Saturday, April 10, 2010

Blueprint for a New Philippines



Following is the unedited first chapter of the book that I am writing with the aid of a friend who has extensive publishing experience. Tentatively titled "Blueprint for a New Philippines," the book will provide a directional map for 21st century nation-building.

Chapter I - Introduction

We are sea creatures. Out of the misty soup of ages we came. One wave of sea-bodies upon another. If indeed the first people on our planet were driven out of Paradise, our forebears found other island paradises in the open sea. We came on shore only to find hundreds, thousands, eventually millions of fruit-bearing trees that we knew we could just live on till our dying days. The fruits and the fish in the rivers and the ocean. We were made for life, for eons.

Just as we came by sea, others heard about our paradises and came. Some say they conquered us, but it never felt like that. It was more like we welcomed them to our shores and they stayed. They taught us how to count, how to study the stars, how to better enjoy our world. They taught us how to worship their God - their Allah - which appeared to be better than our gods who ruled the forests, the mountains and the seas.

The women among us were so beautiful, so redolent, so sensual every stranger who came wanted to marry them and establish families. We men did not mind that our women wanted strangers, there were plenty of beautiful, desirable, sensual women whose hair smelled like coconuts who would share our bed - for one night, for a long time, for a lifetime.

The strangers who came from a far away land, told us how we have souls and that if we followed the laws set by Allah, when it was time to pass on, our souls would be reunited with Allah in a Paradise in the heavens. We liked that, so we began to worship their god, their Allah, and we were certain that someday we would all be reunited in Paradise.

When the palefaces came, they too talked of Paradise beyond death. Their God seemed to be just like Allah. Perhaps it was the same God? The pale faces looked like warriors, handsome and strikingly heroic. Our women adored them.

The warriors among us did not like them. One of our local princes, Lapu-Lapu, wanted to drive them away. Lapu-Lapu had the memory of ages. A long time ago, Lapu-Lapu's forebears fought the pale faces' forebears in wars that lasted over many lifetimes. We were recruited by Lapu-Lapu and his men and we tricked the pale faces and their leader to meet with us on an island at low tide. There, far from the big ships and guns, and at low tide - which meant the ships had to be far from the island's shore - we ambushed the pale faces and slew their leader.

The pale faces turned their ships around and did not return. We would not see them again for many, many years.

Our women did not like to see them go. Years later, we would learn what the pale faces thought of our women. A certain Pigafeta, who was their chronicler, wrote that our women seemed to prefer the men who came on the pale faces' ships. Our women, according to that man, wanted the men on the ships better than us men who grew up on the islands with them.

We native men and macho warriors did not know it then, but our women would over the next four hundred years be attracted to the strong and tall pale faces who would visit our shores. Many of these pale faces stayed. Some liked our women and our paradises so much they established families and clans. Some of the pale faces wore habits that marked them as messengers of the one who died on the Cross.

We grudgingly liked what we saw out of those unions. The children who issued from those coital unions were light-skinned and narrow-nosed. They had finer hair, were taller and had the features of a godly race.

When the pale faces came back, they were well-armed, ready and dangerous. We knew that we simply would be no match for them. There was plenty of paradise to share, so we established compacts, authority-sharing arrangements. The pale faces quickly established neighborhoods where they openly mingled with our people. Many of our women were enticed by the glib tongues and quickly changed their beliefs to match those of the pale faces. They were attracted to the man-god who died on the Cross so that we human beings could reclaim the Paradise we had lost.

More pale faces came, wave after wave of them they came. Some stayed, others went to the other islands of the north. We later learned that they got as far as the land of the Taga-ilogs. They forged a compact with Rajah Soliman and the other rajahs in the land of the Taga-Ilogs and beyond. The Taga-ilogs did not know it yet, but they were soon to become subjects of a King in a far-away land. This King did not know them, nor cared about them. He only knew that from the island paradises that his soldiers and missionaries had appropriated for him, there would come riches that would shore up his kingdom.

The men who came and dominated us had superior technology. They were better prepared for battle, we were better prepared for making love and making nice. It would have been a no-contest, so we went along.

This was our first defeat. It was a defeat of the spirit. We did not resist. We did not know that we needed to resist. We were simply overwhelmed and awed by the strangers with pale faces who worshipped a far more superior God than our gods and goddesses of the forests. Far more superior even than Allah.

