Hope springs eternal in American dream

ANAHEIM, California – To a lot of Filipinos, this is the land of milk and honey. And that’s true too… not just milk and honey but of BMWs, Lexus and the ultimate dream factory of Hollywood. About two miles from where I am camped is Disneyland. Ate Glue would probably enjoy herself here because it is the ultimate Enchanted Kingdom she had been talking about lately.

Less known to the guys who besiege the US Embassy daily for visas is the fact that the man on most American streets today is pretty much like them – struggling to make it in this world. Their big advantage of course is the large American economy that somehow gives them the push that enables them to enjoy the good life, even if the good life is bought on credit.

In fact, The Economist points out, the gap between rich and poor in America "is bigger than in any other advanced country, but most people are unconcerned. Whereas Europeans fret about the way the economic pie is divided, Americans want to join the rich, not soak them." The Economist observes, Americans do not go in for envy. "Eight out of 10, more than anywhere else, believe that though you may start poor, if you work hard, you can make pots of money. It is a central part of the American Dream."

No recent issue showed the American inclination to dream as much as the debate over the abolition of the estate tax. The Economist estimates that "over 70 percent of Americans support the abolition of the estate tax (inheritance tax), even though only one household in 100 pays it." Yet, abolishing the estate tax is expected to benefit less than half of one percent of American citizens but would harm many more by creating a one trillion dollar hole in the already worrisome federal government’s fiscal position. At the moment, the government imposes a tax of about 46 percent on estates worth more than $2 million, or more than $4 million in the case of couples.

So, even if the estate tax affects only the richest households, those with wealth exceeding $1 million and its abolition would put at risk social benefits that most Americans depend on for medical care, unemployment and retirement services, there is grassroots support for it. This can only be explained by a general feeling that getting to the top is not a far-fetched dream and even if the estate tax does not affect them now, it could in the future.

The American attitude towards wealth isn’t focused on wealth redistribution, the foundation of progressive taxation. They pin their hopes on the ability of the American economy to constantly expand and grow, best expressed by the adage that "a rising tide lifts all boats." If they have to blame their current economic woes on anyone, they "tend to blame their woes not on rich compatriots but on poor foreigners," The Economist observes.

This explains why "more than six out of 10 are skeptical of free trade. A new poll in Foreign Affairs suggests that almost nine out of 10 worry about their jobs going offshore. Congressmen reflect their concerns. Though the economy grows, many have become vociferous protectionists."

The good news of the recent past, The Economist reports, is that the tide has indeed been rising fast…Thanks to a jump in productivity growth after 1995, America’s economy has outpaced other rich countries’ for a decade. Its workers now produce over 30 percent more each hour they work than 10 years ago. In the late 1990s everybody shared in this boom. Though incomes were rising fastest at the top, all workers’ wages far outpaced inflation."

But the bad news is, "the rising tide raises too few boats." Still, the Americans are pretty much contended because "the impact of stagnant wages has been dulled by rising house prices…" There is some undeniable unhappiness about the economy… According to the latest Gallup survey, fewer than four out of 10 think it is in "excellent" or "good" shape, compared with almost seven out of 10 when George Bush took office.

Economists may debate on when the tide may turn for the American economy as the statistics suggest the economic boom may fade. But Americans still shop with enough gusto to power their economy’s growth (and China’s), even at the cost of falling savings rates and rising debts. Living the good life is what democracy here is all about too.

The Economist surmised that "the rise of the working rich reinforces America’s self-image as the land of opportunity. But, by some measures, that image is an illusion. Several new studies show parental income to be a better predictor of whether someone will be rich or poor in America than in Canada or much of Europe… The proportion who thinks you can start poor and end up rich has risen 20 percentage points since 1980."

The good thing about the American attitude towards wealth and the growing wealth disparity among them is how it encourages them to reach out even more for that American dream, which in turn supports national economic growth. The greater income disparities, The Economist observes, have created bigger incentives to get an education, which has led to a better trained, more productive workforce. The share of American workers with a college degree, 20 percent in 1980, is over 30 percent today."

Hope springs eternal for the American dream. Some of us can be skeptical about all that, given that so few really make it to the top. But it is the spirit that drives this nation to the economic powerhouse we all know. The widening income disparity among the classes may be bothersome to many observers but the Americans don’t seem to mind it much, if the surveys and the rhetoric we get from their politicians truly reflects the feelings of the heartland.

