Are for-profit colleges worth the cost? Students and employers seem ambivalent, according to Public Agenda research, summarized in this 2014 report.

Current and former for-profit students are satisfied with the quality of their schools. But they also consider the financial burden of these schools high, and alumni in particular aren't certain their degree was worth it.

Many employers perceive no differences between for-profit and public sector institutions, and some are actually unfamiliar with for-profit schools. Among those who do see a difference, most say community colleges and four-year public universities do a better job than for-profits at preparing students for the workplace.

Generally, students – prospective, current and graduates – and employers also seem quite distanced from the enthusiastic policy conversation about for-profit colleges. For-profit colleges dominate headlines (most recently because of federal government scrutiny) and are a top concern for education leaders and policymakers. But most students and employers are actually unfamiliar with the term. Many for-profit students don't even realize that the school they're attending is a for-profit.

Moreover, leaders in higher education, the federal government and philanthropy invest time and effort to make comparative information about colleges more easily accessible and engaging so that students can make informed – and presumably better – decisions about their education. These findings suggest that for-profit students are not comparative shoppers. Just 39 percent considered more than one school before attending, and 20 percent considered a not-for-profit.

The findings from this study also bolster those from on our companion report, "Is College Worth It for Me?" which suggests that efforts and information to help students choose the college that's right for them are not connecting with prospective students. While for-profit alumni say incoming students should pay "a great deal" of attention to statistics like graduation rates and the types of jobs graduates get, most current students do not know this information about their own schools.

The research was funded by The Kresge Foundation and is based on representative surveys with employers, current for-profit undergraduates, for-profit alumni, and prospective students between the ages of 18 and 55. The report also includes findings from focus groups with employers and adult prospective students.

We explore the findings in more depth below. Be sure to download the report for the full story.

Current Students and Alumni Are Enthusiastic About Their Schools' Quality

Students and alumni are clearly enthusiastic about their schools on a number of quality measures. For example, they agree that their schools have caring instructors, keep class sizes small, and give effective guidance (though alumni are slightly less enthusiastic). Current students also say their schools allow them to make good progress in their course of study.

But They Worry About Cost and Long-Term Value

Both students and alumni say their schools are expensive, and nearly half (47 percent) of current students say they worry "a lot" about taking on too much debt.

Alumni in particular are skeptical about the value of their degree, with 32 percent saying their degree "really wasn't worth it." (Thirty-seven percent say their degree was "well worth it"; 30 percent say it "remains to be seen.")

Furthermore, 4 in 10 say their schools were more concerned about making money than about educating students (only 20 percent of current for-profit students feel this way.

We did speak with for-profit alumni during a down job market, which may have an effect on their perspective. Nevertheless, it is certainly the case in this study that many graduates from for-profit schools put some blame on their schools for not adequately preparing them for the job market.

These findings are illustrated in the video below:

Prospective students considering for-profit colleges have distinct priorities

Adult prospective students who are considering a for-profit college are more likely to say that qualities like the availability of online classes, accelerated programs and hands-on support services are absolutely essential when they are choosing a school.

The research doesn’t establish whether there is a causal relationship between these individuals’ priorities and the schools they are favoring. However, these findings, combined with the satisfaction we see among current for-profit undergraduates, certainly raise an important question that warrants further digging: Are for-profits better than public institutions at serving the needs of some students?

Employers Are Still on the Sidelines

About half of the employers surveyed see few differences between for-profit and not-for-profit colleges. The other half typically view public institutions as superior on a number of counts. For example, 41 percent say public universities do a better job preparing students to work at their organizations.

Students Are Unfamiliar with the Term "For-Profit College" – Even When They're Attending One

The research also reveals a startling lack of awareness among students about the overall concept of for-profit colleges, especially in contrast to the energetic debate about the sector among experts, policymakers and the media. Many students who are attending or graduated from a for-profit school say "nothing comes to mind" when they hear the term. Over half of adult prospective students considering attending a for-profit school say the same. Furthermore, a full 65 percent of current for-profit students and 63 percent of for-profit alumni are unsure whether their school is for-profit or not.

