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One more time: Is “Medicare portability” necessary? By Leo Monsalud

I AM constrained to revisit this subject once more because of the confusion created among our Filipino-American population. The signature campaign has made them expect that their Medicare will soon be accepted by medical providers (doctors and hospitals) in the Philippines. If Medicare members who reside in Guam are allowed to enjoy their Medicare benefits in the Philippines, there is no reason why U.S. Congress would not allow Fil-Am Medicare members in the mainland to enjoy the same in the Philippines, the proponents argue. With everything cheap in the Philippines, the U.S. stands to gain in terms of sizable savings if Medicare benefits are enjoyed in the Philippines. Furthermore, if “Medicare portability” comes to pass, the Philippines stands to generate roughly $500M in revenue. This sounds like a win-win situation for everybody!

RESOLVE that U.S. Congress enact a law allowing Fil-Am Medicare members to enjoy their benefits in the Philippines. This is the issue as defined by the proponents of the campaign. I submit to you that I cannot support the position of the AFFIRMATIVE on the ground that it is not necessary, beneficial, nor practicable. (Let’s get back to college debate, ladies and gentlemen).

IT IS NOT NECESSARY. Medicare does not pay for medical expenses outside the United States. BUT, private health insurers approved by Medicare do. Medicare members who have Part A and Part B, not suffering from End Stage Renal Disease (ESRD), and live in an area where a Medicare Advantage (Part C) Plan is offered, may enroll in one  and enjoy the benefit of worldwide coverage for “medical emergencies”. In other words, a FilAm Medicare member who enrolls in a Medicare Advantage Plan is covered for “medical emergencies” worldwide. If he meets one while in the Philippines, or elsewhere for that matter, he just needs to secure the receipts and other documents and submit the same to the plan for reimbursement when he comes back to the U.S. Last time I looked, a friend used his plastic card to pay; it took approximately 90 days for his bills to be included in his monthly card statements. Most plans reimburse bills payment, assuming they’re valid and justified, in less than 30 days. Medicare members who are enrolled in some Medicare Supplement Plans also enjoy worldwide coverage for “medical emergencies”. TRICARE (a health insurance plan for the military and their dependents) allow their members to enjoy their health benefits anywhere in the world, subject to certain conditions.

IT IS NOT BENEFICIAL. We do not want Medicare to die because If Medicare dies, everybody loses. The leaks that siphon off the wellspring of life and health  that is Medicare are waste, fraud and abuse. The Medicare model in the U.S. is one called “fee for service”. Everyone now agrees that this system invites waste, fraud and abuse. Exporting the system outside the U.S. will open the floodgates for more waste, more fraud, and more abuse. This is a catastrophe that is neither beneficial to the U.S., to the Philippines, and ultimately to the Fil-Am Medicare member.

The proponents of the campaign want to plug the leaks by “accrediting” only 3 hospitals and only the doctors “affiliated” with them: namely, St. Luke’s Medical Center, Medical City and Chong Hua. Will this not limit the choice of Medicare members? What if they want to consult with a doctor not “affiliated” with any of those mentioned, but are with equally reputable like UP-PGH, Manila Doctors’, Makati Medical, UST Medical Center, Philippine Heart Center, Lung Center, National Kidney and Transplant Institute, UERMMC,  Cardinal Santos Medical Center,  and the likes? What if they plan to reside in Cotabato City, Bacolod City, or Tuguegarao in the North? (If they have Medicare Part C, they may consult with any doctor and be admitted in any hospital for “medical emergency”).

Incidentally, the Republicans have presented an alternative model – the voucher system. Will the “Medicare portability” proposal work better under this system? If so, why are we not making a stand and supporting it? Besides, the U.S. Congress today is Republican-led. Why limit the submission of signature documents to Barbara Boxer and Dianne Feinstein, both well known Democrats, and not include the likes of John Boehner, Eric Cantor and Paul Ryan among the recipients? Surely, these legislators have some FilAm constituents, too. Let’s not get embroiled in politics, here.

