Our National Decline– Gluttony, Neglect……or Stupidity?

While not directly medical the discussion of our “national decline” in today’s Times has elements that impact our health care non-system.

For years many have maintained we have the “best system of health care in the world.”  I have been even chastised by some libertarian types for questioning whether we have a system of care.  They’ve maintained their view based on the fact that people with money in the U.S. do get excellent access to the latest technology and skilled physicians.  They ignore the economic and medical costs of a system that is the most inefficient and expensive (by an order of magnitude) in the world and that is not affordable by at least 25% of it’s citizens–who  lack health insurance.

The Times article by Matt Bai raises the question of whether our national decline (many won’t admit we’ve lost stature, influence and economic heft)  is due to gluttany that is overspending by government on “unnecessary” projects or neglect that is not investing smartly in our people and infrastructure:

the conversation in the capital is all about the size and role of the federal government. Basically, President Obama would cut some and spend a lot; Republicans would cut a lot and spend much less.


True, Mr. Obama didn’t act on his own debt panel’s recommendation in the budget, and his proposed $1.1 trillion in deficit reduction over the next decade doesn’t amount to a dent in the long-term problem, or even really a ding. But the president did propose some cuts to programs long cherished by his party (like community block grants and aid for water treatment plants), and he has repeatedly acknowledged the need to address the structural problems in the federal budget, which he argues will require a gradual process with cooperation from both parties.

Republicans, on the other hand, while making a strong push for curtailed spending in the short term, have yet to accept the case for any real public investment in technology or education or anything else, for that matter. The entirety of their case rests on the notion that the private sector can by itself build a state-of-the-art infrastructure — a possibility, certainly, but not one for which you can really find much evidence in any previous chapter of the American story.

In the same issue of the Times is a strong argument that the problem is neither.  During the debt crisis there has been much made of Texas’ apparent well being  with housing not suffering as much as elsewhere and that somehow the state government had made smart moves to keep itself solvent.  Guess what (from Gail Collins and the Houston Chronicle) the state of Texas is in deep debt from a combination of decreased revenues and unwise tax cuts:

The Houston Chronicle published an opinion piece by the former first lady titled “We Can’t Afford to Cut Education,” in which Mrs. Bush (Barbara) pointed out that students in Texas currently rank 47th in the nation in literacy, 49th in verbal SAT scores and 46th in math scores.  Medicynical Note:  Hardly an education success story.

In 2006 Governor Perry cut support of schools and hoped somehow to get away with it.  As a result schools, some quite excellent ones, are closing, class size rising and Texas’ miserable rankings in education are unlikely to improve.

Adding to the problems Texas is  the least enlightened places on earth when it comes to contraception and sex education:

The birth rate there is the highest in the country, and if it continues that way, Texas will be educating about a tenth of the future population. It ranks third in teen pregnancies — always the children most likely to be in need of extra help. And it is No. 1 in repeat teen pregnancies.


it’s extremely tough for teenagers to get contraceptives in Texas. “If you are a kid, even in college, if it’s state-funded you have to have parental consent,” said Susan Tortolero, director of the Prevention Research Center at the University of Texas in Houston.

And so on regarding “abstinence education”, Read the article for the details.  It’s hard to believe that a state that thinks so much of itself can be so dumb.

Medicynical note:   Meanwhile on the national scene, our congress, just weeks after adding billions to the budget deficit through tax cuts for the wealthiest, is in the process of  “cutting the deficit” by taking financial support  from programs that help the poorest–including education and family planning. Amazing but true!

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