Exonerating Villar
BY DUCKY PAREDES
Substance in political discourse
A.G ROMUALDEZ JR., M.D
‘Politicians should not be allowed the luxury of talking out of two sides of their mouths.’
The late Senate President Eulogio "Amang" Rodriguez was among this country’s greatest statesmen. He participated in some of the most important events of this country’s history and many important achievements in our development may be credited to him. But if the attribution to him of that famous line "politics is addition" is accurate then he may have also contributed to the substantial decline in the level and quality of discourse in national politics since his time.
In compliance with the famed dictum, politicians running for office will only utter "motherhood and apple pie" statements on issues that truly matter. For the coming elections for example, all candidates (national and local) vow to eliminate poverty, fight corruption, establish peace and order, clean up the environment, improve the quality of education, and promote people’s health. They all promise to improve the business climate, attract foreign investors, encourage farmers to increase food production, and give incentives to clean energy developers. Few of them however bother to even think of specifics because such details will invariably alienate some faction, group, or class that represents a significant number of votes or has enough guns, good, or gold to influence them.
There are a number of examples of such contradictions in the field of health.
While many politicians deny that that there is such a thing as a "Catholic vote" (referring to voting blocs delivered by bishops and priests), some of them still point out that Juan Flavier would have topped the senatorial race in 1995 were it not for Cardinal Sin and his millstone. Most of them will carefully refrain from even uttering the phrase "reproductive health" for fear of displeasing Talibanic clerics and their extremist followers to whom the phrase is anathema. Thus we have the spectacle of candidates supporting family planning but denying the need for population management. They favor freedom of choice while opposing measures that provide information and services on contraceptive methods to poor vulnerable women.
Politicians who say they favor reforms in the health system are careful to point out that Dr. Alfredo Bengzon, a former health secretary, would have surely become a senator were it not for the intense negative campaigning by organizations of physicians angered by the Generics Law and the Local Government Code. Thus candidates will choose to ignore the wide and growing chasm in the incomes of doctors and those of the other health professionals that constitute the health team as one of the root causes of the expanding crisis in the production, deployment and management of human resources for health. In addition, many will not acknowledge the greed of nursing schools owners (many of them doctors or their families or other politicians) as the major reason for the deplorable and deteriorating situation of the nursing profession in this country.
There are few politicians who will oppose expansion of health insurance coverage to include all Filipinos. But even fewer among those who support the National Health Insurance Program will dare denounce the business magnates who through unethical practices avoid having to enroll their employees in PhilHealth. As well, politicians will decry "industry capture" of the government’s regulatory bodies for health but will shun the issue of local commercial interests (who make political contributions) influencing the regulation of health products while continuing to point at defenseless and faceless (but just as culpable) multinational firms.
Because there will be competing interests in any movement towards change in the health sector, it is important to ensure full discussions of the implications of all aspects of health reform. Politicians should not be allowed the luxury of talking out of two sides of their mouths. They must be convinced that in the case of health reform, politics as usual is not necessarily "addition" but should mean the subtraction of those who would frustrate the poor majority of the Philippine population – free-market fundamentalists, religious extremists, conservative medical professionals, and timid academics.
If universal health care is to become a reality in this country, advocates must be prepared to do battle for it. They should debate with and win over those whose interests may be adversely affected transiently by the needed reforms. Obstinate opposition on selfish or otherwise unreasonable grounds should be exposed. Most importantly, the people who should benefit the most from change must be convinced that only their participation will enable a truly responsive health system to assure them equal and fair access to the quality of health care that they deserve.
The recent Maguindanao massacre has cast another shadow on the image of the Philippines – eclipsing the triumphs of boxer Manny Pacquiao and educator Efren Penaflorida. It has put under question the ability of the Macapagal-Arroyo administration to govern the country as a whole and certainly promoted the "failed-state" quality of the government of the Autonomous Region of Muslim Mindanao (ARMM).
Television footages of mansions of the ruling families of the province are out of sync with the least developed country levels of the region’s health status indicators. Life expectancy in the province is lower than 60 years – no doubt reflecting a high death rate from violence including shootings (euphemistically known as "lead poisoning"). Infant and child death rates are the highest in the country – a result of extremely low immunization rates and very high levels of malnutrition. Maternal mortality also approaches levels seen only in Africa -evidence of the very low official attention given to such women’s health problems as rape and other forms of violence. All these are matched by educational status indicators so low that it is extremely doubtful that any health program can soon ease the misery of the poor people of Maguindanao.
It is of more than passing interest that the governor of the ARMM is a scion of the ruling clan of its poorest province – disastrous Maguindanao. Despite the fact that for almost a decade, foreign assistance agencies led by the United States Agency for International Development (USAID) have focused their programs on the region, little progress has been made in improving the lives of the common people. If anything, the gap between the rich who live in mansions and the poor who live in shanties has widened.
Unfortunately, the failure of government in ARMM is only a reflection of the failed policies of the national government in providing for the basic needs of the poorest segments of the population of the Philippines. Symbols of this neglect are the ill-fated poor women and children in city slums continuing to die of preventable causes under the shadow of gleaming tertiary health palaces now deemed tourist attractions.
Emaiul: alberto.romualdez@gmail.com)