Disruptive technology - when CES is the cause of CES

In spite of the arctic weather being experienced in the many US states, Las Vegas is host to this year's Consumer Electronics Show (CES) which is ongoing up to the 10th of January 2014.

The wow factor during the opening day included "toys", gadgets and a tech's dreamworld of having gazillion eye-popping digital devices that would truly change the landscape of the world. While the tech buffs buzzed about with what App would impact among consumers, back in my clinic I was grappling with patients who were being raised by their digitally connected parents by technology.

I was discussing with parents of one of my patient who came in with the chief complaint of occasional headache, dizziness followed by vomiting. You could tell on history and physical examination that the child was a bubble of joy and activity. To cut the long story short (and I will do that because I don't want to bore my readers with medical jargon), the patient has Computer Eye/Vision Syndrome (CES). I referred her to a pediatric ophthalmologist to check if she also has error of refraction.

During the discussion of the diagnosis, I pried on the child's daily activities. And like many children, it's apparent that majority of us utilize digital technology as our official baby sitter. When your kid is uneasy and apparently a bundle to handle, shove an iPad with Angry Birds or Candy Crush or some other inane game installed. You'll also notice that in our hectic busy everyday life, the Telcos have become indispensable partners in raising our children. Blackberry and Apple are not fruits our children eat as source of vitamins. They are gadgets that they want in order to stay connected. Tweets are not sounds that birds make. The are "shout outs" for every little event in our daily lives. It has become a status symbol that to have a Twitter account is tantamount to being famous because you have "followers". The culture of a cult being born is shared by likes and comments on Facebook. You can count the number of friends to the point that many just say YES to friend requests even if they are drug dealers or if real estate pests who ask to be added as "friend". I have nothing against this. It is, after all, a free world. Let's face it - some of the posts are pointless. I see people posting anything from what is relevant information to just plain garbage to even just plain porn!

It's not that I am anti-technology. That's the least and the last message I want to impart in this blog entry. It's more of the fact that I am disturbed with how children are being raised by technology nowadays. You see homes full of Play Stations, Wii, Nintendo or other gaming devices and your kids are just engrossed in it. Never mind if they don't have breakfast, lunch or dinner - as long as they are pinned against the wall and on the gadget, you've got game! It's not unusual to see a family in a restaurant not engaging in any form of verbal communication. Dad is busy banging away in cyberspace at his iPhone. Mom is engaging and rambling with the office while hollering in over the mobile phone. The five kids are on several gadgets. The eldest son has his head wrapped on a headset with music blaring through and his punk head bobbing up and down as if he's having a seizure or orgasm to the rock music which can be heard at a distance of 3 meters. The other three kids are on an iPad, iPad mini and iPhone playing different games each. The feisty little 2 year old is engrossed in some cartoon character dancing and prancing away. This just shows you how bored they are with each other within the family circle. Leave them at home with the same gadget and they wouldn't care less about the world and the relationship within the family will not change anyway. Slaves to technology. Disruptive. Divisive. Raised by android or OS.

High-tech is being attuned to the rapidly changing digital world. You can count your calories burned on a pedometer. You can read your text message from your watch if you've bought a new Samsung phone with the smart watch. Come to think of it, we call it the smart age. Everything that is digitally attractive is called smart. Why does one even bother to have to flip through a textbook when you can have Google answer all your questions? Gone are the days when students had to pour over voluminous reading material in order to arrive at an answer. Today, all you need to do is punch in some key words and voila, you've got the most accurate answers that fit the key words you pounded on your keyboard. And there's even auto-correct for the idiotic bunch who can't get their spelling right. Finally, there's Siri whom you can ask questions or have Siri auto type your message without having to touch your phone's keypads. Yes, technology is so far advanced today, that once you literally go to bed tonight, someone would have a new App running before the sun rises.

And that takes a toll on the children we raise. Think about it. Is this the kind of family bonding you actually want? For example, a weekend at the beach with full battle (gadget) gear may be the ideal vacation for your family. Snap and post every moment in space. Lunch by the seaside with the breeze against your face? Nah. Nobody felt that. Your 6 year old wasn't busy building sand castles. She was probably by the sea playing some silly game on your iPhone. Then the 3 year old is crying because he wants to take a dip in the cool sparkling clear blue sea but since the maid is somewhere texting her boyfriend, and you're frantically looking for her, and you're up to your neck with the crying of your boy, and you hate the sun because you happen to be on some glutathione shot, you decide to just shove the little boy your iPad and put it in a Barney movie. He keeps quite. You sip on your Margarita and thank heaven for Steve Jobs' creation.

