(Part 1)

New York — Barring socialist methods, how can adequate and passable “total health coverage” be made affordable to poor people?

So far, the best answer I have seen is Dr. Jose “Ting” M. Tiongco’s Cooperators Health Program (CHP) and its Cooperative Health Fund (CHF).

The program is spreading in the Philippines where there are hospitals and health clinics run and owned by cooperatives under the program.  It has also begun to attract people here in the United States and, I am told, Europe.

Dr. Tiongco speaks with the quiet, comforting authority of the competent doctor who knows what is good for you.  He is here in the United States once again to meet people who have taken up his cause, address meetings of doctors and other health workers to interest them in CHP.

When you ask Ting Tiongco to explain his cause, he will disappoint you if you are the give-me-the-bottom line type.  He doesn’t want to talk to you about it as if he wants you to put up your money for an investment.  He wants you to get into it first of all because you believe in the justice of helping provide total health coverage to poor people (who otherwise can’t).
But he will later show you that your joining in is really going to reap you some amount of benefits (yes, profits) as an investor.

The Hidden War

But he will first talk about “The Hidden War.”  Which is the war against poverty.  He describes the universality of the fact that a small minority of haves rules the world and individual nations, and the global economy as well as national, provincial and small-territory economies.

He reminds us that in buying and selling, the sellers depend for their profits on their customers.  And the customers are in every case made up overwhelmingly of the poor or at least people poorer than the seller.

And that this basic economic situation is true also of health and medicine.  He says:  “So we decided that if our patients could not afford the Health and the Humanity they deserved because of Economics, then we, the doctors, were going to do something about it.”

“The problem of medical economics is a part of the problem of world economics and is inseparable and indivisible from it.  Medicine, as we are practicing it today, is a luxury trade.  We are selling bread for the price of jewels.  The poor who comprise 80 percent of our population cannot pay and starve; the doctors cannot sell and suffer.  The people have no health protection and the doctors, no economic security,” he says.  These, he tells us, were words spoken first by Dr. Norman Bethune, the Canadian doctor who contributed his services to the Chinese Revolution.

With this altruistic concept in mind, Dr. Tiongco and his band of medical worker angels formed in 1991 a group whose initials might have come from Batman comics: MMGHHSCP.  But the “Medical Mission Group Hospitals and Health Services Cooperative Philippines” is no fantasy.  It is a serious and cheerful reality.

It now has over 50 branches and affiliates in the Philippines.  And new ones are being formed here in the States and soon possibly in Europe.

“We established the first Health Cooperative in the country, approaching health bluntly as the business that it is.  We were going to use big business methods to bump heads with the multinational business organizations, which capitalized on the miseries of our people.  We were going to match them capsule for capsule and dollar for dollar and win in the process.  There is one main difference between the transnationals and the cooperatives.  They are owned and managed by businessmen or big business concerns.  We are owned and managed by the people.  So we were the first health facilities in the Philippines owned by not only the health providers but also more importantly by the poor themselves.

“The poor are more prone to illness than the rich.  Therefore in terms of proportion and in terms of real money, they spend more for their health needs than the rich do.  The poor people form the economic base of the multibillion-dollar worldwide industry called Health.  Yet they do not get the health care they deserve.

“Health is a basic Human Right.  But this human right is for sale.

This puts Health in the market.  The market is subject to the law of supply and demand.  The law of supply and demand is a natural law.  But it is an eminently manipulable natural law.  Nowhere is this manipulation more evident and more deadly than in the area of Health.

Poor Enriches the Rich

“In the Philippines, as in most Third World countries, 75 percent of the people have had, are having, or will have tuberculosis.  This means that 75 percent of the people have tried to buy, are buying or will buy anti-tuberculosis medications.  We spend billions a year buying these medications from countries like Switzerland, Italy and the USA.

“But there is no tuberculosis in Switzerland, there is none in Italy and there is hardly any in America.

“So what does this mean?  This means that it is the money of the poor people that these countries are using to build their industries.  It is the money of the poor people they are using to pay themselves their high salaries and their opulent lifestyles.  And when they come to our countries, behave like royalty and take two or three of our little children to bed with them, it is our money that pays for that.

“But do we have a choice?  They are holding a gun at our heads and telling us that if we do not buy their medicines, we die.  And I, as a doctor, have seen too many children die because their parents could not afford to buy their medications.

“But we realized that we were holding a gun at their heads too.

Because it is the poor who produce the wealth of the world.  To keep the poor people producing maximally, they still have to be kept surviving, minimally.  The poor have to be kept minimally fed, minimally sheltered, minimally educated, minimally informed, minimally trained and minimally healthy so that production continues and the market survives.  Otherwise, the world economy crumbles.   And the rich will tumble from their ivory towers and bite the dust along with the poor who have already been there for ages.

