Why Is College in America So Expensive? • Hacker News Board

Re: Why Is College in America So Expensive?

#321

Post by snikeris » Wed, Sep 12, 2018, 3:22 PM UTC

Emma_Goldman wrote: post #314

mmirate wrote: post #304

Earlier quoted context omitted.

> that value isn't and can't be captured by the educator. Oh, but it is. Quality of education is clearly valued by parents. And depending on which school-district you live in, your property tax rate varies, and the quality of the local public schools correlates rather strongly. While I don't have personal experience with this situation ... I can easily imagine that a good private school's elevator pitch would be some…

The point is that a sufficiently large part of the value of education is a non-excludable public good - i.e. it has huge collective benefits for society as a whole - that if you privatised the education system it would be extremely injurious to everyone. Of course, education also gives people, if you want to use that language, a certain amount of 'human capital' which tends towards a higher earning potential. But it…

> It's an elementary fact of anthropology that human societies for most of history have lived on a communal basis without property.

Interesting. I've assumed that primitive communities were run from the top down with the alpha male effectively owning everything.

I found this:

https://en.wikipedia.org/wiki/Primitive_communism

But it states:

> There is also no agreement among later scholars, including Marxists, on the historical extent, or longevity, of primitive communism.

Re: Why Is College in America So Expensive?

#322

Post by diogenescynic » Wed, Sep 12, 2018, 3:35 PM UTC

blairbeckwith wrote: post #317

diogenescynic wrote: post #237

Earlier quoted context omitted.

You must live in a bubble. $15k in living expenses is a lot of money for even middle class families—$15k is like $25k pre-tax and that’s more than about 40% of Americans even make in a year... Living expenses like dorms/meals are also why so many kids end up taking out student loans and have so much debt. How is that productive for society? It seems like Americans have a very weird attitude towards certain fundamenta…

This is where living at home becomes an option.

You're changing your argument and obviously that's not a solution for all. There aren't universities near many rural areas. You're basically saying college is only practical for upper-middle class and above--that's not beneficial to society or a healthy economy. Higher education should be affordable so everyone can go, which is positive to society and the economy.

Re: Why Is College in America So Expensive?

#323

Post by triviatise » Wed, Sep 12, 2018, 3:52 PM UTC

etiennemarcel wrote: post #291

kansface wrote: post #179

Earlier quoted context omitted.

> The free market does not work in all situations. Sure, but you did not enumerate a single free market. I'd wager the US healthcare industry is far and away the most regulated market in the entire world. We know that regulation protects the big players at the expense of their would be competition and drives up profits. Colleges are hardly any better, and ISPs are nearly all monopolies granted by municipalities in ex…

From a European point of view I have a hard time understanding your opinion. In other countries, regulated/public healthcare works better and is more efficient than your system, it's hard to deny it... I don't see how doubling down on cutting regulations would solve anything. In a way it reminds me of the gun control issue: the idea that deregulating gun ownership and carrying will make everybody safer seems so absur…

Europeans have cheap healthcare because most of the R&D is subsidized by the US paying list prices.

Europeans can spend such a huge amount (16% of govt budget vs 10% in the US) partially because the US is subsidizing their defense.

The US will eventually go to socialized medicine and then you will see the pace of medical advancement slow. Unfortunately it will be impossible to see because it is unknowable what would have been invented with a capitalist system.

Re: Why Is College in America So Expensive?

#324

Post by zoomablemind » Wed, Sep 12, 2018, 4:13 PM UTC

fzeroracer wrote: post #107

bhupy wrote: post #106

Earlier quoted context omitted.

Healthcare in America is one of the least free markets in the country. https://www.vox.com/policy-and-politics/2018/7/31/17629526/m...

I don't see a statistic or actual citation there other than an issue with potentially out of date laws. How are you quantifying American Healthcare as being one of the least free markets? And how does it compare to other countries? I don't see anyone ever actually quantify how 'free' a market is; people only ever argue that if a market is not working therefore it's not free enough, which means we must make it free. A…

In a simple example of a free market a consumer could select a provider based on prices they advertize.

With the exisitng and prevalaent fee-for-service healthcare this 'fee' is not the price. It's different even functionally, where the 'price' is what's expected to be advertized upfront, the 'fee' is what gets billed afterwards. Has anyone tried to ask a doctor's office or a hospital if they could refer you to a price-list for the range of services they provide? If you're lucky, you'd be referred to Medicare regulated pricing, yet it's not even a baseline. I'm not even going into the 'flavors' of the fees formuated to different insurers, ??patients.

While there're rationalizations for such pricing approach, by itself it limits consumer's ability to be an active agent in free market. In healthcare the consumer is treated more like a resource.

Re: Why Is College in America So Expensive?

#325

Post by barrow-rider » Wed, Sep 12, 2018, 4:13 PM UTC

sam0x17 wrote: post #272

kansface wrote: post #179

Earlier quoted context omitted.

> The free market does not work in all situations. Sure, but you did not enumerate a single free market. I'd wager the US healthcare industry is far and away the most regulated market in the entire world. We know that regulation protects the big players at the expense of their would be competition and drives up profits. Colleges are hardly any better, and ISPs are nearly all monopolies granted by municipalities in ex…

I still think the way to go is to have a price index where if procedure X is available in (list of countries with good healthcare system) for $Y, then it should be illegal to charge more than $Y in the U.S. Have a central authority that manages the price index and the list of countries that we survey prices from. Then doctors and hospitals and pharmaceuticals couldn't all take advantage of the system by charging $500…

I believe Australia uses something similar, at least that's what I noticed while living & working there. Ex: https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/co...

