PhilHealth, Luigi Mangione, and this government’s priorities

The recent focus on healthcare insurance in both the Philippines and the United States has sparked significant discussions globally. In the US, the arrest of Luigi Mangione, a young Ivy League-educated man, for the alleged murder of UnitedHealthcare CEO Brian Thompson has drawn worldwide attention. Reports suggest Mangione’s actions were fueled by resentment towards what he called "parasitic" health insurance companies, reflecting public frustration over the exorbitant healthcare costs in the US. This event has prompted debates on how corporate greed may be burdening ordinary Americans, with some expressing sympathy for Mangione's motivations.

Meanwhile, in the Philippines, the controversy revolves around the removal of subsidies for the Philippine Health Insurance Corp. (PhilHealth) by the House and Senate. This decision has caused outrage among Filipinos, especially given claims that PhilHealth received a "0 budget” which have been deemed exaggerated. Under the Universal Healthcare Law, PhilHealth draws funding from various sources, including government subsidies for indigents who cannot afford premiums, individual contributions based on salary, general taxation, and allocations from PAGCOR and PCSO funds. Specifically, 50% of PAGCOR's income and 40% of PCSO's Charity Fund are mandated to support PhilHealth. Healthcare has always taken a backstage in our history, it being almost nonexistent for the ordinary residents of the Philippines during the Spanish period. Things became slightly better when the Americans took over from Spain, although it would take decades more before the signing of the Universal Healthcare Act.

Thanks to the Americans, early legislators made it a priority (though not always supported by many politicians) to allocate funds for health or to improve our healthcare system. The Philippine Medical Care Act of 1969 (Republic Act No. 6111) was enacted to establish a comprehensive medical care program after years of public pressure. The law aimed to complement sick pay provisions for employees while preserving the insured's freedom to choose physicians and hospitals, covering both government and private sectors.

The act introduced two programs: Program I for private and public wage earners and salaried employees already insured under the Social Security System (SSS) and the Government Service Insurance System (GSIS), and Program II, which aimed for universal medical care coverage for all Filipinos. Although passed in 1969, implementation was delayed until August 1971 when the president appointed the Medical Care Commission. Program I began on Jan. 1, 1972, and Program II was expected to be fully operational by 1974. Contributions from employers and employees started in early 1972, with the first payments to healthcare providers issued on April 1, 1972.

By 1983, the Philippine healthcare insurance system covered 23.5% of the economically-active population, including domestic servants, casual employees, family workers, and certain employed students and student nurses. To qualify for benefits, insured individuals needed three monthly contributions within the preceding 12 months before confinement. For deferrable operations like herniotomy, hemorrhoidectomy, and adenoidectomy, 12 monthly contributions were required. The Philippine Medical Care Act played a pivotal role in addressing healthcare needs by balancing costs between the government, employers, and employees. However, achieving full universal access remained a challenge as the system struggled to broaden its coverage to include the entire population.

It was President Rodrigo Duterte signed the Universal Health Care Act into law on February 20, 2019, mandating national health insurance coverage for all Filipinos under PhilHealth. The removal of subsidies for PhilHealth has sparked negative reactions, with lawmakers justifying the move by citing PhilHealth’s billions in unused funds. However, punishing both officials and citizens for the agency’s inefficiencies is unfair. Such decisions risk pushing Filipinos to a breaking point, reminiscent of past mass uprisings, and it is hoped lawmakers realize the consequences before tensions escalate. Or, perhaps, we should have more Luigi Mangiones in the Philippines and introduce Marcos, Romualdez, and Escudero to many Luigis.