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Employers also lack knowledge on for-profit schools. Seventy-six percent haven’t heard or don’t know much about local for-profit schools in their own metropolitan area and 50 percent don’t have an opinion about large national for-profits like the University of Phoenix or DeVry. But nearly nine in ten (87 percent) are familiar with and opinionated about their region’s public universities.

Incoming Students Not Well-Informed About College Choices

Students from for-profit schools – who often come from economically vulnerable populations – are not comparative shoppers. Many are selecting schools without having weighed different options. Just 39 percent of for-profit undergraduates and 32 percent of for-profit alumni had considered more than one school before they enrolled at their current institutions. Students are even less likely to compare for-profit with not-for-profit schools before enrolling, with just 20 percent of for-profit undergraduates and 11 percent of alumni having considered a not-for-profit college. Parallel research with community college students suggests that "comparative shopping" is uncommon among other types of college students as well. Many students seem to be drawn to either for-profit or not-for-profit schools, though rarely to both.

As our Research Director, Carolin Hagelskamp, put it, "I think sometimes policymakers have this idealistic vision of students sitting down with spreadsheets, comparing colleges across columns and columns of data. But the reality is that most students in this research are not really making comparisons at all. They rely on recommendations from friends and families and hear about schools through ads or because they pass by the schools on the street."

The research also suggests that incoming students may not understand how existing data about average student debt and the jobs and salaries of typical graduates relate to their college searches. Even though current for-profit students worry about debt, 61 percent do not know how much debt the average student from their school graduates with. With the benefit of hindsight, for-profit alumni say this information is valuable. Seven in 10 alumni say students should pay a "great deal" of attention to student debt data before enrolling, and 72 percent recommend incoming students pay attention to the types of jobs and salaries graduates typically get before enrolling. The research indicates that these alumni's insights still need to be bestowed on prospective students.

This report is part of a larger project surveying the attitudes of various student and employer groups toward issues in higher education, including online education, for-profit colleges and the needs of nontraditional students. To read the findings from these surveys, see the reports Is College Worth It For Me? and Not Yet Sold.

Public opinion generally isn’t static. As people engage on complex issues and weigh trade-offs, their views tend to evolve. We study this evolution through a process we call Learning Curve Research, which uses a variety of methodologies. (We call it Learning Curve Research because it's based on our founder's Learning Curve theory of public opinion.)

For "Curbing Health Care Costs," we convened 3 extended deliberative focus groups plus 1 pilot focus group, with a total of 44 Americans.

Each participant had at least some recent contact with the health care system as patients. Participants were 40 to 64 years old. We expected that this age group – as patients and potential caretakers of children or elderly parents – would have the broadest perspective on the health care system. This is also a politically significant group that tends to vote at high rates.

Participants were also recruited to represent a broad cross-section of the public in terms of gender, socioeconomic status, race/ethnicity and health insurance status. Focus groups took place in professional focus group facilities and all participants were compensated for their time.

First, participants engaged in three-hour focus groups divided into three main parts:

1. Participants had a general conversation about the health care system, the quality of care they receive and their experiences with costs.

2. Facilitators presented participants with information about the nation’s healthcare costs, including cost and quality comparisons over time, across countries and across different areas in the United States. Participants responded to the information, asked questions and discussed it as a group. This information is available for download here.

3. After a short break, participants deliberated over three approaches to addressing the nation’s health care cost problem using a Choicework discussion guide developed by Public Agenda, which you can read here. The policy approaches were based on a review of reforms and changes to the health care system that leaders and experts have proposed, are experimenting with or have already implemented.

The choices are not meant to be exhaustive or comprehensive, but to provide a basis for deliberation and reflection. The discussion guide laid out a set of concrete practices and policies that could help address the health care cost problem, including the advantages and trade-offs of each approach.

The choices, in brief, were:

• Approach A. Give people more responsibility for their health and health care.

