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.

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.)

Americans are being screwed - royally

I am passionately in agreement with some Republicans who warn us that the health care reform package recently passed by Congress does not go to the roots of the problems and will therefore not solve the health care crisis in America.

The Democrats' health care reform legislation is a very promising start, but the country's efforts to rein in the cost of its health care will not be successful if the root causes are not addressed.

We know that doctors are a major cause. The practice of medicine in this country is an exercise in capitalism. It is no longer considered as a public service, which it is in many countries ranging from the highly industrialized countries such as Canada, Australia, Great Britain, France and Germany all the way to third-world countries such as the Philippines and Cuba.

We know that lawyers drive up costs by going for doctor's jugulars every time doctors make mistakes. If there is no tort reform, costs will remain high.

We also know that drug companies' primary mission is to maximize returns for their stockholders. As public corporations, their ultimate responsibility is to their stockholders. Providing cures or alleviating symptoms is only a secondary mission. Once upon a time, drug companies started out with a mission to find cures for diseases. Not anymore, now Big Pharma's mission is to maximize returns for stockholders.

We know that the same drugs that are sold in the U.S. cost at least twice as much as those sold in Canada. If those drugs were invented by Americans and developed by Americans, how come American consumers pay much more for them than their Canadian counterparts?

There is only one way to explain this. U.S. drug manufacturers made the determination early on that the way to recoup their research and development expenses was to charge American consumers outrageous prices.

The American system is perfect for this. The insurance companies are the ones paying for the drugs, and as everyone knows the huge for-profit insurance companies can afford to pay. They can absorb the costs since they can merely pass them on to their insured by periodically raising insurance premiums. There is no limit to the number of times insurance companies can raise premiums.

The high-cost drugs are absorbed into the health care system in the U.S. because we have a pipeline mentality here. Whatever costs are incurred by the members of the system are merely passed on ultimately to consumers. The drugs go smoothly through the pipeline and as long as the howls and protests are few, drug prices just keep on flowing at prices that have no relation to production costs.

Only the sick notice, but sick people do not have the energy to demonstrate in Congress. They will pay any amount to get well or to keep the symptoms of their ailments under control.

The insurance companies profit from the atrociously high drug prices. Assuming that insurance companies are allowed an 8 percent return on their costs, the higher the cost of the medicines, the bigger the profits for the insurance companies.

We keep reading in the papers that American consumers subsidize the cost of drugs in other countries. To what extent? Below is a comparison of the prices of some life-sustaining and life-saving medicines sold in the U.S., Canada and Mexico.

Prescription Drug-----Dosage------Price in Maryland----Canadian Price--Mexican Price

Zocor--------------5 mg., 60 tab.-----$113.97-------------$46.17----------$67.65

Prilosec-----------20 mg., 30 cap.-----122.62--------------55.10-----------32.10

Procardia XL-------30 mg., 100 tab.----144.89--------------74.25-----------76.60

Zoloft-------------50 mg., 100 tab.----238.44-------------129.05----------219.35

Norvasc-------------5 mg., 90 tab.-----127.17--------------89.91-----------99.32

The average price differential, based on the above drug cocktail, is 98% for Maryland versus Canada and 95% for Maryland vs. Mexico. (Source: Minority Staff Report prepared for U.S. Congressman Elijah E. Cummings of the Committee on Government Reform and Oversight, U.S. House of Representatives - August 10, 1999.)

The prices charged for drugs in Australia are even lower than the prices in Canada, according to one source.

The drug industry apologists do not deny that American consumers are being raked by the drug companies for even their spare change. Every single apologist for the drug industry will tell you that drug companies must be allowed to recoup their huge investments in research and development through atrociously high prices charged American consumers.

Yes, folks, the drug companies have determined that U.S. consumers must underwrite the cost of R & D, ahead of everybody else. We Americans must pay through the nose so that others - Canadians, Mexicans, Australians, Europeans - can have the same drugs at a fraction of the prices charged Americans.

Is this right? Why must it be a disadvantage to be an American compared to being a Candaian, or an Australian? Shouldn't it be the other way around? Shouldn't we Americans pay less for prescription drugs since it is our American drug companies who are constantly coming up with these newer and better drugs with less and less side effects?

Is it because our higher standard of living allows us to afford more? Maybe so. But as we Americans know, and as the whole world now knows, the American standard of living is under attack. We Americans are becoming more and more like the Europeans. The Chinese are fast catching up with us. The Japanese have exceeded us. The Australians and Canadians are right on the trail of the Japanese.

So why do we Americans continue to subsidize the cost of medicines in other countries? Because we allow the drug manufacturers to price discriminate against us. That's the only explanation.