When movies about machines conquering the world was being predicted over a decade ago, everyone thought it was just a sci-fi movie. Today, it is very real. The machines don't actually talk back and govern us, YET. But they have, in more ways than one, disrupted lives that could have been built on more solid foundation of role modeling, love, trust and care. Many of us have actually made these inventions run our lives...or even ruin our families and even relationships. Ironically, what used to be a romantic moment for a date a decade ago meant quality time between two people madly in love with one another is very different today. Facetime and Skype have changed the way we stay connected. It's not a totally bad thing, but it's really not a totally romantic way of expressing true affection. Relationships have changed for worse, all in the name of some gadget or new electronic wiz!

At the end of the day, we just need to ask ourselves, is this the way we want our children to raise their children? And will we leave raising families to technology? It's sad if the answer is yes.

Love him, Hate him

He's iconic in the realm of boxing. Manny Pacquiao, the Philippines greatest boxer ever, has the fairy tale story most people would dream of. From dirt poor to one of the world's highest paid athletes - yeah, even I take my hats off to his phenomenal success. Better known as Pacman, the gargantuan fame and fortune that came his way was beyond anyone's dream. And while his fights were without a doubt some of the highlights of boxing history worldwide, so were his earnings. His statement of assets and liabilities (SALN) to date puts him at over Php2,000,000,000 (which we all believe is probably an understatement)...that's more zeroes than a regular calculator can punch out.

There's no doubt on the legitimacy of his earnings. While Pacman ran for Congressman in his district in Saranggani, General Santos, and won (he is currently in his second term), he was hardly around during the sessions in Congress. His paltry attendance stood out like a sore thumb. The position was there, but the man running and representing his district was not. His excuse - he was busy training and fighting those fights which would bring accolades to his countrymen. When he was chided for his absence in sessions in congress, media and people close to him brushed it aside. Whenever he was criticized for his ineptness, it was always one big holler that everything hurled against his incompetence and irresponsibility was a political ploy. Let's call a spade a spade. He was never even fit to run as Congressman for this district from the get-go. He is a boxer and that's all he knows. Nothing wrong there because boxing is his first job. It's the main source of income, his daily bread, and the reason for maintaining his current lifestyle. You can say that in terms of wealth and success - Pacman has arrived.

But here's the rub.

A few months ago, I had written a blog about doctors and other professionals regarding taxing our professional fees. While Bureau of Internal Revenue honcho Kim Henares was running after tax evaders, the media AND the public did not take too kindly on professionals who were not remitting their taxes correctly. There was even a proposal to place the Menu for Professional Fees plastered on the walls of our clinics and the BIR began publishing in the newspapers the taxes that various establishments paid during the past year.

Really?

The average family and general physician practitioner earns a measly amount compared to Pacman's earnings. One fight of Pacman would easily put me and my family in Nirvanah for the rest of our lives. Most of our earnings are loose change for the BIR. Seriously, I don't think I would even make the same amount of money that Pacman makes in one fight in my whole lifetime as a doctor. The facts are easy to calculate. The HMO makes a killing from those who pay their insurance coverages. The average doctor gets Php250-300 (minus tax around Php225) for every patient seen on an out-patient and Php400-Php500/day gross, for every patient admitted to the hospital. If one saw 10 patients a day, that would mean a net earning of Php2,250 a day of practice and 12% of which we will still to remit as Value Added Tax (or Php1,980 net). If he/she practices 5 days a week in the clinic and has 5 or 7 in-patients with an average stay of 4 days for each hospitalization a month, that would sum up to Php14,000 gross (deduct 15% withholding and 12% VAT or a net of Php10,220.00) for a net total of Php65,440.00 a month. An amount where even a product manager for a pharmaceutical company or even an assistant operations manager for a call center would consider much lower by professional standards.

Unless the doctor is a surgeon by profession, the actual average net income of most of the doctors would range from Php 40,000 to Php 75,000 per month. Or Php480,000 to Php900,000 a year. Not assuming that there are patients that cannot and will not pay the professional fee. If we waive our fees, we still have to execute an affidavit to the effect that we did not charge the patient! This is not enough to even buy a Birken Hermes bag for oneself!

The last few days, we saw the exchange in barbs and words between Kim and Pacman. Pacman cried foul because of his alleged failure to pay P2.2B in taxes from 2008-2009. He blamed it on politics. To me, it was stupid to cry political ploy alone for the BIR to run after Pacman's millions, errr...billions. In fairness to Kim (it's the first time I'm siding with her), the signs were obvious. Pacman was making more money, owning more assets year in and year out, and the taxes he was remitting were less and less. It is a Philippine law that you need to pay the right taxes to the Philippine government even if you make money from earnings elsewhere as long as you're a Filipino citizen (I think the OFWs are exempted, but Pacman is no OFW). Which means that if you paid only 15% taxes in the US for an endeavor, then you will still need to pay the remaining 17% (32% taxes) in the Philippines.

