Access to health care hinging on political favors, warns cardinal

MANILA, Philippines — Kalookan Bishop Pablo Virgilio Cardinal David warned that the growing reliance on politicians’ guarantee letters to access medical assistance undermines human dignity and raises constitutional concerns, as lawmakers debate funding for a controversial health aid program.

David said the practice reflects a deeper moral problem in public life.

"One of the quiet but grave moral failures of our public life is how easily we have normalized a system that forces the poor to beg for what they are already entitled to," David said post over the weekend.

"When access to health care, education, or emergency assistance depends on a politician’s endorsement, a guarantee letter, or personal intervention, something deeply wrong has taken root — not only legally, but morally," he added, as CBCP News quoted.

David said that from a pastoral perspective, the issue goes beyond a technical flaw in governance and amounts to "a violation of human dignity."

Warning against 'soft' pork barrel

The cardinal also warned lawmakers against what he described as "patronage-based" or "soft pork" health and social programs. He argued that such systems degrade the poor and weaken public institutions.

“When public assistance is delivered through patronage — through discretionary lump sums, lists controlled by politicians, and post-enactment intervention — it transforms rights into favors and citizens into supplicants,” David said.

He cited the expanded Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) program, which he said relies on personal endorsements from politicians for access to medical aid.

“Health care is no longer delivered as a right flowing from need and citizenship, but as a favor mediated by political power — a classic system of patronage that turns illness into ‘utang-na-loob,’” David said.

According to the cardinal, such arrangements normalize dependency and teach citizens that survival depends on proximity to politicians rather than on functional public institutions.

Drawing from Catholic social teaching, David said health care, education, and social protection are demands of justice, not acts of generosity dispensed by those in power.

MAIFIP at the budget deliberations

Some lawmakers have expressed similar concerns as David. Sen. Panfilo Lacson objected to the current bicameral committee provisions on the national budget and said he would not sign the budget report unless contentious items including the MAIFIP allocation are corrected, citing constitutional and governance concerns.

Sen. Loren Legarda, meanwhile, endorsed the MAIFIP as a means to offset the lack of universal health care and ongoing reforms of the state insurance system PhilHealth.

Advocates of the higher allocation, including House appropriations chairperson Mikaela Angela Suansing, argued that cutting MAIFIP would reduce coverage for indigent patients, potentially affecting over a million beneficiaries.