The universal health care legislation: a cautionary tale
“The road to hell is paved with good intentions, ”- old proverb. Hailed by politicians of all stripes as a breakthrough in health benefits for all Filipinos, and lauded by the Department of Health as a landmark ruling, the law nonetheless leaves some sectors, particularly the hospital and health care industry, and to some extent health care professionals, with a degree of trepidation.
As contained in the bill, all Filipinos will be covered and will have access to at least basic health care. The nation will be divided into those who, often unwillingly, participate through monthly contributions to PhilHealth or its potential successor-in-assigns, the
National Health
Security Program and those who, as a result of poverty, incapacity or inability to pay, will be paid for by the government.
It is this aspect of being paid by the government that sends chills up and down the spines of those who are able to see through the reality of hard economics, finance and resource allocation. You see, the government is notorious for not paying its bills on time, It is equally disturbing that in our nature of politics, those in power tend to give benefits with abandon for votes and popularity; and then have later administrations pay for the wreckage.
As it is now, the most affected by the current state of things are the government hospitals. In the '90s, as things developed, politicians were distributing PhilHealth cards like water and this resulted in claims to the PhilHealth system that were supposed to be paid for by the respective local and oftentimes the national governments. But these bills remained largely unpaid almost two decades later. The result has been a significant cash drain on the state hospitals as it takes time for government to settle its bills. Private hospitals also have been affected as claims to the PhilHealth system from non-contributing members have mounted have resulted in an actuarial imbalance and as a result, payments to hospitals have been delayed until the government forks out its committed share of funding to the health system.
Charity is a wonderful thing, but it should not be practiced on the resources of unwilling or unwitting individuals. As it is, I am filled with a high degree of confidence that PhilHealth may not be actuarially sound. This is because claims by those who do not contribute, eat into the corpus of the fund contributed by paying PhilHealth members, at least until the government forks out its share, which in many cases, takes ages, if at all. This is the fear of both health institutions and health professionals, that they may not be paid on time, if at all, because the government bureaucracy moves at such a snail's pace and takes a mountain of approvals before any releases.
The law looks brilliant on paper, with appropriations coming from sin taxes and various international donations, among others. The laws of finance and economics are however, immutable and delayed payments mean that somebody doesn't get paid, if at all. What exacerbates the situation, however, is that the government exists from crisis to crisis and putting out fires means shelling out funds, usually diverting them from such sources as health care. Will the government be able to afford its "Build, Build, Build" program, its huge expenditures in national defense, and its ambitious education programs?
From what we have experienced from TRAIN 1 and soon in early 2019 TRAIN 2, we have a citizenry groaning under the weight of rising prices and more cost-push inflation. For a large segment of the working force, the supposed benefit of TRAIN 1 was non-existent and largely negative, because the same take home pay was largely eaten by rising prices. With health care claims expected to rise, will the government be able to raise enough?
The implementing rules and regulations for the Universal Health Care Act are still being worked out and may soon be released, but this is being anticipated with dark forebodings by the health care industry. It should also be of concern to labor groups and the average worker to see to it that their contributions not be siphoned off for what amounts to charity, as it should be only exclusively used for those who contribute, and to see to it that the government contributes its share in a committed and timely fashion.
The most cruel thing to transpire is to need to draw on one's hard-earned contributions only to find out that they have been allocated to someone else who never contributed a single cent.