“So our health cooperative focused on the health expenditure of our poor people.  Just how much are the poor people allowed to spend to keep themselves alive marginally?  The trouble was that whatever the poor people needed to survive, they had to buy at the price of the seller.  When they need to buy, it is a seller’s market.  But whatever the poor produced was sold at the price of the buyer.  When the poor need to sell, it is a buyer’s market.  And the buyer of their products was invariably also the seller of their needs.”*
 
 
 

(Part 2)

New York — To Dr. Jose “Ting” Tiongco and his band of patriotic fellow doctors, nurses and other health workers, the prevailing health delivery system serves only the rich.  It neglects the poor — or treats them less than adequately.

Advocates of the “cooperative health system,” Ting Tiongco and his co-workers believe that “there is no such thing as Private Health.  Health is Public.  Health, like Wealth, must be in the Hands of the People.”  (Dr. Tiongco, writes like a German, capitalizing important nouns.  And he sounds also like that, emphasizing key words, not with loudness but with a playful gravity.)

The cooperative health care system pioneered by Dr. Tiongco and his co-workers in Davao in 1991 is a radically new development.  Its logic and its success in the Philippines have prompted groups in the United States, Australia, Austria, and Latin America to support it.  And to work to replicate it.  However, its success has not received the massive recognition it should have in our nearly 70 million-people society.

Senator Juan Flavier, when he was health secretary in 1992, visited the first cooperative hospital in the Philippines.  This was Ting Tiongco’s and his friends’ Medical Mission Group Hospital and Health Services Cooperative in Davao.  Dr. Flavier was impressed.  The quality of the hospital, its services and the way it was sustained by cooperative funding and the founders’ pure goodwill so astonished him that he called the cooperative health system “the wave of the future.”

And he urged Ting and company and ordered some of his people in the health department to do everything to multiply the Davao experience throughout the country.

In 1993, the Department of Health included cooperative health care in its top 23 priority tasks.  Unfortunately, despite the visible proof — in Davao, Bohol, Cebu — of the  viability and soundness of Ting Tiongco’s and the MMGHHSC’s newly-developed cooperative health delivery system, the government’s cooperative administration agencies were hostile to the concept.

This hostility played into the anti-cooperative — and profit-motivated — mindset of the health-service and health-delivery establishment.

Under President Estrada, however, the government agencies in charge of monitoring cooperatives have become friendlier.  This is one of the positive signs of the genuineness of the Estrada Administration’s pro-poor protestations.

Today the Cooperative Health Program is actively at work in the following places in the Philippines (in some of the cities listed there are more than one health-service facility in separate locations).

In operation nationwide

In Mindanao: Davao City and Tagum, Davao del Norte; Makilala, North Cotabato, Iligan City, General Santos City, Butuan City, Cotabato City, Lebak and Tacurong in Sultan Kudarat, Bislig and Cantilan in Surigao del Sur, Bayugan in Agusan del Sur, Dipolog in Zamboanga del Norte, Pagadian in Zamboanga del Sur, Jolo, and Nasipit in Agusan del Norte.

In the Visayas: Cebu City, Tagbilaran in Bohol, Ormoc and Sogod in South Leyte, Tacloban City, Iloilo City, Miag-ao and San Joaquin in Iloilo, Roxas in Capiz, Kalibo in Aklan, Dumaguete in Negros Oriental and Bacolod in Negros Occidental.

In Luzon: Lucena City and Gumaca in Quezon, Tarlac, Tarlac, Metro Manila, Calamba in Laguna, Sorsogon in Bicol, Batangas, Bocaue in Bulacan and Puerto Princesa in Palawan.

Other areas in the initial stages of the Cooperative Health System in the Philippines are: Maasin, Leyte; Naga and Iriga,Camarines Sur, Ligao in Albay, Masbate, Calbayog and Gen. MacArthur in Samar and Bauko in Mt. Province.

There are all over the Philippines some 2,000 doctors and thousands of other health workers — nurses, midwives, attendants, hospital janitors, etc. — in 51 MMGHHSCP chapters, working in 18 cooperative hospitals and five diagnostic clinics.

Hospitals owned by the masses

The MMG (let’s use that for MMGHHSCP or Medical Mission Group Hospitals and Health Services Cooperative of the Philippines) gave birth in Davao to the Cooperative Health Program — and spread the CHP throughout the country — out of Dr. Tiongco’s and his co-workers’ conscience-driven need to come up with a system to serve the toiling masses.

They were not thinking of returns for their own monetary and service investment.  Their desire was not only to give the poor — together with the rich — first-rate health service but to also arrange for the poor to actually become the owner of their hospitals and health services facilities.

Through the CHP, the cooperators/investors can now avail themselves of the health services offered by the Cooperative Hospital or health facility they own.  The money of the CHP is deposited in the Cooperative Bank so this earns interest.

The Cooperative Bank can pay the Cooperative Health Fund of the CHP premium interest because it loans this money for viable project of the primary cooperatives from who this money comes.  These loans are now used by the primary cooperatives for their own economic activities so that they may be able to profitably address their own basic human needs — food, clothing, shelter, education, information, transportation, among other things.

It marvelously affirms the value of human dignity.  It also proves true a finding in a study that, I think, CRC and the BPI Bank once did: That the best and most honorable loan payers are the poor — when you work with them.*
 

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