The Simons Foundation awarded Stony Brook University, a division of the State University of New York, $500 million. This public university on Long Island received the money as an “unrestricted grant,” which means the school administration can do what it wants with the money.  The Simons Foundation head was a mathematics professor at Stony Brook before he left to found a hedge fund and become a billionaire.  His wife attended and graduated from Stony Brook. They both had fond memories of the time they spent at this university and previously donated hundreds of millions of dollars to Stony Brook.

Multimillion dollar grants to universities are not rare, but one of this size to a public university is record-setting.  More typical is the grant of a few million dollars to a prestigious school when the offspring of a millionaire is seeking admission to the Ivy League institution.  Jared Kushner’s father, Charles Kushner, pledged to donate $2.5 million to Harvard before his son was accepted to the school. Jared’s training at Harvard apparently was sufficient to prepare him for work in Donald Trump’s [his father-in-law] administration. Jared was given a several formidable tasks, including securing peace in the Middle East. He failed. Harvard kept the money.

Although Jared’s father was sent to prison for a variety of crimes and his tax-deductible contribution to Harvard was initially undisclosed by the University, there was nothing illegal about the consideration given to his son.  The generosity of innumerable past and prospective alumni has enabled Harvard to amass an endowment estimated to exceed $53 billion. With a business school that practices what it teaches, Harvard’s endowment has been growing by billions annually and is expected to be the wealthiest university in the world for the foreseeable future. It is also one of the most expensive universities in the world.  The cost of tuition, supplies, fees, etc. for one year at Harvard Medical School is more than $96,000 and growing. Given the only partially disclosed generosity of its thousands of alumni, one must wonder, “Why does it charge its medical students so much?”

Indeed, why does medical school anywhere in the United States cost so much, and why doesn’t the government pay a fair rate for each doctor the school successfully trains? We spend nearly as much of the Federal budget on healthcare [Medicare, Medicaid, etc.] as we do on defense [armed forces, homeland security, etc.]. Few would argue that physicians and other healthcare providers are less essential to the national welfare than the military and supporting agencies. Nonetheless, we spend virtually nothing toward the training of doctors, nurses, therapists, and other health professionals.  In contrast, we pay from $5.6 million to train each F-16 jet fighter pilot to $10.9 million to train each F-22 jet fighter pilot. That does not include the training of support personnel.  After completing their training and getting a license to practice, most physicians will continue to provide healthcare for 30 to 40 years.  Only 17 percent of military enlistees stay with the armed forces 20 years or more.

The answer to why the wealthiest medical schools charge the highest tuition is obvious: People equate cost with value.  It is called Veblenesque economics. If two items cost the same to manufacture and market, the consumer will assume the more expensive item is superior. With medical schools, part of the cost involves the purchase of prestige. Stony Brook Medical School is arguably just as effective in training doctors as Johns Hopkins Medical School, but applicants who can afford Johns Hopkins would invariably choose it over Stony Brook if accepted by that Baltimore, Maryland, school.  It is about image, not quality.

Why the government does not pay all or much of the cost of medical education is more puzzling. We have health wastelands scattered all over the United States.  We need doctors and nurses to care for our citizens. Our population is expanding and aging, and that means the need for health professionals will increase each year. Some of these essential personnel can be provided by the migrants struggling to enter America from our southern border, but barriers to the influx of foreign doctors and nurses are growing even as our need for these people grows. Allowing foreign trained doctors from designated training programs to enter the U.S. and work while their paper work and credentialling is expedited would help relieve the current doctor shortage. There are some existing pathways for foreign-trained physicians and nurses to enter the workforce, but only a fraction of those who are qualified make it through the system and into healthcare.

Another option is to temporarily expand the size of medical school classes to meet our healthcare needs.  Thousands of qualified applicants are rejected by medical schools each year, and most schools are desperate for additional income to sustain their current programs.  If the government stepped in to subsidize this resource expansion [? an M.D. Bill, rather than a G.I. Bill], our elderly and ill would have access to more healthcare providers and would not need to drive hours to reach a doctor.

Some countries charge their citizens little or nothing for public medical school tuition.  The United States is obviously not one of them. Medical school graduates routinely start their careers with hundreds of thousands of dollars of debt. Over the past 2 years, the Federal government has proposed tuition debt forgiveness, but this has faced considerable resistance, and the Supreme Court will probably kill the proposal even if it survives congressional opposition.  What we need are subsidies for all but the wealthiest medical schools so that the cost of a medical education does not disqualify all but our wealthiest citizens.

Although there is a common assumption that most doctors can handle enormous debt because they will reap huge incomes when they go into practice, most are drawn to medicine out of interest in the challenges and the emotional rewards of helping people. Debt burden limits the options for physicians just starting their careers. Being a pediatrician or a family practitioner in North Dakota may be rewarding, but it does not pay the bills. Debt makes subspecialization in wealthy urban centers preferable. As Mr. and Mrs. Simons demonstrate, those seeking wealth do not go to medical school.  They set up hedge funds.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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