The Chinese traders who came with their gold trinkets and their silk robes may have warned us about the secret agenda of the Spaniards. We were not sure when we learned that the pale faces were Spaniards, but eventually we did learn. We also learned from them that the Spaniards were the most powerful people in the world.

The Spaniards taught us that the world was not flat, it was round. They related to us that the Spaniards who first came to our shores, who had been led by Ferdinand Magellan - the man our chieftain Lapu-Lapu had tricked and slain - continued in their voyage westward and eventually got back to Spain. This proved that the world was round.

EUROPEAN FEUDALISM

What followed the Spanish conquest and domination of the archipelago that would eventually be known throughout Europe as "Las Islas Filipinas" reignited the Spanish love for feudalism, a political-economic arrangement that was losing its grip on Europe. The natives learned that their hunting grounds and agricultural lands were no longer theirs. They were told that those lands now belonged to certain Spanish families that were favored by the Spanish crown. There was a land-grabbing rush.

Feudal Spain knew that power - economic and political - emanated from land ownership. Those favored by the Spanish crown were granted large tracts in Las Islas Filipinas and became the most powerful, most influential clans.

Those who must make their living by working the land quickly became beholden to the land barons and a culture of dependency that rewarded the land-owners with the undying loyalty and devotion of the peasants soon became the law of the land.

The natives of Las Islas Filipinas were divided by sea into islands - 7100 at low tide - and were unable to unite and resist. They knew there was something wrong with the way their lives had turned out after the Spaniards got done organizing their towns. They did not know the extent of the problem, and did not have a clue on how to gain redress. They were separated by seas. They spoke different languages. They were made up of separate nations. They might as well have been different countries.

In one sense, they were. They were really different countries with different cultures. They were fast becoming Christians, worshipping the man the Spaniards told them died on the Cross to save their souls. But there was little else they shared. They learned how to speak Spanish more quickly than they learned to speak each other's language. The Ilocanos sounded weird to the Tagalogs. The Cebuanos sounded even weirder.

For the next 300 years, the Spaniards would completely remake their societies and they would simply go along. The brave and smart did rebel, but the rebellions were localized. The Ilocano nation's Diego Silang over-ran a Spanish garrison, imprisoned the Spanish soldiers and some priests. He formed a government that briefly ruled the Ilocano nation, egged on by the British, which had captured Manila in 1762.

The British promised troops to Diego Silang to help defend the fledgling Ilocano government. Those troops never materialized and so Silang's days were numbered. After Silang was slain through the treachery of one of his men, his widow - Josefi Gabriella - bravely carried on the fight but was eventually captured and executed along with hundreds of her troops.

No major challenges to the Spanish throne would spring up until a century later, when the Katipunan was established by Andres Bonifacio and his fellow Masons.

The country's history was a study in exploitation by an abusive foreign power. It was an exploitation that was carried on at the temporal level all the way to the level of the spirit. The Spanish friars were instrumental in this exploitation, selling the bill of goods that suffering on earth would be rewarded by rapture and joy in heaven.

Filipinos were sold on the concept of self-denial, indeed self-flagellation, to purify their souls for eventual ascension to the true Paradise.

If one were to look for an explanation of why Filipinos tolerate so much from foreign invaders, their public officials, their parish priests, their role models, one credible explanation would be that their Christian upbringing over the centuries taught them that true rewards are not in this life but in the after-life.

A SOCIETY WITH FEW WARRIOR HEROES

I mentioned Diego Silang, Lapu-Lapu, Bonifacio. Add to that list Emilio Aguinaldo. Since the Spaniards first set foot on Cebuano soil, despite the friars' and Spanish military abuses, there were no successful major revolts against the Spanish crown. A reading of Philippine history reveals some minor rebellions that would rightly be classified more as mutinies than full-fledged open rebellions.

Lapu-Lapu drove Magellan's men away, but in exchange for Magellan's defeat, hordes of Spanish ships came and intimidated the paradise dwellers of the open seas. Bonifacio and Aguinaldo had brief victories, but they both eventually went down in defeat. Bonifacio was in fact hacked to death by Cavitenos who he thought were his allies.

Our national hero, Rizal, was a martyr. The modern-day Rizal, Benigno Aquino, Jr., was a martyr. We have had plenty of martyrs, but few victorious heroes.

