In a perfect world I think the software industry would have instilled these same virtues- software is just as (or more) capable of causing harm as poor healthcare. Yet we seem to be racing to a dystopian future at record speed courtesy of the tech industry, and our modern egalitarian societies will not survive that transition.

Enshittification continues relentlessly.

For the most part you’re required to deal with all the same laws that a multi billion dollar incumbent is, and often times even more (zoning, permitting that are hard law for small players and easily flexed by local government for dubious jobs claims by large players). Many areas charge fixed annual fees for incorporation that are notable for an individual but irrelevant at scale. Rigorous accounting and record keeping standards. High salaries even for uneducated manual labor work. Building any modest physical structure requires what amounts to most middle class individuals entire expected lifetime earnings and you largely aren’t able to legally do any of that work yourself.

There’s a good reason California startups exist in the way they do, and if you aren’t doing software or running an unlicensed pop up fruit stand or flower shop you often look elsewhere.

"...our incomes are comically higher for skilled persons than European salaries. I literally make 10 times what my French counterpart would in my profession and with a much lower tax rate so the real difference is even larger. I could work for 5 years and retire in France wealthier than if I had worked a 40 year career in France."

This is assuming only 40 hours a week, pick up more shifts and the numbers become even sillier. I suspect that most (if not all) professions could say the same although the magnitude of difference might be a bit smaller. Even if I lived in the EU and never wanted to leave, I'd ride out some years in the US to get life properly rolling back home.

Relevant wiki quotes:

“In the Mongol invasion of the Khwarazmian Empire (1219–1221), Genghis Khan invaded the region from the northeast in one of his many conquests to create the huge Mongol Empire. His armies slaughtered thousands in the cities of Kabul, Kandahar, Jalalabad etc. After Genghis Khan returned to Mongolia, there was a rebellion in the region of Helmand which was brutally put down by his son and successor, Ogedei Khan, who killed all male residents of Ghazni and Helmand in 1222; the women were enslaved and sold. Thereafter most parts of Afghanistan other than the extreme south-eastern remained under Mongol rule as part of the Ilkhanate and the Turko-Mongol Chagatai Khanate.”

And:

“From 1383 to 1385, the Afghanistan area was conquered from the north by Timur, leader of neighboring Transoxiana (roughly modern-day Uzbekistan, Tajikistan, and adjacent areas), and became a part of the Timurid Empire. Timur was from a Turko-Mongol tribe and although a Muslim, saw himself more as an heir of Genghis Khan. Timur's armies caused great devastation and are estimated to have caused the deaths of 17 million people. He brought great destruction on Afghanistan's south, slaughtering thousands and enslaving an equal number of women. Allied with the Uzbeks, Hazaras and other Turkic communities in the north his dominance over Afghanistan was long-lasting, allowing him for his future successful conquests in Central Anatolia against the Ottomans.”

The Mughal empire rose out of this and ruled until the 1800’s.

"vopono is a tool to run applications through VPN tunnels via temporary network namespaces. This allows you to run only a handful of applications through different VPNs simultaneously, whilst keeping your main connection as normal.

vopono includes built-in killswitches for both Wireguard and OpenVPN."

Traveling nurses like myself can fill the holes, but we don't come cheaply as we give up a lot to work away from friends and family in undesirable locations. Traveling docs (locums) feel the same, and are even more expensive- 20k to work a weekend in an ER isn't unheard of.

My personal opinion having driven all across America over the last few years and working in a bunch of these small to mid size cities is that they really have no reason to exist and would fade away without government welfare prolonging the misery. Most were founded near a mine or factory that has long since left and is extremely unlikely to ever return. In the past you'd quickly get a ghost town, today you get an economically depressed meth town that stumbles along for decades consuming lives.

1) Premed - 4 year degree + easily 1-2k+ hours spent volunteering, doing research, gaining medical work experience, obtaining LOR, shadowing, MCAT prep etc. This isn't optional if you actually want any chance of being accepted. Fail to get in and you're working with a (typically) biochem bachelors as a lab tech for $12 an hour and no upward mobility outside of grad school.

2) Medical School - another 4 years of pretty much nonstop studying outside mandated classwork and clinicals. Multiple large exams that basically dictate your entire future and whether you'll be able to match (ie. actually work as a doctor ever) along the way. A few thousand fail to match each year and invested 8 years + 250k med school + 50-100k undergrad to go back to that lab tech career I mentioned at $12/hr. Keep in mind those student loans are non-dischargable through bankruptcy.

3) Residency - 3-7 years. Family Medicine is one of the least rigorous and shortest at 3 years and averages about 10k hours of on the job during that time making less than minimum wage. Surgery is more like 80+ hours/week for much longer with 28 hour shifts standard at the start (minimum, better hope you don't have to finish any work at the end). Oh and don't fuck up because you literally have lives in your hands and face multi-million dollar lawsuits if you mess up after being awake for 20 hours straight on the job.

At the end of all of this and if you matched the most competitive specialties and busted your ass you might be able to make as much as a senior level SV software dev. Or you might be a pediatrician making 150k/yr if that appeals to you more than being wrist deep in someones bowels all day every day, or getting a 3 AM call to come do neurosurgery, or an urgent heart cath. Not feeling it tonight? Well someone is going to literally die if you aren't there within the next 30m- sleep well.