New York medical school eliminates tuition after $1B gift
bbc.com
bbc.com
1. The fact that this donation is 100% going towards tuition. My university has a few B's in endowment, but those money are most definitely not going towards making the tuition fees lower lol. Hopefully this will allow them to select some candidate that are struggling the most financially...
2. The donor being a 93 year old doctor/alumni of that school that studied "learning disabilities and developed screening protocols".
3. The money was from her late husband's "whole portfolio of Berkshire Hathaway stock". And before he passed, he told her to "do whatever you think is right with it" and the article ends with her saying "I hope he's smiling and not frowning". Makes me cry a little.
The Graham gatherings that included Buffett and Gottesman had fine gentlemen, at least one of which has championed a similar cause in the past, whether that was Gottesman or another one of his peers, my memory fails me. While it's sad to see someone I am still reading about pass away, it's heartening to know that he ended on a high note and that he continues to leave a positive impact from beyond the grave.
Just staying poor and spending your whole days on searching for food (or a drink, or a dose) does not provide one with many opportunities to do interesting things with their life.
Giving is what makes a life great. But you have to have something to give first.
I think it can also mean that you are free to do things which are not possible if you chain your actions to the goal of financial success.
I grew up and did my education in Denmark. Here we have another sentiment on philanthropy than the anglo world has. Generally I don't like when a single person decide the destiny for many people, as in this case. It as anti democratic and concentrates power.
Stories like these are heartwarming indeed, but they also help keep status quo. In a more fair world a person should probably not be able to amass more than USD 1B by making the right bet on the stock market. That wealth is build in this way is anti-meritocratic.
Stories like this highlight an interesting paradox of the anglo world: The relationsship between democracy and large scale individual impact and the relationsship between allowing people to make their own wealth while the really rich people are merely early, passive, investors.
(It is hard to write critical comments like this when "The donor being a 93 year old doctor/alumni of that school that studied "learning disabilities and developed screening protocols"." - I hope you can forgive me.)
It's anti-meritocratic for someone to invest their money intelligently in the stock market?
How do you determine the threshold where on one side they're entitled to the wealth they earned, and on the other side their wealth is unfairly earned?
I think most people will agree the threshold to be in the few millions. Some will argue for 5 and few for 50, but nobody can produce $1B of value. Take control of it, sure, but produce, no.
What we could do (besides taxing it away) is configure a limit to what they are allowed to do with it.
I also see room for special titles with cosmetic privileges if someone accomplishes to pay the enormous tax.
It will be hard to find the right privileges. Something like a medal or an outfit is obviously doable. An annual fancy dinner for the group doesn't seem over the top. A daily 30 min slot on the TV for them to bid on exclusively, or each their own slot annually. Can grant 3 lectures in any university. It gets slightly dubious if we add special construction permits for locations no one else may build in.
The funniest I could think of, at 10 bl+ we seize all of your money and assets, you are forbidden to participate in the financial system. You get a robe and a cloak and a card with which you can eat any place, stay at any hotel, buy cloths, do shopping, take a taxi and take any flight with a maximum of 3 guests + partner and kids.
If you funded something with your taxes, you could hire the artist that made the sculptures. Say you build a new civic center with a theater. You have an incentive to hire a good artist to make the place in your preference, with your image, which means the city has more art. If it was an ugly building, it’d be an ugly building with your name on it. The rich during times of war would be separated into those that could fund a whole battleship and those that didn’t. If you shirked your responsibilities during war, you were viewed as a traitor who was so greedy they’d let the city fall.
Maybe we need to stop chastising the rich for building things in their names, but instead give them more opportunities to do so. Additionally maybe we should make all tax payments public, so you can see if your friends and family avoid taxes. Maybe people would become embarrassed to pay less taxes than their employees if everyone could look it up.
“That makes me smart.” - Donald Trump
I want to understand this. If I buy a Novo Nordisk share on the market I never gave novo nordisk a single krone. My counter part is the seller (who rarely would be the company itself).
Generally I would say that investors provide liquidity to the market. Ie. the action of buying and selling are the ones that provide the value. Not holding.
You can conclude that a person holding onto a share for 30 years did not provide any value. That person was merely a rent seeker based on other people providing value by doing the asset allocation – In Denmark these people would be punished by the progressive capital gains tax, while the people trading ones in a while would benefit from a lower tax bill.
Or am I wrong?
I believe the long-term holders of equity investment are the true investors, regardless of whether they bought the shares in an initial offering or a secondary offering.
The initial offering market doesn't exist without the secondary market.
My point is that the value provide is liquidity. Ie. the property that owners of a stock con transfer that stock into money to use on other ventures. People that merely hold a stock does not provide liquidity. You need to have an open order on your stock to do that.
Now, please oppose me! My question is: What value to does term holder provide in virtue of them being long term holders?
In that example, you provided the money; I was just a middle-man.
Except as it pertains to employee/executive comp and future fund-raising, the company doesn't care about the secondary market liquidity. They care about the money they used over that 30 years to grow.
But that value already existed as an intrinsic property of the company (eg. NAV). What the market did was to unlock these money for the company to use - Ie. they provided liquidity.
Example: I have a company that is worth $1000, but I need to spend $200 in R&D. I sell 20% of the company in the market for 200$. No value way produced, but the market transformed my 200$ from company to money - ie. liquidity.
Value that only happens when people trade, and not when people hold. So back to my initial point: Long term investors does not provide value.
Upon what is this based in a world where no long-term investors exist?
Even in the "DCF of dividends plus NPV of terminal enterprise value" model, the last is dependent on long-term investors. (For the high number of tech and high-growth companies who pay no dividends, the first term in the valuation is $0.)
You start the thread saying what people ought to do with their money and presumably having it forcefully taken with little understanding of financial markets. This is [one reason] why nobody takes these suggestions seriously about personally wealth.
Then you should be able to make a well informed comment on the matter, as you clearly understand it.
> This is [one reason] why nobody takes these suggestions seriously about personally wealth.
What suggestions? Capital gains tax? I only know of very few industrialised countries not enforcing capital gains tax. So that idea is most certainly taken serious.
> You start the thread saying what people ought to do with their money and presumably having it forcefully taken with little understanding of financial markets.
Can you expand on this? Having money "forcefully taken" is a core feature of modern efficient markets whether you like it or not.
I certainly don't understand but there is no need. The mechanism (provided it is legal) isn't really important.
We need work, to earn enough to survive and have some quality of life. It must feel like you've contributed something useful and society rewarded you reasonably for it. Others will have to do work for you or it wont work. If there is no money for that it cant work.
I think 100 years before things get truly silly.
That is just, on the face of it, false. Did Stephen King not produce millions and almost a billion in value? Despite writing books that have been read by millions of people, have turned into super successful movies, including some movies considered some of our best art?
If my movie budget is 300m but 200m of that went to high priced actors (think JD, RDJ getting paid 50m~) did that movie produce that amount of value?
Corporations have perfected consumer value extraction, allowing them to pay themselves more and bid higher against the competition, further increasing prices to consumers in an endless loop. It produces nothing of value for us, but we're too dumb to boycott this behaviour.
This flies in the face of most economic theory, and also flies in the face of reality. How many corporations are out there with 90% profit margins? Very few, if any.
> If my movie budget is 300m but 200m of that went to high priced actors (think JD, RDJ getting paid 50m~) did that movie produce that amount of value?
