MANILA (December 15) — For thousands of Filipinos lining up at hospitals with guarantee letters in hand, access to medical care often hinges not on eligibility, but on political connections.
It is a reality that Kalookan Bishop Pablo Virgilio Cardinal David says should trouble the nation’s conscience.
As lawmakers debate funding for a controversial health aid program, Cardinal David warned that the growing reliance on politicians’ endorsements to secure medical assistance undermines human dignity and raises serious constitutional concerns.
“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 in a post over the weekend, as quoted by CBCP News.
He added that when access to health care, education, or emergency aid depends on a politician’s personal intervention or a guarantee letter, “something deeply wrong has taken root — not only legally, but morally.”
A system the poor must navigate
For many indigent patients, a guarantee letter can mean the difference between treatment and delay — or even life and death. But David said this system turns basic rights into acts of political generosity, forcing citizens into dependence.
From a pastoral perspective, he said, the issue goes far beyond bureaucratic inefficiency.
“It is a violation of human dignity,” the cardinal said, noting that no one should have to plead for medical care as if it were a personal favor.
Warning against ‘soft pork’
David cautioned lawmakers against what he described as patronage-based or “soft pork” social programs, arguing that these weaken institutions and degrade those they are meant to help.
“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,” he said.
He specifically cited the expanded Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) program, which he said relies heavily on political endorsements to access health 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 added.
Such arrangements, he warned, normalize dependency and teach citizens that survival depends on proximity to politicians rather than on functional, rights-based public institutions.
Budget debate highlights deeper divide
The cardinal’s remarks come amid heated budget deliberations at Congress.
Sen. Panfilo Lacson has objected to provisions in the bicameral committee report on the national budget, saying he would not sign it unless contentious items — including the MAIFIP allocation — are corrected, citing constitutional and governance concerns.
Others see the issue differently. Sen. Loren Legarda has defended MAIFIP as a necessary stopgap amid gaps in universal health care coverage and ongoing reforms at PhilHealth.
House Appropriations Committee chair Mikaela Angela Suansing warned that reducing MAIFIP funding could limit access to medical aid for indigent patients, potentially affecting more than a million beneficiaries.
A question of rights, not charity
Drawing from Catholic social teaching, David stressed that health care, education, and social protection are matters of justice, not charity dispensed at the discretion of those in power.
For ordinary Filipinos struggling to pay hospital bills, the debate goes beyond budget lines. It cuts to a deeper question: Should access to health care depend on political favors — or on citizenship and need?
As lawmakers weigh competing arguments, David’s warning reframes the issue not just as a policy dispute, but as a moral test of how the state treats its most vulnerable.
