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.
Ben Droz
Ben Droz
U.S. President Donald Trump speaks during a campaign rally at Pinnacle Bank Expo Center on the Nebraska State Fairgrounds on October 05, 2026 in Grand Island, Nebraska.
The President Invited Iran to Bomb My Home
I was driving home to San Diego from Los Angeles on Monday night when I heard that the President of the United States had offered both cities up to Iran as bomb targets. At a rally in Nebraska, defending his war, Trump told the crowd, “let [Iran] take out Los Angeles, let ‘em take out San Diego.” It was, he said, “a very small price to pay.”
I was coming from a Bernie Sanders rally for Proposition 40, the one-time tax on California billionaires that would send 90% of its revenue to healthcare. We desperately need it to pass because, in order to give tax breaks to billionaires, Trump signed a law that will strip health coverage from 10 million Americans; this tax will make sure we can still cover Californians. Call me crazy, but I think taxing billionaires one time so we can make sure kids in California get to see a doctor is a very small price to pay. I also think that even if Trump were joking, it is indefensible to make jokes about the potential destruction of so many lives. Human life is never a small price to pay. Human life is priceless.
Plus, the reality is: here in San Diego, we’re already paying the price for Trump’s actions, and it’s not small at all. He has gutted FEMA, tried to kill climate resiliency programs, and destroyed public health standards, while his signature law is set to cut off health insurance and food support for hundreds of thousands of San Diegans. Like plenty of American cities, San Diego is already busy finding local solutions to respond to the problems this president has recklessly created.
Not to mention, at least 19 American service members have been killed in this war already. Human rights monitors have documented more than 3,600 dead in Iran by April alone. Here at home, gas is sitting just pennies below its all-time record. Taxpayers have already spent more than $45 billion on the war, while Trump’s oil and gas portfolio has grown by roughly $15.5 million this year alone. Of course anything is a “small price” to someone paying free.99 for this war, and profiting from it. Meanwhile, We the People are paying twice: first for the war, and then for the consequences of that war. But now he wants San Diego to pay a third time, flippantly offering us up to Iran.
It is worth noticing which cities he thought to name. Were San Diego and Los Angeles strategically chosen to signify something to his audience, or were they simply the first cities that came to mind as expendable places? Either way, the effect is to normalize—-and to gauge a crowd’s reaction to–the idea of massive violence in major California cities, suitable targets because of their perceived liberal lean. So what if Iran needs to bomb a little bit of America before the war can be over? Who cares, says Trump, if they target Los Angeles and San Diego?
By the way, why didn’t he offer up San Francisco, the free-love hippie-town MAGA loves to hate (and also my birthplace)? Could it be because that’s where the tech titans live? The same ones who joined Trump for Xi Jinping’s state dinner, a guest list worth a combined $2.4 trillion?
San Diego may have fewer billionaires, but it is home to more than 115,000 active-duty service members and 230,000 veterans. One in six active-duty sailors–in the entire Navy–is stationed here. So is one in four Marines. You cannot throw a rock in this county without hitting a military family: brats and spouses and veterans are among us. I got out of the Navy last year after ten years, and eight of those were here in San Diego. When Trump says “let ‘em take out San Diego,” he’s talking about the backbone of the United States military. He’s also talking about the people fighting his war.
San Diego has not been watching this war from the sidelines. Today, the USS Abraham Lincoln returns to North Island after an almost yearlong deployment to the Middle East that featured food shortages, broken toilets, and mold in the showers after 286 days at sea without a single port call. Eight sailors in the Lincoln’s strike group attempted suicide, but in August, when a reporter asked whether the deployment had gone on too long, Trump said “not nearly long enough.” Now he has told a crowd in Nebraska that we should let Iran take out the city those sailors call home. These are sociopathic sentiments.
Last week at Quantico, Pete Hegseth closed his address to the force by telling them, “President Trump has your back and so do I.” To the contrary, President Trump has put one of the biggest military towns in the country forward as a target for our adversaries. With friends like these, the “domestic” in “against all enemies, foreign and domestic” starts to sound a lot less hypothetical.
San Diego is home to Naval Air Station North Island, Naval Base San Diego, Naval Amphibious Base Coronado, the Point Loma submarine base, Camp Pendleton, and Miramar (and I have been permanently stationed at or trained at all of them). If Iran bombed San Diego and Los Angeles, aside from the devastating loss of life, it would cripple an immense share of our national security readiness.
And for what, exactly? Trump says the war is “essentially almost over with.” This is the same man who claimed in June 2025 that Iran’s nuclear program had been “obliterated,” then launched a war over it anyway on February 28. More than seven months later, he wants us to believe two things at once: that we’ve basically won, and that we might need to sacrifice an American city or two to finish winning. If the war is almost over, why does anybody need to take out San Diego?
I wonder if Trump’s endorsed candidate for California’s 48th District here in San Diego County will respond to these remarks. He recently said “no pain, no gain,” when referring to the gas prices San Diegans are paying. Jim Desmond, would you apply that same mindset if we were bombed? Or do you have the moral courage to stand up for the people you’re running to represent?
Last November, six Democratic members of Congress, all veterans, including Senator Mark Kelly, recorded a video reminding troops of their duty to disobey unlawful orders, restating the law that says so. Trump called it “SEDITIOUS BEHAVIOR, punishable by DEATH,” and then his Justice Department went looking for an indictment, which a grand jury refused. The president treated reading the law out loud to the troops as a capital offense, but then he himself invited a foreign enemy to destroy two American cities, possibly as a punchline. Is anyone calling the latter sedition? Who is demanding accountability?
Calling our lives a small price to pay affirms a moral bankruptcy, as well as an obvious dereliction of duty to the office he holds. While we can’t impeach him or invoke the 25th Amendment ourselves, we must stop being so quiet about what we’re paying already. We can make our voices heard by calling our representatives, writing op-eds, knocking doors, phone banking, and voting in defiance of the man who threatens the safety of our city. Ballots are already arriving in mailboxes. Vote, and vote yes on 40 (and no on 41 and 42).
Trump has been harming our cities for a while, but now he is inviting our military adversaries to join him in the harm. If we have any self-respect as Americans, we must not tolerate our leaders disregarding the dignity of lives in this way. We must fight for our home.
Julie Roland was a Naval Officer for ten years, deploying to both the South China Sea and the Persian Gulf as a helicopter pilot before separating in June 2025 as a Lieutenant Commander. She has a law degree from the University of San Diego, a Master of Laws from Columbia University, and is a member of the Truman National Security Project.