If we Americans stand on rooftops and scream enough is enough, we will no longer be forced to subsidize the world's consumption of life-saving and life-preserving drugs things will begin to change. And this is change that we can believe in.

The situation is urgent. Without a reform of the way drug companies price their products in the U.S., health care reform in America will remain just a dream.

We made a great start with the health care reform package passed by Congress and signed by President Obama. But, we must not stop there. Drug companies must charge consumers in other industrialized countries the same or nearly the same prices for their products as they charge American consumers.

It is not only fair, it is one essential way to reduce the cost of health care in America.

(Next week: the hospitals.)

Thank your lucky stars for Lawyers

FLASH! Sunday, March 21, 2010, 6:00 p.m. Las Vegas time:

PELOSI, REID AND OBAMA AND THE NATION TRIUMPH!

In 1936, Franklin Delano Roosevelt offered a new bill of rights that would supplement the list of rights embedded in the U.S. Constitution. Among the new rights that Roosevelt advocated was the right to health care. The U.S. Legislature did not pick up on Roosevelt's idea, and the new American "rights" died with Roosevelt in 1945. Not a single right on Roosevelt's list became law.

This historic weekend, the country enacted a law that makes health care a right (and a duty) in America. While still work in progress, the new health care reform act that creates the right to health care for every American national took a dramatic turn for the finish line when President Obama refused to be intimidated by the recent Democratic defeats in New Jersey, Virginia and Massachusetts.

Grown men and women openly wept when the first black President was elected on November 4, 2008. This time, everybody was all smiles. It was a giddy moment for the Democrats and the country. Everybody in this country will remember what they were doing the night health reform passed.

All of us, you and me, are witness to history. Never before in this country has health care been considered a right of every American. It has taken a black President to get it done. It has taken all of conscience-stricken America to prod him on, telling him he was on the second yard line, all he needed to do was to punch it into the end zone.

Yes, like "all" that was needed was to soften the muscles of the huge defensive linemen, the Republican misinformation machine. In one gigantic muscle coordination move and rocket-like leap, the President, Speaker Pelosi and Senate Majority Leader Harry Reid - all blocking for each other - punched the ball into the end zone.
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I may have made enemies last week, or at the very least I may have tried and tested some friendships, when I openly questioned the present system that rewards U.S. doctors as capitalists rather than reward them as public servants, which most of them are, and which is the way most doctors are treated in other countries - advanced, developing or underdeveloped.

A doctor in Las Vegas has surrendered his license because of the huge scandal
that resulted from the terrifying news that his clinic had reused needles and
that thousands of patients at the clinic had contracted hepatitis B. No HIV
cases had been found, or more appropriately been broadcast to the public, but
suspicions are rampant that there may have been such cases.

The doctor operated on the principle that he was a capitalist and that his first
obligation was to himself and his employees. His first obligation, in his mind,
was to maximize the profitability of his enterprise.

Doctors in most countries are franchised by governments to serve the public good and the systems in those countries afford doctors a comfortable lifestyle but not ordinarily an opportunity to create huge personal fortunes. The U.S. is one of a very few countries that consider the practice of medicine as a capitalist franchise.

Because of the magic of capitalism, huge fortunes are being made by doctors in the U.S. That is why lawyers and the public are holding doctors to heightened scrutiny and unusually high standards.

The nature of work, especially delicate and demanding professions such as doctoring, is that mistakes are inevitable. It is estimated in one study that 80,000 medical malpractices occur every year in the U.S. Of those 80,000, only 10,000 actually result in lawsuits. And out of those 10,000, 96% are settled out of court. Only 4% of the 10,000 - or 400 - actually go to trial by jury.

Insurance companies that issue malpractice insurance to doctors are therefore "saved" by the system. The 96% of the cases that are settled out of court cost the insurance companies an average of $125,000 while those that go to the jury average $235,000 in awards. My statistics do not reveal if the cost figures include the cost of insurance company lawyers. I apologize for not knowing.

The message is clear. Insurance companies are highly motivated to settle malpractice suits out of court because no matter how good their lawyers are, plaintiffs will nearly double their awards if the cases go to trial.

The lawyers know this, and short of encouraging frivolous lawsuits, lawyers tend to advice their clients to sue on the slightest provocation. They know they will collect regardless of merits, what more if there are compelling reasons to sue.

Assuming in all this, of course, is that it is not a frivolous lawsuit.

Chances are, it is not a frivolous lawsuit. People make mistakes, especially when they are on a steep learning curve. Doctors especially, when they are under stress and are making life-or-death decisions.

It is therefore unrealistic for the public to expect that doctors will not make mistakes. They will and they do. Every day. And they will continue to make mistakes. And they will continue to cover up those mistakes.

