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November 4, 2019 – Youth Caucus of America
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“Tuition-Free” Medical School

"Tuition-Free" Medical School

An Effective Attempt At Reducing Student Loans Or An Unfulfilled Promise?

WHAT YOU CAN DO...

By Adelina Branescu

The U.S. is on the brink of a national student loan crisis, with Forbes reporting that this collective debt reached $1.52 trillion in 2018 and impacted 44.2 million Americans. With the upcoming presidential election in 2020, many candidates such as Senators Bernie Sanders and Elizabeth Warren are homing in on younger voters with promises of eliminating student debt. Due to a majority of high-paying jobs requiring applicants to have at least a bachelor’s degree, the scope of debt relief proposals are typically tailored to undergraduate studies. Yet, this narrowness of attention has left out a significant portion of students whom also bear what has become extremely burdensome debt: graduate students. Specifically, the path to becoming a doctor requires rigorous schooling that accumulates large sums of debt not only from undergraduate studies but also from the high price tag attached to medical schools. As a result, programs such as Cornell’s Weill Medical College are beginning to offer lowered costs and tuition-free options for students (2). To medical school applicants across the country, this development raises concerns as to whether they are eligible for the benefits of these newly implemented policies.

 

        The first institution to begin shifting debt relief efforts towards medical school was Columbia Universitywho in 2017 implemented a loan-free policy for all medical students (3). To address the notoriously high cost-of-living in New York City, Columbia also designated need-based aid to students for housing purposes. Columbia’s neighboring medical school at New York University announced a similar policy the following year, planning to cover tuition costs for all of its students. A different route has been taken at universities such as UCLA, which has introduced merit-based scholarships to ease the costs of attending their medical program. Following in the footsteps of these institutions, Cornell’s Weill program has expanded this approach by beginning to cover all costs for students deemed needy. For students looking to apply to medical schools in this upcoming cycle, the varied information per school can be overwhelming. For colleges such as Weill, applying can be nerve-wracking for prospective students who are even unsure of their own need status. Where do institutions draw the line between who qualifies for need and who doesn’t? How do they ensure the determining factors of qualification are not decided arbitrarily? To aid in answering some of these questions, below is a summaryof information for medical school applicants looking to better understand the growing debt-relief trend and how it applies to some of the country’s most popular medical schools.

 

Need-based:

 

Columbia University College of Physicians and Surgeons (4)

The program received $150 million in initial donations from Roy and Diana Vagelos and aims to receive more funding in the upcoming years. Their aid functions by replacing all loans that would have been taken out with grants, meaning that approximately 20% of students will receive entirely free tuition.

 

New York University (5)

        This initiative provides a $56,272 scholarship to each student covering the entirety of tuition. In order to continue receiving this grant, students must maintain good academic standing by NYU board standardswhich have not been specified as of late The dean stated that NYU opes to encourage students to pursue lower paying specialties in high demand, such as family medicine.

 

Cornell University (6) (7)

 

Weill recieved $160 million in donations from the Starr Foundation and Sanford I in order to offer need-based free tuition to those who qualify, which turns out to be about 52% of students per year.

 

Washington University (8)

WashU’s program utilizes over $100 million of donations to lower costs and cover full tuition for approximately half of the students attending. Similar to New York University’s Medical School, a committee determines if a student will receive a grant based on a combination of merit and need.

 

Merit Based:

 

UCLA (9)        

            UCLA provides an entirely meritbased scholarship to students who show dedication to community leadership, as decided by the UCLA admissions committee.

 

University of Pennsylvania (10) (11)

UPenn awarded approximately 30 full-tuition scholarships in a class of 150 (~20%) to students demonstrating academic performance, leadership, relevant life experiences, and other unspecified factors.

 

Conclusion:

At first glance, it appeared that some of these efforts were not entirely ambitious or beneficial. As a college student myself, I went through the process of taking out loans because the “expected parent contribution” was too high and the work-study expectation was infeasible, I wondered if these efforts to reduce student debt were actually effective and fair, or if they were a ploy for increasing university prestige, especially given the language in some of the offerings. However, based on the list of medical schools providing need-based aid, it appears that they are not allocating a portion of their already existing budget towards these programs. Instead, they arereceiving millions of dollars from donations specifically directed towards aid, resulting in less pressure for these schools to cut funding from their own endowment. In particular, New York Universityis attempting to push students towards lower-paying but highly necessary specialties through these grants. These specialties include fields such as family medicine, which has seen a shortage ofstudents pursuing this branch of medicine with primary-care physicians hovering between 14,900 and 35,600 (12) in the United States. NYU is an admirable example of a medical school attempting to create a positive societal changeby ensuring that students are specializing in their passion as opposed to a paycheck.  