In the US there is the Surgery Center of Oklahoma which does something similar; I believe there are doctors in Oregon who do the same as well.

https://surgerycenterok.com/pricing/

Re: Why Is College in America So Expensive?

#326

Post by joe5150 » Wed, Sep 12, 2018, 4:24 PM UTC

oconnor663 wrote: post #262

flukus wrote: post #214

Earlier quoted context omitted.

> Prescription drugs. The FDA has a "no existing alternative first" policy - they work on approving drugs for conditions where no current treatment works before they even start considering competitors to existing drugs. This sounds quite logical, but the effect of it is that every new drug is granted a monopoly for a long period of time before any competitor can even legally sell their alternative, so the drug compan…

Pharmaceuticals is a tricky example, because the marginal cost of producing them is extremely low. Having the government control negotiate the price of, say, automobiles, might have weirder results. > Pharmacists also have to offer a generic if it's available, regardless of what the doctor prescribes. I believe in the US it's actually illegal for a pharmacist to recommend a generic, if the doc didn't check the right…

that's backwards. pharmacists are required by health plans or by law in some states to dispense generics (not "offer," dispense, i.e. if I bring in a script written for AMBIEN 10mg, I'm getting zolpidem 10mg without asking) unless the doctor insists on a name brand.

Re: Why Is College in America So Expensive?

#327

Post by jayd16 » Wed, Sep 12, 2018, 4:35 PM UTC

topkai22 wrote: post #285

sheepmullet wrote: post #180

Earlier quoted context omitted.

There are good and cheap alternatives. My community college was 1/3rd the cost of college. The problem is students don’t understand what they are getting themselves into.

Also it’s almost impossible for private entities to compete with heavily subsidized public institutions on price, so they need to compete in other ways, like superior marketing, ease of financing, or “quality” If states let their subsidies flow to private institutions on a per student basis, you could get some interesting results, but frankly I think community colleges are already so efficient it’s a crowded market.

>Also it’s almost impossible for private entities to compete with heavily subsidized public institutions on price, so they need to compete in other ways, like superior marketing, ease of financing, or “quality”

The entire argument is that they would be cheaper. You could argue they might be better but saying they can't compete on price just concedes the point.

Re: Why Is College in America So Expensive?

#328

Post by closeparen » Wed, Sep 12, 2018, 4:47 PM UTC

Emma_Goldman wrote: post #298

closeparen wrote: post #293

Earlier quoted context omitted.

Regulating a service and providing it at public expense are completely separate concepts. Europeans do not have cheap healthcare as a result of price controls on private medical practices (regulation), but as a result of redistribution and subsidy (spending).

No, the per capita cost of healthcare in the US is astronomically greater than Western European countries, including both private and public spend. In the UK the NHS is a socialised service that is free at the point of use. If that's not 'regulation' then I don't know what is.

To regulate an industry is to make rules about how its participants may behave. This worlds away from government participating in the industry directly.

Public housing is a public service; rent control is regulation.

Public transit is a public service; fuel efficiency standards are regulation.

Medicare is a public service; the medical licensing regime is regulation.

Re: Why Is College in America So Expensive?

#329

Post by closeparen » Wed, Sep 12, 2018, 4:52 PM UTC

etiennemarcel wrote: post #296

closeparen wrote: post #293

Earlier quoted context omitted.

Regulating a service and providing it at public expense are completely separate concepts. Europeans do not have cheap healthcare as a result of price controls on private medical practices (regulation), but as a result of redistribution and subsidy (spending).

At least in France, it's both. The cost for the patient is usually low thanks to the health insurance, but also because of price control. A GP visit is 25 euros by law, covered from 70 to 100% depending on your insurance. Doctors can choose to charge more but then patients need better private insurances to be reimbursed. You can find the price lists here: * https://www.ameli.fr/paris/medecin/exercice-liberal/facturat…

If doctors can choose to charge more to willing patients, that doesn't seem to actually be a price control. Perhaps 25 euros is the amount that the insurance system will reimburse?

Re: Why Is College in America So Expensive?

#330

Post by oconnor663 » Wed, Sep 12, 2018, 4:57 PM UTC

batiudrami wrote: post #286

oconnor663 wrote: post #259

Earlier quoted context omitted.

I remember hearing from someone in the field that health care in Europe is indeed becoming exponentially more expensive. the exponent is smaller than the US, and the cost isn't borne by individuals, but they're still going to have a problem. (I don't have a source for this though.)

There's the aging population and that there are costs associated with improvements in modern medicine. If we save someone from the first expensive-to-treat thing that in the past would have killed them but the second (or third) thing does get them, they have two-to-three times the end of life medical costs. We're able to keep people alive longer, but it is costly. At least in Australia, this is going to go one of two…

I'm curious about this thought experiment when people are discussing the pros and cons of user pays:

> Imagine that in 2019 someone invents a perfect artificial heart, which has zero risks or complications, reliably giving 5 or 10 extra years of life to typical elderly patients with heart issues. The downside is that it has to be made out of a giant diamond and so it costs $100 million. How do we decide who gets one?

The point is that somewhere down the line, as our opportunities to spend money on medicine grow and grow (which by itself is a good thing!), we have to come up with some way to draw the "user pays" line. It might be that people with a "fuck you got mine" attitude want to draw the line a lot lower than everyone else, but that's not the same thing as believing that the line exists at all.