The public's defense is to know as much about their doctor as they possibly can. They must research their surgeon's credentials before they agree to lie on the operating table.

They look into the horse's mouth, don't they, before they buy the horse?

When I was starting out in college in the traditional world of business, there was the caveat emptor rule (Let the buyer beware). It was only recently that the world has been evened out for consumers through consumer protection laws.

For patients, however, it is always wise to assume that caveat emptor rules. Pretend that there are no consumer protection laws. Besides, the government cannot prevent, no matter how tough the laws, doctors from making mistakes. While the law will grant redress, doctor's major mistakes cannot be undone.

The patient is never the same, even after being showered with malpractice money awards.

And, though malpractice awards and settlements are for the most part modest, some awards have been huge, enough to slam the knees of insurance company executives:

Failure to timely diagnose, $10,200,000 settlement (Feb. 11, 2010).
Breast Cancer lawsuit, $17,500,000 settlement (Oct. 30, 2009).
DeKalb County birthing malpractice lawsuit, $15,350,000 settlement (May 23, 2008).
Medical malpractice lawsuit awarded by jury, $60,000,000 (February 18, 2010).

The Disability Insurance Resource Center website lists hundreds of awards and settlements, each one potentially if not actually ruining a doctor's career.

Do you see anything wrong with this picture? I do. We know that doctors will make mistakes. Experience tells us that these mistakes are often unavoidable, which is why malpractice insurance is a major source of revenue for insurance companies that offer them.

If you combine the universality of malpractice insurance policies with the certainty of mistakes occurring in the practice of medicine, you are looking at a gold mine for lawyers. Lawyers will get their 30% - after expenses - whether the plaintiffs settle or the case goes to the jury.

While awards are generally modest and reasonable, there have been very expensive cases to settle or litigate. Insurance companies must set their premium rates according to the possibility that any malpractice case will result in huge settlements or jury awards, tempered only by actuaries' estimates of what the likely breakdown will be between major news-making awards and usual and customary awards.

A recent study demonstrates that in the long-run, as the size of awards have gone up, the premiums charged by insurance companies have also gone up. In insurance underwriting, premiums are set on the basis of potential maximum losses, not on best-case scenarios. This is why malpractice insurance premiums have gone through the roof in this country.

The cost of malpractice insurance, especially in some professions such as obstetrics, gynecology, oncology and all kinds of surgery, has become so prohibitive that doctors have been known to take the early retirement route or branch out to other fields.

Doctors are being squeezed by insurance companies that are on a drive to tamp down the fees charged by doctors, and from below, by the cost of malpractice insurance.

This is the cruel present, but the promise of the future is worse. The doctors who bail out further exacerbate the shortage of doctors in many areas of the U.S..

Something must be done. The country cannot continue on this road to higher and higher malpractice insurance premiums because of higher and higher settlement and jury awards in malpractice cases.

Obama, Pelosi, Reid and others in the Democratic Party have done the heavy lifting in the struggle to provide health care to most Americans. They must now even the playing field for doctors and insurance companies.

The jury awards in malpractice cases must be capped. The Bush administration proposed capping jury awards to $250,000, with exceptions for egregious cases. Obama seems to be open to the suggestion, though the $250,000 figure is arbitrary and likely to change.

I advocate this change because I know that doctors do make mistakes, and it is the responsibility of everyone to select doctors that are least likely to make mistakes. How does one do this? By researching the doctor's qualifications. The Internet has so much information that one can use. Patients should beware of doctors about whom there is little information on the Internet.

Patients must also gather information by word of mouth, from other doctors, nurses or hospital administrators.

We do a thorough research before we buy a new car, it is only fitting that we ask a lot of questions before we agree to being treated by a doctor, or God forbid, being opened up by them.

When we make the final decision on the choice of our doctors, implicit in that decision is that we are partly responsible for what results from that choice. If our doctor makes a mistake we are partly to blame because we chose that doctor.

While this does not absolve the doctor of responsibility for loss of income or loss of job (economic losses), the more lucrative type of settlement or award (pain and suffering and punitive) would be removed from the equation. Should that happen, settlements and jury awards would tend to drop dramatically.

This makes a lot of sense. Let me restate my case in plainer terms. Assuming that we choose our doctors intelligently, what the doctors do to us is partly our fault. If we suffer pain and suffering, it is ultimately because we made the wrong choice. Punitive damages would be unavailable to us because we were a part of the decision making in the choice of our doctor.

Insurance companies are granted by states a certain profit margin based on their expenses. If their expenses are high, their margins are bigger and the total cost of malpractice insurance is high. If their expenses are low, their margins are smaller, resulting in the cost of malpractice insurance going down.