I'm not sure what the high-priced actors have to do with it, but the amount of value produced has nothing to do with the budget - it has to do with the tickets you sell. If your $300m movie tanks and no one ever goes to see it, you've in some sense created 0 value. If everyone in the world goes to see it and you make billions of dollars, you've created billions in value, as decided by actual people choosing to vote with their wallets to giving you money for your art.
The budget only figures into it in the sense that you need to subtract it from the revenue to decide on the actual profit.
We can safely assume that she would have produced absolutely no value, had there been no publisher.
Maybe the publisher produced $1B of value and JK Rowling produced none? They did after all select her over other authors.
You are actually right that publisher produced most of the value... though only in the beginning when she was a nobody. I am sure publishing industry knows that too and read somewhere that their deals with new authors reflect that reality.
After the first 3 books when the series started gaining traction and people talked about lining up for the 4th one? It was absolutely the author who was producing the value. Publishing house couldn't have conjured up the remaining 4 books at the same quality - they are good at publishing, not good at creating. (Just ask HBO / Game of Thrones showrunners how it went after GRRM didn't write the last 2 books).
We agree that we don't want a dictator. A single person with too much wealth can be almost as powerful, hence there are good arguments in favor of setting such limits.
If a cop in my city wants to ruin your life, there's a chance it'll be easier for them to do so than it is for a rich individual, not to mention the mayor of the city.
And unlike a billionaire, who'd have to spend money to actually "control people's lives" and is therefore limited by some constraint , an elected official gets to control people's lives with no constraint at all.
A policeman does not have the same impact over peoples lives as, eg., Jeff Bezos.
And obviously, a policeman is the lowest-power individual in this scenario - my city councilman probably has more impact than that.
Bill Gates improved the lives of countless people around the world. He could as easily made the lives of countless worse if he wanted to or as an unintended consequence of his projects.
As an unintended consequence, sure, but that's more true of scientific/technological progress specifically than what Bill Gates did, which was closer to business and tech popularization. If a scientist invents a super-virus that kills everyone, then yes, obviously, they've made the world worse, but that's not really tied to money.
As for "as easily" making countless lives worse in other ways - I kind of disagree there. He made countless lives better because people voluntarily bought his products. He didn't coerce people, they chose to do it. There's no analagously easy way to spend money to ruin people's lives, and especially not if you consider the kind of scrutiny and backlash he'd receive.
My friends who work in public health research despise the foundation because they are absolute gatekeepers on what can and cannot be funded. If you are trying to do research that is not part of the foundations priorities, good luck, they say.
The Foundation is essentially only accountable to themselves and can have global impacts on health research distribution. A recent example is that their whims affected the speed and distribution of COVID vaccines.
https://www.politico.com/news/2022/09/14/global-covid-pandem...
I like how you threw in the word "intelligently" like this investments was planned and thought out from the beginning ;)
Thresholds are are not that hard to decide: It is about taxation that takes macro-economic behaviour and targets into account.
We have a political party that wants to reduce capital gains tax in Denmark (currently 27%/42%). However, analysis shows that this would benefit only the wealthiest 2% so the consensus is that this is a bad idea from a macro economic perspective.
The value of money is relative. Your 1 million dollars are worthless if everyone else has 10 million dollars. The second people act upon and realise that, we can start to build good economic systems.
Even if success greatest factor is luck it still requires merit. By punishing success you're punishing people that put money into savings, that attempt to innovate and improve human society, that invest in promising areas. In the long term society will be stagnant. And I doubt that in the short term society will be more equal because forced distribution of wealth historically increases inequality.
Citation needed. No, Europe is not doing just fine. https://www.noahpinion.blog/p/americans-are-generally-richer...
try to find some statistics around spending power https://x.com/dima_heyqq/status/1758508340953448525?s=48&t=H...
Singapore – 7922 $ / month
Qatar 5628
UAE – 5585
Kuwait – 5250
Switzerland – 5232
Denmark – 4894
Germany – 4667
Austria – 4484
Saudi Arabia – 4419
South Korea – 4076
USA – 4066
Canada - 4026
Sweden – 3666
France – 3556
Hong Kong – 3219
Spain – 3148
UK – 3127
Finland – 2827
Israel – 2770
Poland – 2753
Portugal – 2220
Russia – 2159
China – 1823 (urban non-private) 1053 (urban private)
Thailand – 1769
Indonesia – 1051And the conclusion is the US generates more wealth for the middle class than Europe does.
If things are so good why Europe is being dominated by authoritarian populists?
I questioned the US paradoxes on philanthropy and meritocracy.
For all I care, you can hold on to your "America first, whatever country second", "F*k yea, America" and all that.
you can derive from my statements that I don't think the current landscape in the US is entirely meritocraric or democratic as a single person can amass serious influence by investing in the stock market.
you respond that at least the US is richer than the EU, which is probably right. But I don't understand what belief it challenges? That it should justify a less democratic or meritocratic system?
please enlighten me :)
I think there is a broad consensus that talent won't make you a billionarie in the stock market, otherwise we had seen many more people become billionaires in the stock market.
If you really believe that that the person in question got billionaire on the stock market by their merits that’s just wrong.
Absolutely. To achieve such results you need so much luck and such a headstart that any merits you might additionally have are drowned in everything else that contributes to "your" "success".
> How do you determine the threshold where on one side they're entitled to the wealth they earned, and on the other side their wealth is unfairly earned?
Rule of thumb. About $10 million.
But it's not about who deserves what. It's about how much influence can society safely let a single random primate have.
The actual number will be determined by the political process. It's a number that seems sufficiently unachievable for 51% of people so that they feel safe to vote to heavily tax those who hace that much.
Current barriers to that is that the very wealthy own the culture and they are selling poor people the illusion that everybody can be the rich and what they are doing is actually building value not extracting it despite the fact that trillions of dollars have been extracted from the control of democracy and market and placed exclusively in their hands.
It's difficult to quantify but many government bureaucrats hold much more power than that.
Your "solution" replaces one problem with a worse problem while punishing sucess.
And why success should not be punished? Do you think people will voluntarily stay poor just because they might be taxed more if they reach 10 million?
And even if that would be the case. It's still good because inequality harms vast majority in the short term and everybody in the medium to long term so any disincentive to people getting rich at the expense of poor consumers is a win.
How would you solve the problem of wealth concentration in free-markets without incurring in greater wealth concentration under a closed-market?
> And why success should not be punished?
Because generally we want to reward and incentive the betterment of society.
> Do you think people will voluntarily stay poor just because they might be taxed more if they reach 10 million?
Maybe. It must be depressing to live in such a place. If you punish success, you reward mediocrity. But the thing is that those that reach 10 million or plus will always have the option to move their fortunes abroad, so it's the middle class that ends up paying the heavier burden in countries ruled by this mindset.
I'd have free market with punishingly progressive taxation and redistribute proceeds of this tax as a basic income.
> Because generally we want to reward and incentive the betterment of society.
Financial success is intrinsically rewarded and it's orthogonal to betterment of society. Tou can't really tell if a rich person improved society or damaged the society just by looking at their wealth. No additional rewards are necessary. And some pubishement would be advisable if the scale of this success causes harm to the system that spawned it.
> But the thing is that those that reach 10 million or plus will always have the option to move their fortunes abroad, so it's the middle class that ends up paying the heavier burden in countries ruled by this mindset.