 


 

1. https://www.forbes.com/sites/zackfriedman/2018/06/13/student-loan-debt-statistics-2018/#6c0a62e97310

2. http://news.cornell.edu/stories/2019/09/weill-cornell-medicine-announces-debt-free-medical-education

3. https://www.nytimes.com/2017/12/04/nyregion/columbia-medical-school-endowment-p-roy-vagelos.html?module=inline

4. https://www.columbiaspectator.com/news/2018/04/17/columbia-medical-school-first-in-nation-to-offer-new-students-debt-free-graduation/

5. https://med.nyu.edu/education/md-degree/md-affordability-financial-aid/cost-attendance

6. https://weill.cornell.edu/our-story/deans-messages/medical-school-debt-reduction

7. https://www.cnbc.com/2019/09/18/cornell-to-offer-full-rides-to-all-medical-students-who-qualify.html

8. https://medicine.wustl.edu/news/washington-university-commits-100-million-to-md-scholarships-education/

9. https://medschool.ucla.edu/geffen-scholarships-about-the-scholarship

10. https://www.med.upenn.edu/admissions/financial-aid.html

11. https://www.med.upenn.edu/admissions/entering-class-profile.html

12. https://www.nejmcareercenter.org/article/physician-shortage-spikes-demand-in-several-specialties-/

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yca administrative healthcare

The Burden Of Inefficiency

The Burden Of Inefficiency

How Rising Administrative Burdens Have Cost U.S. Taxpayers Millions

WHAT YOU CAN DO...

    • S.B. 3434, the Reducing Administrative Costs and Burdens in Health Care Act of 2018, was killed in Committee during the 115th Congress

    • Contact Senator Bill Cassidy (R--LA) and Senator Tina Smith (D--MN) to encourage them to reintroduce this bill

By Zoe Hauser

Debates over the United States healthcare system run rampant throughout the political stage, with each party taking strict oppositional stands. Yet, healthcare should be seen through a lens that removes the party power struggle the issue has become, and as the necessity to American livelihood it truly is. The result of healthcare being posed as merely a political battleground for party quarrels is a vastly inefficient and wasteful U.S. system. If we can reduce waste and inefficiency, then we will be able to improve our system to better serve the country’s citizens and help temper the political stalemate on healthcare.

 

The United States unloads 17.8% of its GDP on healthcare, making us the world’s largest healthcare spender[1]. But this does not mean that our healthcare system uses this money efficiently and/or properly. In 2017, the National Health Expenditure Accounts (NHEA) estimated the United States spends a total of approximately $3.5 trillion each year on healthcare, rendering per capita costs of $10,739[2]. Switzerland, the second largest spender on healthcare, witnessed per capita costs at an estimated $7,317 in USD[3]. This is equal to 12.2% of Swiss GDP, a figure still substantially less than the United States. The United States’ noticeable healthcare waste can be traced to the system’s administrative costs, rooted into the inefficiency of the U.S. healthcare system. Administrative costs include medical records, insurance bills, and other hidden costs which most patients are not aware of.

 

According to a recent Journal of the American Medical Association (JAMA) study, the estimated total cost of waste in the administrative healthcare sector ranges from $760 billion to $935 billion[4]. This accounts for 25% of total healthcare spending in the United States. JAMA identified 6 domains of waste including: failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud, abuse, and administrative complexity3.

 

Administrative complexity, for instance, is the largest producer of administrative waste because the medical system requires many different departments, form duplications, and various other requirements which cause the system to become too complex to remain efficient and functional. This complexity accounts for the largest portion of administrative waste produced, but also has the potential to use innovation and reorganization to reduce its waste by the greatest portion of the six domains.

 

While some misuse of funding is inevitable in all large-scale governmental systems, the amount of administrative waste in the United States is staggering and has become an issue that must be dealt with. Researchers have proposed solutions such as digitalizing all medical records, incorporating a pay-in-advance option for services, and an array of other modifications to the system that would ultimately reduce waste by $191 billion to $282 billion.

 

In 2018, S.3434, title Reducing Administrative Costs and Burdens in Health Care Act, was introduced to Congress[5]. The Senate has referred this bill to the Committee on Health, Education, Labor, and Pensions. This bill would require the Department of Health and Human Services to allow states to implement strategies, recommendations, and actions to reduce unnecessary costs and burdens of the administrative health care system. The bill includes recommendations such as standardizing and automating administrative transactions and implementing more open application programming interfaces to improve communication between patients and their doctors.

 

For young adults, the idea of healthcare is dealt with mostly by our parents. However, as we graduate from college and transition into a lifestyle no longer supplemented by our parent’s aid, healthcare insurance costs and hospital visits will become an increasingly important part of our lives. An inefficient healthcare system handcuffed by administrative deficiencies has caused the cost of health care, and subsequently insurance rates, to increase. Since healthcare is required by law in the United States, young adults as well as other Americans will be forever plagued by these ever-increasing insurance rates.


[1] Papanicolas  I, Woskie  LR, Jha  AK.  Health care spending in the United States and other high-income countries.  JAMA. 2018;319(10):1024-1039.

 

[2] National Health Expenditures BType of Service and Source of Funds, CY 1960-2017. CMS.gov. US Centers for Medicare and Medicaid.

[3] “Health Resources - Health Spending - OECD Data.” TheOECD, data.oecd.org/healthres/health-spending.htm.

[4] Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. Published online October 07, 2019322(15):1501–1509. doi:10.1001/jama.2019.13978

 

[5] United States. Cong. Senate.  Reducing Administrative Costs and Burdens in Health Care Act of 2018. 115th Cong. 2nd sess. S3434.

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