ON the day President Ferdinand Marcos Jr. delivered what will likely be his penultimate State of the Nation Address, I was nowhere near the halls of Congress.
I was in Tanza, Cavite.
In front of my camera sat a young mother struggling to hold back tears. We were taping her story for “Kapwa Ko, Mahal Ko” on GMA Network. Her four-year-old son was born with Tetralogy of Fallot, a congenital heart defect that has turned every day of his young life into a race against time.
She did not complain about doctors or question the competence of our hospitals. She spoke instead of poverty, endless paperwork, and one phrase that has become all too familiar to Filipino families seeking medical help: the guarantee letter.
She described going from one politician’s office to another, hoping someone would issue the document that could help finance her son’s operation. Every trip meant transportation expenses, another day’s wages lost, another emotional burden carried by a mother who should have been spending her time beside her child instead of waiting outside government offices.
A few hours later, President Marcos announced before Congress that the government would abolish the guarantee-letter requirement for medical assistance. The applause inside the Batasang Pambansa was immediate.
I thought of the mother in Tanza.
The announcement may have sounded like a simple administrative reform. It was not. It challenged a practice that has quietly shaped the relationship between politicians and ordinary Filipinos for decades.
The guarantee letter did not appear overnight. Medical assistance came from various sources such as public hospitals, social welfare agencies, charitable institutions, congressional funds, local governments, Assistance to Individuals in Crisis Situations (AICS), and later the Medical Assistance for Indigent and Financially Incapacitated Patients (Maifip) program. Somewhere along the way, the endorsement of an elected official became the informal passport to government assistance.
Perhaps the practice began with good intentions. Legislators and local executives genuinely wanted to help constituents in distress. But institutions have a way of outgrowing their original purpose.
Over time, what was once an act of assistance became an expectation. Families seeking life-saving treatment found themselves navigating political offices before reaching operating rooms.
The question is worth asking: Who truly benefited?
Certainly not the patients or their relatives who often lost precious time collecting endorsements. The obvious beneficiaries were politicians, whose signatures became visible symbols of compassion. Every guarantee letter reinforced the impression that public assistance depended on an elected official’s generosity rather than the taxpayers’ money. The right to care becomes an utang na loob to be collected in the next election cycle.
In Filipino political vocabulary, this is often called epal or pumapapel — taking credit for work one did not actually do. But the deeper issue is institutional.
A mature democracy should never require citizens to seek political sponsorship before accessing public services. Health care assistance funded by public resources should never depend on political patronage.
When medical assistance depends on personal endorsements, the government conditions citizens to believe that access comes through connections rather than rights. Patronage replaces citizenship.
The mother I interviewed in Tanza did not ask for special treatment. She asked only that her son be given a chance to live. That should never require a politician’s signature.
If the abolition of guarantee letters is carried through with sincerity and consistency, its significance will extend far beyond hospital corridors. It will mark a quiet but profound shift in the relationship between the Filipino and the State.
For generations, many of us have learned to approach the government as supplicants. We seek endorsements, plead for assistance, cultivate connections, and hope that someone in power will take notice. Public service becomes personalized. Rights become favors. Gratitude replaces accountability.
A mature democracy demands the opposite. Citizens should not have to make pleas to political offices before entering a public hospital. Public institutions exist to serve citizens — not to remind them who helped them. That is the difference between patronage and public service, between receiving a favor and exercising a right.
The applause that greeted the president’s announcement should therefore be reserved not merely for the abolition of a document, but for the possibility of retiring an old political culture.
For that four-year-old boy in Tanza — and for millions of Filipinos who will never meet the politicians whose names once appeared on guarantee letters — that would be a reform worth remembering. The day parents no longer have to seek a politician’s signature before seeking a doctor’s care will be the day the government earns something more valuable than gratitude: trust.
