There is one thing we can all agree on, surely. The US system of higher education is the best in the world. Harvard, MIT, Princeton and the rest dominate the league tables. Of course Oxford and Cambridge poke their Hogarthian noses in too, but all surveys suggest that around 75% of the world's best universities are in the US.
But what do these universities do so well? Publishing attention-grabbing research, and raising money from alumni, obviously. What they don't seem so good at is supplying the needs of the US high-skill labour market. The US relies on soaking up talent educated elsewhere, as a book entitled Give Us Your Best and Brightest by Devesh Kapur and John McHale amply demonstrates. For example, of Indian-born residents of the US, about 40% have a graduate degree – many in science and technology – compared with about 10% of the "native-born" group.
And the picture is even clearer when it comes to medical education. A recent report in The Lancet shows that the US simply does not train enough doctors to meet its voracious appetite for medical attention. Each year many more doctors retire than graduate from its medical schools and so the US is compelled to raid the world to make up the difference.
For decades about 25% of doctors practising in the US received their training elsewhere. This now amounts to close to 200,000 doctors educated abroad. Around 5,000 were trained in sub-Saharan Africa; predominantly Ghana, Nigeria and South Africa, but also elsewhere. In 2002, there were 47 Liberian-trained doctors working in the US, and just 72 working in Liberia. And even when a doctor is recruited from Canada, Canada then looks to South Africa, and South Africa to wherever it can. The poorest will always lose out.
In most countries, especially in the developing world, doctors are trained at public expense. If a doctor from Ghana is recruited to the US, not only does Ghana lose its doctor, it loses the money paid for the training. It may be that the doctor is likely to send a portion of earnings back home (known in the development business as "remittances"). But this is scant compensation. In sum, the US is receiving a massive subsidy from the developing world in training its medical staff.
But why am I picking on the US? Are we not even worse in the UK? Nigel Crisp, former head of the NHS, points out that, historically, we were, but the picture has largely changed now. Recently, we woke up to the damage we were doing and agreed a code of practice with other Commonwealth countries, and opened more medical schools.
Why the US doesn't supply its own needs may seem a bit of a mystery. After all, doctors in the US are not exactly badly paid. But training is long, arduous, and, of course, expensive. Apparently, a newly trained doctor graduates with about $200,000 of debt. This is a serious business, and, unlike lawyers and bankers, of which there are no American shortages, doctors lack the opportunities to earn immense salaries immediately and pay it all back.
Furthermore, unlike in the UK, there is no central planning of higher education. How could a decision to open up new medical schools be implemented? No doubt there are ways, but the political process would be tortuous. In the UK, it was decreed and it was done. Well, the medical profession, bless them, having first identified the problem, moaned a bit about the new proposals, but subsequently fell into line.
So while we look with envy at the wealth and achievements of the top American universities, we should bear in mind that not all is as well as it seems. In fact, it may be that the weakness of the US higher education system is contributing to the health and development crisis in some of the world's poorest regions.
Jonathan Wolff is professor of philosophy at University College London. His column appears monthly