The mere presence of those who have more than $10mln is the cause of the system collapsing. They price out the middle class out of the real estate that they hoard for investment purposes. And of other limited resources as well.
Rich are more than welcome to leave. Their leaving improves lives of everyone else.
Owning money just means that society owes you some goods and services.
If you move out and request that some other country pays this debt to you then the country of your origin is better of.
Wealthy can be beneficial to capital starverd countries because their people can trade the wealthy low tech services to amass capital necessary to buy technologies from abroad.
So to help african countries we shouldn't be sending them food. We should cast away our billionaires there.
I can't think of any case in history where a brain or capital drain would be a positive think. Historically the US benefited greatly from European drains. Such an absurd idea requires a fantastical level of evidence supporting it.
While I agree that capital starved countries would benefit from additional capital, it is a tautology, there's a reason why those countries are capital starved in the first place. Corruption, bad to make business, etc. Capital moves quickly when there are favorable conditions. Also any billionaire can live at country A, B and C while paying taxes at D and investing in E.
Also it's very simplistic and wrong to put all the blame of home shortages on billionaires. It's more complex than that. Demand is high but why supply is low?
You are severely overrating how much influence $10m buys you, and very severely underrating how much influence you can have without personally having $10m dollars.
And please feel free to have $10 million. Above that it's starting to look like you aren't into it just to secure yourself but rather control and impoverish others.
There are various ways of attaining influence. Money is just the easiest and least controlled. Morally and practically. So let's plug the biggest hole first then worry about the rest.
Thanks, but you don't get to tell me what I'm allowed to have. This is basic property rights.
>control and impoverish others.
This is quite plainly the fixed pie fallacy[1].
[1] https://en.wikipedia.org/wiki/Lump_of_labour_fallacy#:~:text....
"How do you determine the threshold?" Somehow.
It doesn't matter how you determine it or what you end up determing nearly as much as doing it at all by any means, and working out good procedures and results over time.
Currently, we have nothing at all. A sub-optimal limit, a downright wrong limit, derived from sub-optimal, downright wrong methods is better than none at all.
The Bezoss and the Musks of the world are not doing anything we need done badly enough to be worth what we give them.
Those people who like to run big projects will still be full of themselves and still seek to be in charge of everyone else and will still command the same resources even in a world where that isn't expressed as personal private ownership of the resources.
If the change in incentives changes anything, if there are people who currently became billionairs and produced Amazon and Facebook, who would not have bothered if they couldn't own it all, I am prepared to call that only a win.
We'd still get anything that was actually valuable to us rather than just valuable to the owner.
The only problem is needing to incorporate enough ownership and capitalism so that there is any motivation for excellence. If everything is purely communist and no one owns anything, then all products and services suck. There does need to be some sort of reward for making the electric car and the charging network actually good, and some anti-reward for not making it available to everyone. Patents and copyright need to be somehow quite different. Maybe they still exist and confer some sort of benefit, but nothing like now. Rewarding people for inventing or improving things only to let them keep it for themselves, and even retain ownership control through drm and software over products that were sold more than nullifies the value of getting them to invent the thing in the first place. More than merely negates. Their existence suppresses everyone else who might have done it differently.
Where is the line and how do you determine it is no conundrum at all. It's nothing but some boring policy grunt work to hash that out.
It actually detracts from the entire purpose of a stock market.
It has also created our poisonous modern environment where companies chase record profits every year, endless unsustainable growth with the added side effect of ass-covering for all their bad investments.
A lucky investment like this guy is probably fine but the truth is that the system is set up so that wealth begets more wealth; the wealthiest people have so much money that they don't have to be careful with it, look at how much Musk spent on Twitter as a toy for him to destroy, it doesn't matter because record profits and valuations ensure that dumbfuck CEOs and investors are bailed out of their dumb decisions.
Meanwhile we live in a biological society where our evolutionary path has made it exceedingly easy to manipulate people to hate based on sexuality, gender, race, etc ignoring the class war going on. We're too apathetic and ignorant to vote together, we could all share in our species' accomplishments but no, the suit and tie ruling class can have all the Bentleys they like so long as I get to vote for the guy that'll let me hate the people I want to hate.
The US seem to choose their presidents not based on policies or track record but rhetoric. That doesn't seems better than capitalism.
Again, as an EU citizen, the two party system seems to be wildly un-democratic. In Denmark we have 10 parties represented in the parliament (in a country of 5.5million people). This forces decision making to be compromise seeking and represent more real opinions.
To become a billionaire you just need to be lucky enough to purely mechanistically attach yourself to a market phenomenon and drain it. Noone needs to agree to that.
It's common for people to vote in candidate B because they don't want candidate A to win and while they dislike B it is deemed as the lesser of evils as he is the only alternative with a good chance of winning. AFAIK this is the universal case in every representative democracy.
Also vote costs you nothing and oa the same for all people and your voting power in the market is directly proportional to how much money you can spend.
It's not similar. At all.
Not really. You can abstain from voting but not from paying taxes. And if you abstain from voting you will still will be subject to the authority of whoever get's elected and it will probably not be in favor.
> In the market for food, shelter and clothing it's not possible without serious harm to your health.
You can grown, build and craft your own. It's not always practical but you have those options. e.g. I cook my own food and grow produce in the backyard. And we all have way more and better options for food, shelter or clothing than we have for president, governor or mayor.
> Also vote costs you nothing and oa the same for all people and your voting power in the market is directly proportional to how much money you can spend.
I don't know in which world do you live but that just ain't true. Elections are super expensive. In Brazil public funding for political parties is a 10-digits figure. Money win elections. Rich rent-seekers "donate" massive amounts to candidates legally and illegally to later receive favors.
> It's not similar. At all.
Free market is the purest form of democracy. Representative democracy is garbage.
Would you be in favor of that?
https://en.wikipedia.org/wiki/Non-aggression_principle https://en.wikipedia.org/wiki/Anarcho-capitalism
Aren't you in favor of purest form of democracy?
I understand that you are a fan of anarchism but given that it's impossible shouldn't you be in favor of the next best thing?
Remember, umbrella companies are buying up multiple competing brands for ages now. Rather than shutting them down, they just make money from all of em.
We're doomed, lmao: https://blog.cheapism.com/brands-owned-by-same-company/
Problem is that you're right, people don't really vote for the right reasons and hence we'll never tax the rich. It's mutually exclusive imo.
Don't conflate an in-equal system with capitalism. That would be untrue and un-wise.
Most people agree that a free market needs to exists in order to uphold a capitalistic system (what is ownership if you can not transfer it?).
You can make free markets that are regulated in a way that ensures that participants are, roughly, equal - in fact there is an argument that a market is not free unless this is the case.
When participants of a market can increase their profit margins it is usually a sign of an ineffcient market - a participant has an advantage that other participants can not compete with.
In an unfair world it is taken away from me.
It is just numbers.
An example you probably should should think about: Who owns money and their value? What happens when the central banks decide to raise the interest rates to 20% and you loose everything? Just a shame? On the contrary, what happens when the central banks employ quantitative easing and that makes you rich? How does this interact with large-scale projects the government starts to create employment.
Not always are fiscal and monetary policies aligned. This creates either severe depressions or economic bubbles.
When an opinion is funded an understanding of to what extend the greater society defines the value of things it will have gravity. Until then, it is just noise.
