Interesting insight into becoming a doctor in America

[ChicosBailBonds]

http://qz.com/67304/i-just-finished-my-87-hour-work-week-and-have-230000-in-medical-school-debt/

[4everwarriors]

All for the right to have government and private insurance companies dictate your fees. The liability issue in treatin' patients is overwhelmin' as well. "Doctor, why is it so expensive when I come to your office?"

[ChicosBailBonds]

We are going to have a major doctor shortage in this country, especially in rural areas because of how expensive it is to become one and how expensive it is to remain one.

[mu-rara]

We are going to have a major doctor shortage in this country, especially in rural areas because of how expensive it is to become one and how expensive it is to remain one.

What a surprise....NOT.

[Ellisium]

We are going to have a major doctor shortage in this country, especially in rural areas because of how expensive it is to become one and how expensive it is to remain one.

Becoming a doctor has always had high upfront costs.  This is nothing new.  It's been this way for years.  My father is a doctor and didn't pay off most of his debts until around age 40, I believe.  The article only mentions the tough road it takes to get there.  When you start making 200+ grand a year, things get much easier.  It's a sacrifice.

As far as shortages go related to the financial factor, there's no correlation.  Medical schools are still turning away applicants.  Plus, technology is going to eliminate more doctor visits.  Prime example ...... flu shots being available at local pharmacies now which eliminates doctor's visits.  What does the future bring in terms of technology that will help eliminate doctor visits ...... here's a look:  http://www.foxnews.com/health/2014/10/13/revolutionary-blood-test-created-by-planets-youngest-female-billionaire/

[Coleman]

The answers are easy. Universal free education. Universal free health care.

Next issue?

[jficke13]

The answers are easy. Universal free education. Universal free health care.

Next issue?

Free everything for everyone.

[Coleman]

Free everything for everyone.

Not everything. Just education and healthcare. And I even have the answer of where we can get the money from....



"Every gun that is made, every warship launched, every rocket fired signifies, in the final

sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone.

It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children.

The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities.

It is two electric power plants, each serving a town of 60,000 population.

It is two fine, fully equipped hospitals. It is some 50 miles of concrete highway.

We pay for a single fighter plane with a half million bushels of wheat.

We pay for a single destroyer with new homes that could have housed more than 8,000 people."

-Dwight D. Eisenhower (R)

[Groin_pull]

Not everything. Just education and healthcare. And I even have the answer of where we can get the money from....



"Every gun that is made, every warship launched, every rocket fired signifies, in the final

sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone.

It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children.

The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities.

It is two electric power plants, each serving a town of 60,000 population.

It is two fine, fully equipped hospitals. It is some 50 miles of concrete highway.

We pay for a single fighter plane with a half million bushels of wheat.

We pay for a single destroyer with new homes that could have housed more than 8,000 people."

-Dwight D. Eisenhower (R)

Who's this Eisenhower guy? What a commie pinko hippie.

[brandx]

The answers are easy. Universal free education. Universal free health care.

Next issue?

I agree that education should be available to all. But how about another system? Instead of these kids borrowing, sometimes, hundreds of thousands of dollars, how about a system where in return for their education, they pay back 1% or 1.5 % of future income each year to cover the cost of college expenses.

[Ellisium]

I agree that education should be available to all. But how about another system? Instead of these kids borrowing, sometimes, hundreds of thousands of dollars, how about a system where in return for their education, they pay back 1% or 1.5 % of future income each year to cover the cost of college expenses.

How about a more efficient system of delivery for education?  Increase the number of AP courses in high school which effectively eliminates classes you have to pay for in college.  For those who want more technical training, offer more of those classes in high school.  There's a start. 

Ohhhh...  and eliminate those bloodsucking online universities you see on TV late at night.  The people who sign up for those just give themselves more debt.  It's the strong preying on the weak. 

[Coleman]

I agree that education should be available to all. But how about another system? Instead of these kids borrowing, sometimes, hundreds of thousands of dollars, how about a system where in return for their education, they pay back 1% or 1.5 % of future income each year to cover the cost of college expenses.

totally agree, at least for private universities. I'd even argue it should be more like 10-15% of income (could be a sliding scale, like taxes), for maybe 10 years or so.

I will stick to my assertion that state universities should be free, or very close to free. If Germany can do it (http://www.slate.com/blogs/browbeat/2014/10/10/germany_college_is_free_there_even_for_foreign_students_why.html), so can we.