The Vietnamese have Ho Chi Minh, who slew the American dragon and took the Vietnamese people to their current golden age. The Chinese have Mao Tse Tung, the Ming and Han dynasties. Chinese history over the millennia is full of military heroes. The Japanese have the Shogun warriors. The Thais have their Kings of Siam who repelled invaders. India had Akbar the Great and the Madjapahit emperors. Even Mongolia had Genghis Khan.

And the U.S., our modern-day patrons, has George Washington, Andrew Jackson, Abrahan Lincoln, General Eisenhower, General Patton, General Douglas McArthur. The U.S. has many victorious heroes. Americans are a nation of winners.

What we have in our historic consciousness is a revolving door for martyr-heroes. Rizal, Bonifacio, Gregorio del Pilar, Diego Silang, Fathers Gomez, Burgos and Zamora, Benigno Aquino, Jr. and many minor martyr-heroes that are in history's footnotes.

Our greatest hero, Jesus Christ, was crucified. Every year, on Good Friday, we recollect this crucifixion by self-flagellating. Some are willingly nailed to a cross.

This is how our mind works. We can tolerate so much abuse from our officials because our God has shown us the way. Our heroes have shown us the way. We are the martyrs of Asia.

WE MUST RE-FRAME OUR HEROES

One of my all-time favorite movies is Braveheart, which stars Mel Gibson. It is the story of William Wallace, the brave Scottish warrior who resisted the abusive British crown and was initially victorious. The story line ended with William Wallace finally going down in defeat at the hands of a much more superior army of English and Irish soldiers, but Wallace's eventual defeat was not the meat of the story. The focus was on Wallace's victories.

Napoleon finally met his Waterloo after blundering in Russia, but that is not what the French remember him for. He is revered as the great conqueror of much of the known world in his time. Julius Caesar was slain by his so-called friends in the Senate, but that is not the lesson of Caesar. It is his greatness as a military commander and his role in the emergence of Rome as the primary world power at the beginning of the first millennium.

We have to rewrite our history. We must show our heroes as winners, not as losers. Martyrs such as Rizal and Aquino must be de-emphasized. We must extol Lapu-Lapu, Diego Silang, hold up our noses and extol Aguinaldo's victories on the battlefield against the Spaniards. In sports, we must write about Manny Pacquiao and how he has united the many nations that exist side by side in what is known - incorrectly - as the Filipino Nation. We must tell our children about Flash Elorde, Ceferino Garcia and other great boxers. We must tell them about Caloy Loyzaga and his teammates who won third place in the world basketball competitions in the 1950s.

We must fight off our tendency to view life as an opportunity for self-denial and view death as deliverance and reward. That mindset has led to only to one conclusion. We have become a Talunan nation.

We are the losers in Asia. Fellow Asians mock us as the sick man in their midst. We tolerated the abuses of the friars, the murderous ways of the American conquerors, the brutality of the Japanese. We are tolerating the corruption and broken promises of our politicians. We tolerate the abusers, including and especially our sexually predatory masters.

There is a silver lining in all of this. We are great as nurses, as cooks and stewards in ocean vessels, as maids in Hongkong households, as farm hands in Hawaii. We endure, we persevere, we do not complain.

The Jews rejected Jesus as savior because the Jews were waiting for a savior who would lead them in battle. Jesus clearly did not fit the bill. The Jews are still waiting. Meanwhile, their reverence for winning has made them the most influential people in the world despite their minuscule numbers.

What we Filipinos need are stories of victory, not defeat. We are not warrior nations, but paradise dwellers, so we probably will never have the equivalent of a Ho Chi Minh who will unite the many nations that make up the Filipino whole. But we're in dire need of victorious role models. Let us cast away the Talunans - the losers - in our history. Let us embellish the exploits of our victorious heroes such as Lapu-Lapu, Diego Silang, Emilio Aguinaldo and Cory Aquino.

If we do this, by mid-century we may start seeing Filipinos who succeed spectacularly on the world stage. In sports, in business, in all organized life activities.

We can all help this along by making decisions that benefit the Filipino people. We have to restructure our society, our way of doing business, our educational system. We have to create a new religion within our formal religion. This religion will teach us that holiness, like cleanliness, is reaching the limits of our potential. We must think of wealth-making as a virtue. We must promote selfishness. In love, as in war, we must learn to be selfish.

