After spending 10 days outside of the United States for the first time in my life in Peru, there's a few things I've taken for granted that I think is appropriate for this blog.
1. I think we have a pretty good balance of private sector / public or government funded programs here that make the quality of life better for more people. I spent several days in villages outside of Cuzco high in the Andes mountains. These people did not pay taxes, and also didn't receieve anything from the government. The villages surrounding Cuzco and even Cuzco itself had little organization, poor infrastructure, and very little government regulation. There was some public education but it seemed to me to be more under the control of local people and certainly didn't have access to funding like we do here in the U.S. It made me appreciate my own public education, the flat, organized, paved roads I can drive on, and the libraries and schools I can go to.
2. There was very little government regulation in Peru especially in regards to food and water safety that made it dangerous to eat and drink anything. Half our expedition came down with food poisoning, and lots of children out in the villages had parasites, even Hepatitis A that came from eating and drinking contaminated sources. While we do have some of those issues here, it certainly is a lot less. It's comforting to know there are company, industry, and government standards for food safety that make most of our food and water disease-free and safe to consume. That was a luxury not enjoyed in Peru.
3. Oddly enough I gained an appreciation for social security and medicare while there. I do hospice work and the people I take care of all are on Medicare and Social Security. There are no programs like that in Peru, and people really suffer for it. We saw lots of elderly people who suffered severe arthritis who were still working just because they had no choice. They had no access to health care (other than us), and no such thing as retirement. They retired when they died. So while these programs may be in trouble here in the U.S., I still think they are good, and provide a safety net for people to fall on.
In conclusion I just have to say that I love the United States and I'm not sure why I'm lucky enough to be a citizen here and have the opportunities I do. It makes me feel like I have those opportunities specifically to help others that might not. I think we all do. For those of you that have spent time out of the country, what did you feel?
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I wrote too long of a response, then erased it. Too preachy.
After living a year in Ecuador (1970-71) and two years in Spain (1975-77) I felt intense gratitude on my return to the U.S., to the point of weeping while the plane was moving to the terminal.
I was grateful for the privileges of prosperity and freedom of conscience enjoyed as a U.S. citizen. I also felt survivor's guilt, which continues off and on to this day.
Good post. I agree that too often, we take the first world conveniences and amenities for granted and forget that there are billions of people on the planet that aren't able to enjoy the things we can in this country.
I spent 2002-2004 in the ghettos and slums of Bs. As., Argentina. I saw enough heartbreaking poverty and desperation there to last a lifetime. My first Sunday back in the U.S. was July 4th. The first hymn we sang, at a very packed LDS building in Nauvoo, IL, was 'The Star Spangled Banner.' I had a hard time controlling the emotions of patriotism and gratitude I felt for being lucky enough to call this country home as we all stood and sang that song.
However, I think our (Creighton's and my own) experiences abroad were different in that instead of coming home being grateful for amazing government services, regulations, and "safety nets," my experiences turned me off towards many government-provided services, especially health care, and made me appreciate the virtues of the free market and the private sector. A couple stories to illustrate:
(1) Most of the health clinics where I was were owned and operated by the Argentine government, providing cheap or "free" services. Let me tell you, as a missionary, you prayed you never needed to go to a clinic. I went to one with an American companion one time because he needed to get an ingrown toenail taken care of, and let's just say the sanitation and the quality of the care he received was abysmal. After he went home, he wrote back and said his U.S. private sector doctor had to perform 2 pretty extensive operations to fix the terrible job the Argentine doc did. Going to the government-run clinic made his toe worse than it was before. One could argue that government services are better than no services at all, sure, but is that really true in the instances where the patient is worse off after receiving sub par government care?
(2) My MTC companion literally almost died in Dec. 2003 because the inept government-run hospital and its staff did not have the personnel, equipment, or know-how to detect, diagnose, and remove a small brain tumor. We had to scramble to cut through the bureaucratic red tape of the hospital administration, which took dangerously way too long, rush to the airport, and get him on an emergency flight back to the states to save his life and get him to a private sector hospital.
I know that thus far, I've been comparing Argentine's government services to the U.S. private sector. However, the U.S. private sector still beats out the U.S. government when it comes to health care. One of my classmates is an Iraq War Vet and has spent some time at government-run Walter Reed Hospital in the DC area. He's shared many truly sad stories about the kind of medical care and services our veterans receive at the hands of their government.