Only time will tell if the social cohesion would stand further strains from an unabated widening of the income gap among the classes. For now, striving for the American dream is all that matters, even if the going is tough and hard for everyone who wasn’t born rich or got lucky breaks along the way.

Pinoy doctors

My doctor friend responds to the e-mails reacting to a previous column on the topic of Pinoy doctors and America.

First a couple of items: l don’t know the writer’s source for the "average earning of doctors". She quotes $150,000 to $450,000. $150,000 would be near the low end for a diplomated doc. There are doctors who earn well into the seven figures. Nurses may earn more than a first year resident (PGY1) but post residency, there is no comparison. There is a nursing shortage in the first world precisely because of the low pay.

Medical malpractice is NOT always paid by the individual doctor. In general, private practitioners do. Hospital-based and/or academic doctors get their coverage from their employers as part of a salary package (which usually has additional perks to be competitive). Malpractice rates double after being sued? Not true. Malpractice has been so demonized domestically, that a sober discussion on the matter may not be possible.

Now to the nitty gritty:

New graduates have a better chance of passing the entry examinations than those, who wait for some years. That is a given. But the comparison that was being made was about the standards of medical education in the Philippines relative to world standards IN ANY GIVEN PERIOD. Graduates were not being compared as much as the medical education, they got. lf the standard in the local universities is consistent with the rest of the world, the examinations would be easier to pass and assimilation in ANY first world country would be less stressful. lf substandard, the opposite will happen.

But the doctor email writer is correct with regards to the requirements for travel. Exams are one thing. Then, there are the fees and the visa. The correspondence was solely about the exams as reflective of the overall status of the national health standard today and in the future.

The other two items deserve a separate forum as the players would/should not necessarily be relegated to a particular graduate. For instance, the tone of the quoted US article was a plea to lower US standards and for the US to be more hospitable to foreign doctors. This decision will have to be made by the US government. The Philippine government may intervene in the visa problems, IF IT WANTS TO. (see below).

The subtext of the communication is, the Filipino graduate should at least be as good as the Indian graduate, vis a vis, these entry requirements. Well, are we? Last I heard, Indian med graduates are still getting admitted to the USA as doctors, NOT as nurses.

The Philippines, unlike a couple of countries in the area, has resources that can significantly alter this negative course. The sad part is, the country appears to have accepted a slowly deteriorating health standard as a fact of life and to avail of these resources seem unnecessary or at the very least, a low priority. There are less than honorable motivations, for the government, OFW dollar remittance and for the medical establishment, less competition.

Books, seminars, conferences, fellowships, and the like cannot replace a formal residency program. In things scientific, the third world should go to the first world for training and education. They are the ones, who write the books and the procedures with very few exceptions.

They say, that the advances in the last 30 years tantamount to all discoveries prior to that period. This may not be true in Hematology. But it is true in most specialties. To wit, Radiology got divided into Diagnostic and Therapeutic. The therapeutic really meant treatment of cancer with radiation. Diagnostic Radiology became Clinical Imaging, when it started to use non-radiation technology, i.e. microwaves and magnets.

Then, it started TREATING diseases, it diagnosed, e.g., angioplasty, embolization/ablation, drainage, etc. Since it cannot go back to the term "Therapeutic", INTERVENTION was born. Imaging spearheaded the age of "evidence-based medicine". Intervention started the trend for non or minimally invasive procedures. These terms did not even exist, 30 years ago. Today they define healthcare in the USA.

Some procedures have not reached our shores yet. Our capacity to teach and train is thus, very "spotty" at best. It is a serious mistake for the government to see doctors leaving as nurses as just another source of OFW remittance. They should do WHATEVER IT TAKES to assist our medical graduates to be trained abroad as doctors. And it appears, that the USA needs them anyway.

The medical establishment should help too. If they ever get there, let’s hope, some would come back. If they do, we should welcome them, like the Koreans and the Thais do to their returning doctors.

Mystery

Bobby Tordesillas sent in this short classic.

Teacher: Write a short story in a few words discussing Religion, Sexuality and Mystery.

Student wrote: "My God! I’m pregnant. I wonder who the father is?"

Boo Chanco’s e-mail address is [email protected]