You pay for stuff in the supermarket, you get a product. No strings attached. I would be surprised, if people like the idea, that if one buys a piano, that for each song being played, one has to give a dividend to the piano manufacturer. Usually the transaction is closed. Though, such deals can be made. Maybe you get the piano for free.
You pay a worker that what you think is needed to make a piano. If one worker makes a billion pianos, you pay him a lot. And if you sell pianos a billion times, you become a billionaire. And if your worker can buy stocks, he will also get dividends.
The idea that billionaires have to give a share is nice and good, definitly good for hackernews stories and their socialistic readers, but that the billionaire has already given societies wealth manyfolds, well, afterall people bought their stuff to improve their lives, that made him a billionaire, that is silently forgotten.
As usual, it is play with envy and greed, how dare someone has more than me!
The difference I see between US/EU worldview is that in US the biggest emphasis is in what "YOU" did, disregarding luck, chance, environment factors etc. "Bill Gates created the wealth himself". People like feeling like there is a chance for them to become super powerful and important and that there is no system holding you back, even though they never actually do it but the hope/idea is very important for you. I can see this in Eastern Europe where large percentage of people dream of winning the lottery; I guess that is something from which people here draw hope of power and influence, while the same people are ok with strong social measures, high taxes, free healthcare etc. while I feel in US all these social benefits are perceived to prevent people from achieving astronomical results and hence shouldn't be.
Unfair is, if someone else grabs the stuff of the one brother and gives it to the other.
Hell, mining blood diamonds is fair because the local authorities allow it, mining oil from under the impoverished residents of a corrupt country is fair, skirting monopoly laws to create conglomerates is fair.
Nothing is illegal for these guys, it all gets shoved under the rug. Remember the Panama papers? What came of those? Nothing.
(While others have identified religion as a way of avoidance, to not question the status quo. Ha!)
There is not a single billionaire who has made all that money fairly; wages do not rise with inflation, environment; tax dodge; etc costs are carried on to the consumer as well. What sort of world do we live in when people like you think it's okay for things to be like this.
I don't have a problem with people being successful and accumulating wealth, but I do have a problem with the ilegitimate and corrupt practices involved in accumulating billions and trillions.
Ofc everyone hates this idea, idk y'all think you'll be billionaires one day, or otherwise think that someone deserves to make more than $Xmn a year, in a way you're right, because nothing will change, we'll never actually tax the rich properly...so I suppose that means you win.
Individual doing a great thing is great.
A system that depends on hoping and begging for miracles is not great.
weird flex but ok
- At yearly tuition rate of 59K the earned interest is enough to pay for 850 students without drawing down the invested principal.
- Albert Einstein college of medicine admits about 150 freshmen every year and medical school is 4 years long. So at any given time there are 600 students studying medicine at this school.
It seems to me that simply earned interest on this donation should be enough to allow students to attend this school free of tuition indefinitely.
The paper "Physician workforce in the United States of America: forecasting nationwide shortages" [3] mainly blames an aging population and too-slow growth in the number of "residents and fellows".
edit: Found a dissenting view here [4], its main reference seems to be [5].
[1] https://www.washingtonian.com/2020/04/13/were-short-on-healt... [2] https://www.ama-assn.org/system/files/2024-nac-action-kit-gm... [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006215/ [4] https://www.motherjones.com/kevin-drum/2013/11/its-doctors-w... [5] https://washingtonmonthly.com/2013/06/19/first-teach-no-harm...
There’s no law forbidding you, a state government, a local government, an insurance company, the AARP, or anyone else from funding a residency.
If that were the case, then the only ones who would put up with such a system would be those who have rich families to back them up.
I came from a blue collar background and my family could not help subsidize my training and I could not afford to live, make rent, or afford food if I had to pay for my training as well.
There are so many other things that you are completely glossing over including annual income between generalists vs specialists, pediatricians vs non-pediatricians, reimbursement inequality from Medicare (has not kept up with inflation and is ~40% below inflation), Medicaid pays at best 10-15% on the dollar, and so on.
American physicians also work almost teice as many hours as their European counterparts which would increase their incomes.
[1] it’s considerably more because if you report it then the program can be in danger and lose its credentialing
That sounds like an apprenticeship. Many other industries do exactly that. Why should doctors be different?
As an outsider, the whole system seems completely bizarre to me.
> [AMA president] Dr. Richard Corlin has called for re-evaluation of the training process, declaring "We need to take a look again at the issue of why the resident is there."
If you don't do it, they will sack you, fail you or you won't find a job there.
I’d be curious as to where you got that. I was personally suprised to discover that in Germany, doctors in university hospitals can work up to 80 hours a week.
https://www.sciencedirect.com/science/article/pii/S016885102...
https://www.statista.com/statistics/1385440/physicians-work-...
https://medicalschoolexpert.co.uk/how-many-hours-do-doctors-...
https://www.theguardian.com/society/2019/jan/15/junior-docto...
https://www.france24.com/en/france/20240219-france-s-foreign...
https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublica...
https://facharztjetzt.de/24-7-guardians-unveiling-the-workin...
There are multiple reasons why US doctors are unhappy about their profession. I’m not sure where you get being oppressed as being the titular complaint.
I was an engineer before going to medical school and have an outside perspective as well.
I have complaints with medicine as to how it has changed over the last 10 years and not for the best. I have the right to complain to make things better for my patients and my work-life balance. That doesn’t mean that I am oppressed.
My "industry" is only myself as I am beholden to my patients. I work and am paid by each patient who I treat and receive reimbursement by 50% of them at best.
If you don’t care about my work-life balance and lump me in with the rest of the healthcare system, then there’s nothing much to discuss.
I would say that doctors in other countries are not paid accordingly and are UNDER-paid. See the UK NHS strikes as an example.
You should be complaining about is the excessive charges and reimbursement that hospitals receive for the care that they give. It gives me pause that despite having multiple physicians in your family that you do not understand the difficulty of their practice or work environment.
Most white collars jobs including doctors, engineers, and administrators make multiples of our European counterparts. I would say that Europe underpays its workers.
Again, I am a highly paid worker just like the rest of you. If I don’t work and treat patients then I am not paid anything whatsoever.
I would be further much ahead financially if I had stuck to being an engineer 18 years ago and not have put off earning an income for 7 years and going into massive debt. This was a risk because I come from a blue collar, lower middle class background without a safety net.
What is the point of your diatribe?
> hospitals are actually there (from their perspective, at least) to make money
Aren't most hospitals non-profit?
(Disclaimer: These are genuine questions; I have very little knowledge of the medical system.)
They wont train their workforce because they would lose money doing it and can always hire people already trained. It's a tragedy of the commons which is why congress had to step in to subsidize.
> Aren't most hospitals non-profit?
Technically yes, but most are part of massive systems that are run by MBAs like traditional corporations.
> Aren't most hospitals non-profit?
"Non-profit" is not referring to how the company operates. "Non-profit" refers to the owners extracting profit. Of course there are extra pieces, such as regulated transparency, but "non-profit" as a category are not wholly the donation-supported organizations that first come to mind.
In other words, if you are the owner of a successful non-profit, you'll have to simply pay yourself a market rate (TM) salary for such a successful executive as yourself. Instead of buying lavish Christmas presents like all those executives at greedy "profit" companies, your family members will only be able to get lucrative positions at your non-profit.
https://en.wikipedia.org/wiki/List_of_countries_by_governmen...
In the US, $50 million would be closer to the budget of a small city (~50,000 people.)