[jesmu84]

We are going to have a major doctor shortage in this country, especially in rural areas because of how expensive it is to become one and how expensive it is to remain one.

Thus the opening for PAs and NPs. And those are being produced in huge numbers, and growing.

[jesmu84]

Lot of dangerous socialist ideas in this thread

[Hards Alumni]

Lot of dangerous socialist ideas in this thread

Lmao no.  Dangerous no.  Socialist maybe.

Problem is too many kids going to school. 

And doctors in rural areas was going to reduce regardless of the ADA

[ChicosBailBonds]

The answers are easy. Universal free education. Universal free health care.

Next issue?

Nothing is free, ever.  No such thing is free....not in the real world.


Now, having said that I have for many years believed as a society we provide potential doctors with low interest or partially forgiven student debts for reaching certain levels of service.  More forgiveness if you put X years in communities that need doctors, etc. 

I disagree strongly with the other post about it always being expensive to become a doctor in this country.  The costs of lawsuits, specialization, etc are much higher in real and percentage terms now and have been problematic for the last few decades.  Throw in reimbursement nightmares for Medicare, etc....there's a reason why the majority of physicians don't support the newest policies and a reason why doctors are bailing out early.

It's going to be a major problem in terms of access if we don't address it.

[Coleman]

Now, having said that I have for many years believed as a society we provide potential doctors with low interest or partially forgiven student debts for reaching certain levels of service.  More forgiveness if you put X years in communities that need doctors, etc. 

I sort of agree with you on something, I'll take it when I can get it!

And of course nothing is really free. It's a matter of our priorities as a society.

[ChicosBailBonds]

I sort of agree with you on something, I'll take it when I can get it!

And of course nothing is really free. It's a matter of our priorities as a society.

And who is paying for it, and who isn't.  Lots of people are really good at not spending their own money, but cannot wait to spend someone else's.  You want to fix some of these problems...EVERYONE pays.  EVERYONE has skin in the game.  Not 53%, not 25%...EVERYONE.

[Coleman]

And who is paying for it, and who isn't.  Lots of people are really good at not spending their own money, but cannot wait to spend someone else's.  You want to fix some of these problems...EVERYONE pays.  EVERYONE has skin in the game.  Not 53%, not 25%...EVERYONE.

I have skin in the game. Don't make assumptions about me based on my views. I probably pay much more in federal income taxes than you think, and I certainly have paid more into the system over the course of my life than I have taken out (driving on federal highways and subsidized student loans, is pretty much all I can think of). My money is getting spent one way or the other. I would just rather it be spent domestically, on education and healthcare, than on weapons. I would happily have the poor spend my money, rather than it line the pockets of the executives and shareholders of Northrup Grumman and Lockheed Martin. Priorities.

[mu-rara]

I sort of agree with you on something, I'll take it when I can get it!

And of course nothing is really free. It's a matter of our priorities as a society.

Problem is, you never want to prioritize.

Milwaukee will spend $193 million on a streetcar in MKE, plus various infrastructure $$ to accommodate that?  This is a large spend for very little utility.  What else could that $$ be spent on to solve real problems?

[brandx]

Problem is, you never want to prioritize.

Milwaukee will spend $193 million on a streetcar in MKE, plus various infrastructure $$ to accommodate that?  This is a large spend for very little utility.  What else could that $$ be spent on to solve real problems?

I agree with you, rara. Let's see the ROI on building the streetcar. It may add to the esthetic value of Milwaukee (which I am all for), but it still has to return some significant monetary value.

As opposed to a new arena, which could spur a billion $$$ investment by private companies in the city (although we still need to see concrete plans).

[tower912]

In Germany, doctors average the equivalent of $100k in salary or so.   But they graduate debt free and don't have to worry about malpractice, as long as they follow reasonable protocols.   The US continues to be the only industrialized nation where health care is for profit.   

[Coleman]

Problem is, you never want to prioritize.

Milwaukee will spend $193 million on a streetcar in MKE, plus various infrastructure $$ to accommodate that?  This is a large spend for very little utility.  What else could that $$ be spent on to solve real problems?

Where did I ever advocate for a streetcar? Quit building strawmen.

[Canned Goods n Ammo]

We are going to have a major doctor shortage in this country, especially in rural areas because of how expensive it is to become one and how expensive it is to remain one.

If there aren't enough doctors in rural areas, don't live in a rural area.

I know this is an over-simplified view, but seriously, sometimes we create problems for things when there is already a solution.

[Pakuni]

If there aren't enough doctors in rural areas, don't live in a rural area.