If the cost of malpractice insurance goes down, doctors' fees assuming a rational world would also tend to go down. As more doctors return to the practice of medicine because they are no longer intimidated by the cost of malpractice insurance, the doctor shortages occurring in many parts of the U.S. will be alleviated.

The increase in doctors practicing in their fields will tend to keep doctors' fees from spiraling ever upward, and in fact may result on doctors' fees going down. But don't hold your breath for that one.

Of course, we could short-circuit this whole process by eventually going to a single-payer health care system, a Medicare for all system where the Federal government covers all Americans and most doctors no longer make the huge fortunes that they build over their lifetimes. Doctors would be just like every body else in this country. They have to be truly outstanding in their professions in order to earn huge fortunes over their lifetimes.

The lawyers would just have to find others to sue for big bucks.


(Nest week: The pharmaceutical industry.)

What does society owe its doctors?

Shortly after we moved to New Jersey in 1977 from Portland, Oregon, my first wife and I bought a house in South Orange, New Jersey not knowing that my life was about to change in a very dramatic way. I was swimming in the town's community pool when I noticed someone who was trying to figure out if he knew me. After a brief period, he exclaimed, "Chay?" Chay is what all my friends call me. How I got that name is a long story.

My friend, whom I grew up with in school - from grade one through high school - had become an oncologist, a pillar of the community, someone people from all over the country consulted with when they discovered they had cancer.

We quickly renewed our friendship and his wife quickly became one of the closest friends of my wife. I said that my life, unbeknownst to me, was going to take a dramatic turn. It did. My friend introduced me to his circle of doctor friends and suddenly I was moving around in a circle of highly accomplished doctors.

I maxxed out my credit cards, went to the best parties, tried to keep up with the Filipino Joneses. It was very different in Portland, Oregon and before that in Seattle. In both cities where I had been, most of my friends were working-class people and Filipino old-timers. Now my wife and I were in the giddy company of doctors who were destined to become some of the best doctors in their fields in the New York metropolitan area.

I was having career midlife crises at the time and it was inevitable that I would eventually start feeling sorry for myself. I felt, at times, that my new friends were asking, in the back of their heads, why I did not become a doctor. Doctoring, after all, was for them the zenith of anyone's professional aspirations, so why did I not go into medicine when I had the chance? Assuming that I had the chance.

I was convinced that the world was tailor-made for doctors. All they had to do was put in the work and the long hours, and bingo, after a few years they would live in these houses that ordinary people could only dream about. Not to mention the sports cars.

I went through much of my life not being in awe of anyone, but I must admit I looked at doctors with awe. Except my life-long friend. He was my friend, after all, and I would never allow myself to be in awe of him.

I lucked out when later in life my net worth increased to a level I had never imagined I was capable of accumulating. Not in the league of doctors' fortunes, but still more than enough for me to live on for the rest of my life.

It was only then that I felt I was equal to the doctors. I started to ask the questions that I would never have asked if I had not known financial success later in life. I would never question doctors' incomes if by doing so I would expose myself to suspicion of committing the cardinal sin of Envy.

But now that the whole country is discussing health care reform, I feel that it is time to analyze the level of income of doctors and that one of those who will do this analysis is me.

I will also try to analyze the impact of lawyers on the health care costs in this country in a future blog post.

For starters, let us look at the macro picture. Australian doctors earn 70,000 to 98,000 Australian dollars (U.S. 63-90,000 dollars) per year, compared to U.S. general practitioners and internists at $125,000 (according to the McKinsey report). This is a fair comparison because in the latest World Health Organization rankings of health care systems, Australia came in at number 32 while the U.S. came in at number 37. We're comparing similar health care effectiveness, though Australia is ahead of the U.S. in that category for half to 80% of the cost of internists and general practitioners.

The WHO rankings' number one health care system is the French. There general practitioners earn 71,000 to 72,000 Euros (about $100,000 U.S.). Again, compare this to $125,000 Internists and General Practitioners in the U.S. Not much difference in earnings.

It is estimated that the U.S. pays its doctors $58 billion a year more than they deserve to be paid for comparable care in other countries (McKinsey report). If the difference in earnings is not in Internists and General Practitioners between U.S. doctors and doctors in foreign countries, whose earnings account for the excess $58 billion a year that U.S. doctors are paid?

You guessed it. It's in the specialists. While specialists in Australia typically earn $200,000 a year, U.S. specialists' earnings are in the millions.

There is a special category of doctors in the U.S. who have opted out of the health maintenance organizations and the Medicare/Medicaid systems. They don't need the insurance companies because they are in such highly-specialized fields that people mortgage their houses to be treated by them.

