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Apologetics for America
I'm a big fan of the United States. It's a big country. It's a safe country. The people are wealthy, kind, industrious, and have done more than their fair share of upholding the Pax Americana under which the majority of the world prospers, including those who would tear it down.
I would go so far as to say that I'd be significantly happier if I had been so lucky as to have been born in a counterfactual universe where my parents had emigrated there, even keeping all my myriad flaws like ADHD and depression.
It's a country that holds multitudes, and has had such a good track record of making good on its promise of embodying:
And then achieving the minor miracle of making the vast majority of them upstanding proud Americans regardless of caste and creed.
(To such an extent that it has lost the memetic immune system needed to assimilate some of the people who meet that criteria but are resilient to anything but force)
It is gorgeous. Even after the visiting the UK, a nation that even in its sclerosed and ailing state is significantly better than India, I found myself grossly disappointed at how small and dull the place was, compared to what I've seen of the States.
I count myself lucky to still have the memories of when I visited as a toddler, some of my earliest, a period I enjoyed so much that I came back home speaking English with an American accent when I hadn't even been conversant in the language when I left.
I stare at the reels and pictures posted on Insta by my friends studying there with ill-concealed envy. It looks so huge, so clean, so vibrant, so picturesque and unspoiled. Still a land where someone with innate talent, having landed with but a penny to his name, can ennoble himself through hard work, or at the very least his descendants.
If it were not for the fact that I'm currently ineligible to give the USMLE today, for no fault of my own, I'd bid adieu to my current aspirations for practising and settling in the UK. The latter is still better than India, but do you really need me to tell you how low a bar that is to beat?
I'm about as pro-American as it gets without driving a pickup truck with the stars-and-stripes hanging off it!
The people eat great food. They live in huge houses that appear outright intimidating to the rest of us. They can afford to waste gigaliters of water on a modestly appealing perennial grass and mostly not begrudge the expense.
They can travel visa free to most of the world, and act the fool there (can, not necessarily do, the worst I can say about most American tourists I've met is that they were rather underinformed about where they'd ended up), content in the knowledge that none but utter pariah states would dare raise a hand at them out of fear of Uncle Sam.
They earn salaries that make us all look like paupers. The median wage for a doctor in the US is $250k, fresh out of residency, whereas a senior consultant in the UK might be content to make half that. Indian doctors can only weep, especially lowly ones like me. Even my father, so talented in his surgical field that he'd be nationally famous if he was more fluent in English (instead just being regionally famous), makes only $50k PA at the very peak of his career, after a life of suffering and hustling so his sons would have to suffer and hustle just a bit less.
Even that seemingly colossal sum of money does not achieve the QOL a naive purchasing power calculation would suggest. Even billionaires here must be content to have their money only buy quick trips with their windows rolled up from only upper class enclave to the next.
The world, somewhat more multipolar than it once was, still wobbles unsteadily if you try and make it rotate around an axis not centered on America.
I'd give a lot to be there. I really would.
That is why it so severely vexes me that my girlfriend, a smart, intelligent and hard working woman who makes for an enviable partner to have at my side, holds a view of it so jaundiced you don't know whether to cry or laugh.
Like many Americans, she has had her perception of the States clouded by sheer propaganda that is more interested in cherrypicking out all of America's real problems, and when even all the real ones no longer suffice, concoct ones out of half-truths and whole-cloth to terrorize a broken primate brain that only notices the bad and becomes inured to the good, such that it no longer bears a resemblance to how fucking good they have it.
She stares at me like I'm mad when I tell her I've always wanted to live there, and the few warts on the face of the nation can't hide its timeless beauty.
She believes that abortion has been banned. When I protest otherwise and say that it's only a few states putting restrictions on it, and even then, just a few, she shakes in existential terror at the idea that there's a seething crowd coming for the rights of women, eager to snatch them all away. She thinks racism is a serious concern for hardworking and talented immigrants who speak fluent English, whereas you could put me in a room with a Confederate flag and I'd find a way to end up drinking beers and shooting AR-15s before dawn.
Did I mention she's terrified of gun violence, even if she could live a dozen lives in parallel and not get shot?
She categorically refuses to follow me if I wistfully make plans to find some route to make it there, be it fighting tooth and nail with my med school and the ECFMG to give me the right to at least try my luck, so that I can show them I meet even their high standards.
I'm at the point that I am seriously debating abandoning clinical medicine as a career, to upskill myself in medical ML, so that I have an easier route to the States that isn't gated behind a professional licensing exam I'm not allowed to give. I am still young. I am allowed to dream.
She's rather be middle class in the UK, unable to afford air-conditioning, living in a tiny house, watching our salaries erode into nothingness, and then, if Sunak successfully makes doctors into a thin wrapper for GPT-5, potentially resign ourselves to a life of mediocrity, or worse, come back to India with our tails between our legs where we'd have to settle for working shit jobs with longer hours and worse pay.