  Participants discussed measures that were geared toward ensuring that people have more “skin in the game” through taxes on unhealthy lifestyle choices, high-deductible insurance plans and copays, as well as more choice among insurance plans and health care providers.

• Approach B. Make sure doctors and hospitals work in smart, cost-effective ways.

  Participants discussed the issues surrounding payment reform, including pay-for-performance and charging flat fees per patient or episode of care, as well as incentivizing providers to work in teams, coordinate care and share electronic health records.

• Approach C. Contain health care costs by regulating prices.

  In this approach, participants discussed the pros and cons of capping health care prices, regulating insurance markets, bringing generic drugs to market sooner and expanding access to Medicare.

Before and after the group sessions, participants completed surveys that assessed their awareness of and opinions about health care costs, their issue knowledge and their sense of efficacy to effectively deliberate with fellow citizens.

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Finally, we conducted follow-up telephone interviews with all participants, within a week after the focus groups. The interviews explored what participants took away from the conversations and how they were thinking about the various approaches to reducing spending after they had the time to “sleep on” the issues and perhaps discuss them with others.

These interviews also gave participants opportunities to reflect on the deliberative research process and to express views they may not have shared in the groups.

The deliberative focus groups were conducted in Secaucus, New Jersey; Montgomery, Alabama; and Cincinnati, Ohio. A pilot was conducted in Stamford, Connecticut, allowing us to test the Choicework guide, graphs and charts on health care costs, the moderators guide and the surveys.

Health care experts may assume that insurance shields most Americans from the actual costs of their care, leaving them unconcerned about cost effectiveness. And, in the past, the public seemed relatively disinterested in talking about efforts to contain cost. This research raises the question: if we help citizens learn about and deliberate over approaches to contain costs, could they contribute to policy solutions?

For "Curbing Health Care Costs," average Americans aged 40 to 65 gathered, in a series of 4 extended focus groups, to address cost containment in health care. When given the opportunity to learn about and deliberate over various policy proposals, focus group participants became not only willing but eager to consider complicated approaches for containing health care costs. And they did so thoughtfully and civilly.

The research, while modest in scope, provides substantial clues for health care leaders and policymakers regarding the approaches that the public may be more willing to accept and those that they may resist. It also provides guidance to enable leaders to better communicate with and engage the public on cost containment approaches.

Participants in the study also believed that other members of the public, as well as medical professionals and insurers could benefit from similar opportunities to deliberate. While participants didn't reach consensus, they all reported a better understanding of viewpoints different from their own. Many remarked that the civility and quality of their deliberations were evidence that health care leaders and policymakers COULD compromise.

Other Findings:

Even insured participants were deeply concerned about their personal health care spending and the uneven quality of the care they receive. They frequently identified insurance and pharmaceutical companies as causes of rising costs. But they also blamed doctors and hospitals for greed, inefficiency and over treatment.

Participants were eager to talk about how much national spending has risen. Variations in spending and health outcomes across the country and internationally elicited considerable surprise. But the facts alone were not enough. Participants needed time and discussion to make sense of this information. They raised urgent questions about why costs have increased while Americans’ health has not improved.

Participants supported policies that would encourage providers to work together more effectively. They also saw pros and cons in various approaches to payment reform under which insurers would pay physicians some variation of flat fees—per year or per care episode, for example—rather than for each service performed. They agreed that this could reduce over treatment but raised concerns about whether it would lead physicians to skimp on care.

Participants wanted to see limits on what insurance companies, hospitals, and doctors can charge. At the same time, they were divided over how much the federal government should be involved in health care.

The idea of shifting more costs to individuals was troubling to most participants. While many acknowledged that paying more out of pocket could spur more judicious use of medical services, they were already chafing at the increased personal costs they’ve experienced in recent years. Participants worried that further cost sharing could lead people to avoid getting the care they need. They also noted the reasons that make it so difficult for patients to compare prices and shop around for medical services.

