04-19-2026, 05:23 PM
(04-18-2026, 01:32 PM)Punatang Wrote: Centralization vs. decentralization. Simple...
Heynow 'Tang, I'm still wrangling with this concept of yours and have another question about your centralized verses decentralized approach to governance..
Have you ever considered how doctors end up in little ol’ Puna, Hawaii, and, what role our federal, ie centralized, government plays in it?
A case in point…
We all know that becoming a doctor takes a long time and for the most part leaves the new doctor fresh out of the process deep in debt. So, with that in mind, most of them are compelled to seek employment in communities that can afford them. And, as I am sure you can appreciate, we, rural lower income Hawaii, can’t. So where do our doctors come from? I had no idea until an experience with one of mine taught me more than I ever wished to know.
A long while back I got my doctoring done at the Pahoa branch of the Bay Clinic, now known as the Hawaiʻi Island Community Health Center. At the time I had some serious medical issues, but I was fortunate, my doctor was Dr E. (whose name is shortened, but some will know who I am speaking of nonetheless), who is as sincere and competent a doctor as I have ever encountered. In no small measure I credit the care I got from her as one of the reasons I am still alive today.
As I learned, during the time I was in Dr E’s care, the Bay Clinic staffed its clinics with doctors through a national program whereby new doctors contract for three years to work in rural America at a greatly reduced rate of pay in exchange for the feds paying off their student loans. The goal of the program is not only to get doctors temporary assignments in rural clinics like our’s but in the long term to get them to fall in love with those communities and invest in them during that time so as to decide at the end of it to stay, and as such actually build up an inventory of competent doctors more evenly distributed across the country.
Dr. E fell in love with Pahoa. She and her husband bought a home in HPP, her children were entering our charter schools, and at the end of her three year stint she was convinced she would continue working here. So, she set out to renegotiate her contract with the Bay Clinic. She even went so far as to start working with the entire staff to reorganize themselves to be more productive, and show to the board of directors how they could deliver the same level of healthcare to their patiences in a more effect way and a such afford to keep her on.
But the Bay Clinic would have nothing to do with it. Their model is predicated on that three years commitment at the greatly reduced level of salary, period. They, at least at the time, had no intention of ever keeping a doctor on after that period. So Dr E moved back to the mainland.
So, I gotta ask, ’Tang, with that situation in mind, where, in your decentralized model of how we should run our affairs, do we get doctors?