IT IS NOT PRACTICAL. There are 48 million Medicare members. Can anyone make a guess on how many are Fil-Ams? Of the total Fil-Ams, how many have Medicare Parts A and/or B and it is MediCal that pays for the premiums? (This number is significant;  they have to be taken off the equation because they may not stay out of the U.S. for more than 29 days and enjoy their Social Security Income/MediCal benefits as well.) Of the balance, how many will stay in the Philippines 1 or 2 months per year? How many will stay there for 6 months and the other 6 months will be spent here in the US? How many will stay in the Philippines for good, REALLY?, despite the fact that they have already established their roots here, despite the fact that their children and grandchildren are here, despite the fact that in their retirement, their doctors and other medical providers are here? Please secure the numbers and do the math.

Today, many affluent Filipinos come to the US to have major surgical procedures done here. Will not FilAm Medicare members who decide to reside permanently in the Philippines do likewise?

SUMMATION. Ladies and gentlemen, clearly, if “Medicare portability” comes to pass, it will only achieve a marginal improvement in benefits (worldwide “medical emergency” coverage is already available for those who have Medicare Part C) to only a very few FilAm Medicare members. It is the benefit of regular medical consultation (check up) with a limited number of doctors (those “affiliated with the 3 hospitals). Now, tell me, is the cost of the “Medicare portability” campaign – the efforts, the energy, the press releases, the signature campaign, the time and other resources spent – worth it?

Furthermore, the medical billing process is another issue altogether. What about pricing, exchange rates, HIPAA and PPACA compliance? How will the 3 hospitals be sensitive to this challenge?

As regards the Guam thing, the campaign proponents may not have sufficiently researched on the matter. I believe (and please correct me if I am wrong) that such situation is an affirmation that Guam is well within the purview of Social Security Act of 1965 Section 1814 (f) that stipulates the conditions for payment of certain inpatient hospital services furnished outside the U.S. if “such hospital was closer to the residence of such individual (US resident) than the nearest hospital within the U.S. which was adequately equipped to deal with the individual’s illness or injury”.

I believe that the proponents of the “Medicare portability” campaign and the individuals and/or organizations that support them are only motivated by the best and the noblest of intentions for the Philippines. I believe that when they launched and/or expressed their support to the campaign, they have committed to spend their time, effort, energy, and resources to achieve the goals. I believe that the goals of the campaign are to generate $ revenue for the Philippines by allowing the Medicare member enjoy his/her health benefits there.  I submit to you that the goals will be better and faster achieved by employing the commitment of time, effort, energy and resources toward educating our Fil-Am Medicare members on the benefits that they are presently entitled to, but are not aware of; rather than enjoin the Washington lobbyists gather more signatures and submit them only to “Democrat” friends in Congress. By the way, I asked a person who just signed the “document” what it is that he just signed for. And, he answered me:  “I don’t know”. WOW!

You may reach me at 323-535-7373, or e-mail at: leo.balita@gmail.com.

About the Author – LEO MONSALUD

LEO hails from Sta. Cruz, Zambales where he finished his elementary education in a public school. He went to an SVD-run minor seminary in high school. He holds a bachelor’s degree major in economics at the University of Manila (UM) cum laude. He has an MBA (UP), placed 8th in the UP LAE, and studied LAW at the University of the Philippines (UP) in Diliman, Quezon City. LEO worked for the largest pharmaceutical company then in Southeast Asia, United Laboratories, Inc. (UNILAB), where his last position held was vice-president/general manager of a product division.  He worked with San Miguel Corporation (SMC) as a joint venture partner and consolidator in an agribusiness venture. Currently, LEO holds a CA life and health license OG55218. He is currently contracted with major life and health insurance  and annuity companies. A CMS compliant, LEO also  connects people to health, educational, and financial benefits in the USA. ■

 

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