Implications:

For communication:

This research highlights the kinds of concerns and attitudes that Americans bring to conversations about the nation’s health care spending crisis, and the places where they may lack enough information to understand its causes and to judge potential solutions. It demonstrates what happens when citizens have the chance to consider and work through information about trends and variations in spending and health outcomes. And it begins to indicate how they may weigh various policy approaches.

State and federal agencies, insurers and employers are figuring out how to implement health care reforms, cost-saving measures and new ways of purchasing insurance. A more nuanced understanding of public perspectives can help them design policies that will work for patients and their families and communicate more clearly about pending change.

For physicians, nurses and other front-line professionals, understanding these public concerns will be crucial to implementing successful change.

For public engagement:

If, as this research suggests, members of the public are ready to engage more thoughtfully on the challenge of health care costs, then their perspectives can play a robust role in fostering better practices and policies to control costs and improve quality. This role includes participating in how insurance plans are designed, how medical providers deliver care, and how policies encourage further change. Deliberative engagement in a range of settings could help advance this through local initiatives to improve health services.

For example, employers and unions who must deal with significant insurance and health costs could stand to gain significantly from understanding their employees’ and members’ views, educating them and working with them to use benefits and health care more effectively and efficiently.

Community-based organizations and patient advocacy organizations would also be natural places to bring people together to engage with and deliberate over cost-savings practices and policies, from preventive medicine to better use of emergency rooms to Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).

Local and state officials in collaboration with community-based organizations could reach out to their constituents – not only to inform them about changes in the health care system, but to give residents opportunities to share their views, deliberate and influence policy decisions.

This work can and should also inform federal lawmakers’ and regulators’ considerations and decisions, especially as the current federal role in the health care system is not well understood and any changes to that role are controversial.

For policy:

While the scale of this research is small, it provides clues about the policies that Americans will most easily accept and those that are likely to elicit the most resistance.

Coordinated care and electronic medical records held wide appeal. Payment reform was intriguing but raised concerns about whether quality would suffer.

Government price setting was more contentious – and people do not necessarily understand how much the federal government is already involved in health care through Medicare, Medicaid, the military and the FDA.

The suspicions of primary care that we found among our participants mean that Patient-Centered Medical Homes may need to consider how to gain patients’ trust and respect.

Finally, participants were quite dissatisfied with the poor service they so often receive in the health care system. But some policymakers, insurers and employers want patients to act more like savvy shoppers. If they want to achieve that goal, they will have to do a better job of treating patients like valued customers.

For future research:

The health care system is changing. How will public opinion change along with it? Payment reform is central to many reform efforts. But participants in our research had not encountered payment reform before; some did not seem to be aware that the current system is predominantly fee for service. Many worried about getting the right balance of benefits and trade-offs from payment reform.

Future research should track changing public views on, and experiences with, different approaches to payment reform. And because payment reform is supposed to improve quality, future research should also assess how payment reform changes patients’ experiences of care and views on cost savings.

Benefits are increasingly being designed to give Americans more financial responsibility and choice in health care. But our work suggests that citizens may not be fully ready to embrace these responsibilities. How will increased cost sharing affect when and how people seek care? How can insurance plans, hospitals, clinics and medical professionals engage people in medical decision making that is better for their health and for their wallets?

Finally, research on the perspectives and experiences of newly insured Americans who gain coverage under the ACA will be vital to helping actors across the health system adapt in patient-centered and cost-effective ways.

About the Research

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Public Agenda, in partnership with the Kettering Foundation, used an innovative qualitative methodology called Learning Curve Research with Americans aged 40-64 in 4 cities around the country.

In this exploratory research, participants first engaged in open discussions about their views and experiences with the health care system. Next, the groups were presented with key facts about the nation’s health care spending and listened as they asked questions and worked through what those facts meant.

Participants then engaged in facilitated deliberation, during which they considered and discussed three different approaches to getting health care costs under control. Then in small surveys and one-on-one follow-up interviews, participants reflected on the deliberations and talked about their views.

For a more detailed description about the methodology for this report, click here.

