on aim now centers on business models for specialty services in modern facilities. The Big Players in both industries– consolidated hospital systems, big multi-specialty medical groups, corporate insurers and universities with Big Endowments and Big Athletic Department budgets– are doing well while others struggle.

Higher education and healthcare face extinction as we’ve known them. The public thinks their purpose has been compromised by their growing dependence on private capital—boosters, donors, investors, private equity, and corporate partners. Public money plays a small role for the Big Players. The unintended consequences are well documented—higher prices for tuition and services, variable levels of institutional quality based on access to funds, and increased polarization between have’s and have nots.

In healthcare, it’s no secret. Physicians who specialize make 3 times what primary care clinicians earn and 10 times community health worker annual wages. The 2Q earnings of the nation’s multi-hospital systems were robust per Fitch while small and independent hospitals struggled. The same dynamic holds true for nursing homes, health insurers and public health programs—Darwinian reality that money matters (sometimes too much). In healthcare, it’s manifest in a growing number of shifts…

• CMS’ crackdown on fraud, waste and abuse to protect public money is healthcare.
• Congress’ Bipartisan demand for price transparency and limits on private equity ownership of nursing homes, hospitals and medical practices.
• Court challenges to monopolistic-like business practices that control licensing, drug patents or even the CPT coding system.
• Public belief that an unforeseen medical bill will bankrupt the average household.
• The public’s growing acceptance of embracing alternative sites and methods of care and ways of paying for them.
• And recognition by industry leaders that industries like healthcare and higher education face uncertain futures.

I will watch college football this weekend and, no doubt, hear lots about star players one year removed from their previous NIL contracts. They’re usually the highest paid and best known on the team. And, for some of that team’s followers, their performance on the field will matter more than their education off the field and the academic performance of the school.

Healthcare and higher education are institutions of noble, essential purpose to society. Both face criticism they’ve lost their way and their value propositions are suspect.

PS: Last week, Dolly Parton died leaving a legacy of music and philanthropy appreciated worldwide. I first met Dolly and Carl as he inspected the paving job his company completed in my neighborhood and later as a Vanderbilt Medical Center donor ambassador. A life well-lived and worthy of respect and appreciation.

This week, a jury verdict is expected in the trial of Lindsay Clancy that will put the spotlight on postpartum psychosis — a rare, severe psychiatric emergency that causes a rapid loss of touch with reality after childbirth. It’s is not currently included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but there’s momentum to have it added.