What is most disturbing with Pacman's press conferences were that he felt he was being singled out. I also wrote in my blog that the government should run after the government officials embroiled in the Pork Barrel scandal first as they were siphoning our money. But some of my readers didn't respond too kindly. To them, what is due to Ceasar should be paid to Ceasar. I didn't argue with that. How could you argue with logic? It was illogical and irresponsible for Pacquiao to even argue along any line because the BIR demand for payment had been there for over 2 years (hence the penalties slapped on him) and that because he is supposedly a lawmaker, he should have known the law! For him as a congressman to turn his back on the law is something that is mind-boggling.

The fact that even Aling Dionisia, the Pacquiao matriarch, exchanged barbs with Kim and covered by media was really a low blow. Aling Dionisia has three houses in her name. But the old lady says she is jobless so how can she pay taxes? What the f*ck?! So what? Being jobless does not excuse her from paying real estate taxes because the houses in General Santos are under her name. The squatter-like response of the Pacquiaos can only reveal their true color of ignorance of the law.

Even if you blame the accountant and managers of Pacman for the fumble in this tax fiasco our "Pambansang Kamao" is facing, we need to own up to our ultimate responsibilities instead of passing the buck. Gullibility is never an excuse for evading responsibilities. Just because he has brought fame for the Filipino does not exempt him from paying his taxes correctly. We are, after all, heroes in our own little way. From the lowly OFW who toils day in and day out in a country far away to the physician who provides heroic gestures to cure the sick and the least of our brethren.

It peeves me that the public, media and fellow politicians are siding with Pacman on this charade. Let him prove that he has no obligations to the government. Let him prove himself that Kim is wrong and that he is right. And let's not drag our dirty linen in public by abusing public trust. As a government official, Pacman owes it to the public to fight this fight in the right venue by producing the right documents.

Lessons from Yolanda

"Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things." - Winston Churchill



Typhoon Yolanda arrived in the Philippines last November 8, 2013 leaving a trail of massive damage beyond proportions. Perhaps I will underestimate the tragedy if I say that this wrath of nature changed not only the landscape of many cities and provinces in my country, but their lives as well. As many of us in Metro Manila stayed glued to the onslaught of the typhoon, I guess most underestimated the strength of this storm. Local media had not captured how horrific the storm was until ANCs Atom Araullo could not be contacted and neither could anyone from the President's men who had already been sent to Tacloban.

If there was anyone who said that we were prepared for Yolanda, it was the president himself. The night before the storm, "President Benigno Aquino III on Thursday assured the public of the government’s readiness to face supertyphoon “Yolanda” which will directly hit Samar and Leyte at midnight. Aquino said in a televised speech that the country’s C130 aircrafts are fully mission capable to respond to those in need, adding that 32 airplanes and helicopters from the Air Force are on standby together with the Philippine Navy’s 20 ships which are positioned in Cebu, Bicol, Cavite and Zamboanga. He said that relief goods are also pre-positioned in many of the areas expected to be affected by the supertyphoon. Disaster Risk Reduction and Management Councils, both national and local, have also been activated to mitigate the effects of the typhoon." [http://newsinfo.inquirer.net/522661/aquino-ph-ready-to-face-supertyphoon-yolanda]

It turned out that we were not and someone had to take back his words. The blame game followed. During a press conference immediately in the aftermath, PNoy had shifted the blame on the local government units in Tacloban. Tacloban is the bailiwick of the Romualdez, one of the richest political clans in the country and relatives to former first lady Imelda. In his disgust, he had walked out of the press conference in a huff and puff and typical of what he usually does when faced with frustration.

When media had eyes and ears on Tacloban already, we knew that help in whatever form, if it came, would be too late.

A part of me died that day. Tacloban has always been close to my heart. This is where I grew up the first six years of my life. I have friends and distant relatives and from where my family and I were in Manila, watching the news and trying to get in touch with loved ones was futile and agonizing.

While local media scrambled to get accurate news on all fronts, foreign media, in particular CNN had been at ground zero from the get go. There were mixed reports on casualties and what was left of Tacloban City after Haiyan (Typhoon Yolanda) exited the Philippine Area of Responsibility the following day.

Technology played a vital role in the relief operations for the people who were affected by recent calamities. Twitter and Facebook were abuzz in asking people to help our brothers and sisters in the Central Visayas area. It is undeniable that social media played a pivotal role in disaster management and in the operations after the carnage. It is undeniable also that social media has been and is being used for both good and bad intentions even during a calamity like this.

