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There are few more sobering online activities than entering data into college-tuition calculators and gasping as the Web spits back a six-figure sum, But economists say families about to go into debt to fund four years of partying, as well as studying, can console themselves with the knowledge that college is an investment that, unlike many bank stocks, should yield huge dividends. A 2008 study by two Harvard economists notes that the "labor-market premium to skilr " —or the amount college graduates earned that’s greater than what high-school graduates earned—decreased for much of the 20th century, but has come back with a vengeance since the 1980s. In 2005, the typical full-time year-round U.S. worker with a four-year college degree earned $ 50,900, 62% more than the $ 31,500 earned by a worker with only a high-school diploma. There’s no question that going to college is a smart economic choice. But a look at the strange variations in tuition reveals that the choice about which college to attend doesn’t come down merely to dollars and cents. Does going to Columbia University (tuition, room and board $ 49,260 in 2007-2008) yield a 40% greater return than attending the University of Colorado at Boulder as an out-of-state student( $ 35,542) Probably not. Does being an out-of-state student at the University of Colorado at Boulder yield twice the amount of income as being an in-state students( $17,380) there Not likely. No, in this consumerist age, most buyers aren’t evaluating college as an investment, but rather as a consumer product—like a car or clothes or a house. And with such purchases, price is only one of many crucial factors to consider. As with automobiles, consumers in today’s college marketplace have vast choices, and people search for the one that gives them the most comfort and satisfaction in line with their budgets. This accounts for the willingness of people to pay more for different types of experiences(such as attending a private liberal-arts college or going to an out-of-state public school that has a great marine-biology program). And just as two auto purchasers might spend an equal amount of money on very different cars, college students(or, more accurately, their parents)often show a willingness to pay essentially the same price for vastly different products. So which is it Student who attend an in-state college or university can ______.
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Crippling health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily. Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The US takes the opposite approach by emphasizing the specialist rather than the primary care physician. A recent study analyzed the providers who treat Medicare beneficiaries.The startling finding was that the average Medicare patient saw a total of seven doctors—two primary care physicians and five specialists—in given one year. Contrary to a popular belief, the more physicians taking care of you doesn’t guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors. How did we let primary care slip so far The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he’s reimbursed. Moreover, the amount a physician receive leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient’s disease.Combine this fact with annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income. Primary care physicians who refuse to compromise quality are either driven out of business or to each-only practices, further contributing to the decline of primary care. Medical students aren’t blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. How do we fix this problem It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally managing their diseases and practicing evidence based medicine. Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries. The author’s chief concern about the current US health care system is ______.
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