I know this is an over-simplified view, but seriously, sometimes we create problems for things when there is already a solution.

Fact is, there's been a shortage of doctors in rural areas for about as long as they've tracked such thing, at least inasmuch as we view the number of doctors in urban areas as the "right" amount.
Also fact is that the number of rural doctors per 100,000 people in rural areas has remained relatively flat since the 1940s. What's changed is the number of doctors in urban areas, which has risen significantly.

[Aughnanure]

Lot of dangerous socialist ideas in this thread

Are you scared to leave America?

[Aughnanure]

Problem is, you never want to prioritize.

Milwaukee will spend $193 million on a streetcar in MKE, plus various infrastructure $$ to accommodate that?  This is a large spend for very little utility.  What else could that $$ be spent on to solve real problems?

It's worked out quite well for Portland. When cities stop investing in themselves, they start to decay.

[brandx]

Are you scared to leave America?

Just a guess - but I think that was sarcasm by jesmu.

[🏀]

It's worked out quite well for Portland. When cities stop investing in themselves, they start to decay.

Maybe they should work on upgrading their existing infrastructure that is decaying.

[MU Fan in Connecticut]

I agree with you, rara. Let's see the ROI on building the streetcar. It may add to the esthetic value of Milwaukee (which I am all for), but it still has to return some significant monetary value.

As opposed to a new arena, which could spur a billion $$$ investment by private companies in the city (although we still need to see concrete plans).

There's a stat, where every mile of light rail / street car line that is installed a $1billion dollars of private investment follows. 
Charlotte, NC sometime this century added a 1 mile line.

[brandx]

There's a stat, where every mile of light rail / street car line that is installed a $1billion dollars of private investment follows. 
Charlotte, NC sometime this century added a 1 mile line.

Maybe I'm not getting what you are saying, but I meant that the arena would generate the $1 billion - not the streetcar.

[jficke13]

There's a stat, where every mile of light rail / street car line that is installed a $1billion dollars of private investment follows. 
Charlotte, NC sometime this century added a 1 mile line.

I would like to see this stat.

Did a one mile long light rail from point A to point B (one mile away) in Charlotte really spur $1 billion in private investment?

[mu-rara]

Where did I ever advocate for a streetcar? Quit building strawmen.

You mentioned priorities of a society.  The streetcar in MKE is an example of out of line priorities.  $193 million plus infrastructure for a system that has very low utility.  What greater social ills could be addressed by these $$. 

At least the yuppies will have transport from Elsa's to the lower east side.

[Canned Goods n Ammo]

You mentioned priorities of a society.  The streetcar in MKE is an example of out of line priorities.  $193 million plus infrastructure for a system that has very low utility.  What greater social ills could be addressed by these $$. 

At least the yuppies will have transport from Elsa's to the lower east side.

Seems reasonable.

[WellsstreetWanderer]

It's worked out quite well for Portland. When cities stop investing in themselves, they start to decay.

  Spent last week in Portland and am a frequent visitor. The light rail is a gem and heavily used. You can go from the airport baggage area to a downtown hotel for @ $ 2.40. Most hotels are within a block or two from a stop. Downtown , the Pearl and Rose Quarter ( where Trailblazers play)  are in a free zone..  Have not heard of any major infrastructure issues in Portland.

[mu-rara]

  Spent last week in Portland and am a frequent visitor. The light rail is a gem and heavily used. You can go from the airport baggage area to a downtown hotel for @ $ 2.40. Most hotels are within a block or two from a stop. Downtown , the Pearl and Rose Quarter ( where Trailblazers play)  are in a free zone..  Have not heard of any major infrastructure issues in Portland.

I am assuming this is a complete system serving most of the city.  What Mayor Barrett is proposing is roughly 2 miles of trolley, serving a small portion of the east side.  Need to re-route much of the telecom serving downtown due to vicinity of old AT&T building, adding millions more to the project.  It is a cluster.

[PVMagic]

The shortage is largely due to medical students flocking away from primary care careers.  Reimbursement is pretty poor (compared to subspecialties) for family medicine, general pediatrics, etc., and with loads of debt many students who may fill those gaps chose other specialties; I had several classmates who considered primary care but chose other routes in part for this reason.

I don't know anything about light rail.

[MU Fan in Connecticut]

I would like to see this stat.

Did a one mile long light rail from point A to point B (one mile away) in Charlotte really spur $1 billion in private investment?