Why do U.S. specialists earn as much as they do? Most people will tell you that it is because of two factors. One, U.S. doctors - especially those who have specialized in extremely complicated surgeries - went through highly intensive and rigorous study not only in medical school but also in hospitals as interns and residents before they began their independent practice. They therefore deserve whatever rewards society will grant them. U.S. doctors go through 16 to 18 years of intensive study, according to some reports, before they establish their practice.

Two, doctors are in the business of saving lives and making lives more productive by curing diseases.

Let's analyze reason number one. If doctors are compensated highly for the number of years they spent in intensive study, then we should also compensate the PhD's in philosophy, in science, in psychology nearly as much as if not as much as the doctors.

Aha, you might say, those PhD's do not do a lot of overtime work and save lives. I will grant this, though in the case of the PhD's in Psychology, they do save lives by preventing suicides. I will not go there, will instead grant that doctors save lives and PhD's don't.

But what about the firemen and the policemen? Don't they save lives? And don't they put in long hours? Don't they patrol the dangerous streets where in an instant they could be dead? Firemen and policemen save more lives than doctors, so why do they not make anywhere near as much as doctors?

Let's redirect our inquiry to doctors all over the world - not just in the U.S. Why is it that doctors in Australia, in many European countries and in developing countries like the Philippines are not automatically some of the richest people in those countries?

What is unique about doctors in the U.S.? I have wrestled with this subject lately because I am one of those who are glued to the TV watching talking heads spew their wisdoms about the health care crisis in America.

Doctors in underdeveloped countries are operating in lean mines. The economies simply cannot support the lavish lifestyles of doctors that are typical in America. Some doctors in third-world countries like the Philippines are in fact paid, not with currency, but with livestock (chicken, pigs, etc.)

In Europe, Canada and Australia the practice of medicine is restricted because doctors for the most part work for a single payer, the government. Government, as we all know, is stingy. It's built that way. Have you ever heard of anyone working for the government - except the successfully corrupt - getting rich from that employment?

The conditions in the U.S. are tailor-made for the fortunes being amassed by doctors. This, after all, is the richest country in the world, and in this richest country, there is no mechanism for keeping doctors' incomes down. The sky is the limit for doctors' incomes, and that is the way it should be, if one embraces the pure capitalistic system of charging patients what the market will bear.

And here is where we go back to Adam Smith. Is there perfect competition in the practice of medicine? Adam Smith always assumed that perfect competition was possible. When we look at the fees charged by doctors to rich or uninsured patients or to insurance companies, etc. are these fees what a willing market must pay?

Why are there shortages of doctors in the U.S., which should have a bumper crop of doctors since the practice of medicine is very profitable here? Has our legal system in fact created conditions that led to a chronic shortage of doctors thereby insuring that those who practice medicine here are rewarded with lavish lifestyles?

I must be careful not to overstate this case since there are many doctors who are barely getting by. The insurance companies have over the years cut back on doctors' compensations and doctors no longer make as much as they did.

You want to know why health care is so expensive in the U.S. that now 17% of the country's GDP is spent on health care? It is because many doctors, including most specialists here, are automatic multi-millionaires. Radiology companies, independent staffers of nursing, collection agents for doctors, ambulance companies, MRI and kidney dialysis companies - all businesses connected to the field of medicine - are raking in. If no drastic changes occur, the field of medicine and satellite industries will bankrupt the Medicare and Medicaid systems in as little as one generation.

More and more Americans are just one major sickness away from bankruptcy - even if they have insurance.

How do we get out of this loop? The obvious solution is through a single-payer system. Let there be universal health care, with the government setting limits on what doctors and peripheral medical service providers charge for their services.

If Americans do not want a single-payer system, then they must lobby their government to step in and address the problem of too few specialists and too many general practitioners in the field of medicine.

For far too long, the actual numbers of specialists have been kept down artificially by all the silly requirements imposed by the states' medical boards and by the AMA. A doctor who performs complicated surgeries in India, Thailand or the Philippines, for example, will not be allowed to practice in the U.S. unless those doctors are willing to take the medical board exams, go through an internship program, etc. which will set these eminent foreign doctors back a few years from which the doctors could never recover. So these accomplished doctors don't come here.

The doctors who are recent graduates of medical schools in foreign countries are being shunted into general practice and internal medicine and psychiatry, which are not as lucrative as the glamour specialties.

This assures that the glamour specialties - the various surgery specialties, oncology, cardiology, etc. - always have a shortage of practitioners. The system has institutionalized those shortages. That is why we as a country pay so much for surgical procedures and other highly specialized doctors' services.

We pay to the tune of $58 billion a year more than what we should pay each year, according to the McKinsey report.

The solution, therefore, is to open up the practice of medicine in this country, with the specific mission of recruiting more specialists who have made a name for themselves in their home countries. Actual work experience in foreign countries must be considered equivalent to work experience in the U.S. Only U.S. arrogance denies that fact.

