Pinoy Kasi
Critical care
By Michael Tan
Philippine Daily Inquirer
First Posted 23:47:00 02/28/2008
Healthcare in the United States has been receiving a lot of attention lately, mainly because it is a major issue in the current presidential campaign, with the candidates expressing different views on solving America’s serious problem of access to healthcare.
A few months back, controversial documentary film director Michael Moore released “Sicko,” which contrasts the US healthcare system with that of Canada, Britain, France and Cuba. Last month, CNN broadcast its own documentary, “Broken Government: Healthcare Critical Condition,” and asked American voters to deliver a “prescription” for their ailing healthcare system, by voting in the presidential polls.
Because the Philippine healthcare system is basically patterned after that of the United States, we Filipinos should be following these documentaries, the US presidential debates and the results of the elections. If a Democrat becomes president, especially if it is Hillary Clinton, there are likely to be significant reforms there and, maybe after some time (a decade or two?), the Philippines might follow.
Rich but poor
The United States is the world’s most powerful and richest nation, and has the highest per capita expenditure on health, at more than $6,000 a year, yet it lags behind many other countries, including some of the so-called developing ones, in terms of health indices, from life expectancy to child death rates.
One reason the US health situation is so poor is that one has to buy health, at great cost. Those most vulnerable are those who have no health insurance, and that’s about 50 million Americans, according to CNN and 60 million, according to Moore. But even those with some kind of health financing, through private health maintenance organizations, for example, often find themselves in trouble trying to pay for the treatment of serious illnesses, or a major accident.
Among developed countries, the United States is the only country that leaves healthcare almost completely to the “free” market. All the others chose to develop systems with universal health coverage, through compulsory health insurance and a national health service run by government.
We get a glimpse into these national health services in “Sicko.” The parts on Britain were particularly informative, and entertaining. Moore interviews a chemist (British English for a druggist), who explains that people pay a flat fee of 6.60 pounds for each prescription, no matter what the medicine is, or in what quantity. Moore moves on to a hospital asking patients how much they paid, for emergency room services, for a child delivery. All answered, “Nothing,” with one man naughtily adding, “This isn’t America.”
Incredulous, Moore roams the hospital looking for a cashier’s office. He finally finds one and is about to gloat, and then discovers that the cashier’s role is to give money to patients, reimbursing them for their transportation!
“Sicko” also talks about how American doctors blocked efforts to bring in universal health coverage. In the 1950s, the American Medical Association launched a massive campaign against “socialized medicine,” using Ronald Reagan, then an actor, to warn that a national health service would take away freedom of choice for patients and for doctors and would lead to impersonal, assembly-line medicine. (Should we be surprised that about the same time, in the Philippines, our doctors also lobbied against a proposed social security system, saying this too was “socialistic”?)
Today, it’s hard to imagine life without the Social Security System, or our PhilHealth system, yet our system, like that of the United States, remains primitive compared to the gains made in Canada, Britain and other countries with national health services. Sure, there are complaints: Filipinos who live in Canada and Britain are always telling me about how they have to wait for elective (non-emergency) surgery, or the occasional long waiting lines at clinics (as if we didn’t have that, too, even our private hospitals). Yet, given the choice between Canada or Britain and the United States, most of these Filipinos would avoid the last. One elderly aunt put it graphically: “It’s worse in the States than in the Philippines if you get sick and don’t have money.”
Moore interviews a young British doctor working for the National Health Service, and finds out the doctor owns a BMW, a $1-million apartment, certainly a far cry from the image of an underpaid, overworked government doctor. The doctor also explains that he was paid not just for treating patients but also for keeping them healthy by getting them to stop smoking, exercise more, eat healthier foods.
Poor, but rich
Third World governments often argue that they don’t have enough money to put in place an efficient national health service, but Britain and other European countries actually beefed up their national healthcare systems right after World War II, when they were in shambles. The leaders of these countries recognized that a vital part of post-war reconstruction was to ensure the health of the citizens.
Moore also gives a lot of coverage to Cuba, a country much poorer than the United States and yet with health indices that are as good. In his documentary, Moore brings a group of American patients without health insurance to Guantanamo Bay, where the US government has a prison for suspected Islamist terrorists, because he heard they had good healthcare there. They are, of course, turned away but Moore then crosses the border to Cuba, where his patients are taken into a rather impressive Cuban hospital, and given the care they need.
Moore, of course, is a master of drama and I know a lot of “Sicko” was scripted, but the contrasts between the United States and its neighbors, Canada and Cuba, are just so stark. The Cuban example is especially important because it shows how a Third World country can provide good healthcare.
Moore might want to look as well at some Asian countries, like Singapore and Malaysia, which followed the British model of building a strong national health service. Such efforts started even when they were still poor countries.
Although our PhilHealth system still has a long way to go, it does reimburse for a growing number of medical procedures, from end-stage renal dialysis to cataract operations. If we want PhilHealth and the Department of Health to grow and to improve, we will have to ask ourselves if we are willing to pay higher taxes and PhilHealth premiums. We will also need to support such initiatives as the Cheaper Medicines Law, and, in the future, push for a healthcare system that also rewards health professionals for promoting healthy behavior.
It won’t be easy. As in the United States, our private health sector has become too entrenched, too powerful for a national health service to be instituted, but there is no lack of alternative measures and programs that might help to make healthcare more accessible for Filipinos, here at home or in the United States.
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