I'm not arguing that our country should abandon all government regulations/services and leave everything to an unregulated private sector. There certainly has to be a balance. I'm just not convinced that government is capable of providing the best solutions to all of society's problems, so I would prefer a balance that favored more liberty and freedom. Under Pres. Obama, the balance is undoubtedly tipping in favor of much more government, more regulation, and more control over the private sector and our private lives. This is troubling because I am unconvinced that a bigger, more powerful, inefficient federal government is the answer, but rather fear, like Reagan did, that it is the problem. History indicates that this is true as well. Numerous well-respected economists and experts have concluded that the huge expansion of government and regulation during the New Deal actually prolonged the Great Depression by 7 years or more.
As always, sorry for the long comment.
OK, I'm not exactly an expert on all the intricacies of South-American third world countries, but I'd like to at least offer an alternate explanation about the causes of all the poverty Creighton encountered, which is that government is actually the problem down there.
When I took my grandpa's class he told us a story about trying to hire a tractor-driver while in South America. He said that this tractor driver straight-up refused to accept the job at first, even though he had no other jobs and there was plenty of money in it for him. It turned out that the problem was actually that there was too much money involved: the guy learned (most likely through experience) that if he ever earned too much money, the corrupt government would just find a way to take it from him. As such, this guy made a point of never earning too much money at any given point.
So here's the bottom-line: I think that the type of government (i.e. totally corrupt) is just as much--if not more--to blame for all the poverty in South America and throughout the world as there not being enough government. THAT'S what's great about America: it's not just that we have a pleasant amount of government, but that (on the whole at least) the government we do have ISN'T CORRUPT.
So what (I think) is REALLY lacking in these third-world countries isn't more busy-body bureaucrats and regulators, it's a legitimate SYSTEM of government--i.e. true democracy, checks and balances, an adequate legal system, etc.--that can keep in line the government that's already there. I think we'd all be amazed at how faster all that poverty would end if these governments could somehow be fixed that our current practice of just throwing money down there or whatever.
I'm not saying that it's necessarily wrong to do what we can like what Creighton recently did, all I'm saying is that it doesn't fix the real problem, which (in my opinion) isn't just a simple lack of government. As long as there's systematic corruption throughout their entire governments, all the foreign aid we can spare won't do very much at all to raise the living-standards of all those powerless civilians who, like that tractor driver my grandpa had trouble hiring, will forever be held back from TRUE "relief" as long as their governments (as presently constituted) have any say in the matter.
You know for me it's sort of ironic: one of those things I was grateful for coming back to the U.S. was NOT having to worry about having to deal with "social medicine" anymore... I guess next time I leave and come back there will be one less thing to be grateful for (in my own opinion, obviously). Well I guess technically the battle isn't officially over until the new bill becomes fully implemented, but it's an uphill battle to say the least. Personally, I'm deathly (pun intended) afraid about how things will play out here if and when we have social medicine. I guess we'll just have to see...
Jeff's right - if there's one thing that has continually plagued South American countries, it has been the corrupt "caudillismos" that have been around in governments for centuries down there. Throwing millions in foreign aid at these countries won't do much good as long as the people in power are crooks.
Although I disagree to a certain degree with Jeff that our government isn't corrupt. Perhaps not as much as the governments in S. America, but the sausage factory that was the passage of the health care bill should put to rest any doubts that our government isn't corrupt. I was shocked to see how votes were literally and blatantly bought and sold with taxpayer dollars by the democratic leadership. 2 days before Rep. Stupak sold his pro-life soul to Nancy Pelosi for a weak sauce executive order, it came out that a municipal airport in his district received a government grant of $750,000 (small change in Washington dollars, but still, it's the principle). Hmmmm, coincidence? Yeah right. Senators Ben Nelson and Mary Landrieu needed millions in federal money to help their states' future Medicaid budgets before they would vote yes. Wow, I'm still heated about all that. If that isn't downright corruption, I don't know what is.
Creighton, great post. It is nice to have our blessings put in some perspective. I have long felt as you have said that we have been given these opportunities that we might help others.
Great thoughts. Thanks for the post.
I hve thought about your comparison of argentine socialized medicine to US medicine, and this is my response. In Peru, the health sector was run completely by the private sector, with no regulation from the government. The training there is minimal, the health care is marginal, and I would be terrified to have anything done there. When I was in Peru I decided everything was better in the US. The roads, education, construction, organization, everything. I don't really think you cab compare the health care system in Argentina to what it would be if it were completely universal in the US. We already have the base for it and I don't think we'd ever see conditions you saw in Argentina. I'm not saying I advocate universal health care, and I think the law that was passed is far from universal care. But if it was, I believe it would be head and shoulders above any other system in the world. With that being said, j realize the way we got there was through a balance of public and private sector involvement, which has proved the best way to have quality health care, now just getting access to it is the last obstacle.