It’s reasonably clear that younger and older Americans think differently about tattoos. And maybe there’s a divide over e-mail versus texting. But now that Congress and the President are resuming talks about long-term federal budget issues, proposals to reform Social Security to stabilize its costs are back on the table.

In contrast, opinion leaders like Paul Krugman and Senator Elizabeth Warren say we should expand Social Security, arguing that current retirement policies will leave too many Americans living in poverty in their later years.

So that raises a question: Are the views and preferences of younger and older Americans really at odds when it comes to Social Security? What do polls show, and what happens when Americans of all ages have a chance to talk together about this issue?

The answers to these questions will be important for us to explore as we and our elected officials discuss and negotiate solutions to the issue of Social Security.

A quick glance at some recent polling does seem to show some wide gaps among the generations:

As you can see in the charts above, a solid two-thirds of people over 65 say preserving Social Security is more important than reducing the federal deficit, while less than half of Americans under 30 agree. Also, fewer older Americans worry that the costs of Social Security and Medicare will burden the next generation.

Numbers like these fuel claims that the nation’s seniors are “greedy geezers” preoccupied with protecting their turf no matter what the consequences. Looking at these numbers alone sets up an “us-versus-them,” zero-sum public discussion from the get-go. That might be unavoidable in some situations, but it doesn’t look to be the case here.

For one thing, a closer look at a range of polls suggests that the country isn’t neatly divided into diametrically opposed camps. As you might expect, ninety percent of seniors say Social Security is very important to them personally, but so do a whopping 8 in 10 Americans between 35 and 64. The numbers drop for people under 35, but more than half of this group also says the program is personally important to them.

Furthermore, if you ask about some widely-discussed ideas for stabilizing Social Security’s finances for the coming decades, you’ll also find the generations pretty much in agreement.

• More than 6 in 10 Americans of all ages support the idea of raising payroll taxes on higher income earners, with only a few percentage points difference between older and younger people.
• More than half of Americans of all ages say reducing benefits for high-income seniors is an idea they can support, again with very little variation by age.
• But proposals to increase the retirement age aren’t that popular with anyone. Among people in their 20s, 30s, 40s, and 50s, fewer than 4 in 10 back this approach. Since nearly all proposals phase in the higher retirement age, most people over 65 wouldn’t even be affected by it. Nonetheless, fewer than half of seniors see this as a good solution.

The prospect of the generations warring over Social Security, with “greedy geezers” blocking any and all reforms and younger Americans blithely cavalier to the economic problems facing seniors, may make good headlines, but the public’s views on Social Security are actually far more nuanced. And this is even more evident, we find, when people of all ages have time to think and talk about the issue together.

Last year, when the National Issues Forums convened citizens in conversations across the nation to deliberate on the federal budget, older participants repeatedly said they had decided to attend specifically because of their worries about how government debt might affect their grandchildren. Rather than refusing to talk about Social Security, seniors in the forums often brought it up. Younger and older participants alike agreed that political leaders lack the courage to discuss needed modifications. A Kansas man made a fairly typical comment: “Nobody wants to touch it, but it has got to be looked at.”

But forum participants also talked repeatedly about the need to protect Americans who struggle economically in whatever decisions we make about the budget—especially in the wake of the Great Recession: “Some people lost a lot,” one woman in the DC area pointed out. “They lost a lot of their IRA money.”

It’s normal for people to approach public policy issues based on their own experiences and situations. People on Social Security or nearing retirement see the program as a concrete factor in their personal lives. At ages 25, 26 or 27, not so much.

But that doesn’t mean that younger and older Americans are gearing up for battle on the future of Social Security. In fact, as we’ve seen in the National Issues Forums, given the chance, citizens of all ages are ready to weigh the options pragmatically, bringing a spirit of empathy and good will to the discussion.

Beyond the Polls is a joint endeavor of Public Agenda, the National Issues Forums, and the Kettering Foundation. Sign up to receive an email update when we have a new Beyond the Polls post.