The government must provide incentives by underwriting the cost of medical school for aspiring high school graduates. The government can start by canceling student loans for those medical school graduates who choose to specialize in fields where there are shortages that cause huge fees being charged by doctors.

Recently, two new medical schools have opened up. More are on the pipeline. That will help.

We are on the cusp of insuring 30 million Americans who have not had health insurance through the health care reform movement in Congress, graduating more doctors will tend to keep costs where they currently are. Or bring costs down. "Down" is ironic because in the U.S. that still means high up there in the deep blue sky.

Either we do this, or we as a country will be forced at some future date to revisit the idea of a single-payer system similar to Australia's, and Canada's, and many European countries.

We will have to ask ourselves: What does American society owe its doctors?

(Next week: How do lawyers contribute to the high cost of health care in this country? After lawyers, we will examine the drug companies, then the hospitals.)

Is health care a right?

Is health care a right or a privilege? If you ask the Europeans, the Canadians and Australians, health care is a right. If you ask Americans, nearly half will tell you that it's a privilege, though nobody disputes that emergency treatment at the nation's hospitals is a right.

We in America are deeply divided on the issue of health care. And we are conflicted, very conflicted. We want Medicare to be a right for our parents, and ourselves if we are age-qualified. We want children to have health insurance. We want the poor, through Medicaid, to have health insurance. We want our criminals to have access to health care - at our expense.

But we don't think that our taxes should pay for the health care of the unfortunate Americans who can't afford to pay the high premiums charged by insurance companies.

One could argue that old people have earned the right to Medicare because - generally - they have worked for many, many years and have contributed to the Medicare fund all those years.

People who are 65 and older are presumed to have contributed to the Medicare fund and therefore deserve Medicare in their old age. But how accurate is this, really? Americans who turn 65 - whether or not they have worked most of their lives - automatically are enrolled in Medicare.

Housewives who never worked a day in their lives, old retirees who lived most of their working years in a foreign country and worked in the U.S. for only a few years, are all eligible.

No matter how one cuts it, ultimately Medicare is a right - for old people.

Now, let's look at health care as a right. Why do old people have that right, while young people don't? Because young people are presumably working and their employers are providing them with health care? True, in the 1970s, in the 80s, in the 90s. But is this true today? More and more companies are dropping their health insurance because they can no longer pay for it. More and more companies are classifying their employees as independent contractors to avoid giving them benefits.

What happens to such people - the backbone of American industry - people who are not old enough to be on Medicare, not poor enough to be on Medicaid, not young enough to be on CHIP, the children's version of Medicare?

Small businesses cannot afford to provide health insurance to their employees, so employees who go through life working for small businesses live their lives without health insurance. Many of the older folks wait for their 65th birthday, hoping they do not get seriously ill, so they can finally have health insurance.

Artists, entertainers, musicians, writers, editors and other self-employed people go through their whole lives without health insurance. Because health insurance is so expensive, these Americans treat health insurance as a luxury that they cannot and probably would not be able to afford.

They buy auto insurance, renters insurance, credit insurance. They buy life insurance because it's so much cheaper, and they want their children to have something if they pass on prematurely because they don't have health insurance.

How many Americans are we talking about? The high estimate is up to a staggering 50 million Americans. The low estimate is 40 million.

Do those 40 or 50 million Americans have a right to health care? Not if you ask about half of Americans. This is Darwinian politics at their worst. This is the movie 2012, where only the lucky and wealthy - they have to be both lucky and wealthy - can be saved. The rest are left fending for themselves.

Whatever the actual number, the Democratic-sponsored legislation approved in both Houses of Congress will insure 33 million of them. And the Congressional Budget Office has certified that the legislation will not cost the country a dime. In fact, the savings to the U.S. government will be 100 billion dollars over the first ten years and more than a trillion dollars in years 11 to 20.

So why are the Republicans - to a man - opposed to health care reform now working its way to the reconciliation process and eventually to President Obama's desk? You have to ask the Republicans that, but don't expect a credible or cogent response.

There is none. What they want the country to do is to shelve the two health care reform bills approved by the House of Representatives and the U.S. Senate and start over. Yes, start over!

They want us to go back more than one hundred years, when Teddy Roosevelt was President and when health care reform was first proposed by a sitting President.

After the U.S. government has spent countless hours and billions on salaries and research and development costs, the Republicans want the Democrats to throw away all of that work and start with a blank sheet of paper.

They are not arguing the truly debatable question, such as, do Americans have the right to health care, or is it a privilege? The Republicans don't want to go there. They have conceded that health care is a right. They just don't think that the country can afford to act on this right. It's been 100 years since this question came up. Each time, Republicans tell us that the country cannot afford to act on the right of Americans to have health insurance.

