Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
During my residency at Stanford, I traveled to Mexico with a group of surgeons to operate on children with cleft lips and palates. On the first day, I watched in awe as the team leader meticulously realigned the tissues of the lip, mouth and nose of a 3-month-old boy, leaving behind nothing but a faint scar — all in just 90 minutes.
I immediately fell in love with plastic and reconstructive surgery. As a surgeon, I visited over a dozen countries to repair the cleft lips and palates of children. But later, in my leadership role as CEO at Kaiser Permanente, extended travel proved impossible. And I missed those trips dearly.
Last month marked my first global surgery mission in many years. Not only did our time in the Philippines reignite my passion for global surgery, but it also left me with three surprising lessons for American health care:
Without mission and purpose, medicine proves exhausting
Surgical trips are physically and emotionally demanding. Far from the sterilized corridors of American hospitals, you are plunged into environments where resources are scarce and the needs overwhelming. In remote towns and underdeveloped cities, you operate in tight spaces with erratic electricity and limited clean water. The days stretch long, with five to seven surgeries in a 12-hour day.
Each child you treat carries a story of hardship and hope, their families’ eyes filled with a mix of fear and optimism. And just as you start to tire from the heat and yearn for a good night’s sleep, another mother arrives. She has walked for two days through the mountains with a child in her arms, praying her baby can be added to the surgical schedule. There is no saying “no” to this. You immediately become reinvigorated.
After a physically trying week, you return to the United States not exhausted, but emotionally replenished. Nearly every clinician who has participated in a surgical mission feels the exact same way.
American health care today obscures the fundamental mission and purpose that motivates clinicians. Physicians find themselves ensnared in a web of administrative tasks and insurance disputes. For many doctors, this noble calling has become just a job.
To revive the profession and address the burnout crisis that affects more than 60 percent of clinicians, a renaissance of purpose is imperative.
To get there, we must pivot away from the transactional “fee for service” financial model that rewards doctors for the sheer quantity of services rendered. In its place: a reimbursement model led by clinicians who are paid based on the quality of clinical outcomes achieved.
Inherent in the privilege of healing is the duty to lead this transformation. Taking on that accountability — and thereby eliminating the care restrictions that insurance companies impose — will rejuvenate, not further fatigue, health care professionals.
American doctors are excellent but so are physicians around the globe
U.S. physicians believe that training outside the States is a second-rate education. It’s time to alter that perspective.
During my week in the Philippines, I had the pleasure to work alongside five local physicians, often at adjoining operating room tables. They’d trained in residency and fellowship programs all around the world to maximize their expertise. To a person, their results matched the leading pediatric hospitals in the United States.
Although American doctors have access to the best facilities, machines and materials, physicians in other nations have a competitive advantage that comes from higher volume. The best way to hone any medical skill is through repetition and experience. American surgeons lag their global colleagues in this area.
U.S. clinicians bring a wealth of knowledge that can greatly benefit doctors worldwide, yet there are equally rich lessons to learn from the experiences and practices of physicians abroad.
In the U.S. today, doctors adhere to minimum surgical volume standards. Patient outcomes would improve tremendously if, instead, our nation set benchmarks for superior performance. Combining high-volume surgical experience with our advanced technologies and top-notch facilities would produce superlative clinical outcomes.
But first, America’s health care professionals need to embrace humility and be open to learning from our global colleagues.
U.S. resources are vast but access is still scarce
In countries like the Philippines, health care challenges are magnified by economic constraints. Despite government coverage, per capita health care spending remains low, under $200 annually. This financial reality forces difficult choices, leaving significant gaps between the health care needs of the population and the services available.
Witnessing these disparities firsthand is a poignant reminder of the abundance the United States enjoys, with health care spending now exceeding $13,000 per American. And yet, despite our nation’s wealth, independent studies reveal that U.S. health care ranks last among a dozen wealthy nations and near the bottom of 38 OECD countries in more than a dozen health measures.
The United States has earned its distinction as home to the most expensive and least effective health care system in the developed world. This isn’t just because of our 30 million uninsured citizens (and tens of millions who are underinsured). It’s the result of decades of underinvestment in primary care, tolerance of inefficient hospital systems and exorbitant drug prices.
The challenge of transforming American health care is daunting, and it requires a willingness to embrace change and confront uncomfortable truths. Observing the efficiency and ingenuity of less affluent nations inspires a reevaluation of our own care-delivery practices and health care finances.
The biggest problem in our health care system isn’t a lack of money. It’s the deficit in leadership and innovation.
