[Test0129]

> Combined with sorting dynamics that concentrated talent and resources at some schools—and the emergence of tenure—this enhanced research performance.

Something tells me this is only part of the story. Yes, after several wars we took in scientists who subsequently brought new ideas, improved teaching, etc to the country.

But this ignores the biggest factor: US universities have tremendous endowments [1]. Having deployable capital that is larger than the GDP of some nations helps not only with the acquisition of the absolute best, but also the maintenance of programs who may not have an obvious path to profit. Moreover US students pay more for their tuition than any other country in the world, further factoring in to the availability of money that can be used for such purposes. Additionally, the US spends the most capital on R&D by the dollar than any other country [2].

In the end, it comes down to money. It doesn't matter if you grow the talent if you can simply purchase the best from where ever it happens to grow.

[1] https://en.wikipedia.org/wiki/List_of_colleges_and_universit...

[2] https://www.investopedia.com/ask/answers/021715/what-country...

[forbiddenvoid]

Saw the title and was immediately confused about why the answer to this question isn't just money. Turns out it is. US universities are benefited by subsidies from the US government and large grants from the private sector. Much of that capital is a direct result of the advantage gained by both US colonial interests abroad and by the US not suffering the infrastructure damage most of the rest of the wealthy world experienced as a result of WWII.

Edited to add: the brain drain from Europe to the US during WWII is also a factor. We ended up with a disproportionate number of foreign scientists during that period as well.

[dcolkitt]

These are all good points. But what's interesting is that very similar things could also be said about the US healthcare system. And yet unlike American universities, it's not clear that American hospitals or healthcare is worldclass.

[SllX]

Where we fall down is on our convoluted system of billing and opaque pricing. The actual care in my experience is top notch.

To give you an idea, I can pay $60 for a FaceTime call with an urgent care clinic. That exact same call is billed to my insurance for $200 or 333.3334% more than what I would pay. An inhaler is priced at $70 at my local pharmacy, but can be had for $15 with a co-pay (God knows what they’re billing insurance for the “rest”) or $12 without insurance and just a coupon I picked up from a doctor rendering one of the “benefits” of my insurance moot. I’m pretty sure the inhaler itself can’t be more than a dollar to manufacture, but whatever, the pharmacist has to get paid, right?

[dr_dshiv]

Really? Few would argue that America has the best healthcare system but the healthcare, hospitals and medical education are, perhaps, unsurpassed.

[Test0129]

It’s actually related. While the system itself may be broken the healthcare, when available, is second to none in the world.

This, once again, owing to the exorbitant amount of money spent on healthcare both by the public and the government. A lot of people seem surprised that our government spends way more money on healthcare than a lot of other countries and yet the system disenfranchises the vast majority of its consumers.

In fact, US citizens subsidize the healthcare of other countries as well. The money we are forced to spend on absurd medicine costs goes directly into making it cheaper in other parts of the globe. The standard for treatment and care is decided in the US at the expense of her citizens, and then it is offloaded to the rest of the world where it becomes cheap. Doctors from other parts of the world go to medical school in the US, once again subsidized by citizens, and then go home and take that knowledge with them. If other countries paid their “fair share” it would likely result in total medical costs going down in the US.

If you need a pill, go to another country. If you need treatment for an extremely rare disease there is no better place than the US (supposing you can afford it). This isn’t so much a complaint despite myself being a victim of the system, but rather the reality of it. America subsidizes the cheap healthcare of the rest of the world. This is why, on a practical level, a system on par with Europe in the US is fiscally intractable. To both subsidize the world and continue to lead the standard of treatment and care, the taxpayer would be on the hook for an absurd amount of money. I’ve yet to see an accurate tax burden calculation but I’d imagine it would be several dozen trillion a year, or around a flat 800-1000% increase in current taxes along with trimming the budgetary fat.

[mrguyorama]

If that world class healthcare is only accessible to a small percentage of americans, does america really have world class healthcare?

[jhanschoo]

It's useful to separate, as the parent commenter did, the notion of healthcare quality (for those who can afford it), and the state of public health.

[mrguyorama]

It's only useful in that it allows the US to still claim they have good healthcare. I disagree that it has any other utility.

[jhanschoo]

You're ignoring, willfully or not, that the notion of a good quality of healthcare is useful in many dimensions, e.g. where you might want to go to learn cutting-edge techniques and best practices, or receive them if you can afford them.

[RC_ITR]

The US had some of the best hospitals in the world, often because they are associated with the best research universities.

The problem with US healthcare is distribution (a similar but less acute problem exists in education) and efficiency (same).

In fact you could argue that US healthcare priorities being so similar to our education priorities (i.e. spend a bunch of resources on the absolute best, particularly infinitely scalable research like pharmaceuticals, but then hope and pray for the underfunded rest) is what causes a lot of the criticism people levy against US healthcare.

[vanviegen]

Most American universities aren't worldclass either. I'm not even sure if the average quality is higher than that of the rest of the developed world

But the US seems to have worldclass outliers in just about any field you can think of.

[gpsx]

US Healthcare system is very good at what it does. It just isn't doing the right thing. Looking at it another way, the US healthcare system is far better at bringing in revenue than any other country's healthcare system, but like a factor of two.

[Auracle]

The Mayo Clinic gets 8,000 international patients a year. That’s quite a few people who are willing to take a flight and pay our high prices for medical care.

[otikik]

“Worldclass only if you can afford it” isn’t wordclass. One should look at how the system helps the poor, not the rich.

[Cwizard]

How is the comparison to GDP relevant? GDP is the amount of good and services a country produced in a year expressed in some currency. An endowment is an amount of money? Totally different things I would say? But I have seen this type of phrasing a lot in the media. I don’t understand the connection.

[gt565k]

It's not really a comparison, but more so used to show you the perspective of the university's deep pockets and just how deep they are.

If a single university has a bigger endowment than the entire monetary value of produced goods and services of a country for a whole year, it gives you perspective on what that money can do when poured specifically into a single purpose (education, R&D, attracting academic talent, etc)

[importantbrian]

Well having a large endowment allows you to have a larger budget and spend more on salaries, research, instruction, etc. For example, Harvard with the largest endowment had ~$5 billion in operating expenses in 2021. That alone is more than the entire GDP of more than 50 countries. So Harvard by itself spent more money than the entire economies of 24% of the worlds countries.

[fezfight]

It's about expectations. Most folks expect that the GDP of a country would be a larger number than the endowment of any one thing. It's no deeper than that.

[unmole]

How do you feel about comparing debt to GDP?

[Cwizard]

It’s a better metric because GDP gives some insight in the potential income of a country. Although it must be coupled with current tax % to be really useful. Debt usually has monthly or yearly payments, GDP refers to yearly income. In that sense I see a relation. An endowment is just a pile of money, I don’t see a time element there.

[unmole]

> Debt usually has monthly or yearly payments

Sovereign debt, the kind that is typically compared to GDP only pays out interest periodically, not the principal.