Posted November 30, 2001. It did not take that long for people to react to the piece of news about deposed President Joseph Estrada seeking medical treatment in the United States for cataract and osteoarthritis. I myself put my own 2 cents in my column of November 14 (on Today's Last Words). A columnist for the Philippine Daily Inquirer wrote that Erap was "insulting Filipino doctors". It's no surprise that no doctors reacted. Let's get real here. The only reason Erap wanted to go out of the country is to have a vacation (and not come back?). Cataract operation in the US? Please. Dr. Grace Manderico (1992) can do the procedure flawlessly while at the same time singing "Looking through the eyes of love".

     Of course, you are smart enough to realize that we are not demeaning US physicians in any way. It is just that for a very simple operation, a US trip is not needed because there are equally capable specialists who can deal with the problem in the Philippines. For sure Erap's personal physician did not mean to underestimate his Filipino colleagues when he released a statement to the media saying that Erap's problem can only be treated in the US. He probably either succumbed to friendly pressure from his prominent patient, or he knows something more of Erap's affliction than what was publicly released. A few days ago, another news item said Erap needs knee replacement. A group of Filipino orthopedic surgeons (they didn't have to) quickly released a statement that they can do it and no US trip is needed. I am wondering what disorder will Erap think of next just to get out of the 'hellhole' where he is being detained right now.

     Still, even if we all know the bottomline in all these, reactions keep coming. On November 16, the Inquirer published a letter in its Reaction section written by a "foreigner with over 20 years of involvement in the Philippines, although it has not been continuous." The letter-writer, Rev. Joseph P. Frary, PhD, an American citizen, wrote in response to, you guessed it, Erap seeking medical treatment in the United States. I would have written the same things that the good Reverend wrote, but considering that I am a Filipino citizen who practiced Medicine in the Philippines for a few years, many of you may read 'bias' all over it.

     Meanwhile, let's give the floor to the letter-writer:

     "....I am a foreigner with over 20 years of involvement in the Philippines, although it has not been continuous. A citizen of the United States, I am paying about 4,000 dollars (about 207,840 pesos) a year for medical problems in the United States with insurance (without insurance it would merely be disaster)."

     "I have determined that if it is absolutely necessary to be ill, one should be ill in the Philippines. The medical establishment here can be excellent, although like many other things here the quality varies wildly."

     "I was diagnosed by an excellent diagnostician and operated on by a superb surgeon. And I would like to go on record as being eternally grateful to Doctors Isidor Pasion and Bienvenido Aldenese."

     "At the time someone suggested that I might want to return to the States for the operation. The thought had never occurred to me and I dismissed it out of hand."

     "Indeed, if I were to fall ill the United States I would pray that my attending physicians and nurses be Filipino. Fortunately (for the United States) there are lots of them around."

     "To be sure, the American medical establishment is the best in the world -- for the rich. And to be sure, if one has a rare disease the chances of appropriate treatment are better in the United States than anywhere else in the world. But for almost all medical conditions, the Philippines is world-class. And more than that because of the basic kindness of the people which is especially manifest among doctors, nurses and other medical personnel, being ill here is almost pleasure."

     "I can think of only four reasons why a Filipino would seek to go to the United States for medical treatment: (1) Some rare disease is at work requiring extraordinary therapies available only in the United States; (2) To show that he/she has pails of money recklessly to throw around; (3) The infamous "colonial mentality;" (4) To escape some difficulty here in the Philippines. Any Filipino who does go to the United States for medical treatment may even be lucky enough to be attended by Filipino doctors and nurses."

     "As for Dr. Cristopher Mow's (Mr. Estrada's physician - R.G.) views, either he knows something about Mr. Estrada's condition that is not being made public, or he is exhibiting the unfortunately all too common arrogance of the American medical establishment."

     Did he hit the nail right in the head, or what? I am not trying to slam anyone by sharing this letter, especially so that there's a lot of co-alumni practicing Medicine in this land of 'HMO's versus PPO's'. First and foremost, this is not by definition, and only one opinion. It so happened that I share it. Let's forget for a moment that I am a doctor who practiced a few years in the Philippines. I don't practice now and I am strictly sharing my opinion as a patient, as somebody who relies on the American medical establishment to maintain my sanity.

