Universal healthcare can’t be inaugurated – and that’s the problem

Seven years into the Universal Healthcare Act, the most honest line at last month’s Ateneo Breakthroughs lecture wasn’t about budgets or building blocks. It was researcher Veincent Christian Pepito’s quiet observation that health rarely wins political priority. A road can be cut with a ribbon. Flood control gives you a photo and a tarpaulin. A health system that keeps people from getting sick in the first place gives a politician nothing to point at.

That sounds cynical until you follow the money. In 2024, the Department of Finance ordered PHP 89.9 billion in PhilHealth reserves moved to the national treasury, calling the funds idle. PhilHealth handed over PHP 60 billion before the Supreme Court stepped in. Last December, the Court struck down the transfer and ordered the money returned. So the problem was never simply that the country can’t afford universal care. For a while we had the money, and treated it as spare change.

Filipinos, meanwhile, kept paying. Out-of-pocket spending reached PHP 615.16 billion in 2024 — about 43 percent of all health spending in the country. Government schemes have grown, but a system where more than two of every five pesos spent on health still comes straight from the patient hasn’t really pooled risk. It has just relabeled the bill. The poorest families absorb that first, and hardest.

Part of the trouble is that universal healthcare was never honestly explained. Many Filipinos think it means free care. It doesn’t. It’s insurance — a shared pool that only works if people pay in. The self-employed, by and large, don’t, then need care anyway. It’s hard to scold them for it. Why send premiums to an institution you just watched get raided?

Then there’s geography. Pepito found specialists still clustered in Metro Manila, while devolution left each town’s health service hostage to its own mayor — and, in some provinces, to which party that mayor happens to belong to. For a patient in a Western Visayas upland barangay, “universal” can still mean a bus, a boat, and a borrowed sum to reach a specialist a province away. Coverage isn’t supposed to depend on your postal code. Right now it does.

It’s worth saying the lecture wasn’t all grim. Pepito’s most practical fix costs comparatively little: make the data systems talk to each other, so a patient’s record follows them from the rural health unit to the referral hospital instead of starting from zero each time. Some local governments have already shown what’s possible — Quezon City’s pandemic-era reforms among them — and those experiments deserve to outlive the administrations that launched them. PhilHealth’s repackaged primary care benefit and the new procurement law’s implementing rules are real steps too, even if still unproven.

The harder fix is the unglamorous one. Stop treating health funds as a piggy bank. Tie local health budgets to outcomes rather than goodwill. And maybe accept the uncomfortable thing Pepito was really saying — that the best health policy is the kind no politician will ever get to inaugurate.