I couldn't find the exact stat.  $1bil is probably overstated on my part (misremembered).  3-4 years ago New Haven was discussing funding a study on installation of a 1-mile stretch of light rail and I had read it in one of the many articles on the subject.
But I found several examples online in a quick search on "private investment generated by light rail".  They always pay-off and then some.

On expansion of the Metro into the DC suburbs including a blurb on impact in Portland & Seattle:
Riding light rail and streetcars into better communities
http://www.washingtonpost.com/opinions/riding-light-rail-and-streetcars-into-better-communities/2014/11/14/58fd98b2-6a86-11e4-a31c-77759fc1eacc_story.html
Modern streetcars in this country have a proven track record. There have been outstanding success stories. Portland, Ore., and Seattle stand out. Portland’s first-phase streetcar line cost about $100 million to build but resulted in more than $3.5 billion in private investment in a decade. The first modern streetcar in Seattle, going from downtown to an obsolete industrial area to the north, in a mere decade has resulted in Amazon moving its corporate headquarters there, a biotech cluster anchored by the University of Washington Medical School and thousands of new residences.
Streetcars have shown that the corridors they traverse redevelop rapidly, which did not happen with buses. Why? Streetcar lines are permanent, signaling to the private market that the transportation system is not going to change tomorrow. Also, middle-class Americans like streetcars. Consumers who have a choice ride streetcars and other rail transit but generally not buses.

On Minneapolis-St. Paul:
http://www.dot.gov/fastlane/central-corridor-light-rail-links-twin-cities-each-other-and-opportunity
The Central Corridor has also been an engine of economic development; since the line was announced, it has helped attract more than a hundred economic development projects that are planned or being built and generated billions of dollars in private investment.

On Dallas, TX:
http://www.dart.org/about/inmotion/march14/3.asp
The expansion to date has generated $7.4 billion in regional economic activity, creating more than 54,000 person-years of employment that paid in excess of $3.3 billion in salaries, wages and benefits.
http://www.metro-magazine.com/news/story/2014/01/studies-tout-dallas-light-rail-s-impact.aspx
The region’s long-term investment in the Dallas Area Rapid Transit (DART) light rail system has generated more than $7.4 billion in regional economic impact, according to a new study of the agency’s capital spending between 2003 and 2013.

[mu-rara]

I am sorry for starting the light rail discussion.  I was only illustrating the priorities comment from ??? (not sure).

Back to the doctors discussion......

[hairy worthen]

Maybe they should work on upgrading their existing infrastructure that is decaying.

Right, like an underground sewer system that pumps thousands maybe millions of gallons of raw sewage into Lake Michigan every year and backs up people's basements.

(Oh no, I am posting in a political discussion, Icky,  bad.)

[Aughnanure]

I am assuming this is a complete system serving most of the city.  What Mayor Barrett is proposing is roughly 2 miles of trolley, serving a small portion of the east side.  Need to re-route much of the telecom serving downtown due to vicinity of old AT&T building, adding millions more to the project.  It is a cluster.

Ummm, that's how they all start. You just don't suddenly get an entire transportation system. It takes time, but that doesn't mean you just give up. How middle America fights against public transportation is just sad.

[Coleman]

Ummm, that's how they all start. You just don't suddenly get an entire transportation system. It takes time, but that doesn't mean you just give up. How middle America fights against public transportation is just sad.

Right. I don't know the specifics of MKE's light rail proposal and have no opinion on the matter.

But Chicago didn't just flip a switch and get world-class public transit one day. It has taken over 100 years to build, incrementally, over time.

[hairy worthen]

Ummm, that's how they all start. You just don't suddenly get an entire transportation system. It takes time, but that doesn't mean you just give up. How middle America fights against public transportation is just sad.

Ummm, you act like Milwaukee has no public transportation. It does. It’s not public transportation; it’s the type and scope of public transportation that the proposed light rail would be.  Not a lot of bang for the buck. If the public transportation in downtown Milwaukee is so poor, there are other ways to approach the problem.

[MU Fan in Connecticut]

I would like to see this stat.

Did a one mile long light rail from point A to point B (one mile away) in Charlotte really spur $1 billion in private investment?

Found some more.

Charlotte does light rail right
http://grist.org/article/2010-06-25-charlotte-does-light-rail-right/

City bonds could open new routes to Research Park jobs, sidewalks to light-rail stops and bikeways to downtown!
http://universitycitypartners.org/city-bonds-could-open-new-routes-to-research-park-jobs-sidewalks-to-light-rail-stops-and-bikeways-to-downtown/
"The original Blue Line has led to an estimated $1.5 billion in private investment."