Postings on what allegedly transpired or did not happen became the trending topics. It was obvious that we did not need to add to the chaos but that's the reason why technology is called Disruptive Technology. And while there are good intentioned people, there will always be bad. But that is what social media is all about. We either live with it or get the hell out of it. I'd rather take the brighter side of life and say that social media is one of the best tools invented because it not only became an instrument for communicating with those who were affected by the typhoon but because it was used intelligently to pan out to the world on the disaster in the Philippines and how the world responded to our cry for help. Seriously, we could have never done it alone.

It's 10 days after Yolanda devastated my country and its people.

What lessons have we learned from this?

1. We have no disaster preparedness program in place. It's all lip service but if you look through the budget of the Philippines, it's zero. PNoy vetoed disaster preparedness budget in 2011 and left disaster preparedness to local discretion and as part of local calamity funding. I guess when it becomes a national problem as in this case, then the national government is really unprepared. Let's cut the crap on saying that "NO ONE IS EVER PREPARED FOR A DISASTER LIKE THIS." An earthquake I would understand. But a typhoon? Get real. We get it year in and year out. We just weren't ready for something as strong as this and we underestimated nature. The president's hullaballoo on preparedness was crap. When we needed the C130s and planes and helicopters and ships, we were caught flat footed. When foreign ships and aid came to the rescue, we found out that this country has a paltry army, navy and air force. We need to face reality and the truth eventually comes out. No matter how painful it is, we need to swallow our pride. At the end of the day, the thousands of lives that could and should have been saved had pride not taken precedence would be a more decent approach to caring for your countrymen. [http://www.interaksyon.com/article/14493/pnoy-vetoed-disaster-preparation-in-2011-budget]

2. There are opportunists in our midsts. The painful part is that many of them are in government. Calling them insensitive is too kind. They are like are vultures who circle even the living, waiting for us to die. Take the example of the BIR commissioner who said that "The Bureau of Internal Revenue (BIR) on Thursday clarified that relief goods both from here and abroad for the victims of monster typhoon Yolanda (international name Haiyan) will be spared from tax as long as it is coursed through the Department of Social Welfare and Development (DSWD) or accredited private foundations." Ms. Henares was quoted as saying that this was meant to curb people who would take advantage of this calamity to claim donations for and on behalf of the calamity later on. [http://newsinfo.inquirer.net/527239/bir-wont-impose-tax-on-relief-goods-if-coursed-through-govt-agencies]


This did not sit well because essentially all the goods we buy for donating it to the typhoon victims already carry a 12%VAT at the cash register in the supermarket counter. Why do we need to get taxed doubly? So if we called a spade a spade, perhaps it would be a good reminder that prior to this devastation, another devastation had just hit us in the form of Janet Napoles (remember - the bitch and the typhoon had arrived simultaneously). This is where our taxes went. This is where government officials were enriching themselves. Had these been addressed from the get go, my beloved country which is mired in so much corruption would have a definite road map to recovery.

It's a fair reminder that if you like to help, help. But don't stand in the way of those who want to help. And calling its citizens "thieves" isn't helping any. Perhaps our government officials need to look closely at themselves in the mirror before they look at its people.

It is a fair reminder that after we recover from this gargantuan task of rebuilding, we need to focus on the corruption and governmental faux pax so that we can serve our citizens better. We need to remember that everyone - rich or poor - is a contributor to the growth of this nation. We need to focus on the bad eggs so that we can make relief efforts work to our advantage.

3. There is no single hero in a calamity like this. Big or small, every relief effort, every single donation is a step to a greater good. It is expected that those who have more in life share more of their blessings, but those who have little, and yet who have spared their small change are big heroes in my heart. It becomes irritating that there are politicians or media men or even church officials who act as if they were God-sent. Repacking relief goods under the guise that you gave it yourselves or even if you gave it yourselves is not in good taste. During a crisis like this, there is no "I". Every effort begins with "We".

It was uncalled for to be exchanging barbs with foreign journalists who had only good intentions in alleviating the sufferings of our people. Dapat ba parating may bida sa bawat sakuna?


4. The Filipino people are resilient. I take great pride in being a Filipino. Living in a country with 70% of my fellow men impoverished has taught me that behind the hardship we go through and in spite of all the tragedy we live through day in and day out, we learn to rise above it all. Our dignity may be scarred but it will remain intact. Our bodies may be broken but our spirit will always rise above every occasion. I have friends who have migrated to land of more verdant pastures. They have better lives today. But they will remain Filipinos in their heart. They understand what it is like to live in a country that in spite of our limited resources, learn to make it through the toughest of times and celebrate the best of our successes as well.

Today, many of us will bury our dead.

Tomorrow, we rebuild our country - from sand to rubble and brick by brick we will rise to rebuild our hopes and dreams. There will be scars in our lives and we will all have our stories to tell.

But the story that will be remembered most is that we are a proud nation that is grateful for all the help from other nations who are determined to help us rise from the storms of our lives. And rise we will, for tomorrow is another day.