She's scared of paying the medical bills, when the kind of comprehensive coverage that two professionals making 500k together buys care beyond the dreams of the NHS. Perhaps not value for money, but value.
I criticize America all the time, but only because I love it. I want to gorge myself on cheeseburgers with ridiculous portion sizes, because even if I die fat, I die happy.
I cherish what the Founding Fathers built, a shining city built on a hill of negentropy and abundance, rising out of a swamp wherein dwell the majority of us, only a generation or two removed from near-Malthusian conditions. I would die to keep the barbarians away from the gates, if only because I want to cross them myself, as an esteemed guest if nothing else, hopefully to be one of their own.
I set out to write a post somewhat glorifying (fairly) America, and to invite others to submit arguments that would let my girlfriend see reason. It would seem I've inadvertently done all the heavy lifting, if not for the fact that I've marshaled all these arguments before her and still found them wanting.
I don't want to jump to the conclusion that the two of us are moral mutants who can never reconcile our preferences. I prefer to think that she's wrong about her fears, or weighs the wrong facts too heavily and the right ones not at all.
Help me convince her. I will find it hard to live with myself if I fail.
Oh, and Happy Fourth of July to you all, ye sons and daughters living several decades in the future, hailing from the nation from whose physical and mental toil most of the good things in the world come.
Wait, is it a bit late for that? Um, I blame timezones, pernicious and insidious things that they are.
Don't think I don't see the cracks in the pristine facade, the erosion of the meritocracy that made your country glorious. I simply think that if America wakes up and patches a few holes, it can earn the right to slumber again in peace for centuries hence.
You've put my feelings into words better than I ever could.
We're not too different. I too am Indian, ADHD riddled, and confused at how un-appreciative my fellow coastal-Americans are of this great nation. My American girlfriend lives out in Europe and refuses to appreciate the great nation for what it is. I quote her from last week : "Screye, we need to talk about settling down in the US and how it is going to shit. Abortion is illegal and everyone is becoming conversative." God bless her.
I was lucky enough to choose the 'right' science, the one with an easier pathway to the US, but that's about it.
All global super powers are ruthless. America too is a ruthless global superpower, one that tries to be benevolent, more so than any that came before. There is no ruthless superpower I'd rather be oppressed by. The US is so wildly productive, that no amount of crumbling infrastructure or urban zombie hordes can so much as dent its economic productivity. It's a fucking cheat code in nation form. Competing is futile.
If that wasn't enough, its secular founding document has an appeal so universal through time and space, that even the best efforts of enemy nations can't stop their best from dreaming of America. The people here are fair and uncorrupt. They try to be race blind, as much as their caveman genes would allow. They don't treat me as an outsider, and all they ask is I try.
The country has issues, but the US is a nation in decline in the same way that Michael Jordan was 'over' after his 1st retirement.
All that being said, this is exactly what I thought about Intel, and they some how managed to stay in their slumber until everyone had leap frogged them and it was too late.
Intel can go on begging Congress for a hundred billion every few years to “keep America in the race” for chip development.
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You're already in the States and I'm not, that seems likely a major difference to me haha
I'm glad you made it out, it would take a real asshole to begrudge others for achieving what they dreamt of themselves, especially when it costs me nothing.
Medical licensing restrictions are driving me up the wall, we doctors really do forget how much less red tape is involved for most professions when it comes to simply just grabbing a new job and heading over. I know the US is still unusually difficult in that regard!
I think I've already said in this very thread that there's no jackboot I'd rather live under. Do you think they'd annex India if we shot at a few of their ships? A man can dream can't he?
For legal reasons, I must inform the officers at the local American Consulate, and well as my future immigrations officer, that this is a joke.
Do you mind if I ask what the specific problem seems to be? I'm... let's say friendly with some US attorneys who specialize in immigration law and can probably propose a hypothetical some time that'd get a relatively serious answer. It wouldn't be "legal advice" and there'd be a game-of-telephone aspect, so I obviously can't promise anything would come of it, but I can at least see if the roadblock is insurmountable or simply difficult.
Sure, I appreciate the offer a great deal indeed.
There's a website called the World Directory of Medical Schools, that collates the details of individual med schools across the globe, and is pretty much the official registry recognized by most nations across the world.
In said website, you can find things like the date of establishment of an entity, its address, contact details and such.
There's a section called "Sponsor Notes", which records information such as whether the ECFMG has verified the credentials of the place and has given its stamp of approval as meeting the standards they set. I believe it's also used by a few other bodies, in places like Singapore, but the ECFMG is the most important by far. This is entirely unrelated to whether the med school is recognized by the government or licensing body of its own nation, just an additional certificate.
This is also nigh ubiquitous, you'll be hard pressed to find a med school that doesn't have it, at least when I checked, but is also not a legal requirement for a legitimate med school in India. People simply take it for granted.
My alma mater lacks this sponsor note. I suspect it's due to a tumultuous period in its founding, when even its standing with the local government was contested, and since this is India, the corrupt millionaire politician who founded it beefed with the other corrupt millionaire politician who lead the party he seceded from, the latter leaning on the government to get back at him by blocking the process of certification by the IMC.
