Democracy often stinks in poor countries

I am deeply fortunate to be born in a relatively free, rich, and un-corrupt country. I probably should spend more time being grateful for that fact, but I do make special time for it on Passover and Thanksgiving. I was reminded of that fact this morning when I came across The Dictator’s Handbook on Foreign Affairs. It lists the various ways that dictators rig elections, how well they work, and why they sometimes don’t. An interesting and melancholy read. Take a look and be glad you don’t live in a country like that.

A good idea in a letter to the NY Times

Thirty-six years ago, as one of the first members of the National Health Service Corps, I was sent to western New Mexico, where there was a shortage of doctors. Although delivering primary care to this medically needy population was probably the most meaningful period in my medical career, there were difficulties, including the lack of accessible specialty care. Seriously ill patients were transported 160 miles to the nearest tertiary medical center. I realized that most of my primary care services could have been delivered by a nurse practitioner. Many of the medically underserved areas are geographically remote and lack educational and cultural opportunities that would encourage doctors’ families to set roots. Instead of sending doctors from afar, the government should train local nurses to become midlevel practitioners. By using a sophisticated electronic medical record, these practitioners could develop enhanced relationships with specialists in larger medical centers.

Where Did All the Doctors Go? This partially confirms my belief that it is a bad idea to let doctors alone decide who is qualified to practice medicine. Allowing a continuum of training levels in medical care would lower medical costs and increase the availability of medical services. All this is in response to Shortage of Doctors an Obstacle to Obama Goals