[photos from Philstar, Philippine Daily Inquirer, news reports from sources named]

Wealth, happiness and pretending

There's a saying that goes "I owe, I owe, so off to work I go."

Who doesn't like to be making tons of cash? I know some people who even bend back ethics and morals as long as their bags (and bathtubs) are awash in cash. After all - it makes the world go round, it makes you buy all the best things in life, and even on a temporary basis, yes, it even buys you happiness.

While cash is a necessity in order to live, survive, and yes, remain sane in our day to day existence, at times the end does not justify the means. The operative word being "justification".

The other week at the clinic, the parents of one of my patients had told me that she was giving birth in a few months. I congratulated her! Then the grandmother said that the obstetrician would be doctor so and so...I remarked, "why?, wasn't your OB so on and so forth two years ago?" They said yes, but that the obstetrician was building a house. And I understood what they meant.

It's not only in the medical world that this scenario is seen. We all try to make a decent living in order to fulfill our dreams. Some of us want to own houses and condominiums in posh villages. Others want to drive brand new European cars or send their children to high-end schools even if it is beyond our budget.

And this does not occur only in the upper and middle class families. My driver is a prime example of this. He has three children and the youngest is 3 years old. While he sends his two older children to public school, he sends his youngest to a semi-private nursery school. I asked him why and he said that the other two are boys and they have the tendency to drop out of school and be lazy. But because his youngest is a girl, she will most likely study harder and be the breadwinner of their family later on in life. And while I have nothing against dreams and ambition, there's a thin line in having to sacrifice the rest of the family by being pretentious.

Pretending to be someone or something that one isn't is the greatest deceit of all. Whether it's a relationship, a job, a business - pretending to be adept at a task in order to profit for wealth (and the temporary happiness) it provides can prove to be uncanny at the end of the day. There are people who are not fit to run an organization because they have no knowledge about how to run it well except the fact that they base the selection of managers based on trust and not on competence. It creates problems in the work force and becomes frustrating for employees whose bosses pretend that they know so much when they know so little, and the work force is not appreciated back no matter how hard they try.

Here are five pointers to remember:

1. There's no point in using limited life chasing unlimited wealth. When we all die, we can't bring the wealth with us. Even if your casket is made of gold.

2. There's no point in earning so much money if you can't live to spend it. Sometimes we spend our lives chasing the money that we forget the people we've trampled upon just so we have more material things in life. We forget that life comes full circle. If that money isn't meant to be for us, karma is such a bitch at getting it back.

3. Money isn't yours until you spend it. And earning it rightly is just as proper as spending it and sleeping well at nights knowing that it was earned well.

4. When you're young, you use your health to chase your wealth. When you're old, well, it's sad that you use your wealth to get back your health. Happiness at any stage and at any age is not all about money. It's about being true to yourself and being just with the people around your lives. The trouble is, often times, it's too late. Your children don't know you. Your friends have left you. Your family won't even care if you lived or died.

Finally,
5. Man is happy not because of how much he has, but how little he needs.

Think about it...what buys you happiness?

Defining moments...

Over our work career, some of us simply wear one hat. For the average employee, he goes to work, does his job, punches out then goes home. He waits for the 15th and 30th of every month for his paycheck. It's like that day in, day out. The paycheck defines his existence.

Then there are those who wear more than one hat. In my case, I have been tiptoeing from corporate role, to committee head role, to the role of leading of a department, to consultancy role for certain groups in the research and pharmaceutical industry, and of course, to private practice. Multi-tasking is definitely a driver for stress and anxiety. The paycheck is not the defining reason for this. It's the challenge.

Over the years, I have virtually multi-tasked. I have become accustomed to multi-tasking. Each time I try to unload myself from one task, there is an emptiness that takes over. For example, when I decided to retire from teaching from the Faculty of Medicine and Surgery after 23 years being with the academe, I had a separation-anxiety attack for a few months. The day after retirement, I would wake up at 4AM prepping myself to get ready to go to the university, thinking about how traffic would be that day, and looking forward to the students whom I would mentor and colleagues whom I considered best friends. Then reality would hit me that I had retired. A few months sank in before I moved on, but move on I did.

There are several reasons why we make choices in our career(s). Why we suddenly make a left or right turn or decide that it's the end of the road. Financial remuneration is probably at the top of the list for most. To others, it is the search for something they become passionate about - a teaching position, an administrative post, a new career, a life-changing experience, to better health (both mind and body), or a bold brave new world. And then there's the game changer - your self respect. Of all the reasons that interplay with the choices we make in life, it's the self respect that impacts on your will and becomes the deciding factor.

