It looks like a well-packaged scam in today’s digital vernacular. And, it’s about political reprobates exploiting our centuries-old culture’s emotional “utang na loob (debt of gratitude).”

But while it’s something to guard against, the very people who should know better are cultivating it, as happened in the last few days when the budget for the government’s Medical Assistance fort Indigent and Financially Incapacitated Patients (MAIFIP) program came under fire.

If you came late to the ballyhooed MAIFIP controversy, during last week’s livestreamed congressional bicameral conference committee deliberations on the budget, lawmakers pumped up the MAIFIP’s budget to a whopping P51 billion, despite earlier Senate reductions and public pushback.

On the surface, of course, there’s nothing fundamentally wrong with giving financial aid to the sick who literally have nothing but the clothes on their back. Everyone, including even the government itself, wants to help.

But like all scams, there’s a catch that even the poorest of the poor are in on. And that catch comes in the form of typewritten guarantee letters from our usual pork barrel-loving suspect, the lawmaker. Guarantee letters that a reporter characterized as a “political coupon.” Or to put it better in our online shopping era, a Shopee or Lazada voucher.

But in the real world, that sadly means relatives of a poor patient having to “line up outside a congressman’s or senator’s office, clutching folders and medical abstracts,” begging for that prized note.

Once the precious note is obtained, it’s then submitted to the hospital, where it’s treated as a binding financial instrument. After which, the hospital makes further deductions to a poor patient’s bill alongside the mandated PhilHealth and other deductions.

The funds for a lawmaker’s requests or endorsements for deductions come from the MAIFIP budget.

And, that’s where the dam broke. Why are public monies allotted for the poor’s medical emergencies dependent on a politician’s caprice and political gain?

Or, to put it in abstract political terms, why is the state funding political patronage, clientelism, voter manipulation, and the sure erosion of political meritocracy?

Something, therefore, is definitely amiss here.

“When access to health care, education, and emergency assistance depends on a politician’s endorsement, a guarantee letter, or personal intervention, something deeply wrong has taken root — not only legally, but morally,” thundered Kalookan Bishop Cardinal Pablo Virgilio David last week.

Morally wrong because David says that “one of the quiet but grave moral failures of our public life is how easily we have normalized a system that forces the poor to beg for what they are already entitled to.”

It’s also illegal since, as one noted lawyer points out, it begs the separation-of-powers issue, meaning why do legislators have powers to identify beneficiaries after the budget becomes law when the legislators’ only role is to “step back and allow the Executive to administer the funds in accordance with the law.”

In the MAIFIP’s case, it should be the health department or related implementing agencies to make the decisions and do the hard work of assisting poor patients.

Anyway, there are still many other worthwhile features of the MAIFIP needing discussion, particularly on how it can be made better, on what guardrails need to be put in place so that a poor patient is ably assisted right by his or her hospital bedside.

But for now, as some senators are loudly demanding, legislators must either make the beefed-up MAIFIP acceptable or, if they can’t, the President should veto it.