Unsustainable health care

The universality of the proposed Universal Health Care (UHC) bill that recently passed both chambers of Congress may be the UHC’s most critical weakness as opposed to its much ballyhooed and beneficial strength.

“While the UHC’s universality feature is critical to its success, inversely the same could likewise be ironically limiting… from the perspective of funding and sustainability.

The difference between this measure and previous others is that the UHC will be available to every Filipino citizen regardless of any demographic delineations that might disenfranchise one from needed medical attention. It is so inclusive, it will include drunkards, addicts, smokers, even those excessively balding with Asperger’s syndrome.

For one, it will not be conditional on an identification card signifying enrollment. We’ve seen how those were prone to selectivity based on partisanship when previous administrations not only politicized such programs but had effectively corrupted them.

Remember when health cards were distributed during a campaign period simply to obtain votes? Never mind that they were inactive, unregistered and worthless. Remember also instances where politicos appointed to public health agencies insidiously used agency funds to pay for advertisements featuring their grinning mugs immediately prior to their senatorial candidacies?

For another, funding for such universality will be multidimensional from a merry mix of sin taxes on products considered as health threats to the appropriations budgeted for agencies that currently fund health and welfare requisites.

While the UHC’s universality feature is critical to its success, inversely the same could likewise be ironically limiting and be paradoxically problematic from the perspective of funding and sustainability.

Now lodged at the bicameral committee, there seems to be some road bumps ahead.

Strangely, the bicameral House members appear characteristically reluctant to pass a bill that makes health care accessible without the political strings that previous administrations had attached to it, both in the government’s past experiments with public health and as it now stands inherited, warts and all, under the Duterte administration.

While Senate Bill 1896, very competently shepherded through the political gauntlet by Senator J.V. Ejercito, might be the better bill between the House and the Senate versions and should essentially be the prevailing statute once passed through the bicameral sieve, the fundamental universality aspect of both is a fundamental weakness that remains common in all UHC programs.

This leaves the prospective act, should it pass into law sans a presidential imprimatur, open to some serious additions or, worse, a watering down, when it’s implementing rules and regulations are subsequently drawn to fill in its existential gaps.

The core of the UHC debate is in its sustainability by the government that will be funding it from year one to its 10th year.

To understand the magnitude of the sustainability question, allow us to backtrack a bit and review the proposed statute’s salient objectives and preamble. As we do so and as our title suggests, keep in mind the question of sustainability for an ambitious proposal that covers an unlimited number of people as well as unlimited possible ailments arrayed against a finite source of funding constantly facing fiscal deficits.

Under Chapter I, Section 2 of the UHC bill, the proposed coverage encompasses “preventive, curative, rehabilitative and palliative health service without financial hardships.” Chapter III, Section 20 sets for “Immediate Entitlement.” That’s quite a challenge and quite a vast and unlimited universe going well beyond primary care. Likewise, the term “without financial hardships” is an open-ended and subjective definition. It, in no way, sets funding parameters regardless of real limitations set by fiscal realities.

While such realities are anticipated in Chapter II, Sections 7 and 8, the UHC considers these as limiting Beta Coefficients only on the 10th year of the UHC’s life. Prior to that it is completely socialist, expensive, unsustainable and needy. Thus, exerting successive tax escalations on an already over-taxed public.