I have been in many game changing situations in the past. Whether it was a personal change or a change in work environment, the defining factor that makes you decide that it's over is self respect. Sadness overtakes your impetus in looking forward to a brand new day. Seeing your better half becomes overbearing rather than happy. Going to work becomes a burden rather than a challenge. I would rather wake up to an empty feeling which I can eventually get over with rather than feel the anxiety of having to go through each day of my life not having to deal with the issue that I allowed sadness to consume me. It's the most difficult decision that I had to make, but what lied within me was what mattered.

One of the most difficult choices we make is when we find passion in what we do, the circumstances surrounding the passion become too heavy to bear. No matter how you try to make it right, no matter how much explanation you provide, it becomes frustrating that people who do not understand the work actually become the burden to the work. Corporate businesses are usually run that way, with half the people in the lower work force going unrecognized and the blame being shifted to the lowly employees because of corporate greed and mistakes made by upper management. Bigger rewards are merited by people who pose to have delivered the outcome but not the people who actually made it possible for the company to survive the worst of times.

Personal or work relationships are similar to one another. In a personal relationship, you invest not only time and money but mostly your emotions and personal worth. You probably give up half your pride in search of happiness. You work at making the relationship work and search for happily-ever-afters. It's what defines fulfillment. It's what defines our core being.

I tell my friends that there are two defining moments in the choices we make in life.

The first is when we decide to take the plunge. Make choices for better lives. Make choices because we wanted to make changes not only in our lives but in other peoples lives.

In the process, there will be friends we make along the way, co-workers whom we empower to become stronger, a better half who becomes part of our lives. Then there is the shattering moment. The one that breaks our heart or principles in life. The one that makes the game changing decision we need to make.

The second defining moment is when we decide to walk away with our principles shattered but still together. Head up high, hurt from within, you know that it was and is, the right thing to do.

And we move on. To write a new chapter in our life.

Professional fees and the physician

A week after Napoles surrendered, BIR chief Kim Henares was back - blazing her guns at what she calls the professional tax evaders of the Philippines whom she fondly identifies as mostly coming from the sector of physicians, dentists, and lawyers.

It's such a shame to wash our dirty linen in public, but some people have to become popular at a job that is highly unpopular - tax collection. Some of my friends and colleagues abroad who have been practicing medicine since they graduated from medical school and decided to hie off to a country with lesser corruption were asking me - do we really not remit the taxes due to the government?

Good question! No answer?

For the sake of argument, let's stick to the basic rules and principles. As citizens of the Republic of the Philippines, we need to pay our taxes. We are considered by the government as a value added service. Never mind the fact that we get patients that we do not charge (like our colleagues and their families, the poor people whom we get to see but don't have the money to pay, compadres and comadres and some of the celebrity friends we cater to) - the point of it all is that services rendered and paid for should have an accompanying receipt. The receipt should incorporate the 12% VAT already.

With over 100,000 registered physicians, over 1,000,000 nurses, over 100,000 lawyers and over 100,000 dentists in the country, Kim asks a simple question - why is the collection from this bunch of professionals so paltry? Her argument, particularly for physicians, lawyers and dentists is that the majority of us in this profession can afford luxury houses, several cars, send our children to expensive schools, post pictures on Facebook on so many travels abroad - and yet many of us remit taxes less than P100,000.00 a year.

What does P100,000 a year in taxes paid mean? It means that in your profession you more or less should make around P65,000 a month or P2,166.66 a day presuming that you hold clinic every day. If you charge an average of P500.00 per consultation on an out-patient basis, that means you see around 4-5 paying patients a day. This is probably a very low end computation because this consultation fee does not include specialties that need procedures (like ophthalmologists, ENT, cardiologists, etc.).

I get the point. We're not all good people. Some of us don't walk the talk. But neither is the government. With all the money that is being siphoned off to Napoles and PDAF and government officials who literally, brazenly steal under our very noses, it wasn't really a good time to call tit for tat. But Kim was just doing her job. Obviously, you cannot please everyone. The doctors ask back - how about the patients that run away and don't pay us? Where do we charge this to? Or the patients that pay you with chicken or eggs, or JCo or coffee or cologne? How do we deal with that? And the answer of Kim is that if they don't pay, don't issue a receipt. The majority of our patients, however, contribute to the food on our tables, roof over our heads, schooling of our children, gasoline of our cars, travels we have abroad (not to include the drug companies share), and according to Kim, all taxes to these professional fees should be duly remitted to the government (to steal?).

But like other businesses in the country, what is paid for is duly taxed and a receipt is duly provided. The bureau describes the scenario as - when you go to a restaurant, you don't tell them that "okay don't issue the receipt and you can remove the 12% VAT on our food". And if the owner of the restaurant is your friend and he gives you the meal or dessert on the house, he doesn't include that meal on your tab. And we can do the same.