[swoopem]

Even Detroit is building a 4 mile light rail system (to begin with, it'll expand later). The project started this past spring and I, for one, can't wait for it to be complete.

[brandx]

I am sorry for starting the light rail discussion.  I was only illustrating the priorities comment from ??? (not sure).

Back to the doctors discussion......

No need to be sorry. It opened an interesting discussion even though I don't have a strong view one way or the other. Generally, I think that culture and adding to the aesthetics of a city are worth using tax dollars, but I can understand the opposite argument as well.

[Eldon]

What purpose do streetcars serve? They are glorified buses IMO.

Heavy rail and, to a lesser extent, light rail, can go places that a bus cannot (e.g., under ground). They can also carry more passengers per trip than a bus.

But a street car? Someone convince why a streetcar/trolley is better than a bus?

I'm all for public transit improvements. In fact, one area of public transit that doesnt get enough attention is bus rapid transit, as exeplified in Bogota, Colombia. To my knowledge, no American cities are talking about this (except Kansas City)

[tower912]

What purpose do streetcars serve? They are glorified buses IMO.

Heavy rail and, to a lesser extent, light rail, can go places that a bus cannot (e.g., under ground). They can also carry more passengers per trip than a bus.

But a street car? Someone convince why a streetcar/trolley is better than a bus?

I'm all for public transit improvements. In fact, one area of public transit that doesnt get enough attention is bus rapid transit, as exeplified in Bogota, Colombia. To my knowledge, no American cities are talking about this (except Kansas City)

http://en.wikipedia.org/wiki/Silver_Line_(Grand_Rapids)
The BRT experiment is alive and well here in Grand Rapids.   Operational for the last 3 months.

[mu-rara]

What purpose do streetcars serve? They are glorified buses IMO.

Heavy rail and, to a lesser extent, light rail, can go places that a bus cannot (e.g., under ground). They can also carry more passengers per trip than a bus.

But a street car? Someone convince why a streetcar/trolley is better than a bus?

I'm all for public transit improvements. In fact, one area of public transit that doesnt get enough attention is bus rapid transit, as exeplified in Bogota, Colombia. To my knowledge, no American cities are talking about this (except Kansas City)

Milwaukee had light rail before it was light rail.   It was called a street car.  I think that service ended in 1958 because the city needed the flexibility afforded by the bus system.  If there was such a demand for the service that Mayor Barrett is demanding, a  bus route could provide it at a fraction of the cost.  (Aren't buses mass transit?)

As to the comment about heavy rail, the infrastructure for that was built along with the growth of the city.  Retrofitting a system like into a city the size of Milwaukee doesn't make economic sense.   Milwaukee doesn't have the the scale to support it anyway.

[Canned Goods n Ammo]

Milwaukee had light rail before it was light rail.   It was called a street car.  I think that service ended in 1958 because the city needed the flexibility afforded by the bus system.  If there was such a demand for the service that Mayor Barrett is demanding, a  bus route could provide it at a fraction of the cost.  (Aren't buses mass transit?)

As to the comment about heavy rail, the infrastructure for that was built along with the growth of the city.  Retrofitting a system like into a city the size of Milwaukee doesn't make economic sense.   Milwaukee doesn't have the the scale to support it anyway.

I'm not an expert on the street car project, so I can't speak to it without making a bunch of assumptions, which is stupid.

But, I will say this: Municipal infrastructure is really tough to measure with just dollars and cents. That doesn't mean I'm in favor of the street car per se, but evaluating it simply from a short term budgetary perspective is short-sighted.

True infrastructure is built with future needs in mind, so realistically, it's never going to make economic sense until you have hindsight to look back on it.

[MU Fan in Connecticut]

Milwaukee had light rail before it was light rail.   It was called a street car.  I think that service ended in 1958 because the city needed the flexibility afforded by the bus system.  If there was such a demand for the service that Mayor Barrett is demanding, a  bus route could provide it at a fraction of the cost.  (Aren't buses mass transit?)

As to the comment about heavy rail, the infrastructure for that was built along with the growth of the city.  Retrofitting a system like into a city the size of Milwaukee doesn't make economic sense.   Milwaukee doesn't have the the scale to support it anyway.

mu ra-ra, you do know that street cars & light rail were ripped up all over the country because "cities needed the flexibility afforded by the bus".  The rip-up was directly paid for by the Detroit car companies, so they could make & sell busses to cities and not have to worry about any competition at all from rail.

