One morning late last month, the financial futures of hundreds of medical students in the Bronx changed forever. A gift of $1 billion from Ruth Gottesman, a former professor at the Albert Einstein College of Medicine and chair of its board of trustees, will make the school tuition-free in perpetuity. The donation, one of the largest in US higher education history, is an act of generosity that will undoubtedly improve life for Einstein’s students and potentially benefit the surrounding community, one of the nation’s poorest.

It also highlights how much US colleges and universities rely on wealthy donors — and raises the question of whether more systemic changes would better serve students and society.

I’m under no illusions about how hard that change would be. When the federal government attempts to forgive or cancel student loan debt, there is an outcry. This includes Republican attempts to end the Public Service Loan Forgiveness program for new borrowers, which requires 10 years of work in exchange for forgiving remaining debt. This is in a nation whose citizens regularly rely on friends, neighbors, relatives and perfect strangers on the internet, on sites such as GoFundMe and ModestNeeds, to help pay for such things as rebuilding after a natural disaster, educational debt or medical expenses.

Relying on the kindness of strangers in the wake of a tragedy is not a new phenomenon, of course. Yet the sheer proliferation of requests for help is an indicator of gaping holes in America’s social safety nets. Some 30 million people, including from outside the US, gave or received help on GoFundMe in 2023, according to the company’s 2023 Giving Report.

It’s important to reiterate that gifts such as Gottesman’s — or those of Bloomberg LP founder Michael Bloomberg, whose $1.8 billion donation to Johns Hopkins in 2018 was the largest ever to a college or university — deserve to be celebrated, as was New York University’s announcement in 2018 that its medical school would be free. Gottesman’s bequest also represents a significant share of her wealth, estimated to be about $3 billion. If we’re going to applaud billionaires for their philanthropy, we should consider the percentage of their wealth they donate.

It’s also important to note that the high cost of higher education in the US forces millions of students to take out loans to pay tuition. The estimated costs for a student entering Albert Einstein in the 2024-25 school year, including living expenses, amount to almost $400,000 for all four years. According to the Association of American Medical Colleges, 54% of medical-school graduates in 2023 had at least $200,000 in education debt, and 84% had $100,000 or more, which is inclusive of undergrad.

Medical students who anticipate hundreds of thousands of dollars in debt will likely make career decisions based on whether they can afford their monthly payments. Graduating debt-free opens every possible option — including working in less lucrative specialties or in underserved communities. Some Einstein graduates may opt to work in the Bronx, which needs more doctors.

Then again, there’s no requirement for medical students to become bleeding hearts willing to forgo wealth and prestige so they can help those less fortunate. It’s entirely possible that plenty of Einstein students will just become millionaires significantly faster than they otherwise would have because they don’t have a heavy debt load keeping their net worth in the red.

What to do with their debt-free future will be a personal choice for Einstein’s students. What to do about the excessive costs of higher education is a question for society. Continuing to streamline repayment programs, as well as protecting public service loan forgiveness and income-driven repayment plans, is a start. Considering how many professions require education beyond an undergraduate degree, expanding grant options for graduate school would also help. And state governments should continue supporting public universities and community colleges to keep tuition at affordable levels relative to median income levels in their state.

Students should also have access to federal grants and loans that cover the cost of tuition plus room and board for an in-state university. If the maximum a student can borrow is set below the cost of tuition plus room and board, then more students will rely on expensive private student loans. Finally, there has been bipartisan support for ending interest capitalization, which would help prevent loan payments from spiraling into huge financial burdens.

Wealthy donors can help make education more affordable for individual students, groups of students, even entire universities. Making it more affordable for everyone is a challenge that can only be met by all of us, wealthy and not, working together to ensure the federal and state governments do as much as possible to clear the paths to higher education for everyone.

Erin Lowry is a Bloomberg Opinion columnist covering personal finance. She is the author of the three-part “Broke Millennial” series.