Out of the goodness of their heart, the Republicans, through their House leader John Boehner, are proposing that 3 million out of the 40 to 50 million uninsured Americans should be helped. The rest, wait around a little bit, they will get their turn.

When there's a blizzard in hell. That's what the Republicans are asking the rest of the uninsured Americans to watch out for, because that very likely phenomenon - snow in hell - is not too far down the road.

Meanwhile, about 14,000 Americans lose their health insurance every day in this country, according to some studies. And, of the many bankruptcy filings in the U.S., two-thirds are filed by people who got sick and could not afford to pay their hospital and doctor's bills.

Also, a Harvard study demonstrates that those without health insurance are much more likely to die from sickness than those with insurance.

We have in this country decided that old people have a right to health insurance, so do children and so do the very poor. So do criminals. But for the great percentage of Americans - those who are neither young enough or old enough or poor enough, or criminals - they're on their own.

Who benefits from this system? The insurance companies, the drug companies, doctors, nurses and hospitals, the old, the poor and the young. The rest of Americans are getting squeezed and if you ask them, being screwed.

The country is in a state of vigil. We have lighted our imaginary candles. We have waited long enough, a few more days or weeks is no big deal. We are waiting for our legislators to get the damn bill passed. We expect President Obama to keep on top of these Democratic legislators and whip them into action. We think the President has it in him to muster enough courage and energy to get that ball across the goal line.

Next week: What are fair earnings levels for doctors? What should the top oncologists and surgeons make? Does society owe surgeons and other specialists their lavish lifestyles? If doctors are being compensated for saving lives, should they not charge millions for each life saved? Isn't human life, after all, worth millions?

Governments on Ice

The earthquake that hit Chile a little more than 24 hours ago is nothing compared to the earthquakes that have been collapsing governments all over the world.

I am talking about the social, political and economic earthquakes brought about by the clash of tectonic plates of confrontational ideologies in cyberspace, cellular waves and cable TV. It started, innocently, with the creation of cable TV and the Internet two generations ago, followed briskly by the invention of technologies that filled the expanded needs of people who suddenly found themselves armed with the most potent force in the universe.

Yahoo, notebooks, texting, google, YouTube, I-pods, Blackberry and I-phone all followed in quick succession, and not necessarily in that order.

The world's new literates - those who see the computer and the cellphone as their friends and constant companions - have erected a new international society that can topple many of the world's governments.

Every wild gallop and swaying of a government structure in recent years has been the result of people texting and communicating on the Internet through mammoth e-groups and YouTube.

Police brutality cases, captured on cellphones and video cameras. In inner cities of the U.S. In Iran. In China.

Abu Ghraib and torture of prisoners. Dissident students in China's Tiananmen square.

"Obamacare" massacred on the Internet and on cable news shows by allies of the health insurance industry in the U.S. Obama's birth certificate issued by the state of Hawaii determined to be a fake by bloggers and Internet phantoms.

A deluge of text messages quickly formed the Filipino people's resolve to topple Philippine President Estrada and his government. A few years later they turned around and almost toppled the Gloria Arroyo government.

England's former Prime Minister Tony Blair, Italy's Premier Silvio Berlusconi, New York's Eliot Spitzer, Tiger Woods and many others swiftly falling from grace as Internet savvy folks and opinion-making bloggers weaponized the new technologies and fired away.

Everything happens instantaneously. Reputations are lost, frauds are exposed in cyber-speed. To compete, the traditional media such as newspapers and magazines must jump in the mud pool quickly and match the Internet and cable TV speed for speed.

The fallen cannot recover, because speed breeds finality. Senator Ensign in Nevada and Governors Mark Sanford of South Carolina and Paterson of New York are still in office, despite their much-publicized human frailties, but in reality all is lost for them.

This is our world now. We have created arguably the best inventions in the history of man - the Internet, the cell phone and texting, the Personal Computer and Notebook - which are also fast becoming an arsenal for assassins.

Without our having intended it, or being aware of it, we have transformed ourselves into piranhas in cyberspace and cellular waves. Governments are no match against us. Duly elected governments - even those overwhelmingly voted in by the electorate - can be neutered into inactivity by people like you and me.

All we need are people who think like us - and there are plenty of us on the Internet universe - and what we have created, overnight, is an invincible army of radioactive activists. We may be the loneliest creatures on earth, abrasive fools with no friends in the real world, yet if we can find a handful of people who believe as we do, we can suddenly be leaders of an army that has the potential of toppling governments.

