A Visit to the USA - The Good, the Bad, the Ugly

I just returned from an 18 day vacation to the USA. This time around, my understanding of the issues affecting the country was certainly better than ever in the past. Some thoughts.

The Good

Nature has been kind to the USA, and the citizens have used nature well. Large open spaces (outside the metro cities – and large parks in most metros), clean air and reasonable infrastructure in most parts make the country extremely livable. I envy the houses and community infrastructure most places enjoy – something India may take a long time to achieve, if at all.

Obama’s policy of funding infrastructure is clearly visible, with roads being built in most places I visited. Perhaps more so than in India!

Local government representatives seem responsive to needs of their electorate. I heard stories of people reaching out to their senators to get issues sorted out, and the senators responding! India seems to have the same population per MP. Some lessons to learn here.

The Bad

Bureaucracy is abundant. JFK immigration took 90 minutes to clear – with immigration officers either absent from their stations, or busy sipping coffee and chatting among themselves – oblivious to the mile long line of travelers waiting to have their passports checked. Reminded me of Calcutta of the late ’70 when communists were at their peak!

Compared to that, Indian immigration is now a breeze – at 3:30 at night, it takes less than 10 mins to clear two plane load of travelers.

Socialism exists in various forms – housing taxes come bundled with school fees – clearly detrimental to those who have no children, but have to pay. This forces ghetto of a different kind – communities are generally homogenous with age and social strata determining housing – because of the taxes involved. The argument that the same level of education is available to all levels of income earners is fallacious – you can only stay in a community if you can afford to pay the house taxes of that area!

The Ugly

The healthcare system is a rip-off. Hospitals charge fees that have no connection to the value of service provided – George Washington University Hospital charged me a $1000 for a clinical examination of my daughter – no tests, no ambulance, no admission. I was advised (later on) that these fees are best “negotiated”! Wow!

The pharmacies are even more of a rip-off. A medicine that was supplied by Sun Pharma (which would, I assume, be making about 20 paise per tablet) was charged at $6 per tablet! Further, the pharmacy keeps the prescription – so that more than the prescribed medication is not made available to the patient. In a country where guns can be purchased in the department stores (almost), and where freedom to harm yourself is protected as a fundamental right (almost), the need to “protect” the patient against medication, (increasing the cost of drug delivery by several times what it needs to be – by eliminating competition in distribution) is criminal.

Overall, the country remains seriously uncompetitive in most matters. Most businesses make money through cartelization (finance), or through regulations (patent protection, visa controls, minimum wages) creating entry barriers. The basic education system stresses more on games and less on studies – a football coach at a college will likely earn 5x-10x what the math teacher makes. The country has some serious challenges to face as it comes to terms with a world where other countries offer greater opportunities for growth.