GUAM Delegate Madeleine Bordallo, who delivered her annual address to a session of the Guam Legislature last night, is reportedly considering to introduce federal legislation that would allow Medicare to pay for treatment received in the Philippines.

This has drawn attention from the president of the Guam Medical Association (GMA), Dr. Thomas Shieh, who said U.S. medical dollars should remain in the US of A, period. “We all want patients to get the best health care on island and we need to strive for that,” Shieh wrote in a letter to the Bordallo expressing his concern. “Medicare needs to help our hospital by investing Medicare dollars here locally. Exporting U.S. healthcare dollars is going the wrong route.”

In her response, Bordallo pointed out “Medicare currently covers non-emergency and emergency services in a foreign hospital if the nearest U.S.-based hospital cannot provide the needed care, and if the foreign hospital is closer, or more accessible, than a U.S. hospital equipped to provide the service.” We could not independently verify that statement. It appears the reimbursement of Medicare beneficiaries for services rendered overseas is handled, if approved at all, on a case-by-case basis.

In suggesting such foreign use of Medicare dollars be codified, Bordallo needs to be careful, lest she run up against the powerful American Medical Association which we are told has consistently opposed the export of U.S. healthcare dollars. Medicare, which has been in existence for nearly 50 years since the presidency of Lyndon Johnson, has become a huge behemoth of an entitlement program, dispensing literally billions of dollars into the American system of health care.

There are Americans retired in countless foreign countries from Mexico to France, many of whom would love to get reimbursed by Medicare for their medical bills in the nations where they have chosen to retire. A significant number of Americans living in close proximity to first-class medical facilities in a country like Canada, for example, would probably love to have the option of going across the border for care.

A law making a special case for senior citizen residents of Guam and the CNMI would set a possible precedent, one the American medical establishment might not want. Bordallo said her legislation is still being developed. Before she goes any further down that road, she might want to accept Dr. Shieh’s invitation to meet with GMA members talk about it.

We understand there is a lobbyist working on behalf of one or more hospitals in the Philippines who is pushing the bill. We also understand an argument has been put forth that Guam could benefit from a requirement that a Guam-based physician would need to refer all Medicare patients before they could get reimbursed for care received in the Philippines. We think such a scheme would be cumbersome to administer and subject to fraud.