Volunteering on global missions offers invaluable perspectives that could catalyze change in the United States. I’m optimistic that by learning from countries that achieve remarkable outcomes with modest means, we can enhance clinical outcomes, reduce clinician burnout, and make quality health care accessible and affordable for all Americans.
Eric Trump, the newly appointed ALT5 board director of World Liberty Financial, walks outside of the NASDAQ in Times Square as they mark the $1.5- billion partnership between World Liberty Financial and ALT5 Sigma with the ringing of the NASDAQ opening bell, on Aug. 13, 2025, in New York City.
Why does the Trump family always get a pass?
Deputy Attorney General Todd Blanche joined ABC’s “This Week” on Sunday to defend or explain a lot of controversies for the Trump administration: the Epstein files release, the events in Minneapolis, etc. He was also asked about possible conflicts of interest between President Trump’s family business and his job. Specifically, Blanche was asked about a very sketchy deal Trump’s son Eric signed with the UAE’s national security adviser, Sheikh Tahnoon.
Shortly before Trump was inaugurated in early 2025, Tahnoon invested $500 million in the Trump-owned World Liberty, a then newly launched cryptocurrency outfit. A few months later, UAE was granted permission to purchase sensitive American AI chips. According to the Wall Street Journal, which broke the story, “the deal marks something unprecedented in American politics: a foreign government official taking a major ownership stake in an incoming U.S. president’s company.”
“How do you respond to those who say this is a serious conflict of interest?” ABC host George Stephanopoulos asked.
“I love it when these papers talk about something being unprecedented or never happening before,” Blanche replied, “as if the Biden family and the Biden administration didn’t do exactly the same thing, and they were just in office.”
Blanche went on to boast about how the president is utterly transparent regarding his questionable business practices: “I don’t have a comment on it beyond Trump has been completely transparent when his family travels for business reasons. They don’t do so in secret. We don’t learn about it when we find a laptop a few years later. We learn about it when it’s happening.”
Sadly, Stephanopoulos didn’t offer the obvious response, which may have gone something like this: “OK, but the president and countless leading Republicans insisted that President Biden was the head of what they dubbed ‘the Biden Crime family’ and insisted his business dealings were corrupt, and indeed that his corruption merited impeachment. So how is being ‘transparent’ about similar corruption a defense?”
Now, I should be clear that I do think the Biden family’s business dealings were corrupt, whether or not laws were broken. Others disagree. I also think Trump’s business dealings appear to be worse in many ways than even what Biden was alleged to have done. But none of that is relevant. The standard set by Trump and Republicans is the relevant political standard, and by the deputy attorney general’s own account, the Trump administration is doing “exactly the same thing,” just more openly.
Since when is being more transparent about wrongdoing a defense? Try telling a cop or judge, “Yes, I robbed that bank. I’ve been completely transparent about that. So, what’s the big deal?”
This is just a small example of the broader dysfunction in the way we talk about politics.
Americans have a special hatred for hypocrisy. I think it goes back to the founding era. As Alexis de Tocqueville observed in “Democracy In America,” the old world had a different way of dealing with the moral shortcomings of leaders. Rank had its privileges. Nobles, never mind kings, were entitled to behave in ways that were forbidden to the little people.
In America, titles of nobility were banned in the Constitution and in our democratic culture. In a society built on notions of equality (the obvious exceptions of Black people, women, Native Americans notwithstanding) no one has access to special carve-outs or exemptions as to what is right and wrong. Claiming them, particularly in secret, feels like a betrayal against the whole idea of equality.
The problem in the modern era is that elites — of all ideological stripes — have violated that bargain. The result isn’t that we’ve abandoned any notion of right and wrong. Instead, by elevating hypocrisy to the greatest of sins, we end up weaponizing the principles, using them as a cudgel against the other side but not against our own.
Pick an issue: violent rhetoric by politicians, sexual misconduct, corruption and so on. With every revelation, almost immediately the debate becomes a riot of whataboutism. Team A says that Team B has no right to criticize because they did the same thing. Team B points out that Team A has switched positions. Everyone has a point. And everyone is missing the point.
Sure, hypocrisy is a moral failing, and partisan inconsistency is an intellectual one. But neither changes the objective facts. This is something you’re supposed to learn as a child: It doesn’t matter what everyone else is doing or saying, wrong is wrong. It’s also something lawyers like Mr. Blanche are supposed to know. Telling a judge that the hypocrisy of the prosecutor — or your client’s transparency — means your client did nothing wrong would earn you nothing but a laugh.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.