The campaign for Medicare portability
In the autumn of our lives, my wife and I would love to retire in the Philippines, no matter what the naysayers, the pessimists and the sensationprone media say about the traffic, the anti-drug war, and other socalled Third World problems. But we are stymied by one obstacle. Adequate health care.
For sure, there are cost advantages in availing of certain medical services in the Philippines. One can get excellent and professional dental work in Manila and enjoy substantial savings compared to the US, even with roundtrip air fare and modest vacation expenses added on.
But preventive care and health maintenance are unheard of in the Philippines. One usually sees a doctor when an ailment has reached an advanced stage, sometimes a terminal stage. Complicated medical procedures, which already cost a ton of money in the US (if you don’t have health insurance) can also drive you to poverty if availed of in the Philippines — that is, if the expertise and technology are available at all.
It is for this reason that thousands of Filipino-American senior citizens like my wife and I are praying that a group called US Medicare Philippines, Inc. succeeds in persuading the US government to approve Medicare portability.
Medicare is a government health care program that covers medical expenses incurred by those who are 65 years and over, as well as the disabled. It is funded by taxes, federal subsidies, and a modest portion of one’s Social Security pension. However, coverage does not extend beyond the US borders. In other words, not portable.
There are exceptions that provide a positive precedent.
US citizens residing in Guam and Saipan can get critical treatment in accredited Philippine hospitals, because of proximity to our country. The Pentagon’s Tricare and Veterans Affairs department’s health program reimburses medical expenses of US military retirees residing overseas, including the Philippines.
The group proposing Medicare portability — which means allowing Medicare coverage outside the US — has been lobbying Capitol Hill and badgering Philippine officialdom for over 5 years now. There are major obstacles confronting the group but through tireless legwork, networking, and persuasion, some progress is being made.
To appreciate the cost-saving and life-saving benefits of Medicare, consider what I went through.
Some two years ago, I underwent a five-week daily regimen of external beam radiation to arrest my worsening prostate condition. That would have cost a fortune without Medicare coverage.
Medicare reimbursed Kaiser Permanente, my health care provider. I did not spend a cent. My prostate condition is now hardly detectable, and a team of specialists and my primary physician have been closely monitoring my condition to prevent a recurrence — an impressive example of health maintenance and preventive care.
My wife, who is in relatively good health, also undergoes periodic blood tests, her blood pressure is regularly checked, and her prescriptions are constantly reviewed, on the initiative of Kaiser, to make sure that any threats are spotted early.
Our problem is, if we were to retire and reside permanently in the Philippines, we would lose all of these benefits and services — unless the US government approves Medicare portability.
The good news is that experienced lobbyists are at work on the campaign for portability.
Among them is Eric Lachica, executive director of the American Coalition for Filipino Veterans that was at the forefront of the successful effort to secure equity for Filipino World War II veterans who had fought under the US flag.
Eric has been frequenting Manila to cobble together the necessary components in health care and government capabilities that will soften the attitude of the US Congress towards Medicare portability. An aggressive medical tourism program is one of the key components.
But the main challenge is in the US.
On the surface, allowing Medicare Portability is a proverbial win-win proposition. The Medicare system is fast approaching insolvency. Health care expenditures are growing faster, at 7% per annum, than the economy, and the number of Medicare baby boomer beneficiaries is increasing at an annual rate of 3%, while the number of American workers contributing to the Medicare fund is diminishing: 3.2 workers in 2013 and a forecast of 2.8 in 2020 and 2.3 in 2030. To top it all off, there is a worsening shortage of doctors and health care professionals.
One logical solution is to reduce the cost of health care through Medicare portability.
The experience with medical tourism in Mexico, Costa Rica, Thailand, South Korea, Singapore, and Malaysia supports this thesis. Medical procedures — mainly dental, optical, cosmetic, heart and orthopedic surgeries — range from 15% to 35% of US costs, with the added advantage of quality care and shorter waiting periods.
The cost of health care in the Philippines is estimated to be even lower than in these other countries. One industry study estimates costs up to 80%-90% lower than in the US.
The Philippines offers other advantages, particularly in medical tourism. The Department of Tourism has a dedicated Medical Tourism Team, six-month tourist visas can be availed of, and there are daily flights from the US West Coast to Manila, making the Philippines very accessible.
The downside, however, is in terms of facilities, infrastructure, and technology. There are only 3 hospitals accredited by the Joint Commission International Standards (JCI) compared to 18 in Thailand, a mandatory requirement for portability.
The other problems, according to an industry study, are the inadequate number of hospital beds, the low government per capita expenditure on health care (the lowest in Southeast Asia). limited innovation in medical technology, a sub-par level of post-operative care, plus a higher mortality rate and a lower rate of worldwide health accreditation, compared to other Asian countries. All that in addition to inadequate infrastructure, needed for medical tourism.
On Capitol Hill, a divided Congress has also made it difficult to forge a consensus on a long-term health care policy.
The Republican- dominated Senate and House of Representatives have moved to repeal Obamacare, the universal health care program which was the centerpiece of the administration of President Barack Obama. Newly installed President Donald Trump has begun to dismantle Obamacare, even without a viable alternative that will soften the impact on some 20 million Americans who could lose health insurance. Trump’s other campaign promise, to curb outsourcing of American jobs and investments, has underscored the latent resistance to farming out medical services and sending American funds overseas. Additionally, there are concerns over the possibility of fraud and loose crossborder security in the course of information sharing.
But Lachica and his group are not fazed by these obstacles. Believing that small victories can result in major triumphs, they are currently building a case around the impressive savings enjoyed by the US government from the Guam- Saipan Medicare portability experience and the much lower costs incurred by the Tricare and VA department’s health program benefiting US military retirees in the Philippines.
But that is just one part of the equation.
The other part has to be undertaken at the Philippine end, starting with a successful medical tourism program that can at least be competitive with those in Thailand, Malaysia, South Korea and India.
Hopefully, these things will happen sooner rather than later because there are several thousands of us eagerly wanting to come home. And we’re not getting any younger.