Like a lot of my fellow physicians, I think I’m two issues: a baby of immigrants and a baby of a doctor. That mixture gave me a novel window into two elementary techniques, well being care and world economics, lengthy earlier than I studied both formally. I noticed the sacrifices and laborious decisions required to navigate each, typically concurrently, with no geographic boundary ever limiting our obligations.
Many vivid recollections from childhood have stayed with me, however what stands out most is my mom’s tireless dedication, not simply to her sufferers, however to household. Her power appeared boundless. She juggled lab and hospital duties, dealt with after-hours calls, and nonetheless managed the logistics of caring for household throughout continents. She would fly again to Calcutta, India, one of many world’s largest exporters of physicians, with suitcases full of American items requested by kinfolk: lipstick, Ritz crackers, and Keebler’s Sandies, which my grandmother adored regardless of their dry, sawdust-like texture that I may by no means tolerate. These “care packages” weren’t trivial. They had been a part of a ritual, bodily tokens of affection and connection in a world the place distance didn’t uninteresting obligation. Each journey again felt like Christmas by way of Air India, and each present was a reminder that we hadn’t forgotten the place we got here from.
However way more vital than the snacks and souvenirs had been the remittances, cash despatched dwelling often to cowl every thing from residing bills to emergency medical procedures. I vividly bear in mind a late-night name my father acquired from his brother, explaining that their sister’s household in East Bengal, now Bangladesh, was in disaster. The home was falling aside. Well being points had gone untreated. A toddler wanted surgical procedure. Medicines had been unaffordable. The native hospitals required full money cost up entrance, and there have been no security nets.
These calls all the time ended the identical manner, with hushed debates over tea within the kitchen about who wanted assist most and the way a lot might be despatched. My dad and mom would weigh medical urgency in opposition to monetary feasibility, juggle the payments, and someway discover a manner. I used to be a small, silent observer, however I understood early on that cash and drugs had been inseparable, and each had been transnational in our family.
The formal time period for what my dad and mom had been doing is “remittances,” usually small money flows from immigrants to their international locations of origin. I didn’t even know the phrase till a lot later, after I learn Primary Economics by Stanford professor Thomas Sowell. He described remittances as a “switch of wealth,” and I laughed out loud. These modest wire transfers, despatched often and infrequently with quiet urgency, by no means felt like “wealth.” However in mixture, they’re.
Based on 2024 World Financial institution figures, India acquired over 129 billion {dollars} in remittances, adopted by Mexico at 68.2 billion, China at 48 billion, and the Philippines at 40.2 billion. In international locations like Tajikistan, Tonga, and Nicaragua, remittances make up greater than 1 / 4 of the complete GDP. Now, with a proposed 3.5 p.c remittance tax on the desk, the talk over what these transfers imply, for people, households, and nations, is extra pressing than ever.
From a medical economics standpoint, remittances perform as a type of decentralized, casual insurance coverage. In lots of low- and middle-income international locations the place public well being infrastructure is fragmented, remittances cowl what governments and weak well being techniques can’t. They fund every thing from dialysis to diagnostic imaging, maternal care to surgical procedure, even routine treatment refills. In India, it’s not unusual for hospitals to require full cost earlier than offering remedy and even admitting a affected person. My mom typically despatched cash to cowl simply such bills for kinfolk, with no co-pays, no preauthorization, simply the laborious actuality: No money, no care.
On this manner, remittances scale back pressure on underfunded nationwide well being techniques by serving as a parallel stream of well being care financing. They forestall worse outcomes by funding early interventions, enhance well being literacy by means of entry to personal care, and typically even subsidize small, community-based clinics. From an financial perspective, this has a ripple impact, as a result of more healthy people are extra economically productive and fewer reliant on their very own governments for emergency providers.
In the meantime, my father’s transfers typically supported each medical and entrepreneurial wants, funding a cousin’s trekking firm in Darjeeling, or investing in a neighborhood hostel. These weren’t simply enterprise ventures, they had been long-term methods to foster stability and resilience in environments the place each jobs and well being care had been insecure.
So once we discuss taxing remittances, we’re not discussing luxurious expenditures. We’re speaking about taxing folks for supporting their households, typically in ways in which straight scale back public well being burdens in each the sending and receiving international locations. These funds fill the gaps left by damaged or underfunded techniques. And but, the typical value to ship simply 200 {dollars} stays stubbornly excessive, 6.4 p.c globally, and even increased in components of sub-Saharan Africa. South Asia has fared higher, with a median of 5 p.c, due to the rise of digital platforms. However now we’re proposing to tack on an extra 3.5 p.c? For a lot of senders, particularly those that are underbanked or paid in money, this turns into a regressive tax on the poor, a lot of whom are already paying into native, state, and federal tax techniques.
The problem isn’t simply financial, it’s sensible and moral. Individuals received’t cease sending cash. They’ll merely resort to riskier, casual strategies, handing off money to couriers, mailing envelopes full of payments, or trusting acquaintances to ship cash throughout oceans. These strategies are unsafe and untraceable. Historical past exhibits that when survival mechanisms are over-regulated, folks adapt, typically with harmful penalties.
What’s most troubling is the message this tax sends. This nation was constructed on the concept that we entice and assist the most effective expertise from world wide. Immigrants already give a lot. They’re typically underpaid, under-credentialed, and but nonetheless assist two households, one right here, and one again dwelling. If we now penalize that generosity, are we not undermining the very spirit of inclusion, alternative, and innovation that defines the American excellent?
In at this time’s cellular, globalized world, the place distant work, digital entrepreneurship, and twin citizenship are more and more widespread, younger professionals are already questioning whether or not america is the most effective place to construct a life. Burdens like this remittance tax may speed up a gradual however regular reverse mind drain. And that’s not a hypothetical concern, it’s a measurable shift already underway. Remittances are greater than cash. They’re medical lifelines, emotional bridges, financial investments, and deeply symbolic acts of care. They’re typically used to purchase somebody extra time, in a really literal sense. And they’re a two-way road. We might be clever to maintain that street open.
Dalia Saha is a nocturnist.
