FIRST PERSON - Alex Magno (The Philippine Star) - May 2, 2019 - 12:00am

Politicians running for office love talking about – and claiming credit for – the newly minted universal health care bill. No one, so far, in this unremarkable campaign period, has talked about the institutional weaknesses that could undermine the delivery of universal health care protection.

At first blush, the universal health care law appears to be a mountain of a freebie. It conjures images of people in need of health care simply walking up to a medical facility to receive the treatment they need.

The reality, unfortunately, is a lot more complex.

At the moment, we are not sure the excise taxes imposed on “sin” products will produce the revenue needed to fund universal health care. Like the free tuition granted students in tertiary public institutions, the universal health care bill presents government a huge spending bill that cannot be funded without increasing taxes.

The politicians who present government huge items of expenditure to win popularity are also the ones who rail against new taxes to get themselves reelected to office. Populist democracy always creates impossible circumstances for those whose job is to keep government from going bankrupt.

Fortunately, over the past few days, the national government has received upgrades from international credit rating agencies. This is despite the free tuition law, the promise of universal health care and the ambitious outlays for modernizing the nation’s infrastructure. Our economic managers deserve a medal or something for this achievement.

The delivery systems for accessible health care, however, remain utterly problematic.

When the Local Government Code was passed nearly three decades ago, health care was among the concerns to be devolved. Many local governments, however, found they could not afford to run the hospitals and refused to accept responsibility for them. Many of the health facilities simply deteriorated for sheer lack of funding or because of corruption at the local government level.

In the intervening years, crafty legislators used their power over the purse to build dozens of district hospitals to please their constituency. The same practice also resulted in a proliferation of public tertiary education institutions. After the funds for building the hospitals or schools were granted, the local governments were left burdened with the cost of maintaining them. Observing the highest standards was always a problem.

When I was serving at the DBP, I recall a case where the provincial government took out a large loan to build four district hospitals. When a supposedly “reformist” governor was elected, she refused to spend for medicines and staff for fear of anomalies. As a result, the bright new district hospitals did not function at all. The “reformist” was booted out of office after a single term for incompetence.

Many public health care institutions have not been supported enough by local governments to deliver the quality of service intended. Some have become decrepit and others merely decorative.

We need a full audit of the quality of our public health care institutions that are the principal means for ensuring universal health care access.


A few years ago, the wealthy City of Makati decided to build a medical facility to complement the existing Ospital ng Makati (Osmak). The second facility (Osmak-2) was intended to serve constituents in the city’s first district.

To this day, however, Osmak-2 remains unused and unusable. The local government has invested nearly P2 billion on this facility that has yet to cater to its first patient. The unfinished facility is turning into a white elephant.

The reason Osmak-2 could not be completed is that the project remains subject to an intensive audit. The facility, we will recall, was one of the projects called out for overpricing and corruption during that comprehensive scrutiny by the Senate of the Binay father and son some years back.

Of the P2 billion spent by the City of Makati on the Osmak-2 project, P1.4 billion was paid out during the term of former mayor Junjun Binay. That amount was only for the first and second phases of the project. Much more money is required to complete the facility.

The Commission on Audit issued several notices of disallowance for several construction projects undertaken when Junjun was mayor. The watchdog agency has ordered the former mayor to return some P2.3 billion in questionable expenditure for the controversial Makati City Hall parking building.

Junjun Binay has been charged before the Sandiganbayan for graft, falsification of public documents and misuse of public funds. The cases are still pending. Meanwhile, continuing investigations hamper the completion of projects commenced years ago.

Meanwhile, the existing Ospital ng Makati is pushed to the limits of its design capacity, having to serve constituents in two districts when it should now be serving only one. Patients have spilled out to the corridors. The sheer number of people it needs to attend to dramatically reduce the quality of service the facility could deliver.

Osmak-2 might as well be the icon for the state of public health care services nationwide. In nearly every locality, we have substandard health facilities tasked to do more than they are equipped to do.

Those lured by the popularity points promised by passing the universal health care law should now take a long, hard look are the state of the facilities indispensable to delivering the luscious promises of this law.

We know that many of the tertiary education institutions are substandard, explaining the high youth unemployment rate. The health care facilities rate even worse.

We need a comprehensive, expert and patient effort to build the base of our health care system.

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