The illusion of the Internet and cellular waves is that people who are drawn to the same causes and who share the same biases and pet peeves are friends. The reality is that such people do not even know each other. They have each other's email addresses and cell phone numbers and through the magic of the communication channels, act overnight as friends and allies.

Complete strangers who are allies and protagonists in cyberspace have already determined that whoever wins the presidential election in the Philippines in May cannot govern effectively. The candidates' reputations are shot.

Today's technology does not just wreck and topple governments, groups and individuals; it also builds reputations and careers where none should exist. The emergence of Sarah Palin, who in a sane world would be laughed out of politics in an instant, is proof of this. The Iranian opposition leader, Mir Mousavi, is most certainly a creation of the YouTube technology - a leader who overnight went from being an ally of the religious dictatorship in Iran to the symbol of the democratic ideals and yearnings of the Iranian people.

The shadowy forces that make up the Tea Party movement, can anyone really put a finger on them? Yet the Tea Party thrives, fueled by the libertarian front, aided by today's talking heads on cable.

Ever wonder why the world is so divided? Ever wonder why people's ideologies have hardened? Right-wingers will not talk to liberals and progressives. Libertarians condemn both liberals and progressives. Religious zealots are in a permanent war with the religious moderates and liberals.

People with opposing views do not need to talk to each other anymore. Every ideology, every major sliver of philosophy attracts almost an unlimited number of allies and adherents. You can find on the Internet millions of people who believe that Obama was born in Kenya. If you believe that the Ten Commandments should be in all the government buildings in the U.S., there are millions of Americans and non-Americans who will chorus "Hear, Hear" at cyber-speed.

If you are a racist, you have millions of friends on the Internet and in the world of texting. If you are a bleeding-heart liberal, you belong in a huge community of bleeding hearts. No need to link up with people who do not believe as you do - you don't need them. Why risk injury to your heart?

You can debate people you do not agree with all you want and there is no possibility of defeat. You could be illogical, obtuse and dumb in your thinking - not to worry, there are others on the Internet who will be your cheering squad. In our world not too long ago, your arguments could be demolished by people who were more informed than you. Not now, not while people create their own realities and truths on the Internet and are supported by huge peanut galleries.

We used to call these peanut galleries "Chu-chu-wa" in the Philippines and that is probably an appropriate label. For that is what they do: they sing "Chu-chu-wa" in the background while their leaders make one outlandish claim after another. Their existence assures that you never have to admit your mistakes on the Internet. Even and maybe especially when you are very, very wrong.

While our world has most certainly been enriched beyond the wildest expectations of our grandfathers because of the new technologies, we also have awakened to a world where half of us cannot have a meaningful conversation with the other half.

Governments cannot communicate with those that oppose them.

Everywhere we turn, we see evidence of governments being on the brink, as a great portion of the citizenry refuses to pay lip service. In fact, nearly everyone in the world, it seems, is angry with their government. Those who support their governments are angry that their leaders appear to be flummoxed by the challenges they face. Those who oppose the governments are indignant because those same leaders are unable to see the world as they see it.

Governing has become nearly impossible. If you are an elected official, how can you in conscience pursue a course of action that half of your constituents oppose? Yet this is the challenge that confronts elected public officials in every corner of the world.

Some, mainly leaders in Africa, find it easier to simply resort to genocide. Leaders of tribes that oppose them are hacked to death in front of their families. The wives and daughters of those tribal leaders and their followers are raped before being hacked to death.

Such leaders may eventually end up in the World Court, if the Interpol can get its hands on the slippery characters. It's a risk that the brutal African dictators can take because those dictators know that the probability of capture and extradition is low.

Absent large-scale eradication of opponents and intransigent citizens, the world's political leaders really have no solution to the problem that confronts them. Their country's citizenry has become ungovernable. It is as though a strange new virus has infected the system and mechanism for communication between the government and the governed. And this new virus threatens to kill the government.

The solution is for the world to step back and survey the open fields, the Elysian fields of victims of wars and intransigence, the sacrificed offerings to the gods of communication and technology and to exclaim with one voice: My God, what have we done to our world? Why can't we together find solutions? Why can't we march together anymore?

What can we do to manage our future - not as Blue Staters and Red Staters in America, or Muslims and Infidels in Europe, or pro-Gloria and anti-Gloria in the Philippines - not as soldiers of competing armies but as common citizens of a world that must pick up the pieces?

We must be forewarned that if the monster of the Internet becomes bigger, it will consume all of us, just as those who ride the tiger invariably end up in its belly. The Chinese may be on the right track. They seek to tame the Internet.

We in America must do the same. In addition, we must tame hate radio and hate cable TV.

But how do we do that without infringing on the right of free speech?

And we haven't even talked about the mountains of debt being created by some of the advanced nations, such as the United States, Greece, Spain and Ireland.