ON ONE hand, people on Guam with Medicare should be able to use that federal insurance in the Philippines because access to U.S. mainland health care is too far way.

On the other hand, people with Medicare should use their federal insurance on Guam because their dollars will help fund U.S. mainland quality health care here on-island. To be or not to be, that is the question.

Medicare is a national program which guarantees access to health insurance for Americans age 65 and older and younger people with disabilities. In 1965, Congress created Medicare to provide health insurance to people age 65 and older, regardless of income or medical history. Before Medicare, only half of older adults had health insurance, with coverage either unavailable or unaffordable to the other half.

With the continuing aging of the baby boom generation, a lot more older adults now rely on Medicare for health insurance. In 2010, Medicare provided health insurance to 48 million Americans – 40 million people age 65 and older and 8 million younger people with disabilities. Without Medicare, many of these people would not have access to health insurance and would have to forgo needed medical care.

Total Medicare spending is huge and is projected to increase from $523 billion in 2010 to $932 billion by 2020. Many economists believe that reducing costs in Medicare and the federal government’s other major healthcare programs is ultimately the nation’s central long-term challenge in setting federal fiscal policy.

Meanwhile, Medicare's uncertain future and the federal government's inability to fix the program has many doctors deciding to drop Medicare. Over the past 20 years, more than 7,000 physicians and healthcare professionals across the nation have stopped accepting Medicare patients due to decreasing reimbursement for medical services. On Guam, doctors still struggling with Medicare have been faced with mounting paperwork and impending cuts. A massive 27.4 percent pay cut was set to hit doctors on March 1, but Washington lawmakers adopted stopgap legislation that pushed real Medicare solutions back until after this year’s national elections.

If you are reading this newspaper, you have probably been paying for Medicare most of your working life. Yet this American benefit is almost wholly useless to you if you live in the U.S. territories and decide to obtain higher level medical care at an international hospital. Medicare currently only recognizes Canadian and Mexican hospitals for those beneficiaries whose U.S.-based home is geographically closer to an international hospital than to one in the United States. Almost certainly, there is no U.S. home further to the continental United States than our homes here on Guam.

In 2010, more than 2,600 Guamanians spent in excess of $7 million to receive medical care in the Philippines. In the process, they saved approximately $9.1 million in medical services, travel, and accommodation costs that would have been incurred had they gone to Hawaii. In the name of territorial healthcare disparities, Guam's man'amko should call Madeleine to get Medicare to Manila.