It’s a reminder of what can be done when billionaires give back and pass it through to society instead of passing it along to their heirs.
This kindness is going to change the world and provide doctors that will treat and help hundreds of thousands.
Compound interest is the eighth wonder of the world. He who understands it, earns it … he who doesn't … pays it.
Any return above GDP growth is not conservative. On average, real world GDP has grown at 3 to 5% per year since 1964 [1]. (We use real GDP because university costs will increase with inflation.)
600 students would have paid $35.4mm in tuition a year at $59,000 per year. That's a 3.54% drawdown per annum, right in line with real GDP growth. A 4 to 5% real return target is doable, but not conservative and certainly not a figure with a lot of margin for error.
[1] https://www.macrotrends.net/countries/WLD/world/gdp-growth-r...
I'll sidestep that Piketty measures wealth and calls it capital. Because that observation says nothing about how risk is distributed across those returns.
> large investors have access to especially high return assets
$1bn doesn't make for a "large investor" in institutional terms.
> OP is right that a 5% average annual return is conservative
No, they are not.
There are objective measures for this. I've worked closely with endowments the world over. A manager pitching a 5% target return on a fund with a 3.5% annual drawdown as conservative would be fired. A banker pitching the same would be subject to professional sanctions.
Sorry, this is childish and you don't substantively respond to the core point. I am not going to waste my time.
> you don't substantively respond to the core point
Yes, I do. Even if capital returns well in excess of growth on average, that doesn't change that the returns on assets in that excess regime are riskier than those below it. (This actually being formally provable by way of seniority.) Excess returns are never achived conservatively, let alone very conservatively.
Piketty's work has been seriously challenged. It makes good points. But it also contains bad ones, including a couple really sloppy and unsubstantiated assertions. His conflation of wealth and capital being germane to your argument.
That would be true if additional GDP was distributed equally. But the rich capture majority of it in their investment vessels. So for a person with capital I think double of GDP is still conservative as long as inequality grows.
https://www.highereddive.com/news/college-endowment-returns-...
Here it serves to simply add weight to an argument that expecting a 5% annual return for invested endowment funds is reasonable and supported by historical evidence.
If things do not go as well going forward - all it means that principal will erode over time.
But let’s turn to examples:
“As of October 2023, Harvard's endowment has an 8.2% 10-year return. In fiscal year 2023, endowment returns averaged 7.7%, with smaller endowments posting larger returns. Institutions with over $5 billion in assets have historically had higher 10-year average returns of 9.1%.”
https://www.highereddive.com/news/college-endowment-returns-...
Why single out a particular private individual or his publicly traded company when you could simply pressure the institution itself to make tuition free?
She should have made the gift contingent on keeping tuition costs indexed at 2023 level plus a tiny fraction of inflation say 0.5%
Then the real challenge would be very interesting - what they could cut every year to keep the program going.
My guess is that having free tuition for all students forever will have a much bigger impact. I believe Princeton's policy school is similarly endowed, [1] and it's basically the top choice for anyone getting an MPP. Of course, it also has the prestige of Princeton associated with it; I could imagine some student choosing Harvard over this school, which doesn't currently have the same name recognition/prestige. But surely that will grow as a result of this announcement!
1: https://spia.princeton.edu/blogs/we-fully-fund-all-students-...
Hard to find them, however, that aren't just scams.
In order to be accredited, you need to show you can produce a decent class of students. But how do you get the students if you’re not accredited?
Free tuition.
The accreditation can be retroactive, so they might be getting an accredited degree for free.
I don’t know if this was the case at UC Irvine Law School.
> We award Full-Tuition Scholarships to all current students and future matriculated students, regardless of merit or financial need, that cover the majority of the cost of attendance, provided each student maintains satisfactory academic progress in accordance with NYU Grossman School of Medicine’s Satisfactory Academic Progress Policy
I wonder what it means to cover a "majority" of the cost of attendance. Does this mean they cover tuition, but living expenses (which are not trivial in NYC, but which are less than tuition) are not covered? Or are they just referring to their own fees?
https://nypost.com/2023/07/21/langones-200m-gift-makes-nyu-m...
I just hope they have enough decency to delay it till the donor dies so she doesn't have to witness it.
Their acceptance rate was 50/11,000 applicants last year (0.45%).
[0] https://www.nbclosangeles.com/news/health-wellness/kaiser-pe...
It's not like there's a requirement here that the doctors are going to work in the non-profit sector. It's not going to make the field less overworked and toxic. The students at this school have the same demographics as every other medical school.
Given that nearly all of the students who graduate from a medical program end up in the top 10% of wage earners, this seems like a temporary alleviation of financial problems for a very small cadre of well-to-do.
I am happy Dr. Gottesman felt such an affinity for her former employer, but it kind of strikes me as an ... uncreative(?) deployment of a billion dollars.
So maybe this will actually lose an effective lever at getting doctors to serve those populations?
The reality is doctors have the ability to practice anywhere and tend to choose desirable places to live like NYC, LA, etc because they are humans with wants and needs, too. Anecdotally, living in NYC, many doctors and dentists tell me they could make more elsewhere, but they love living in the city.
[1] https://comphealth.com/resources/physician-salary-report-202...
But there are tons of programs that will pay off your medical student loans if you go work in an undeserved area. Some states offer free tuition if you promise to work in that state for a few years after. The hope with that is that the person will establish roots and not leave.
Not to mention the 10 year Federal forgiveness for working in a qualified institution (aka nonprofit hospital/academic)
Public Service Loan Forgiveness requires 10 years of making student loan payments.
> Some states offer free tuition if you promise to work in that state for a few years after.
for example, the Georgia program offers up to $25k per year for up to 4 years max [1]. It requires application and takes into account health outcomes, specialty, debt, etc so it seems its not automatic acceptance. With an average medical school debt of over $200k this is not free tuition.
[1] https://healthcareworkforce.georgia.gov/loan-repayment-schol...
https://www.whitecoatinvestor.com/not-so-common-debt-forgive...
So why not structure it so the tuition is completely forgiven if someone does this rather unconditionally free?
I don't see why someone who goes to this medical school, only to become a cosmetic surgeon who ultimately makes millions a year doing discretionary procedures should have free tuition.
There seems to be some shift going on in society. Like we've acknowledged a world with "haves" and "have nots" is unavoidable, so we might as well just focus on diversifying the "haves" and give everyone an equal shot at winning the lottery.
I guess that's better, but it's a sad thing to settle for.
Michael Bloomberg spent almost $1B trying to become president, and didn't even move the needle. That's capital inefficient; you want to target spend for maximum outcome return. This is a win, enjoy the hope for a moment, it's a long slog ahead.
Obligatory https://runforsomething.net/ and always vote PSA.
https://www.npr.org/sections/money/2014/10/16/356176018/the-...
It’s mad that someone accrued billions and students can’t get 60k for free to study
I consider this kind of events more as a proof of the inadequacy of the system rather than the contrary
studying medicine is not a right. Basic education is - but k-12 schools are publicly funded already.
Have countries with public universities suffered the same amount of opioids prescriptions epidemic?
but this one relieves the donator from the responsibility and at the end of the day, a very selfless work. i would not judge it any beyond that.
Meanwhile, you look at that wealth and trace it through and think "Hang on, that's an incredible amount of wealth accumulated over decades. I wonder how much tax revenue that resulted in? $0.
