Population growth's the real thing here. Attractive cities tend to grow more attractive; in practical terms their size is limited, so real estate prices are going to increase. Education works similarly; normally state education could take up the slack, but years of "no taxes!" movements have slashed their tax-proceeds budgets, causing rapid tuition increases. Private schools are even worse off, competing for a limited pool of "sweet spots"--academically talented kids from families who can just write a check for freshman year. In the meantime, the increased enrollment has led to drastic increases in administrative personnel, including many in fields like mental health.

Medicine? Well, my brother, who lives in Czech Republic as a long-term resident alien with US citizenship, slashed his hand in a dumb woodworking accident a couple weeks ago. He went to the hospital, where they stitched up the hand and put a cast on it. Fortunately he'd missed the tendon. It cost about $10. The thing to remark here isn't the price. It's the *protocol*. If he'd been in the US, a specialist would have ensured he hadn't hit the tendon. The ER (another doctor) would then in all likelihood have Superglued the wound shut and sent him home. They don't *do* stitches or casts any more; it's an outdated protocol. Total charge would probably be about $1,000. With insurance, he'd pay some amount of that. Maybe.

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