By Eisenberg, Barry; Romero, Lisa
Academe , Vol. 96, No. 5
Librarians and scholars who seek to counter the rampant commercialism and consolidation that endanger equal and affordable access to knowledge can learn from the recent successful effort to pass health-care reform.
After a long and contentious national debate, and after many failed attempts over the course of decades, health-care reform was signed into law on March 23, 2010. The goals of reform were twofold: to extend health care to the vast majority of U.S. citizens and to start to control health-care costs.
The need to reform the publication and distribution of academic journals is also great, and for the same reasons: scholarship should reach all who need it and be affordable. The central elements of the health-care debate can frame how the academic community approaches widening and accelerating the flow of scholarly journal content so all can benefit from it. In this article, we identify lessons from health-care reform and show how these lessons might be applied to periodical publishing and distribution.
The United States spent $2.4 trillion on health care in 2008, according to National Health Expenditure Projections, 2008-2018, a report issued by the U.S. Department of Health and Human Services. Almost $50 billion was spent on subscriptions to academic periodicals, according to the U.S. Economic Census. In both cases, over the course of decades, the rate of increase exceeded the consumer price index (CPI). Surely these industries differ in scope, size, and utilization. But there are three noteworthy parallels between them. First, both are vital to any advanced society. Second, we spend vast sums for their products and services. Third, similar forces and dynamics drove these industries to a place beyond the reach of many people who need their products and services.
Peer-reviewed scholarly journals remain principal repositories of research. Largely invisible to the general public, the publication and distribution of journal content have been at the center of a tug of war between cost and access; however, because subscription fees have been escalating for years, the balance has been shifting demonstrably toward cost, with less wealthy academics and colleges losing access. This is akin to the argument over whether health care is a "right" or a "privilege." Also, like managed-care companies in the health-care industry, publishers, aggregators, and distributors of scholarship have had a powerful influence on both prices and the scope of dissemination of published products, while profiting overwhelmingly from this arrangement. A brief examination of how health-care reform came to be urgently needed helps set the stage for how to reform academic periodical publishing.
The Health-Care Context
Since the end of World War II, costs for health care have escalated faster than the inflation rate and the CPI. In Health Care USA: Understanding Its Organization and Delivery, epidemiologist Harry Sultz and public-health instructor Kristina Young, both of the State University of New York at Buffalo, demonstrate that efforts to manage costs have been secondary to expanding coverage and maintaining standards of quality care. Reimbursement formulas placed an emphasis on capital development in which hospitals continuously acquired more technology. In Improving Health Policy and Management, Kenneth Thorpe explored health-care costs during the past twenty years and found that efforts to suppress health-care inflation were largely unsuccessful. For example, the Diagnostic Related Groups program, instituted in 1983 by Medicare to curb inflationary spending growth, established fixed fees for hundreds of diagnoses without meaningfully reducing costs. Comprehensive efforts to reform the health-care system, such as the Clinton initiative in the early 1990s, also failed. By the 1990s, health care had become intolerably unaffordable, with "employer-sponsored health insurance premiums . . . increasing 119 percent" between 1997 and 2006. …