Sam Uretsky


Chess players do it all the time, so why can't everybody else? Chess players understand that if they make a move, their opponent will make a countermove. Sometimes a chess player will sacrifice a piece, giving up a bishop in order to take a rook. Chess games often end in draws.

Economists and military officers know this too, but perhaps not quite as well. Or perhaps the game is just more complicated. In the games they play, the pawns have families, and blood, and don't just move quietly off the board when they're sacrificed. Besides, there are more moves available, like three-dimensional chess, and what looks good on one level may be a disaster on another. There are more players in the game, and different rules for different squares. And while economists and military officers do their best to understand which moves are possible, politicians and businessmen don't. Politicians and businessmen watch their own squares and don't stop to think about anybody or anything else, and that's the way everything goes wrong.

Globalization isn't a particularly new concept. The economist David Ricardo wrote "On The Principles of Political Economy and Taxation" in 1817, and discussed the impact of foreign trade and the concept of creating trading partners and markets. Among the things he explained is that you can't make money selling things to poor people. In international terms, that means that building the economies of poor nations will help them become better trading partners in the long run, and everybody can (potentially) profit. There are tradeoffs that can be particularly unpleasant, but done properly, everybody profits. Buy a Hyundai, and somewhere, an American automobile worker may be laid off -- but the Koreans will be better able to import corn, meat, hides, soybeans, wheat and cotton. Do it right and, in macroeconomic terms, it balances.

Still, there are some industries that you may want to protect. The US has been a major exporter of munitions, but has always kept the good stuff to itself. You may be permitted to sell a jet fighter overseas, as long as the US has a jet fighter that's better than the one you're selling.

Lately, though, there has been a trend toward globalization of health care, and that can cause major problems. For years there has been a major trade in medical tourism on an individual basis. Go to the right places and you can get top-quality medical care and luxury accommodations at prices that are far lower than anything locally available.

Singapore, with Gleneagles and Mount Elizabeth Hospitals, was the pioneer in ultra-luxurious accommodations, offering rooms that look more like those in a five-star hotel than a hospital. In 2003 and 2004, Mount Elizabeth and Gleneagles Hospitals won the Superbrands award, an accolade that measures market dominance, longevity, goodwill, customer loyalty and overall market acceptance.

Travel for medical care has been an important option for Americans without health insurance. The New York Times described one uninsured patient who paid $9,000 for a trip to India for back surgery that would have cost from $36,000 to $50,000 in the US. But the paper also described an attempt by Blue Ridge Paper Products in Canton, N.C., and its medical insurer to send an employee to India for gall bladder surgery. In this case, the United Steelworkers stepped in and prevented the trip -- but its reasoning was based on questions of quality and liability: What happens if something goes wrong?

It's more important to ask what happens if everything goes right, and the insurance companies all start collecting frequent flyer miles on Air India. It's not that free trade is inherently bad, or good -- but it has to be looked at more closely than it has been so far.

Has anybody considered the next move? If patients go to India or Thailand for gall bladder and back surgery, there will be less business for US hospitals. Less business can force hospital closings, and when they close, they take their emergency rooms with them.

Medical Travel Inc. in Delray Beach, Fla., can arrange for you to have your teeth cleaned by dentists in Bangkok, followed by a vacation on some of the world's most beautiful beaches -- but they may not be that useful if you have a toothache.

Your insurance company wants you to mail your prescriptions for blood pressure and cholesterol medications to some town in Texas, and they'll mail you the drugs. They don't have good advice on what to do if your next prescription is for an ear infection.

On a large scale, and over enough time, globalization can be a good thing. But life doesn't happen on a large scale over unlimited time. It would be nice if somebody thought these things through, but only chess players do that.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, November 15, 2006

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