You're right. Comparing U.S. services to those in S. America is like comparing apples to oranges. I agree with you that everything is better in the U.S. than it is in Peru and Argentina. But you must have missed my point about the inferiority of U.S. government-provided health services (for example at Walter Reed) when compared to health services provided by the U.S. private sector. That isn't an apples to oranges comparison.
I'd also disagree with you regarding the superiority of government-provided universal care. Countries that do have it (UK and Canada, for example) experience major problems in wait-times, sub par care, training, care shortages, and rationing by government panels. Why or how would our universal health care system be any different? Where do the wealthy in those countries go when they want the best care available? They all come here to the U.S. I'm not saying the system here is perfect, and there are definitely problems that need the right kind of reform, but in my opinion, universal health care would not be 'head and shoulders above any other system in the world.' That's a tough sell when you consider the state of 'universal' health care in Massachusetts.
You also touched on an important point. How did U.S. goods/services become so superior to those in the the 3rd World? It certainly wasn't because our government doled out entitlements and free everything to everyone, making everyone dependent on government handouts instead of themselves. Governments cannot create wealth, plain and simple. They transfer wealth from the private sector. Every dollar spent or borrowed by the government is taken sooner or later from dollars earned in the private sector. The private sector is where wealth is created. Unlike in the government, people in the private sector actually have incentives and will face consequences (going out of business) if they don't minimize costs, maximize efficiency, innovate, be creative, and respond quickly to market forces of supply and demand. Government's proper role in all of this (along with supplying the appropriate amount of regulations) is to ensure that people's property rights are protected, so that those who work hard can retain most of the fruits of their labors. When governments fail to do this, you'll see disparities in the quantity and quality of services and goods available in the U.S. and S. America, for example, or between the U.S. and any current or former communist or socialist country, where there are no incentives to work hard because the government will take most of it anyway, and either give it to freeloaders or keep it for themselves, like in Jeff's tractor driver example.
Anyway, the size of the pizza, borrowing Dad's analogy, has increased because of these private sector/free market incentives, meaning everyone's slice of the pizza gets bigger. Government too, is able to bring in more tax revenues as a result, which in turn has led to the funding of our superior roads, schools, infrastructure, and national defense. Without capitalism and these free market forces and incentives to work hard, combined with government protections of individual and property rights and reasonable regulations, the U.S. isn't the superpower it is today and we don't weep tears of gratitude when we return here after living in Europe or S. America. For more on the optimal conditions of wealth creation, "The Birth of Plenty" is a great read.
You might find this WSJ article interesting: "Medical Schools Can't Keep Up - As Ranks of Insured Expand, Nation Faces Shortage of 150,000 Doctors in 15 Years"
http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsSecond
Let me try to address some of the points you brought up.
I did not miss your point about Walter Reed, but I am not going to infer based on one person's account that health care from the VA is bad. I take care of some WWII vets that get their health care from the VA and asking them it seems to have served them just fine. But I can't really say the VA is highly inferior to private sector health care, because I don't have the expertise or experience to make such a conclusion.
You put words in my mouth. "I'd also disagree with you regarding the superiority of government-provided universal care." I never said this. I would disagree with me too. What I said was is that the balance between the public and private sector of health care seems to be pretty darn good in this country, it's access to that care where we are lacking. If you look at the top ten medical schools in the country, based on primary care, a public, not private, school is #1 (University of Washington.) But both public and private schools dot the top ten for both sets of rankings (research and primary care.) I think this, combined with the idea you brought up about private companies seeking new ways of health care to improve care and reduced costs has made health care in the U.S. excellent. There's no doubt the quality of care in the U.S. is excellent. But only if you can pay for it. Do you ever wonder why they have wait lists in Canada but not here in the US? Because the people who in the US who can't pay for it, don't get it! Eliminating millions of people who can't pay for the care is an effective way of getting rid of waiting times.
What I meant with this line "I'm not saying I advocate universal health care, and I think the law that was passed is far from universal care. But if it was, I believe it would be head and shoulders above any other system in the world," is that if we switched over to a universal health care system right now, I believe how advanced our medicine is would automatically propel us above other universal health care systems in the world. But, and this is important, it wouldn't stack up to what our health system could be with private sector influence. So I believe that our system, as it stands, is great for producing a very high quality health care system. Our problem is access, and that's my main point. That is why I liked the idea of this health care reform bill, because it does improve access. I don't think it's a perfect bill, I think it has numerous problems, but at least it's something. I think over the next 20, 30, 40, 50 years we will see an improvement in preventative care, which will hopefully decrease incidence of advanced diseases which raise costs.