Which now goes to the stupid idea of putting a menu for services we render (akin to a restaurant). There was more hoopla when the doctors were fighting back (like me) at the idea of a menu for patient services.

CHECK-UP P500.00
WITH DIAGNOSIS OF PNEUMONIA add P1000.00
WITH DIAGNOSIS OF ACUTE GASTROENTERITIS add P1000.00
Confinement in standard room P2500.00 per day
Confinement in suite room P5000.00 per day
Confinement in ICU P10,000 per day
Cesarean section without anesthesia P5000.00 (this is a sick joke)
Cesarean section with anesthesia P100,000.00


These were thoughts that were playing in my mind...and I was aghast because we don't actually charge patients on a standard fee for in-patients (well I don't for that matter). We charge patients according to the capacity they pay and gazillion patients end up bartering with you for your professional fees at the end of the stay. There's an ethical dilemma in advertising the professional fees - it's not fair to barter with healthcare levels because patients don't understand why there are disparate charges between doctors - the level of expertise, practice and achievement - comes with a price.

We have patients that are disappointed with how some doctors provide services. As one FB person would say, it is just correct that the BIR run after the doctors because we charge P500 "para sa laway na puhunan". A clear misunderstanding, but clearly also a disappointed patient who may have his own views on why in God's name they need to pay this much for a 60 seconds consult.

Health Insurances are different and the charges are fixed rates depending on the room and the disease or what was performed on them during their hospital stay. A good many of doctors are not affiliated with health insurances and quite a number of us hold clinic only sparingly because some of us wear multiple hats and have a more fixed paying job. Which means that the clinic is there to accommodate some of our private patients but 60-90% of the time some of us are doing some other corporate activity or have their own small businesses while the remaining 10-30% see patients as a hobby and not a full time profession.

The health profession in the Philippines is significantly different from the US, Canada, Japan or even any other country. Here, the doctor has to make ends meet by multi-tasking and taking on different hospitals at different hours of the day at different days of the week. We have no 13th month pay. We pay for our own transportation and gasoline and car maintenance. We have no fringe benefits. If we don't make it as a doctor, many of us take a nursing course in the hopes of finding greener pastures in some other far away country because what we actually make is not enough to make ends meet. It's the way the healthcare is built in this country. Of course, Kim Henares is getting accolades from the US and other countries about her being one tough cookie trying to address the tax deficits in the country. But a tough cookie not in tangent with reality speaks poorly of the knowledge of the bureau on the practice of law, medicine or dentistry in this country.

What counts actually is to really run after the largesse that use taxpayers money in order to enrich themselves. And that's where the difficulty lies because most (if not all) of them are from the government. It is obvious that they have the manpower, the will and the innovativeness to hide what they steal and steal what is supposedly for the people. I guess at the end of the day, we just draw the line and say - let's follow the leader.

A perfect example are how some young people drive around in spankingly expensive Mercedes Benz owned by their parents who probably do not have legitimate resources for funding these. I have neighbors (sad to say) who really have no cash or are not even financially well off but they have a dozen cars or so in their garages. Why can't the BIR start from that? Look at all these fancy cars, find their owners and dig backwards and see if they even paid their taxes due compared to the properties they own or the businesses they run or even the cars they have? It's a simple way of running after tax evaders.

The meat of the problem lies not in government being inefficient but rather in who enriches himself while he/she is in power - are the ones running after the people who apparently do not pay taxes correctly. You can only expect the professionals to abide by what the government says if you dialogue with them and look for solutions by understanding what the real concerns are. Until government is able to take this step, there will always be an avenue for misunderstanding. With one side opposing the other side with various reasons. You can only expect people to pay taxes correctly if the taxpayers palpably see where their taxes are going to.

Several months after Kim has said that she would run after online businesses, where has that gone? Nowhere!

Several months after the government has run after former AFP Comptroller Garcia, where is the loot his family has stolen? What has happened to the Euro Generals in the term of GMA?

When you're running after the small fry, they only get angry because government has not resolved the bigger fries.

Start with them and then you can expect all professionals to follow your rules. In the meantime, it will be a long, tedious, painful debate on what Kim expects the professionals like doctors, dentists and lawyers to follow.

You can only make changes if you make the changes within the bureaucracy first. You cannot expect people to trust you just because you say so. Trust is a long relationship and the most pivotal one. It will wear itself thin because rules and regulations are made only for a select few.

Professionalize the Bureau of Internal Revenue. Then change will come. You cannot start with the taxpayers. Like every family, change begins from home.

Pork, the BIR and Justice in the Philippines

There's something awry in this picture. Former Chief Justice Renato Corona had said during his trial that he was subjecting himself to allowing the court to open his bank accounts as long as the other lawmakers were too. A year after his being ousted from the third highest position in the land, the same lawmakers that found him guilty are now embroiled in graft and corruption in what would be one of the biggest scandal in the use of the pork barrel funds allotted to the upper and lower houses of governance in the Philippines.

