Good post.
I do think, however, that you conflate issues.
Your comments about college are all too true. Personally I would expand your comments by asking are we even sending the right kids to college?" many who now go to college in effect are getting remedial high school at a huge price.
The Med Ed seems to me to be another affair entirely. First, I have seen no data that the says the existence of specialists is the major cause of UW overcostly medicine. Second, I am not sure that it is even true that Americans get fewer procedures than Swedes. Third, the Swedish retirement and job security systems make it impossible to compare the value of salaries here with the salaries in Sverige.
A bigger question here is why we need 16 years post secondary school to train someone for the functions of a general medical officer? Military medics, nurse practitioners, etc are as useful as full MDs for a lot of the care you are discussing. To make matters worse we are now taking these 16 years educated folks and restricting them form hospitals practice. As a result, they are way overeducated for what they do.
Does it really makie sense to set very high admissions criteria, then require 16 years of school and then tell someone they can not take inb the more intellectually challenging part of their profession?
--
Stephen M. Schwartz
Pathology
Comment by John Sahr on an editorial by two presidents of pricey private colleges bemoaning loss of state support for their stu8dents...
The problem with asserting 'the one thing the state can't afford' is this: it assumes that we are all right-thinking people.
It's interesting that Thomas and Anderson are the presidents of two (very nice) private colleges, with tuitions far in excess of those charged by the public baccalaureates in WA. ($35,000 and (approximately) $26,000 (quick web search)). Note that those tuitions exceed even the non-resident tuition of the UW.
upshot: the UW is a bargain, at least relatively.
[ note that the OSPI subsidy to public K-12 schools is about $4700/year/student. No wonder that local school levy bonds perpetually exist. ]
But is the UW a bargain, in an absolute sense? How much should a college education cost? Are UPS and PLU and Harvard just over-the-top?
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Think about medical school for a moment: Med Schools can charge just about anything they want to charge: why?
(a) because students will pay it, to become docs.
(b) because banks would *love* to lend money to docs at the start of their careers.
(c) ... and thus the med schools don't have any real brakes on the tuition they charge.
At the output end, we get docs (*very* well trained) who emerge from their training and residency, at age 30-35, somewhere around a quarter million dollars in debt.
These proto docs need to make a lot of money. They really do have to make a lot of money. It's not an option. It totally works for the banks to have these docs start their careers deeply in debt. It also explains why 'docs' may seem to be pretty hawkish about the medical finance system.
It also explains why we are long on specialists, and short on General Internal Medicine docs, Family Practice Docs, and ObGyn docs, docs in exurb and rural communities --- because (loosely speaking) GIs are not specialized enough to pay for their debt. Even though the GIs and FPs are arguably the most cost efficient docs we can have.
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Suppose we had a higher education system in which proto docs emerged
(a) through pure merit, and
(b) without much debt, and
(c) at age 30.
They wouldn't need to aggressively look for jobs that pay $200k and up per year.
They wouldn't have to accept exotic careers like that of Paul Farmer.
Sweden, for example; one of a dozen countries where the average lifespan exceeds that of the US. Of course, the demographics of the US are much more complicated than Sweden, ... but we are spending $2.5T/year or ($8k per capita) on health care. And for what?
jds
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