How rich is too rich to receive free tuition at medical school?
That is the question raised by the $1 billion gift from Bloomberg Philanthropies to Johns Hopkins University to cover tuition for most of its medical students, announced on Monday.
The gift put the charity set up by Michael Bloomberg, a former mayor of New York City, in the same league as the $1 billion donation from Ruth Gottesman, a longtime professor at Albert Einstein College of Medicine in the Bronx and the widow of a Wall Street tycoon. Her gift to Einstein in February promised that no medical student there would ever again have to pay tuition. 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 key difference among the programs: Mr. Bloomberg’s generosity is means-tested, given only to students whose family income is under $300,000 a year. The programs at Einstein and N.Y.U. cover all medical students, regardless of income, need or merit.
Before the Bloomberg gift, tuition at Johns Hopkins came to roughly $65,000 a year for four years, a hefty sum even for a family earning $300,000 a year. The university estimates the overall cost of attending, including living expenses and fees, at more than $102,000 in the first year.
What makes $300,000 the right cutoff? And should medical school students be compelled to rely on their parents, however wealthy, for tuition?
Aides to Mr. Bloomberg say that the cutoff 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 have the ability to pay should pay,” Howard Wolfson, who runs Mr. Bloomberg’s educational philanthropy, said in an interview.
“I suppose you can have an academic discussion about whether or not something like that should be universal,” he said. “But generally speaking, he believes there should be some means test. If you come from a wealthier family, you should pay. But $300,000 — it’s not like we’re talking about $50,000 as the cutoff.”
Mr. Bloomberg, he said, was influenced by his own modest upbringing, where a scholarship to college helped put him on the path to being a billionaire.
Ronald J. Daniels, president of the university, described a program that made a conscious effort to be anti-elitist. Part of the gift has been set aside to expand financial aid to students in nursing, public health and other graduate studies. And for future doctors, the gift will offer not only free tuition but also living expenses for students with household incomes up to $175,000. One way or the other, the gift reaches nearly two-thirds of its medical students, the university said.
“Free tuition is of course a huge benefit,” Mr. Daniels said. “But the living expenses are non-trivial.”
He said the philanthropy and the university had given a lot of thought to creating “simple thresholds” that students could readily understand.
The announcement of the gift never uses the term “diversity.” Instead, it talks about attracting “the broadest and deepest range of socioeconomic and geographic backgrounds.”
But even so, the hope, Mr. Daniels said, was that with financial barriers removed, students would be more likely to follow their hearts into underserved areas of medicine and areas of the country.
Ellie Rose Mattoon, 21, will be entering her first year of medical school at Hopkins this year, and she qualified for free tuition under the terms of the gift. Her aid package increased by $47,291 a year, and she is grateful. “I no longer have to take out loans, which is like absolutely amazing,” she said.
Her parents both work in real estate, and their income fluctuates from year to year, she said. Asked if a $300,000 cutoff made sense to her, she said that she did not think medical school students should have to depend on their parents’ financial circumstances.
“I was so lucky to have a lot of support from them for college,” she said. “In their stage of life, they should be worried about retirement. They should be worried about maybe supporting aging parents who are even older. There are a lot of other things they could be putting their finances towards that are not their children’s graduate school.”
The jury is still out on the impact of free tuition on medical school programs.
After N.Y.U.’s medical school went tuition-free, applications surged, especially from underrepresented groups, according to a March article in STAT, a medicine, science and health news website. But admissions also became more selective, in a process that already favors wealthy families, the article said.
And contrary to predictions that graduates would gain the financial flexibility to go into primary care rather than a more lucrative specialty, few of the students in the first tuition-free classes went into pediatrics or family medicine, the article said.
Mr. Daniels, of Johns Hopkins, said that while there was no guarantee that a student spared from paying tuition would choose primary care, “there’s one less reason” not to choose it.
Steve Ritea, a spokesman for the N.Y.U. medical school, said the point was never to increase the number of primary doctors. It was to relieve students of the stress of going through medical school wondering how they would pay. It was also to help those in “that squishy middle where you don’t necessarily qualify for all those loans.”
At Johns Hopkins, the $300,000 cutoff excludes roughly the most affluent 5 percent of all Americans, the university stated in its announcement.
Mr. Daniels said the gift builds on a $1.8 billion gift from Mr. Bloomberg in 2018 that provides financial aid for low- and moderate-income undergraduate students at the university.
Johns Hopkins said the number of undergraduates who are low-income or are the first in their families to attend college has risen by 43 percent since the 2018 gift, and now stands at nearly one-third of the undergraduate population.
The latest gift, Mr. Wolfson said, marries 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 in restaurants and required calorie counts to be posted in chain restaurants, among other initiatives.
“Like a lot of people, he’s very concerned that we are going backwards in this country on longevity, and especially post-Covid, our health system is struggling pretty significantly,” Mr. Wolfson said.
Kirsten Noyes and Kitty Bennett contributed research.