Healthcare as Vote-Buying: Tito Sotto’s “Reform” and the P51-Billion Health Pork Barrel

Tito Sotto’s Magic Trick: Making Pork Barrel Disappear (While Doubling It)

By Louis ‘Barok‘ C. Biraogo — December 17, 2025

MGA ka-kweba, let us pause for a moment of ironic applause. Senate President Vicente “Tito” Sotto III has graciously announced that he aims to eliminate lawmakers’ guarantee letters in the Medical Assistance for Indigent and Financially Incapacitated Patients (MAIFIP) program. How noble. How timely. How utterly convenient—right after the bicameral conference committee ballooned the program’s 2026 budget to a staggering P51 billion, more than double the executive’s modest P24.2 billion proposal.

Sotto insists this is not pork barrel. “Hindi yan pork barrel,” he declares, with the straight face only a veteran politician can muster. “We want to eliminate the GLs and disburse the funding directly to DOH and PhilHealth.” Ah, yes. A reform proposed while simultaneously inflating the fund to levels that would make the old PDAF ghosts blush. Is this genuine change, or sophisticated political theater? One hand offers “reform” while the other quietly stuffs the piggy bank fuller than ever.

Let us dissect this contradiction with the precision it deserves. Sotto defends the massive hike as necessary to allow indigent patients access to private hospitals, decongesting public ones. Fair enough on paper. But why double the budget for a program the Commission on Audit (COA) flagged for P3.013 billion in unspent funds in 2024 alone—money rotting away due to delays, incompetence, and unliquidated transfers? Regions like Western Visayas left over 80% idle; Mimaropa, 38%; Eastern Visayas, nearly half. Throw more money at a leaking bucket, and what do you get? A bigger puddle of waste, dressed up as compassion.

This is not mere inefficiency. This is systemic rot.

***Abracadabra! Your cancer is now… a campaign collateral!***

The Guarantee Letter: Your Free Ticket to Utang na Loob

At the heart of MAIFIP lies the guarantee letter—the political coupon that transforms a public right into a private favor. The sick, the dying, the desperate must prostrate themselves before congressional patrons, begging for an endorsement to access funds that are already theirs by right. As Cardinal Pablo Virgilio David so powerfully put it: “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.’”

Free medicine! (Side effects include lifelong political servitude.)

This is not hyperbole. It is the lived indignity of millions: queuing at politicians’ offices, solicitation letter in hand, hoping for mercy from the powerful. Private hospitals boycott these letters due to delayed reimbursements—breaching the 60-day guideline—leaving patients in limbo. Staffing shortages, incomplete documentation, inconsistent guidelines: these aren’t minor hiccups; they’re the feudal ritual dressed in modern bureaucracy.

And yet, we normalize it. We call it “assistance.” We pretend it is charity, when it is control.

Pork Barrel 2.0, Cloaked in a White Doctor’s Coat

MAIFIP is the PDAF’s undead successor—”healthcare pork,” as critics rightly label it. The Supreme Court struck down the old pork barrel in 2013 for precisely this: post-enactment meddling, discretionary abuse, ghost projects, kickbacks. Yet here we are, resurrecting it in the health sector. Billions diverted from PhilHealth, starving the Universal Health Care (UHC) Act of the resources it needs for automatic coverage, zero-balance billing, and institutional care without political gatekeepers.

Senator Loren Legarda admits that “in an ideal world,” no guarantee letters would be needed—but until UHC is “fully implemented,” we must provide for the poorest. A transitional stopgap? Or a parasitic parallel system that actively sabotages genuine reform? MAIFIP doesn’t bridge gaps; it widens them, perpetuating dependency while politicians claim visible credit in poor districts.

This fits a pattern. Flood control “ghost projects” draining billions. Unconstitutional PhilHealth fund transfers. “Creative accounting” in the budgetary circus. All while public hospitals crumble and out-of-pocket costs crush families.

Tito Sotto’s Motivations: Reformist or Reputation Manager?

Let us interrogate Sotto’s role ruthlessly. Is he the naive reformist, genuinely seeking to de-politicize aid? Possible, but unlikely from a Senate President who has long defended legislative budget insertions. Or is this cynical reputation management—proposing to eliminate guarantee letters as a PR shield while protecting the larger patronage ecosystem? The timing screams obfuscation: amid outrage over the hike, dangle a “reform” to deflect scrutiny.

Perhaps pure political survival. With 2028 looming, framing himself as the anti-pork crusader while ensuring funds flow to allies’ districts. Whatever the truth, the result is the same: a bloated program vulnerable to the very abuses he claims to oppose.

Even Senator Panfilo Lacson—hardly a radical—refuses to ratify the budget unless MAIFIP provisions are corrected, citing non-compliance with UHC and entrenched patronage.

The Human Cost and the Stakes

If this stands, what do we get? Deeper clientelism. Eroded trust in institutions. Resources wasted on a mendicant culture instead of building hospitals, training doctors, strengthening PhilHealth. A nation where the sick beg for scraps while politicians feast on gratitude—and votes.

This is not just fiscal recklessness. It is moral failure. As Cardinal David warns, it violates human dignity, teaching citizens that survival depends on proximity to power, not on functional systems.

The Path to Dignity

Enough despair. We demand real reform—not tweaks to a broken machine, but its dismantling.

Abolish the guarantee letter system entirely.
Integrate all MAIFIP funds into PhilHealth under the UHC framework, with transparent, automated eligibility and real-time tracking.
Impose strict penalties for political manipulation.
Redirect savings to public hospital capacity, zero-balance billing, and preventive care.
President Marcos: Veto the P51-billion hike if safeguards fail.
Congress: Pass laws severing patronage ties once and for all.

Healthcare is a right, not a privilege doled out by patrons. It is time to choose dignity over dependency, institutions over individuals, rights over favors.

While people are dying in hospitals, some are living large on pork barrel. Thanks for your understanding.

– Barok