I have crafted a plan, a Blueprint for a New Philippines, based on Filipino selfishness. It may not be the only way, but it sure as hell beats the usual Filipino way.

We are sea creatures. Only the sea will cleanse us. Now the sea is giving birth, not to new life forms, but to new ideas. From far away lands these ideas are coming, waves upon waves of them. The ideas come as echoes, insistent, plaintive echoes. Books such as "A Country of Our Own," as plaintive as South Africa's "Cry, My Beloved Country." Defiant Filipino voices from all over the world exhorting their countrymen not to assume that what goes on in the country needs to be the way of the future.

We are sea creatures, we are being baptized with the holy water of progressive ideas. We are being transformed by the religion of self interest. We need not accept as our lot what four hundred years of foreign rule and influence have wrought on our psyches.

We can reinvent ourselves, just as the sea creatures of eons ago emerged from the water to walk on soil and become creative forces that rule the known universe.

As the Chinese learned to be selfish, not in a personal way but in a collective way through their collective culture and will, the Chinese giant has awakened. Filipinos must learn to be selfish, in a collective way - not in a personal, corrupt way. We must chuck the culture of victimization that we have all been accustomed to. In certain very crucial instances, we must be the victimizers, not the victims.

I'm not just talking about the traditional politicians who victimize us. God knows what a complicated mess that is. I'm talking about the international business people who come to our shores to promise us all the great things in life, all we have to do is sign on the dotted line. We must become smarter and out-smart them all. Just as Lapu-Lapu outsmarted the worldly-wise Magellan.

We must emerge as a new nation, a new people, a new living ambition that is tailor-made for this new century and all centuries to come. Out of misty sea we must.

Sunday, April 4, 2010

Ailing hospitals as patients




While doing my research on hospitals in the U.S., I felt like one of the cartoon characters in my son's video game. The character, Mario, runs - no, trots - all over the place, jumping across brooks, over brick fences, on tiled rooftops. Hop-scotching on cobblestone roads, all the while evading weird-looking monsters trying to stop Mario dead on his tracks.

He is able to take evasive action and drops dozens of monsters and even when he sustains a direct hit, he manages to rise again and take flight, focused on a mission that he alone knows about. I don't know why he purposefully runs, or what the prize is at the end of his journey.

Eventually he is face-to-face with a tall brick wall. He can't scale it. He hurls his body against the wall. It won't budge. He considers going back, but the monsters are close on his tail. I stop the action.

I call my 11-year-old son. He comes over and shows me the way out of Mario's dilemma. Mario is able to escape once again and he is off running, er, trotting.

Researching the hospitals in the U.S. is a long journey into discovery. But each discovery leads to more questions, not answers. So you continue to do further research, which leads to still further research. You feel like Mario running for his life while focused on his destination. You feel like you're running for your life because you fear that you will arrive at a wrong conclusion and you will come up with a useless product.

The hospitals are supposed to be part of the solution to the health care mess the U.S. is in. Instead, it cries for itself solutions and answers.

Hospitals across the U.S. are losing money. One study shows that about a third of the hospitals across the country are in danger of closing their doors.

The other two-thirds would clearly benefit if the unprofitable hospitals do close their doors. Except many in the two-thirds-profitable category own many of the hospitals in the one-third-unprofitable category.

This of course is the short term conundrum. What are the long-term prospects for hospitals in this country?

I struggled with this question because the learned people in the industry are all over the place on this issue.

Hospitals are in trouble because of long-term trends and structural problems. These trends are permanent and call into question the hospitals' continued viability.

1. People are generally in better health at all age levels in the U.S. than their parents or grandparents because of more and better medicines. As a result, a smaller percentage of people is ending up in hospitals.

2. Americans are also living longer, postponing the end-of-life sicknesses that finally land them for longer-than-normal stays in hospitals.

3. Insurance companies, worried about their own bottom lines, are insisting on shorter hospital stays for maternity patients and all sorts of patients.

4. America has discovered the much-cheaper alternative of highly-skilled nurses going to patients' homes. Visiting nurses businesses have sprung up all over the landscape. America actually likes this better than traditional hospitals.

5. Many surgeries can be done on an outpatient basis, delighting the insurance companies.

6. The growth of the below-cost Medicare and Medicaid businesses that hospitals must accept has put tremendous pressure on hospitals to increase their prices charged to insurance companies. Insurance companies react by denying long hospital stays for their insured, further limiting hospitals' revenues.