From my quick search a majority seem to all top-ten be in the US and UK. #16 gets you Karolinska Institute but even then they are followed by more US Medical Schools.
Without any cynicism, I am curious what sort of negotiation and terms go into a donation of such size. As all the founders here can attest, taking money requires agreeing to a complex array of terms.
For example - what kind of protections are in place to preserve the donor's intent? Is there a board of directors for the donated funds that provides oversight? Could the med school 10X the salary of administrators and raise tuition equally? Could the med school hire 10X more staff? Could they relocate the med school to a 5 Star hotel?
People do funny things when vast sums of money appear.
I have never heard of a school getting this lucky from there alumni/faculty and even hearing there students getting something out of it so it touched my heart I have always had a toxic opinion about my teachers. Perhaps this could turn into an example for the rest of Americas medical schools in the coming decades.
$360K of debt would be a massive burden if the system had fixed costs.
- We cap the number of residency students per year, creating an artificial limited supply.
- We don't allow immigrant doctors to transfer their credentials, creating an artificial limited supply.
- Med school is expensive, limiting the pool of applicants.
- Nurses and nurse practitioners are extremely close to the action on a daily basis. There should be a path for them to graduate into doctors, perhaps by attending night school and then some form of on-the-job residency.
Even if doctors and nurses worked for $0, we'd still have the most expensive healthcare system due to admin, drug, etc costs.
Do you really believe this when a loved one’s life is on the line?
The hurdles I see are: There’s a reason doctors have really intense study time before residency, and you’d have to replicate that. There’s also a reason residency is so intense, you’re not going to get anything like resident experience doing ordinary mid level work.
You’d need to hybrid model, but who is going to agree to something like: instead of working as a nurse 40 hours per week, you’re going to work 40hrs/wk and study 40hrs/wk, for 8 years, and if you pass the tests you’ll move on to the next level. This could work but basically sounds like part-time med school.
Part time residency would be even less appealing, it would take you like 10+ years to get the amount of cases a resident has if you were only doing it part time
Compare that to an NP that went from their 18 month NP class, to work in primary medicine/family practice office - and lets say they work there for 10 years, so great, now they are an experienced NP in family medicine (and someone I for one would be perfectly happy to see as a patient for most routine things) - but what they don't have is the experience in all those other areas that matter - even if they are not practicing it.
There is just no shortcut without putting in the time - thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD.
There is nothing wrong with being an experienced NP seeing patients (and that is mostly who I end up seeing) - but there is simply no reason to somehow 'promote' those people to doctors - they don't have the same skills or the same experience, and doing so doesn't solve any problem.
What do you think is 10+ years of experience as NP in a busy office setting, exactly ?
>>> thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD.
You mean, the hours that you were cognitively impaired and mostly a blur due to sleep deprivation ? Or the hours of time you will not get any feedback whatsoever because the patient went home and you will never ever see him/her again? (as opposed to a NP, who's always 1 one call away and has a direct feedback loop to the consequences to her/his actions?)
Primary care NPs are good at what they do, but what they do is very limited - most of them will admit it. Anything they haven't seen before comes along, first thing they want to do is call an ambulance and send them to the hospital or a specialist - or they will pull in an actual MD to ask them what they should do.
So if an NP has 10 years of experience working in a primary care facility - what problem does it solve to somehow 'promote' them to an MD based on that experience? Will they magically now be able to see more patients per hour? How does that solve any systemic health care system issues? It doesn't - it simply allows them to get paid like a real MD, when they aren't - so if anything, drives up costs.
Getting motivated people moving up in the pipeline opens more avenue for care of patients, relieving the stress on the existing system. The fact that you think it drives up costs actually goes against the rules of reality. If you have more supply of something, it simply lowers the cost of that supplied.
The problems we have in healthcare in USA is not one of quality. People from all over the world go to USA, seekign help.
The problems in healthcare are related to access and cost. Both of which, this is a magic bullet for.
Why would you keep someone hostage at an underpaid role where they have no way of advancing unless they bend the knee and pay tribute to the powers that be, even though they are perfectly qualified to the role and have more experience than virtually all applicants? If you are concerned because you had to pay your way thru med school, think of it this way:
1) MD paid in dollars and sweat equity to afford that BMW at age 32.
2) NPs will pay in opportunity cost to afford to promote into an MD at age 32. No BMW yet either.
NP vs MD education is not even close to being similar - that is why their is no easy path from one to the other - a typical NP will graduate having done ~600 to 700 hours of patient care hours. A typical MD will have had 12,000 to 16,000 hours of patient care experience before they start practicing - there are plenty of things were seeing an NP is more than enough - but you can't just give a few months of extra training to bump an NP to an MD - their education and knowledge is not even close to comparable.
There is a place for both in our health care system - but they are not the same job.
The NP has seen more and been around the block. The doctor still is a baby in medicine.
One (not all) aspects of the NP program was similar to your comment, building off career and professional experience, and using that as one basis for knowledge.
These programs are not even giving you the RN -student- nursing experience (let alone post graduation), they're skipping that entirely.
Looking online:
"Become an NP in 20 months". "NP in 27 months".
From HIGH SCHOOL.
In EMS, there is a push to make paramedicine at least an associates, if not a bachelors degree (there are programs with all three, certificate, associate, bachelors).
Paramedics are the advanced version of when you call 911. The invasive side (versus EMT which is - largely - non-invasive). Cardiac arrest and dysrhythmia management (ECG interpretation, manual defib and pacing, approximately a dozen cardiac drugs), airway management and intubation (including sedatives, paralytics and analgesia), childbirth, trauma, burns. In my area we can give approximately 60 different meds IM, IV, IN, IO from fairly benign to quite acute (adenosine, atropine, etomidate, rocuronium, etc.)
The push for this is for at least two years of school, if not four.
But yet you have schools pumping out NPs in as little as a year and eight months? With zero field supervision (for better or worse, and with varying degrees of intensity, PAs ostensibly operate under physician supervision/direction).
This is going to cause a huge problem, I expect. Not the concept as a whole, but our YOLO attitude to these things, and schools seeing dollar signs.
I specifically pointed at older NPs for a reason.
Heck even old RNs will know what they are doing.
For us programmers it is a bit like why you don't let the new kid push straight to prod. But an older engineer may have a key to do it. ;) There is some wisdom that comes with the grey hair.
They don't have a medical education. They have a nursing education. They are different things. A good doctor relies on experienced nurses for what they are good at - which is recognizing someone who's in trouble, because they have spent a lot more hours at the bedside than we have and have superb spidey senses. If a nurse asks me to look at a patient, I will. If it's an experienced nurse, I'll come running.
The best friend to have is an OR nurse. She knows which doctor is on cocaine, who cannot stop shaking when handling the scalpel, who cannot bother with a prep checklist before a surgery.
If you are doing surgery for a loved one, consult an OR nurse. They will tell you what's up.
Best of all, nurses all talk to each other, so chances are someone in their group will know that Dr. Charming over at hospital X is nicknamed The Undertaker by in-the-know staff...
I've also seen doctors where their social skills honestly impaired them from getting through to people and thus getting the needed outcomes.
Also... Your "roadkill" doc may do well with me. Smooth talkers always seem to come up short for me.
That said, especially in primary care, give me an NP over a PA anytime. Primary care is a numbers game and NPs roll the dice better. Specialty PAs are great; I learned some of my best ortho from ortho PAs. But generalist PAs scare me and have been the source of some horrific consults in the past.