It was eventually resolved, but either served as sufficient deterrent that the ECFMG wouldn't accept them, or far more likely, they simply didn't bother applying since it's not legally required, whereas being recognized by the IMC/NMC in India is. They also didn't have much motivation to, because the overwhelming majority of my seniors or even my classmates had absolutely no aspirations regarding going abroad, it was a very middling med school and they had their hands full getting into our own competitive postgraduate programs.
I contacted the ECFMG on my own, or rather with a friend who also wanted to give the USMLE, and they informed us that in order to pursue the matter, they need to correspond with the relevant authorities in my med school. I did my best to plead the case to them, and while the Principal at the time was sympathetic to our plight and pleased that some of her students had higher aspirations, she had to speak to the managing board who held the purse strings (it's for profit, and I don't know how much this sponsor note actually costs, the ECFMG doesn't say).
She ended up leaving and being replaced by a new one, and there the matter languished as I was too busy applying myself to the one country that would take me as is, the UK.
That's where it stands, while my friend is rich enough that she could sue my alma mater, that would be pure lawfare and I don't think we actually have a case, since it's not a legal requirement, just a nice to have that almost everyone else does.
That's about it, it's not obvious to me that legal recourse will help, but I'm not averse to finding out! I am perfectly eligible to go to the US by other routes, but the USMLE gatekeeps my ability to match into a program and thus practise there.
Please do let me know what your friends say, even if it only confirms my fears, and thank you again for offering!
I apologize for the lengthy delay in getting back to you, there was indeed a game of telephone as well as having to wait for someone to return from leave. Unfortunately the people I spoke to were of the opinion that while your issue may be resolvable, it's not something any of them have experience in. It appears you were correct in that it is more of a USMLE issue than a legal issue, and so they cannot offer any real answers to the hypothetical I proposed. That's not to say an immigration attorney would be useless to you, in fact they would probably make a good resource, but unfortunately I have come up dry on my end. Also, immigration attorneys are not cheap. I realize this was a very long wait for a very short drink of water, for which I again apologize.
Hey, I genuinely appreciate you remembering to get back to me!
It's as I feared, but that's fine, I was ready to deal with this outcome. I'll do my best to handle things from this end, and given that immigration lawyers are unlikely to help with the USMLE as you've said, it's a good thing I don't have to pay for them just yet.
Thank you, you did keep up your promise, and I hope I can find a solution on my lonesome or with the help of people in the same boat.
Glad I was able to get back to you - even if it was with less than ideal news. I will say that I wouldn't rule out all immigration attorneys as being unhelpful, merely that the ones I spoke to had never encountered your specific issue before. I also hope you're able to come up with a good solution! Best of luck.
Thank you, and I'll keep at it from my end! If it does seem to end up at a point where I could use a lawyer, I'll be sure to ask.
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Our State Department is dumb but not that dumb. We didn't even try to annex Grenada; we ain't fool enough to try to take India. And America, despite the common claims, has never really been much of an imperial power in the traditional sense of sending governors to run vassal states, so you can't even get that much. (You'll note we effectively did the empire thing in Afghanistan, but it wasn't even what we were trying to do and we did a bad job of it.)
Spoilsport!
I don't think the US has expanded its borders for almost a century at this point, I'm struggling to think of anything but some remote pacific islands with 3 coconut trees where that might not be the case. I'll have to Google that.
We should at least have called dibs on Luna. Outer Space Treaty my ass.
Hey, depending on how fast SpaceX advances, it might be a reality. What are the Chinese going to do, throw rocks at you?
They should at least try and claim a large chunk of it, because the OST is more an artifact of nobody really having the ability to monopolize most astral objects than something with staying power. If you can't get there in numbers and with the ability to stay, it's all moot.
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Cold comfort, but this is frustrating and bad for Americans as well. What's sold as being about medical safety sure looks a lot more like professional protectionism, controlling medicine as a cartel from where I sit. Extending the same opportunities to Indian doctors that we do to Indian software developers holds significant appeal, but I doubt it's coming any time soon.
I certainly have mixed feelings on the matter, since it both makes it difficult to get in as barring a few states like Texas (and Minnesota too? I think they did something recently), foreign doctors must match into a residency program regardless of their international qualifications.
This obviously inflates the salary the locals command, since there isn't nearly enough of them to meet all the demand. They're also more immune to mid-level creep, which is absolutely not the case in the UK. They make more than junior doctors like I do, for less work and better conditions, and they can't even prescribe.
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Don't count Intel out yet. Institutional inertia at enterprise scale is a hell of a thing, and all it takes is one big breakthrough to get most/all of the performance- or value-conscious people to switch sides. They can coast for quite a few more years while they try to pull a miracle out of somewhere.
Honestly, Intel CPUs are still perfectly competitive with AMD on the server side. And frankly we have less problems at scale with Intel than I see on our AMD fleet.
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