I haven't read your article yet, I will, but from the title it brings up a good point. However over the next few years I think we'll see an increase in the use of physician's assitants, nurse practioners, and others to provide more of the primary care. I spent a week with these two kinds of professionals and let me tell you they are more than capable of providing that kind of care.
These long debates are beautiful. It's like watching the new Star Trek Movie after watching the original Star Trek show and movies. It's much more exciting with the added bonus of drastically better special effects.
I've read debates between old Scalia and ancient Stevens. Now I get to read them from the younger and much cooler Scalia and Stevens. Even now the court is tilted with a conservative lean and Stevens is still writing the dissent. It's also nice to see Thomas throwing down in concurrence.
Well said Publius, I think I would make a pretty rockin supreme court justice. Psych!
I read the article and thought it brought up a few good points, let me bring up a few.
Let me tell you from personal experience, there are far more people who want to become doctors that do not. They (medical schools, undergraduate science professors, the man) make it pretty difficult to get into medical school. It takes a lot of work, let me tell you. I have had a lot of friends drop out and go into business, most of them to law school (just kidding guys), but nonetheless they go for something else. I'm a total believer in making it difficult to get into medical school. I think it ensures you have doctors that are truly dedicated and you can really have confidence that they know what they are doing. However, when it comes time to apply, there just simply aren't enough seats to fulfill the demand. For example, I have a friend who has a high GPA, a very good MCAT score (a 30, which is like the 75th percentile) but was not admitted to any medical school. Out of 15, not one would take him. This person is more than capable at becoming a physician, but the U of U cut their seats by 25% and no other state would take him. That makes me wonder how many other students there are out there like him. I think we need more medical schools. The problem is especially pronounced in my great home state of Idaho, where there is no medical school. They face a huge doctor shortage, #2 in the country for worst doctor-to-population ratio. Maybe a wise investment by the government would be to construct more medical schools. Especially in Utah and Idaho, where a lot of students could go.
The fact that the U of U might not accept me leads to some financial difficulties. If I could go to the U of U medical school, my schooling would cost about $150,000 for everything over 4 years. That sounds like a lot, but it's manageable. If I don't get in there, and lets say I get it at Creighton University, my schooling would cost over $300,000. It will be very hard to say, okay, I will be a primary care doc to help fill the shortage when I have a huge amount of debt to cover. Whereas if the U would let me go there, I could potentially be a primary care doc. After this long and boring comment, my main point is that I think we need more medical schools, especially in Idaho and Utah.
Sorry, didn't mean to put words in your mouth. I didn't know how else to interpret: "I think the law that was passed is far from universal care. But if it was, I believe it would be head and shoulders above any other system in the world." That sounded like a Michael Moore-type endorsement of universal health care to me.
And about the Walter Reed thing, there are PLENTY more accounts than just one man's about the inferior quality of health care our veterans receive by the government. Here's an article from the liberal-leaning Washington Post that list multiple accounts: "It is Just Not Walter Reed: Soldiers Share Troubling Stories of Military Health Care Across U.S." Accounts include stories of overflowing trash, syringes on tables, fruit flies, mold, and 3rd degree burns from nurse negligence. Sounds like the 3rd world, right? Sadly, yes, but this stuff is going on right here in the U.S. at our VA hospitals. I don't know about you, but I've never been exposed to conditions like those, either first-hand or otherwise, at a private sector hospital or clinic here in the States. Check it out:
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/04/AR2007030401394.html
And, lest I put words in your mouth again, are you arguing that a big reason why Canada's lines and wait times are really long is because the lines are filled with tons of disenfranchised Americans who have come across the border because they can't afford health care in the U.S.? Is that why Canada's lines are so long?
Who ever said that private sector medical schools were better or ranked higher than public sector medical schools? I certainly didn't. I have no idea about that stuff. My point was that the private professional sector in general provides superior care than the government. It's not as if public med school grads don't practice in the private sector and vice versa (not that you said that, but I had a hard time understanding what your point about public vs. private med schools had to do with what I was saying earlier).
I agree with you and Rich about med school admission standards. I'm glad they don't let everyone that wants to be a doctor into med school. That makes me confident when I go see a doctor that he/she is competent at his chosen field, and a smart guy/gal just to have gotten into med school, much less having graduated to boot.