I think foreign doctors could fill a niche there too. I don't know why we have people going bankrupt due to medical bills when we have foreign doctors that could drive prices down significantly so that the poorest or underinsured could benefit.
We’ve had to change our terminology from “international medical graduates” to “foreign medical graduates” because a lot of those trying to get foreign credentials recognized are locals.
Probably a tough slog upon return to pay back the debts but net-positive in the long-run (unless interest rates go up, uh oh).
It's not just the physician/surgeon aspect of US healthcare that's expensive, it's all of it.
I'm on the Canadian side, and drugs have never been single-payer outside of a hospital, but that leg of the system is still much cheaper (on average) in Canada.
My wife is an OB and has to pay $140,000/yr per year for tail insurance in my state. So she literally needs to make, after all other costs of the practice, $140k just to break an even $0/yr.
And people wonder why it costs so much to have a baby.
(Sure, charging precisely for risk would just result in some patients/scenarios being avoided, but per case or a percentage of billing would make much more sense).
Mid career, she should only expect to pay about $120k/yr…
Someone who does one vaginal delivery a month is not going to be as good at doing them as someone who does two or three a day. And they certainly won't be as good at cesarean sections. Delivering just one baby costs a hell of a lot of money in insurance, which is a major part of why family doctors in rural areas don't do that anymore.
By contrast, people who drive more miles - even if they are excellent drivers - are at higher risk of being in a collision because they have to deal with other people on the road, who may be terrible drivers.
I can't imagine (but do not know) that it is more efficient to pay claims-made AND tail, versus claims-made with prior acts (unless of course your employer is paying the claims-made).
For those not in the medical field, tail or ERP (extended reporting period) coverage is liability coverage for when the original policy has ended - i.e. you were insured for 2024, but in 2025 a malpractice suit comes to you for an incident in 2024. In the auto/general world, this is fairly well accommodated, but in the medical liability world, insurers say it is because of the preponderance of claims that may arrive significantly later than coverage.
However, many insurers absolutely ream providers on it. Tail insurance is typically double the actual claim premium, i.e. insurers are saying that your insurance premium is only covering 1/3 of the claims they expect to pay on your behalf. I ... have doubts ... on that number. And I also suspect that there is a bell curve happening where certainly, complex malpractice claims may take time to be built out and filed, and that may extend beyond coverage, but then at a certain point, you can relatively confidently assume that the incoming claims are asymptotically approaching zero.
Additionally, I cannot exactly remember if malpractice insurers are required to abide by MLR - profit restrictions - like the 80/20 rule, but in your wife's case, the insurers as a whole (claims-made and tail) are implying that they expect to pay out $168,000 a year for her liability.
I feel like you're conflating 2 separate issues:
1. You are correct, one of the biggest concerns for physicians is malpractice risk, and thus a big draw for physicians (especially in high risk specialties) is states that have low caps on max malpractice damage awards. I'd say there is a tendency of red states to have lower caps, but it's really a mix. E.g. Texas has some of the lowest malpractice caps, while Wyoming has a constitutional provision prohibiting caps.
2. When it comes to the risk of obgyns, the main fear is not really the cost of malpractice, but it's simply that extremely restrictive abortion laws make it impossible to give proper care. Lots of people, and politicians especially, like to see the world in absolute black and white, but obgyns know more than anyone else that there are a whole host of issues that can cause a fetus to be nonviable, or dangerous to the mother, and laws that protect the fetus above all else are not rationale. Obgyns can fall anywhere on the political spectrum just like the populace at large, and there are plenty of conservative obgyns who are against abortion for moral or religious reasons, but they also know the realities of pregnancy and that many of these laws are simply unworkable.
It doesn't matter that some states have caps on malpractice payouts. That's only half the matter. It's the number of times that a doctor has to be sued FOR malpractice, because a lot of those costs are going to be attorney fees. If I were a lawyer in Texas, I'd be posting billboards about specializing in suing doctors for not providing care. When women realize they can win a windfall in court for being denied care with life threatening conditions, they're going to start suing. And winning. Juries love giving away insurance company money.
More suits, higher premiums. Since that risk is spread across the state, so is the insurance rate. Most conservative OBs still understand, know, and respect the science. If Texas or Idaho or Alabama gets too expensive, especially given how absolutely garbage the standard of living is in those states, they're gonna haul ass political affiliation be damned.
This is a fantasy, it has never happened, and it's fundamentally not how the law works. Show a single instance where a doctor has been sued for refusing to give care due to risk of running afoul of restrictive abortion laws.
Where's all this noise about a regulatory stance causing malpractice lawsuits to skyrocket ?
There are patients that make a living going around doctor offices and suing them. I know 1 patient in particular that went around suing doctor offices because they would not cater to his blindness. He would threaten a lawsuit without setting a foot in the doctor's office.
He would browse the doctor's website and complain it was not blind-compliant. And start from there.
Why assume the problem is the legal system and not the doctors? Maybe their performance is the problem.
For example, last I saw, hospital error was a leading cause of death in the US. Until recently it was hard to get doctors to wash their hands between patients, or follow checklists to ensure quality. There are stories of an omerta-like rule of silence about surgical errors.
Try shopping around insurance or go with a mutual, or perhaps go with a IPA ?
NOTE: This rate is CERTAINLY valid if the OB has a long track record of attracting litigation. All insurers will ask for your "run rate" of claims. So, you can't escape a bad record. If you have a history, insurers will charge accordingly. You can't escape a poor record.
This is OB in the state of Illinois, it’s roughly the same cost ans all of the other OBs we’ve talked to here. She doesn’t have a litigation history at all yet.
I've seen many Northeast, more expensive states quotes, and West coast. I do not know about IL. So if theres some kind of special racket there, i could be ignorant of that.
No surgery. No facility /ASC . Straight up MD offices with FT coverage for malpractice.
Olin college was founded on free tuition paid outbid the endowment. Unfortunately this didn’t last. https://www.olin.edu/admission-financial-aid-afford/cost-att...
Just some examples I see:
1. people don't turn off the lights when they leave a hotel room. I ask why, they say "who cares".
2. people abuse rental cars, because "it's just a rental".
3. students abuse free textbooks.
4. heck, the whole free public school system.
5. nobody values a "participation" award.
And so it goes. Students should have some sweat equity in their education.
I don’t think you mean “sweat” here.
Because they do have sweat equity in their education. They have years of hard work behind them and ahead of them.
If they fail out of this school they can reapply and pay $300k at another school.
If people are halfway through, a motivating thing to keep them going is the money they've already invested in it.
I bet you'll see a significantly higher dropout rate with free tuition. Like we see in public high school.
This is not what medical school is like from the people I know.
Nobody has a bigger stick up their butts about how important their work is than medical students. Computer programmers (despite what reading comments here on HN would make you think) are at best a distant, distant second.
And those are people who are paying tuition.
Med school students aren’t competitive type A driven psychos because they’re writing tuition checks.
Another effect we see these days is the government education loans encourage people to sign up for expensive and useless degrees, and then they are apparently shocked that they have to pay back those loans. Hence the push for loan "forgiveness".
Without these loans, I bet there would be far less demand for these degrees with no market value.
True, it was possible (barely) at the time to work part time during the school year and full time during the summer to pay the bills. Borrowing money still (at least used to) means you had to pay it back.
