Public money well spent

Today I depart from that heavy diet of political issues which leaves many of us with indigestion. But since we’ve all got stomachs made of granite, and we don’t follow schedules as punishing as that of the President, we’re not likely to land in the hospital with a bad case of gastro-enteritis, complicated by fatigue. A couple of aspirin, at most, and we’re all set for another round of binging on politics.

Anyway, among the good wishes I got last Father’s Day was an interesting note I received from an old family friend, Dr. Benjie Abela Jr., who called my attention to a medical problem which affects more than 5 million Filipinos. The affliction is eye cataracts. Unbeknownst to Benjie, my family has had some experience with cataracts.

I remember vividly that my paternal grandfather, Dr. Clemente N. Puno, began to weaken noticeably when he had any eye cataract operation over four decades ago. In those days, cataract operations were not the minor procedures they seem to be today. At the time, while in his 80’s, he had to spend several days in the hospital. When he was allowed to go home, he had to wear a steel eye patch. I knew he was left considerably weakened by that experience. My lolo was never quite the same after that operation. Although elderly, he had kept a busy schedule seeing patients regularly at his Guagua, Pampanga clinic and visiting a "puericulture" center, actually a small clinic for children, in Bacolor several times a week. He had established that center himself and it was named after him. I have always wondered if he would have stayed with us longer if he never had to go through that operation.

Dr. Abela says the First Gentleman has had a project called "Free Cataract Surgery for Indigents" which has provided free eye surgery to more than 10,000 Filipinos nationwide. Each procedure would have cost about P60,000 in private clinics or hospitals, but the project has been blessed with the voluntary services of ophthalmologists who sometimes have to perform 100 operations per day gratis.

The problem, according to Dr. Abela, is that the missions may no longer be sustainable. Although the out-of-pocket costs of approximately P2,000 in terms of medical supplies have been funded by donations, initially from the FG Foundation, and later from "key political figures" in the area being served, those sources are not inexhaustible. Benjie also admits that although the spirit of volunteerism is strong, the time the doctors spend to serve the indigents also deprives them of needed income.

The concern, of course, is that funding sources may dry up and the good graces of the doctors may have to surrender to the practical demands of making a decent living. But even if this project is indisputably beneficial to our indigent countrymen who would not otherwise be able to afford eye cataract surgeries, the Department of Health obviously does not have the budget, or the available manpower, to undertake a project of this magnitude. Benjie thinks the solution may be to tap, of all people, the politicians.

Dr. Abela puts it best: "Politicians use these missions to boost their campaign or, maybe, just their popularity. To those politicians who willfully provide for the expenses, regardless of the ulterior motive, I say kudos to them. At least, they give back some of their wealth to the constituents who elected them into office. But what about those areas whose politicians do not give a hoot about the medical problems of their locality? I have learned that unless the mission has political backing, particularly from the congressman, governor, or mayor, the mission will be a total flop. This is a truth in our country. Politics play a key role even in simple tasks like cataract medical missions."

A Great Amen to that! Politicians can be part of the problem, but they very often are also essential ingredients of any solution. But so as not to put too much faith in the generosity or the civic spiritedness of politicians, which may be in short supply, Benjie thinks any solution must be put into law, if it’s going to have any chance to work. Moreover, he is convinced that PhilHealth must play a key role. I would suggest that PhilHealth must indeed play a significant role, if it is to break out of its public image, arguably not totally deserved I must acknowledge, of having been used as a political tool rather than being a true provider of health facilities and insurance coverage.

Dr. Abela’s proposal for an implementing law would go as follows: "The congressman, governor, and the politicians from the LGU will be required annually to appropriate a certain percentage of their ‘pork barrel’ to a trust fund which will be overseen by a coop organized by the regional PhilHealth office together with the local chapter of the Philippine Academy of Ophthalmology.

"The trust fund will be seed money to buy the supplies needed for the surgery of the indigent patient including payment for the Phil Health coverage if the patient does not already have one (so far, according to PhilHealth officials, only 65 percent of Filipinos have PhilHealth coverage).

"After the patient has had the surgery, PhilHealth will remit payments due to the hospital and to the eye doctor. However, a percentage of these payments go back to the trust fund pool to replenish it. The trust fund should also be open to outside donations as a charitable cause. It’s a simple design but unless it is legislated, we cannot force the apathetic politicians and the local doctors to do their part."

Politicians have always protested that their pork barrel is used to benefit their constituents, even if the projects are no more than constructions of local roads which tend to disappear with the first rains of the season. Further, with more public awareness and scrutiny of the uses of pork barrel, there have been increasing pressures to devote the funds to, say, building local hospitals and school buildings and putting up the funds to buy fire trucks and upgrading rescue equipment for use in local disasters,

These demands and pressures can help prevent wastage of pork barrel. After all, congressmen always plead that the money benefits the communities they serve. Somehow, that hasn’t gone over too well. Now, local officials have numerous chances to show their sincerity, and dispel the impression that once in power, all they think of is accumulating funds for the next political exercise and that the first object of their insatiable lust and gluttony is pork.

Next time, we discuss another suggestion to put the people’s money to more effective use to solve the medical needs of the desperately poor.