ShareThisItay and Inay took care of their grandchildren, the offsprings of their only daughter. Now that they are in their golden years, they sense a certain apprehension about the uncertainty of their own future.
Although they dwelled in America for so many years, their soul never left the shores of their birthplace, the hometown nestled in their hearts. The sole reason they came and remained was to help their only daughter achieve her own dream, a lifestyle they did not aspire for. For them, a huge house, fancy cars, good food and a Caucasian in-law cannot replace the sonnet of a rooster’s melody, the idyllic rendezvous of sun and rain, and all the cherished tradition among familiar faces sharing the same tongue. They did their part, worked odd jobs and paid their taxes. They did so to earn the credits needed for their retirement. And they are convinced that it will not be here. But then, they asked, what if they get sick back home? While hospitals in America will provide the most adequate care to get rid of the patient as soon as good health is restored, many hospitals in the Philippines do not mind overstaying patients as long as they pay. And they see to it that they do pay, even in advance.
Itay and Inay are entitled to Medicare and will be receiving social security retirement benefits soon. Since they have pledged citizenship to America, they have every right to claim what rightfully belongs to them. Spending American cash in foreign soil is as easy as a breath of air. Yet the benefits of Medicare and the guarantees of a medical care seem to be restricted to the confines of local policies, statutes and insurance regulations. What if they got seriously ill? It is the same question that their only daughter asks and the same question that many retirees have reflected upon.
True, the American Dollar amplifies the powers of a Philippine Peso, even with in a fixed American income. Nonetheless, Medicare is not yet portable. What Itay and Inay partially paid for through their hard work and taxes cannot be permanently used out of America. This is where the polemics come in.
Since Medicare is a social insurance program administered by the American government, it operates through regulation, compliance and a constant auditing of recipient qualifications. It is mired in a network of political chicanery, vulnerable to fraud, an easy prey to abuse, protected by legislation, very costly and underfunded. The Medicare system involves the complexities of multi-billion reimbursements, inefficient operations, and white collar criminals in different skin colors.
Itay and Inay are now back in the Philippines. After a month of living in excessive heat, Inay became a target of bronchial pathogens, sending her directly to the local hospital. While in the hospital, Itay did not want to release a down payment. He showed them their Medicare card instead. He told the hospital folks that they were retired American citizens and Inay deserved to have a hospital room as soon as possible. “Sorry”, the nurse said. “We cannot admit her here without first paying us 10,000 pesos”. “I know that”, Itay responded. “But we are now American citizens”. “Sure you are”, the nurse said. “But you are now back in the Philippines. We are very sorry”, she continued.
Universal medical care in the Philippines does not exist. Most health care centers function only through cash basis. The concept of reimbursement is not yet part of their vocabulary. Hard cash is the most common tool for any commercial transaction. Extra cash is often used as an osmotic device to speed up things.
Itay took out his cell phone and called up his daughter who is fast asleep in a different time zone. “Hello, Anak. Your Inay and I are in the hospital. She is sick and they do not want to admit her. I know hospitals here require cash. I told them I am now an American citizen. No use. They told me I am back in the Philippines so I need to pay them 10,000 pesos or your Inay cannot stay here. What should I do?”
What would you do? Ten thousand pesos is probably less than $200 dollars. Inay will have a room and a doctor can see her. Itay thought that working in America could take away their concerns for future medical expenses. He thought that all benefits of American citizenship and taxpayer contribution could extend beyond American grounds.
A current discussion about this controversy is brewing in cyberspace. Many elderly Filipinos who did not arrive young in America aspire to live a life of ease back home. Yet they are aware about their friends who tried to do just that and met a premature death instead. A simple illness could easily become a complicated ailment and could lead to a fatal infection. Although this could happen anywhere, systems make them quite different. There are consumer protection laws in America that dissuade medical negligence from taking place. Tort litigations are as rampant as a common flu. Health care providers are forced to do their best lest they lose being paid. Back in the Philippines, judicial protection is oftentimes afforded only to those who have tons of cash, patience and a long life to wait in court proceedings. Over there it is oftentimes pay first and be served later, even if death is knocking by the door.
Can Medicare be allowed to escape the watchful eye of the local geo-political American scenario? Is it strong enough to meet the cultural diversities of the different places where American retirees would want to live in? Can it afford to adjust to systems so different than what it is and be able to impose compliance and efficiency where there is none?
Itay left Inay for a while to go to the bank. Ten thousand pesos is nothing compared to the well- being of his wife. After all those years of hard work, he can’t believe he is doing the same thing back in the Philippines – long lines and patience.
For some strange reason, he quietly recalled the blizzard of 2011. He thought of spring. He remembered last year’s summer trip….