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Going Bimaru

Reading this news about medical students in America avoiding residencies in states with abortion restrictions coupled with stories about doctors fleeing red states, reminds me of things I have observed growing up in India. All states are very far from equal in India. I grew up in one of the more distressed ones home and Kolkata is home now. Kolkata has been draining talent for decades because the conditions in that city (and state) go from bad to worse. There is now an abundance of retirees and legions of services providers for the frail, ailing and elderly. 

Elsewhere in India, some states have enjoyed an influx of talent combined with decent governance. Over time, this has produced two kind of India - one the BIMARU kind and the other that is modern, progressive, dynamic, optimistic and poised for even better things ahead. The people from the two flavors of India have little in common to begin with and the disparity of their circumstances continue to pull them further and further apart. We already have a solid underclass from the failed states of India like West Bengal - the last time any of us Bengalis felt proud to talk about our provenance was maybe fifty years ago. My younger friends and relatives who have long left West Bengal to better pastures home and abroad don't ever intend to return to Kolkata. 

These folks are much like these doctors and medical residents fleeing states that are regressing to a primitive time. From what I have seen in India, the drain starts with one kind of talent for a specific reason - in America, doctors responding to abortion restrictions but that changes the tone fundamentally for the overall population and decisions they make about where they will live and work. A young couple hoping to start a family will likely not want to be in such a state if they have better options - they want both good pregnancy care and be prepared for unwelcome accidents.

 A single professional young woman will likely not want the state will not come in between her and her doctor. And it follows from there, the state will get stigmatized as a place where people with options in life don't go to live. Often the individual decisions will be based on perception of problematic and regressive and not wanting to be seen as someone who associates with all that and has no better options. We seem to be on track to create a BIMARU class of states in America. 

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