How rich is too rich to get free medical school tuition?
That’s the question raised by Bloomberg Philanthropies’ $1 billion gift to Johns Hopkins University to cover tuition for most of its medical students, announced Monday.
The gift put the charity founded by Michael Bloomberg, a former New York City mayor, in the same league as the $1 billion donation from Ruth Gottesman, a longtime professor at the Albert Einstein College of Medicine in the Bronx and the widow of a Wall Street magnate. Her gift to Einstein in February promised that no medical student there would ever have to pay tuition again. And New York University’s medical school began covering its students’ tuition in 2018, helped by a $100 million contribution from Kenneth G. Langone, a co-founder of Home Depot, and his wife, Elaine.
But there is one important difference between the programs: Mr. Bloomberg Generosity is means-based and is given only to students with family incomes of less than $300,000 per year. The programs at Einstein and NYU are open to all medical students, regardless of income, need, or merit.
Before Bloomberg’s gift, tuition at Johns Hopkins was about $65,000 a year for four years, a hefty sum even for a family earning $300,000 a year. The university estimates the total cost of attendance, including living expenses and tuition, at more than $102,000 the first year.
What makes $300,000 the right limit? And should medical students be forced to rely on their parents for tuition, no matter how wealthy?
Aides to Mr. Bloomberg say the limit was carefully calibrated to weigh the total size of the gift — $1 billion — and its maximum impact.
“The idea behind it is that families who can afford it should pay,” Howard Wolfson, who heads Bloomberg’s education philanthropy, said in an interview.
“I think you can have an academic discussion about whether something like this should be universal,” he said. “But generally speaking, he believes there should be a means test. If you come from a wealthier family, you should have to pay. But $300,000 — it’s not like we’re talking about $50,000 as a cutoff.”
Bloomberg said he was influenced by his own modest upbringing, with a college scholarship helping him on his path to billionaire status.
Ronald J. Daniels, the university’s president, described a program that made a conscious effort to be anti-elitist. A portion of the gift is earmarked to extend financial aid to students in nursing, public health and other postgraduate programs. And for future doctors, the gift not only provides free tuition but also living expenses for students with family incomes of up to $175,000. Either way, the gift reaches nearly two-thirds of medical students, the university said.
“Free college tuition is obviously a huge benefit,” Mr. Daniels said. “But the cost of living is not trivial.”
He said the philanthropy and the university had put a lot of effort into creating “simple barriers” that students could easily understand.
The announcement of the gift never uses the term “diversity,” instead referring to attracting “the broadest and deepest range of socioeconomic and geographic backgrounds.”
Still, Mr Daniels said, the hope was that with financial barriers removed, students would be more likely to follow their hearts and choose less privileged medical fields and parts of the country.
Ellie Rose Mattoon, 21, is starting her first year of medical school at Hopkins this year and she qualified for free tuition under the terms of the grant. Her aid package increased by $47,291 a year, and she is grateful. “I don’t have to take out any loans anymore, which is really great,” she said.
Her parents both work in real estate, and their incomes fluctuate from year to year, she said. When asked if a $300,000 threshold made sense to her, she said she didn’t think medical students should be at the mercy of their parents’ financial circumstances.
“I was fortunate that I had a lot of support from them for college,” she said. “At their stage in life, they should be worried about retirement. They should be worried about supporting their aging parents who are even older. There are a lot of other things they could be spending their finances on that aren’t their kids’ graduate school.”
There is still no clarity about the impact of free tuition on medical education.
After NYU Medical School made tuition free, applications surged, especially from underrepresented groups, according to a March article in STANDSa website about medical, science and health news. But admissions also became more selective, in a process that already favors wealthy families, the article said.
And contrary to predictions that graduates would have the financial flexibility to study primary care instead of a more lucrative specialty, few students in the first free courses chose pediatrics or family medicine, the article said.
Johns Hopkins’ Mr. Daniels said that while there’s no guarantee that a tuition-free student will choose primary care, there’s “one less reason” not to.
Steve Ritea, a spokesman for NYU’s medical school, said the goal was never to increase the number of tenured physicians. It was to relieve students of the stress of going through medical school, wondering how they were going to pay. It was also to help those who are in “that vulnerable middle where you don’t necessarily qualify for all those loans.”
At Johns Hopkins, the $300,000 threshold excludes about the wealthiest 5 percent of Americans, the university said in its announcement.
Mr. Daniels said the gift builds on a $1.8 billion gift from Mr. Bloomberg in 2018, which provides financial aid to low- and middle-income students at the university.
According to Johns Hopkins, the number of students from low incomes or who are the first in their families to attend college has increased by 43 percent since the endowment began in 2018, and now represents nearly a third of the total student population.
The latest gift, Mr. Wolfson said, combines the former mayor’s belief in the value of education with his passion for public health. His administration banned smoking in bars and restaurants, eliminated trans fats from restaurants and required that calorie counts be displayed in chain restaurants, among other initiatives.
“Like many people, he is very concerned that we are going backwards in this country in terms of life expectancy, and particularly after Covid our health system is struggling quite badly,” Mr Wolfson said.
Kirsten Noyes And Kitty Bennett contributed to research.
