If your goal is admission to medical school, first of all, you need to understand that “premed” is not a major. For admission to med school, you need to have excellent grades in two years of chemistry, one year of biology, and one year of Physics, all with lab. You also need a year of English. Some schools also want a year of Calculus, or Statistics (which is much more useful, in my opinion, because you need Stat to understand validity of studies). You also need excellent scores on the MCAT. Most importantly, you need a field of major study that makes them want to admit you. Believe it or not, although the majority of those admitted to med school majored in fields like Biology and Chemistry (because the majority who apply majored in those fields), the highest rate of acceptance goes to people who majored in other fields totally unrelated to medicine - music, art, languages, political science, anything that made them seem like they would be a decent human being who would become a compassionate, communicative physician.
I think that schools do understand that those coming from highly competitive schools did have to work harder and learn more in order to get an A, than those coming from middle of the road schools, or local state colleges. But you have to consider, where can YOU do extremely well? If you’re going to be a B student at the Ivy, but would be a superstar at your flagship state U or your local state college, it might be better for you to choose the flagship state U. Sure, straight A’s at an Ivy looks better than straight A’s at down the street local branch state college - but it’s a lot harder to get straight A’s in premed courses at the Ivy.
I have seen so many students who entered as premeds at highly competitive very selective schools wind up abandoning premed, because the classes were so competitive that they couldn’t do well. They would have gotten straight A’s at a lesser school, and gotten into a mid-level med school, and become doctors, gotten into residencies that they desired.
Me? I went to an Ivy. Studied what I wanted to - which was an obscure field having nothing to do with medicine. Did okay in premed courses, did very well on the MCATs. I remember an interviewer asking how a person who got B/C in Organic was able to get a nearly perfect score in Chem on the MCAT, and I told them, “Look. I went to an Ivy. The course was very tough. But clearly, I learned the material.” I got into that school. I got into every school I applied to, because they saw me as an interesting and unusual candidate - not another Bio or Chem major. And my grades in my major were very good, because I was studying what I loved.
So, think about what you love to learn about. Go to the school that offers you the best opportunity to study what you love, or to explore to find what you love. If the premed courses at the school you wind up at are so killer cut throat that you’re thinking about giving up the idea of med school, then DON’T TAKE THEM THERE. Take your premed courses at your local state college during the summer, and study what you love at your Ivy. Or do what you love in college, and then do a postbac year at the local cheap state college to get your premed prereqs done. If what you want is to be a basic science researcher/MD-PhD, then choose the school that gives you the best opportunity to get involved in basic science research. Same goes for if what you want is to be a clinical researcher, or to work in public health policy, or to improve healthcare or health policy in the third world. But if you just want to be a doctor, honestly, it doesn’t matter where you go to college, as long as your grades and MCATs are good enough, and you can come across as a human being who they want to admit.