Universities today give out free rides to various groups of students for various reasons. I'd expect their dropout rate to be considerably higher.
BTW, I was offered a free ride by ASU. I couldn't escape the feeling that because it was offered for free, it wasn't worth as much. It's just human nature at work. I am sadly amused by all the people that deny these effects.
I can see what you mean about the halfway point. Maybe undergrad came easily, and at the halfway point, the student realizes that medical school simply isn't a good fit, or it's more work than they thought it would be. So they drop out. This is probably a good thing, to prevent people becoming doctors who don't have the chops or the attitude for it. Unfortunately, the school does lose some money on a candidate they ought to have filtered out in the interview.
Happily it's an empirical question, and we can circle back in a few years to see if the drop out rate increased or not. Maybe the drop out rate increases at first, and then the entrance interview becomes more stringent.
Private engineering schools tend to be seen as schools for those who couldn’t get in public schools but have parents with enough money to pay the fees.
So I disagree with you, keep in mind that there’s a significant barrier of admission to get accepted.
From the stats I could find, there's a drop out rate of around 20% between the first year and second year. Then 85% success rate in getting in an engineering school.
Once they are in an engineering school, the drop out rate is very low (both for private and public schools).
There are some engineering school that include the preparatory classes (we call that integrated prepa, an example is the National Institute of Applied Sciences INSA my alma mater) during the first 2 years, in that case the drop out rate is around 20% during the first 2 years and then less than 1% after that.
For both type of preparatory classes (integrated or not), students who drop out change major to something else and get to transfer credits to their new major.
For medicines, it's different. Until 2020 everyone could do the first year of medicine but only 20% would go on to the second year. Students were allowed to redo it once and then had to change major. There are no private medicine cursus in France. This has now changed and I'm not familiar with the new system.
With majors like liberal arts, etc... University is free and the drop out rate seems to be almost 60%. So yes, for majors with easy admission and free tuition (very little skin in the game) drop out rates are high.
But for highly selective programs where admission is difficult, there's very little drop out once students actually get in.
I trust the medical school admission process to select good students for their program. I'm sure with free tuition they'll have more than enough promising candidates.
It's definitely also cultural as you can see in many Asian countries where public infrastructure (parks, public workout machines, public toilets) are treated well and are in good shape compared to other places (My point of reference being Berlin).
For another data point, look at how clean and well-kept public "free" housing is compared with privately owned housing.
Or how those experiments with free bicycles were a miserable failure.
This is why modern hotels have you put your room key in a slot that enables the lights to go on. When you leave the room, you take your room key, and the lights go out.
Evidently, people leaving the lights on is expensive enough to justify these key light switches.
FWIW, if an AI "satan" wins and becomes the hyper-advanced intelligence that rules our galaxy, it could just reverse simulate the light cone and torture each of us for all eternity anyway. It doesn't matter how good you are or which god you worship or how many "Hail Mary"s you say. We could be in that simulation now -- at any moment fire could erupt from beneath us.
Sometimes it simply doesn't make economic sense to provide a service that people need.
Witness broadband availability and other things, and you'll see that the free market won't provide a service if it can't make money.
This is about government funding - it's not a free market solution, it's about the government being honest in how much it is subsidizing different areas. If the total cost was visible perhaps people would say - hey maybe people shouldn't live there.
I'm also pro-single payer healthcare, and want us just to get on with it.
I don't believe the value of people is just the money they earn.
The school has about 1250 students (Wikipedia). I'm guessing the difference comes from other sources.. or it slowly will drain downward.
Interesting to see nonetheless.
Can you do better than that? Almost certainly! But at least TIPS has some inflation protection built-in.
Oops BBC. Eliminates tuition /fees/.
Linguistic divergence is not a new phenomenon, perhaps we will have two completely different Englishes in a few centuries?
Given this headline doesn't say "pay" either. I don't see how restoring "for" can help it.
And note the headline is by the BBC - not Americans.
I put it down to error, not language.
Overall it's a great thing, a more lean administration and better efficiency, but it's a small peek into what would happen if the U.S. ever gets single-payer healthcare (as I fully hope we do).
On a different note, if things like this became more common, with fewer new doctors having massive debt, that would pull down salaries and medical bills. How you view that depends on if you're a doctor or a patient.
https://college.harvard.edu/admissions/why-harvard/affordabi...
In fact Harvard charges more in tuition just because your family is rich!
If your parents refuse to pay or fill out the FAFSA, the only way to get off their income:
- They die
- You turn 24
- You get married
As a salaryman, I wish I got to donate pre-tax amounts! I get some credits, but if your income is high enough, it doesn’t even cover the taxes already paid.
"When you donate stock to charity, you’ll generally take a tax deduction for the full fair market value" [1].
[1] https://www.fidelitycharitable.org/giving-account/what-you-c...
For most people, the standard deduction is freaking huge now due to the changes under Trump - for married couples in 2024 it will be $29,200.
So you have to have deductions that equal almost $30k before they start to "matter". If your itemized deductions would be about $10k (mortgage interest, perhaps, SALT, etc) you would have to donate $20k before you would start to see some effect from the donations.
There are still some ways to do pre-tax donations even without that, but you may have to involve estate-planning trickery.
Their death could be no surprise and the accountants/lawyers on speed deal would be limitless.
Surely they had their books in order, unless they wanted to pay tax.
Tax-efficient to get employers to donate money to charities of the employee's choosing in their honor maybe? Probably some opportunity for a startup here.
But I can see some employers not being too happy being linked with some of the choices, or employees being unhappy some of their favorites aren't on the list.
https://www.irs.gov/instructions/i1040sca (Control-F "Gifts to Charity")
I understand that the intent is good, but the effect is mostly negative. It's about cherry-picking one set of people and giving them an unfair advantage over everyone else.
The irony is that those who are in a position to be engaging in some kind of charity or philanthropy are the only ones who don't understand that the economy is a zero-sum game, by their own hand! It's a zero-sum game for everyone else except them.
Perhaps if we wait patiently by this here table leg, we can get cheaper prescription medication or some workplace safety. We can hope!
Admittedly pedantic, but they are not wrong.
Do you have a source for this? I am reasonably sure that in American English "Tuition" can certainly mean the fees you pay to be taught.
https://en.wiktionary.org/wiki/tuition#English
> (Canada, US) A sum of money paid for instruction (such as in a high school, boarding school, university, or college).
> Synonym: (UK) tuition fees
Slater's correction may still be fair, despite the context of this being an American school, because it's a headline from a British website..
Tuition = the money you pay for your schooling, I.e., credit hours.
Fees = Costs on top of tuition like registration fees, application fees, and other miscellaneous charges that aren’t represented in the per-credit hour price of school.
If you told someone in the US that their school was eliminating fees they’d take that to mean that they were getting a small discount on a still-very large cost. Think in the realm of $30-100 per semester.
American English has basically detached the word “tuition” to have anything to do with the teaching.
This school is located in America.
The state kept advertising how kids could get 'free tuition' if the met the academic requirements (combination of testing high enough and overall GPA) - but in reality, it worked out to less than 10% of the actual cost of attending this in-state, public university.
Was still nice to get the $1,800 off the bill, but it was hardly 'free tuition'.
PS: Not criticizing this medical school plan - just pointing out that the definition of tuition can, and does, vary - even in the USA.
These language shortcuts can be confusing for those of us not in the USA.