Now there is a market solution, or an approach to it: If you need more nurses, pay them more money, and more young people will train for that profession. It isn't as though there were a need for 100,000 more brain surgeons: The market, in some situations, has to come to terms with the latent pool of resources. Not everybody can be taught to play like Horowitz, no matter what you agree to pay them.
The need for care intensifies for the most benevolent reason, which is that medicine is successfully harnessed to promote longevity. But in America, there is the flip side, which affects medical facilities as also, of course, old-age benefits. Here we have people living longer -- and procreating less. The only way to ameliorate that problem is to advance the retirement age or to reduce benefits.
But in matters of health there is a distinction, an approach to the problem that hasn't been explored and that the new president could illuminate with a truly incandescent point of light. The young generation, between high school graduation and college matriculation, should be called on for a year's voluntary service.
The shortage of nurses would be relieved if many of their duties were performed by others. Highly trained nurses are required at the operating table and to provide therapy and sophisticated supervision. But much that a nurse now has to do, everything from bedpan changing to writing down routine measurements on charts, could be done by l8-year-olds after very little training. How would they be recruited? And paid?
Ten years ago I looked into the question in a book called "Gratitude: Reflections on What We Owe to Our Country." The initiative came after reading an essay by James Michener in which he predicted, with that fluency of vision for which he was celebrated, that in America the problem of caring for the aged would before too long quite simply overcome us. He made projections -- and this was 20 years ago -- that are coming true. Life spans have increased dramatically, by six to eight years.
George W.'s distinguished father called, in the famous phrase, for a thousand points of light. Those whose tendency is to federalize any charitable impulse immediately assumed that new government projects would sprout, craning their necks for sustenance from the new light.
At that point, James Strock, who served President Bush in the Environmental Protection Agency, came through with a spirited reply. His point was that what was needed was a mobilization of voluntary help. There was manifest already a desire by a huge number of Americans to donate time for social work of one kind or another. He gave specific figures. Twenty-three million people spent, in l988, five hours per week or more in volunteer social work of one kind another. Fifty-seven million give some time every week, if less than five hours. That being so, more than 80 million Americans volunteer nearly a billion hours of their time to activity generally thought of as philanthropic or civic-minded, a contribution worth (in l988 dollars) $150 billion.
What eventuated, in the hands of President Clinton, was the America Corps. But this wasn't the exercise of genuine charity. It was a gentrification of a career move: In exchange for this contribution in time, the government will contribute X dollars toward your higher education. That is very different from the kind of thing done by the Mormon community, where a year or two years of service to fellow human beings in need is a near-dogmatical practice.
What do you need to steer the country in the desired direction? George W. would need to have the cooperation of right-minded educators. Suppose that 10 top colleges announced that no applicants for the class of 2007 would be matriculated without evidence of having served six months in voluntary health service?
You laugh. But the old, sick people wouldn't laugh. Their lives are prolonged as it is, but now they could be changed.