And that leaves a black eye in the President of the Philippines, where his passion to convict Corona seems to take a backlash at his own men who are now scrambling to deny or defend themselves in public because of Janet Napoles and her family's acquisition of illegal wealth at the expense of the Filipino people.

Hence, the million people march.

My niece is skeptical about the march. She told me that even if two million people charged to Malacanan Palace for this cause, the problem would not be solved. Over the weekend, I talked to some parents who are lawyers and they said that in this country, the truth is that justice is elusive among those who have the money to splurge for lawyers and connections in the military, police and other government officials. As Filipino citizens, we've been there, we've done that. I have friends who are more optimistic with PNoy. Seriously, with this latest scandal, my optimism has faded.

I was one of those that voted for PNoy because I believed in his parents crusade that the Filipino was worth fighting and dying for. But graft and corruption in Philippine Politics has become so entrenched in a web so complex that I just watch from the sidelines hoping that one day, some day, some ray of hope can come from the changes we so believe and fight for. Yet each election is the same. The trapos are still around. Their children and grandchildren have now become adults and run to take their places and entrench themselves in the complicated web of learning hands on how to keep their dynasties alive. And we can only have the Philippine electorate to blame.

Yes, the million people who will march tomorrow in Luneta will be mostly the taxpaying citizens of this country who are the most affected. While I am a doctor, I have retired from the academe and joined the pharmaceutical industry. And in my years in the academe and my current years in the pharmaceutical industry, I cringe at the amount of taxes I pay to the government. The chunk of hard-earned cash slips through my fingertips even before I enjoy the fruits of my toil. I always believed that while it was painful to part with the large chunk, at least it went to social programs of the government for reforms, education, and alleviating the poor.

When Kim Henares lambasts my colleagues on tax evasion charges, I cannot help but hate her. To those in government who have not committed a sin, they can cast the first stone. But even Madam Kim will agree with me that even her cohorts, those that work in the Bureau of Internal Revenue (Bureau of Internal Robbers as my friend would call them), and those affiliated with various government sectors have not brought changes to the various branches of government. Francis Tolentino, head of the MMDA for example had smoking bans in public places and jaywalking as initial initiatives of the government agency. Where is it now? The BIR is busy chasing the middle men who try to cheat the government from the taxes they are required to pay. Can you blame them if we don't want to pay because all the money that we make simply go to the coffers of people like Napoles and government officials and their families? What has she done to run after these lawmakers who apparently make oodles and caboodles of money from what we so painstakingly try to earn decently from our blood, sweat and tears? Where is her passion and conviction against people and government officials who steal from taxpayers hard earned money so that their children and family can afford luxurious lifestyles? If you asked me, these people and their family should be hanged in public. The temerity to spend what is rightfully not theirs from the get go.

Accountability, transparency and good governance are apparently not on the list of most of our public servants. They run for petty offices so that they can part with the largesse of funds that are appropriated for their constituents. As I would put it, "makapal talaga ang mga mukha nila", but they wouldn't care what words you choose to describe them. Even if you called them pigs or scums of the earth, as long as they financially gain from their positions in government, you can even call them the devil.

Many of my friends have migrated to other countries and for the very reason that they have found no hope in the Philippines. Those of us left behind are left with little choice - "maghanap na lang ng ibang raket" or join in an upheaval for change every time we elect a new president.

And believe me, it's not only tiring, but frustrating as well. The working class is left with little choice. You dance with the music or you just leave your family with no food on the table, no money for medicines, no roof over their heads, and yes, no education at all.

But I will make this message loud and clear to PNoy. My dear president, you have three years left to leave a legacy. I may not understand politics as much as you because you were born into a family of politicians. I have only this to say. You were not ready to take on the helm of president of the Republic of the Philippines. In all honesty, I seriously doubted your capability from the get go. But I took the chance. The chance that with your parents background for love of country who were willing to die for us, maybe, just maybe they passed the same passion and burning flame to you. At this point, doing what is right and not who your allies or friends or compatriots or family is what you were elected to do. You have nothing to lose by taking the right road or as you would call it, "ang daang matuwid". I don't buy the fucking claim of the NBI or other police officials that Napoles is hard to find. You are the most powerful man in this country and by all means, use your power and have some balls to go after the bitch and all her cohorts. If there is one legacy you can leave behind, it's earning respect not only for you, but for your family name.

Maawa ka naman sa mga Pilipino.

If you need to die for your country fighting this crusade, so be it.

Tama na ang babuyan sa mga buwis namin na pinaghihirapan ng bayan. Nakakasuka na ang kababuyan na ito!