7. America has discovered medical tourism. A major surgery costing up to $150,000 in the U.S. costs about $15,000 in India, Thailand or Malaysia, and the bill includes a one-week stay in a first-class hotel.

8. Hospitals are forced to purchase expensive new equipment to remain competitive. Industry continues to turn out new and better equipment at a torrid pace and hospitals are going into major debt to afford them.

Because of modern drugs and equipment that aid in detection of diseases at an early stage, Americans are living longer and are much healthier today.

The evidence is everywhere. Women in their sixties look like they are in their forties. Journalists are telling us that 50 is the new 40. MSNBC's Chris Matthews remarked, upon seeing Speaker of the House Nancy Pelosi celebrate her 70th birthday recently, that "70 is the new 40."

On I-15 in Las Vegas, there is a billboard for a Dr. Life, who is 78 years old and has the body of an Arnold Schwarzenegger at age 40. Doctors allied with Dr. Life and new-age doctors all across the country are predicting that the practice of medicine will slowly evolve into keeping people healthy, which will cause a decrease in the demand for sickness-curing patient care. That's a death knell for hospitals.

A relatively new company called Cenegenics, LLC, based in Las Vegas, is one of the firms in the new field of age management. Dr. Life is one of the doctor-licensees of Cenegenics, whose licensees are scattered all over the U.S.

The sad news for traditional hospitals is that their problems are structural and permanent and nearly impossible to scale, like that wall that always stumps Mario in my son's video game. But, like in the video game, the key to getting past that wall is to find the end-around passage. Hospitals must adapt and reinvent themselves, if they are to survive.

One ally of the hospitals is the epidemic of obesity in this country which will certainly take its toll eventually and will cause a temporary bump in business for hospitals - down the road, down Mario's road. But that is temporary, the long term trend by all accounts is that Americans are getting healthier.

What can hospitals do immediately to weather the triple-whammy of decreasing demand, decreasing money paid by insurance companies and increasing Medicare and Medicaid businesses that pay hospitals at below-cost rates?

They have to cut back, as many of them are doing. In Las Vegas and across the country, hospitals are cutting their staffs in a manner that mimics what is happening to the newspaper industry. A lot of pink slips are flying around these days because traditional hospitals are becoming obsolete, just as newspapers are being slowly replaced by cable news and the Internet.

While the outlook for hospital workers in the short run is not particularly encouraging, there is a projected huge demand for nurses and others in the medical field, with predictions for serious shortages across the country by the end of this decade. Nurses will be in great demand, though a smaller percentage of them will be working in hospitals.

How do all of these hospital problems relate to the health care reform?

It is clear that the health care reform legislation, which draws more than 30 million Americans into the insured pool, will cause an increase in hospital business. People who are allergic to hospitals because they can't afford them and not because they are not sick will of course avail of the hospitals' services and cause a modest increase in hospitals' revenues.

The sad part is that many of the new insured will be in either Medicaid or low-cost insurance policies that will not necessarily add to the hospitals' bottom line.

There will be plenty of work for the hospitals for a while, until the currently uninsured catch up with the general population in terms of general healthiness.

I can always count on my son to show me how Mario could go around that tall unscaleable wall. I can't ask him how hospitals can do an end-around. It may be too late in the day for some hospitals. The patients - now a third of the hospitals are the patients - may be too far gone in their ailments. Many of them cannot be saved.

The surviving hospitals - to no one's surprise - will of course be stronger financially and will serve Americans well as the country adapts to the conversion of the practice of medicine from curing diseases to maintaining patients' good health, helping them age gracefully and disease-free.

Oh, by the way, since hospitals must recoup some of their losses from serving Medicare and Medicaid patients, they will continue to charge outrageous fees for their services supplied to patients who are covered by private insurance. Hospital costs will remain high and will increase further, causing insurance companies to react by shortening hospital stays further. This will accelerate the growth of the visiting nurses businesses.

Only a single-payer system will solve the problem of high hospitalization costs because the single-payer - the national government - does not have to make a profit. It can absorb the increased hospitalization costs and not have to raise premiums, which private insurance companies must do to stay in business.

(Disclosure: My wife works for Cenegenics and both my wife and I own member units in Cenegenics, LLC.)