Richard Reeves

Train Doctors and Nurses, Not Soldiers

LOS ANGELES -- Some days, I feel I have seen it all. Other days, I just don't want to get out of bed. Over eight years my family has been hit with lung cancer, brain cancer, strokes and various other medical calamities. My wife has had eight operations, in the United States and in France.

For what it is worth, my wife and I have the best medical insurance money can buy. But it adds up, and sooner or later you are broken, as the bills, the "incidentals," pile up and up. One day, you give up your club membership here and the next you cancel your subscription to The New Yorker. So it goes. It must be much worse for families with smaller incomes.

Your life becomes a blur of men and women in white and green. These days the people in white tend to be Asian, most of them female. Often, the people in green, the nurses, are men, Caucasians, bored or disillusioned by the daily grind of corporate America. I've talked to a lot of those guys over these years, and I am surprised how many make career changes to professions that they feel will enable them to do worthwhile work.

I have also spent more time in French hospitals than I ever could have imagined. My impression is that French "socialized" medicine, with much less technological gadgetry, is better than American ultra-technical medicine. There came a day in our lives when my wife needed a brain scan and there were only two MRIs in the country, and the one in Marseille was broken.

On another day, you try to pay the surgeon at Institute Rothschild who saved your wife's life, and he says: "I work for a government salary. I've never taken a dime and I don't intend to start now." So you send him a case of good Chateauneuf du Pape.

The difference is that you have a true one-on-one relationship with a real person in France, rather than the "team" system used by America's best research hospitals. The teams, in green and white, come in and take their readings and measurements, and then march into the hall. Then you find they have put a "central line" backward into an artery rather than a vein. Your wife has a stroke.

Now we are told that the United States has a shortage of physicians, particularly primary care physicians, family doctors. The money is in dermatology and cosmetic surgery. Why deal with some kid with whooping cough -- to pay off your six-figure tuition loans -- when you can do nose jobs?

American medical care is still getting by with Medicare, machines built by General Electric, and doctors and nurses from India and the Philippines. And with the blind faith of Americans that we have the best medical care in the world. A myth.

As you know, we have national academies to train soldiers, sailors and airmen, probably the best in the world. No tuition.

Why not medical academies? The U.S. social welfare and medical system was built on the assumption that people, on average, would live to 65. No longer. People are now living well into their 80s in relatively good health. That's why Social Security will face crisis after crisis. That is why Medicare and Medicaid will eventually collapse. Our "safety net" was designed in the 1930s. Different time. Different problems.

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