I'll be the first to admit that I'm not doctor material. I know you're not serious when you're making fun of us lawyers because your dad is one as well, haha. I got terrible grades in undergrad in biology 1210 and biology 2000 (physiology) and realized that the med/dental route wasn't in the cards for me. So I switched majors to economics political science, graduated summa cum laude, and were it not for those terrible grades in biology, I would have graduated with darn near a 4.0 GPA. Yet, despite the good grades, getting into law school wasn't a cakewalk. I got a middle-of-the-road LSAT score, and was limited in my choices of schools that accepted me. Acceptance rates are low for law schools as well, but unlike the doctor shortage situation, I don't see a shortage crisis on the horizon for lawyers. I'm rambling now and need to stop.
Why does the government have to solve all of our problems? Forget about putting the effort required to pass a bill mandating a medical school in every state (I know that's not exactly what you are saying, I'm just exaggerating your point). Instead, petition to the private sector. Build a list of 1000 competitive applicants who would be willing to attend a med school in Idaho. A for-profit med school just opened in Colorado and another will open in Idaho if the market exists.
PAs and nurse practitioners will fill some of the empty spots in the primary care field. The are BOOMING right now. Government doesn't need to force or push that process. They, PAs and NPs, have less debt and lower expected/average salaries. Besides that, just because a physician makes it through the incredibly difficult path of becoming Dr. Lewis does not mean he/she should make a great income or even be guaranteed loan repayment.
Devin is going through what must be comparable to hell right now. If he graduates and is a terrible businessman and/or lawyer, he'll go bankrupt. Why should it be different for me because I am a physician and not a lawyer? Both are very essential pieces of our country, and both provide a service to citizens. Some primary care doctors make tons of money. They are smart businesspeople and great at what they do.
Here's what I think: the government should pay all educational fees so there is no risk in any career, the government should pay for all of my health expenses because I can't guarantee my ability to afford future hazards to my health, and air flights should be capped at $40 each way to guarantee fair availability to all citizens (unless the individual makes less than $12,000/year, then it will be taken care of in total by the government).
I should add more qualifiers and explanation with my points to make them more clear. Sorry about that. I apologize for not making it clearer that I believe our health system is superior in quality to any other. I can't say that with total confidence because I don't have the experience, but that's what it seems. I still think even if you have the best health care it doesn't matter if you can't afford it.
And thank you for this...And, lest I put words in your mouth again, are you arguing that a big reason why Canada's lines and wait times are really long is because the lines are filled with tons of disenfranchised Americans who have come across the border because they can't afford health care in the U.S.? Is that why Canada's lines are so long? ... No, I believe Canada's lines are long because everyone (who is Canadian) has access to health care there. I believe our lines could be that long if everyone had access to it here. So instead of having long lines with everyone, we cut out the people that can't afford it. Then we can say our health care system is awesome because we don't have wait times like Canada.
My point with public and private med schools was to say a mix of public and private contributions seem to have advanced the quality of our health care system.
I think you (Devin) are easily smart enough to be a doctor, I think bad circumstances led to what happened in those biology classes. And I was kidding about the whole law school thing. I think there are equally smart people in all fields.
This is my main overall point, both of this post and the ensuing debate. I feel most comfortable in a system that is largely based on the private sector, with government playing a few essential roles in terms of fairness, regulation, defense, infrastructure, education, and equality. I believe a government too big or too small can be bad. I feel there's a good middle ground for the two, and I feel like overall, the U.S. has a pretty good middle ground.
Rich, let's do it. Me and you will be in the first year. Now we just need 998 more. If we build it, they will come.
Thanks for the compliment, Creighton. I appreciate that. You're definitely no slouch yourself! I think you're right about how there's smart people in both fields. I think it's a different kind of smarts though. When I tell my med school counterparts in our ward about my finals and how they involve 4-6 hours of straight essay writing, or about 40 page law review articles with 200 plus footnotes, or 35 page appellate briefs we have to write, or the countless legal opinions we have to read before each class, they all cringe and assure me they could NEVER do stuff like that. On the flip side, when they tell me about the countless hours they have to spend memorizing the complicated names of drugs and their effects on the body, the intricacies of human anatomy, and the multiple choice tests they have to take, my reaction is identical to theirs. I hate multiple choice tests, and would MUCH rather write essays and briefs (surprised? lol). Medical school and law school are both difficult in their own ways, for sure.
I don't like making excuses for my low biology grades, but am I correct in assuming that the "bad circumstances" you referred to = my ex bipolar, abusive, semi-suicidal girlfriend at the time? If so, I'll have to tell you more about her and that time in my life in person. Melissa only knows the tip of the iceberg. Looking forward to visiting this summer!
Speaking of which, I second Rich's proposal to cap plane tickets at $80 round trip. You have my vote, Rich :) Do bags fly free on your plan?
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