[mu-rara]

mu ra-ra, you do know that street cars & light rail were ripped up all over the country because "cities needed the flexibility afforded by the bus".  The rip-up was directly paid for by the Detroit car companies, so they could make & sell busses to cities and not have to worry about any competition at all from rail.

Did not know that.  Can you point me to the documentation.

[ChicosBailBonds]

Did not know that.  Can you point me to the documentation.

For conspiracy wonks


http://www.cato.org/sites/cato.org/files/pubs/pdf/PA699.pdf

And here

http://debunkportland.com/printables/TQOrigin.pdf

And here


http://www.cbsnews.com/news/the-gm-trolley-conspiracy-what-really-happened/

And here

http://marketurbanism.com/2010/09/23/the-great-american-streetcar-myth/

[mu-rara]

For conspiracy wonks
http://www.cato.org/sites/cato.org/files/pubs/pdf/PA699.pdf
And here
http://debunkportland.com/printables/TQOrigin.pdf
And here
http://www.cbsnews.com/news/the-gm-trolley-conspiracy-what-really-happened/
And here
http://marketurbanism.com/2010/09/23/the-great-american-streetcar-myth/

I found some of these.  Was looking for support of MU Fan in Connecticut's argument.

[Eldon]

Milwaukee had light rail before it was light rail.   It was called a street car.  I think that service ended in 1958 because the city needed the flexibility afforded by the bus system.  If there was such a demand for the service that Mayor Barrett is demanding, a  bus route could provide it at a fraction of the cost.  (Aren't buses mass transit?)

As to the comment about heavy rail, the infrastructure for that was built along with the growth of the city.  Retrofitting a system like into a city the size of Milwaukee doesn't make economic sense.   Milwaukee doesn't have the the scale to support it anyway.

I completely agree about Milwaukee getting an El or subway system, the city is much too small population-wise. In fact, for most (all?) American cities, building a heavy rail line(s) is way too high of a fixed cost. It would take generations to pay itself off. I was simply expressing my general affinity for (already-built) heavy rail systems.

My overall point was to express my love of mass transit (especially the potential of BRT), but also express my apathy, if not outright dislike, of streetcars/trolleys. IMO, a bus gets you the exact same thing as a streetcar at a significant fraction of the cost. Thus, if we need mass transit to go from the Pabst brewery to Ogden or whatever, why not simple create a new bus line?

I mean, i get that street cars are sexy, and more aesthetically-pleasing than a bus, but that's a steep price to pay for trying to look cool.

[jficke13]

My main skepticism on the light rail front is its ridership and therefore its ongoing ability to pay for its own upkeep. Good mass transit goes from where people are to where people want to be. From what I can tell about the proposed line is that it will only serve a very limited slice of the city, won't work for business commuting, and I'm afraid it won't have nearly enough regular riders.

[MU Fan in Connecticut]

For conspiracy wonks


http://www.cato.org/sites/cato.org/files/pubs/pdf/PA699.pdf

And here

http://debunkportland.com/printables/TQOrigin.pdf

And here


http://www.cbsnews.com/news/the-gm-trolley-conspiracy-what-really-happened/

And here

http://marketurbanism.com/2010/09/23/the-great-american-streetcar-myth/

The CBS article was straight forward with two big money lines: 
 
"Bus lines were less expensive to operate than trolleys, and far less costly to build because there were no rails. Extending service to rapidly growing suburbs could be accomplished quickly, by simply building a few bus stops, rather than taking years to construct rail lines. So, buses replaced streetcars.

For similar reasons, with the added one of personal preference for individual transportation, private cars also played an important role in the demise of streetcars. People understandably liked driving their own cars directly to their destinations more than crowding onto trolleys that dropped them blocks from where they were going."

Like most things there is no one silver bullet just a combination of factors that when mixed together spelled the downgrade of trolleys, street cars & light rail. 
I just think we've reached a tipping point and are headed back towards rails. 

[GooooMarquette]

Agree that streetcars don't seem like a very cost-effective solution compared to a bus.

If the goal is to increase mass transit ridership, create more user-friendly bus routes (as suggested earlier).  Then take some of the money you'd have spent on rails, and put it into making more attractive, well-lit bus stops. 

[MU Fan in Connecticut]

They are installing in Hartford a "Busway" which is kind of a compromise between light rail & a bus.  It's used in Pittsburgh and other cities.  It's set up like a light rail line with stations, however instead of a train or trolley only busses are allowed on the "track" or road. 
It's been controversial to say the least.