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Why Is College in America So Expensive?

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Re: Why Is College in America So Expensive?

#331

Post by oconnor663 »

joe5150 wrote: post #326
oconnor663 wrote: post #262

Earlier quoted context omitted.

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.

I feel like I heard my wrong version in an article about EpiPens. Is it different for devices maybe?

Re: Why Is College in America So Expensive?

#332

Post by linuxftw »

fouc wrote: post #186

College is expensive because people still pay that price. People pay that price because they have easy access to student loans. So if we get rid of student loans, colleges would be forced to change their pricing. If governments still want to encourage students to go to college, then perhaps non-price based methods would help. Scholarships could move away from being a monetary amount, to being a fixed amount of semest…

We shouldn't get rid of student loans, we should force colleges to loan the money themselves with no special backing from the government.

If they really believe in their crap degrees, they'll be willing to put up their own cash and make a return on investment.

Re: Why Is College in America So Expensive?

#333

Post by joe5150 »

oconnor663 wrote: post #331
joe5150 wrote: post #326

Earlier quoted context omitted.

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.

I feel like I heard my wrong version in an article about EpiPens. Is it different for devices maybe?

the first generic EpiPens were just approved a month ago, I don't know if they're widely available yet. if for now some plan formularies only have name-brand injectors on them, some people with insurance could potentially pay less for the brand than the generic until that changes. otherwise, the same substitution allowances and requirements should apply.

EpiPens aren't really medical devices, it's just a drug with a specialized route of administration. it's not any different from an inhaler, a nasal spray bottle, an eyedrop bottle, etc., from a dispensing point of view.

EDIT: it's true that pharmacists aren't always allowed to tell patients when they could save money by buying a generic and paying out of pocket rather than buying a more expensive name brand and paying their share of the full price with insurance. that may be what you heard.

Re: Why Is College in America So Expensive?

#334

Post by etiennemarcel »

closeparen wrote: post #329
etiennemarcel wrote: post #296

Earlier quoted context omitted.

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?

The French system is fairly complex, it's not single payer. To sum up, for "everyday" health issues the public health insurance reimburses 70%. For grave long-term illnesses, you're covered 100%.

You're supposed to have a private health insurance (it's now mandatory for all employees) that reimburses the remaining 30% and all extra costs. That includes some dental and optical work, but also stuff like single-bed rooms in the hospital. Your additional private insurance also covers doctors charging more than the "official" price.

Re: Why Is College in America So Expensive?

#335

Post by tmaly »

Domenic_S wrote: post #3

I didn't see this discussed in the article, but IMO the main driver is the availability of student loans. When the government guarantees loans, you can lend whatever you want! The price of a TRIPLE occupancy dorm + 7 day meal access is $14,813.29/YEAR at UC Davis. The "meals", if they haven't changed in the last decade, are Sodexo garbage. And don't forget a "year" doesn't count the summer, or winter break.

Back in the 1950s and 1960s you could get a decent middle class blue collar job with just a high school degree.

About 20 years ago I had met a retired math professor that believed the cost of college went up as a result of the anti-war protests in the 1970s.

Re: Why Is College in America So Expensive?

#336

Post by mhh__ »

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…

The argument is that although the U.S healthcare system - based off of some metric - underperforms compared to a system which makes no claim of being based on a free market, the U.S. healthcare is also not a free market by any means. Lightly regulated it is not.

Also, you combine "works better" and efficiency: This is slightly unheplful, as although (let's say) the NHS is very cost efficient is - however - not anywhere near as impressive when it comes to patient outcomes. I am not well-versed in the topic to provide a well thought out counterexample however I believe that the Swiss system would be a suitable example?

Comparing the deregulation of businesses with guns is fallacious if not ridiculous: However, being British etc, I do share your fears as to healthcare deregulation.

Re: Why Is College in America So Expensive?

#337

Post by mhh__ »

jayd16 wrote: post #174
topkai22 wrote: post #132

In summary, the reason (from a spending perspective) presumably non-profit colleges are so expensive in the US is that US colleges spends 2x/student as much on staff and faculty as many OECD counterparts. College faculty, staff, and administrators form a large constituency that will be campaigning to keep spending (private, public, or otherwise) up, which campaigners for lower higher-educational spending will need to…

If the free market is the answer why aren't there a swath of good and cheap private options?

In a market, for example in this one where there is a lumbering - government backed - behemoth distorting it, it may not be viable to create new options.

Starting a new University, especially a for-profit one, and marketing it right is probably one the biggest challenges I could think of for a business.

Re: Why Is College in America So Expensive?

#338

Post by JoeAltmaier »

fallingfrog wrote: post #313
JoeAltmaier wrote: post #312

Earlier quoted context omitted.

I read it more softly than that. Of course we get 'paid back' for making the Thanksgiving turkey - by goodwill. I'm paid for moral acts by a reinforced self-image and satisfaction. There are lots of forms of payment.

Right, but those feelings are the result of the culture you were raised in and the normal feelings of compassion you have as a member of a highly social species of animal. The whole reason society works at all is because I teach my kids to share, and not to hurt each other. If everyone starts believing that they should only do things out of pure self interest, then I'd say you're looking at a society that's about to…

Like every online multiplayer game!

Re: Why Is College in America So Expensive?

#339

Post by sjg007 »

frebord wrote: post #91
Domenic_S wrote: post #3

I didn't see this discussed in the article, but IMO the main driver is the availability of student loans. When the government guarantees loans, you can lend whatever you want! The price of a TRIPLE occupancy dorm + 7 day meal access is $14,813.29/YEAR at UC Davis. The "meals", if they haven't changed in the last decade, are Sodexo garbage. And don't forget a "year" doesn't count the summer, or winter break.

> Ultimately, college is expensive in the U.S. for the same reason MRIs are expensive: There is no central mechanism to control price increases. “Universities extract money from students because they can,” says Schleicher at the OECD. “It’s the inevitable outcome of an unregulated fee structure.” Why do people always reach for central control, when we have the ultimate mechanism of price control as a core part of our…

The Fed guarantee is basically an enforced tax on the student’s earnings until the debt is repayed. Dischargeable only if dead or disabled. This is to make up for states cutting educational budgets for colleges and universities. It’s a progressive tax too where students at higher cost schools (that typically lead to higher incomes) pay more. It sucks for drop outs who can’t make enough to pay the bill but in those cases income dependent payment plans are supposed to help alleviate the pain. The Feds could regulate this by taking back money from schools whose graduates underperform or are whose programs are outright scams etc.. so the government subsidizing the loans is not the problem. The feds could even regulate tuition increases retroactively. It also exempts scholarships and the rich who are otherwise funded. So instead of a state or fed tax on the 1% to fund higher ed, you just guarantee payments from the students.

Re: Why Is College in America So Expensive?

#340

Post by batiudrami »

oconnor663 wrote: post #330
batiudrami wrote: post #286

Earlier quoted context omitted.

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?…

It's an okay thought experiment but I don't think it's especially valuable when the reality is closer to "we take an additional 1-2% of your taxable income in return for people being confident that they can go to the hospital if they need to". Which is where we're at, not $100M hearts.

Of course there are issues with it. Government inefficiency, people taking up GP time when they don't need to, over-prescription pushed by drug reps as the government pays for it etc. But comparatively I think it's a small cost to pay for avoiding poor people dying because they can't afford to go to the hospital.

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