     If you've lived in America for quite some time, you are most definitely aware of HMO and PPO. They are two organizations you can choose from to manage your health, and not some boxing organizations or channels on cable TV. Health insurance companies (Humana, Blue Cross Blue Shield, Principal) usually have an HMO or a PPO plan, if not both. When I applied for the job I have now (I'll tell you in detail in a future column what I am being paid for, but definitely, not for writing this column), one thing I was asked was to choose between HMO or PPO for my health insurance (that included my wife and daughter). Why do I have to choose was beyond me then. As far as I was concerned, I'd get treated by a competent physician no matter what. So I asked that dope from Human Resources what's the difference between the two. With HMO (by the way, it means Health Maintenance Organization), he said, insurance will pay for everything, except for a very small co-payment fee (usually 5 dollars for each visit or each prescription), while with PPO (Private Practice Organization), insurance will pay a specified amount and you'll pay the rest (usually 10 to 40 percent of the total bill or cost of prescription). Wow. I have never made an easier choice in my whole life than that. On second thought, I was asked on the application if I am a Male or Female. I think that was the easiest. But the insurance question was definitely a close second.

     So I chose HMO. I have never regretted it, and I hope, I never will. It's been six years since that day and I never had a single problem (as well as my family) with my insurance. I've been on maintenance medication (Lopid) for my cholesterol problem for years now. I visit my physician (an Internist) every 6 months for a 6-month worth of prescription as well as follow-up laboratory examinations. When my wife gave birth to our daughter (normal delivery), the total bill amounted to 4,500 dollars, and all I paid for from my own pocket was 50 dollars. My daughter had a nasty laceration on her forehead a few months ago (slipped on the floor, hit a chair), so I had to take her to an Emergency clinic for a few stitches. The bill was close to 500 dollars. I did not pay anything from my own pocket.

     The person who sits next to me (please rent the movie Office Space to see how a typical American company office looks like), has PPO, and he whines regularly. He went to his doctor a few months ago for check-up and some laboratory workup. When the bill arrived, close to 400 dollars (don't faint, that's how it is here), his PPO wouldn't pay a single cent of it. Reason? The diagnosis as written by the doctor was 'Overweight'. That ain't no diagnosis, said the insurance. So my good friend went back to his doctor to have the diagnosis changed. I haven't inquired since then.

     So, like the Sprite (or was it 7Up?) commercial, the choice is clear, right? Wait. Not so fast. If HMO is better (at least to me), why is there a lot of HMO horror stories? Why are there more into PPO (possibly 8 out of 10) than HMO in the company I work for? Why are there a lot more people willing to pay the extra 20% for PPO. And Jay Leno of The Tonight Show never runs out of HMO jokes. Why?

     A few months into my job, I got curious. I started asking co-workers who are on PPO. With PPO, they said, they get to choose any doctor, while with HMO, you are given a list of doctors to choose from. I have no problem with that. The list I was given was enormous, I had to close my eyes to choose. With HMO, you can't go to a specialist unless referred by your primary physician. I have no problem with that either. Then came a horror story I refused to believe. If you are in a serious condition, the doctor may not order a diagnostic procedure (MRI, CT Scan, and some state-of-the-art procedure) if you are with HMO since your insurance may not pay for it. With PPO, since it will pay a part of the bill anyway, doctors tend to order every laboratory procedure to get to the bottom of your problem. At least that's what I've been told here at the office. Bottomline: you get to live longer with PPO. Who determines if you should live or die? Is it the doctor or the insurance? Sadly, many people here believe it's the latter.

     Realizing that my co-workers may not be as smart as they claim they are and I don't really trust that dope from Human Resources, I decided to do my own little research. How does an HMO or a PPO work? How are these two completely different health plans determine how complicated your life may become in the future? Should you live by the insurance and die by the insurance?

     Next week, it's HMO versus PPO.

     Get ready to rumble!

TODAY'S LAST WORDS:

• All the newscasts this morning started with the death of ex-Beatle George Harrison. I am not that old to remember the Beatles but I do love their songs. And perhaps you do, too. My father had one long-playing album of the Beatles before. It did not survive because of so many scratches. If you have used a turntable before, you are familiar with the 45 rpm and the 33 rpm records. The turntable we had before had a 78 rpm adjustment. Until this day, I still don't know what it's used for. I remember when we want a song to sound like the 'Chipmunks', we would adjust the turntable to 78 rpm.

  Anyway, I heard my first Beatle song in that long-playing vinyl record. The title of the album, I think, was Magical Mystery Tour. It included the songs Penny Lane, Hello Goodbye, I am the Walrus, among others.

  Although John Lennon and Paul Mccartney wrote most of the Beatles' songs, one of my favorites was actually written by George Harrison. It goes something like this, "Something in the way she moves, Attracts me like no other lover, Something in the way she woos me, I don't want to leave her now, You know I believe her now...." I think the title of the song is something like...well, who cares, it's a wonderful song.

     E-mail the author at drgarcia@wvsumedaa.com

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