Healthy hypocrisy

Who doesn't love a good presidential gaffe? Susilo Bambang Yudhoyono has two more years to revel in his status as Indonesia's lame-duck president, and it appears he intends to spend those years much like the rest of his time in office -- issuing toothless, out-of-touch directives while leaving the populace shaking their heads and wondering how such an ineffectual ninny got elected to the highest office in the land.

SBY's latest exercise in Not Getting It came this past week when he told his fellow Indonesians to stop seeking medical treatment abroad. While such an admonishment likely raised a few eyebrows among the estimated 600,000 Indonesians who spend $1.2 in so-called "medical tourism" each year, it was at least in keeping with his previous rhetoric. He said last July that he had always sought medical check-ups in Indonesia, adding that the quality of the country's hospitals and doctors was "something to be proud of."

It should come as no surprise, though, that the president is just as susceptible to the "do as I say, don't do as I do" syndrome that is so prevalent among Indonesia's elite. It turns out SBY has sought medical treatment abroad, with confirmation coming from the former head of the president's medical team and the Kuala Lumpur hospital, which brags on its website about SBY being a "regular customer" and that 60 percent of its medical tourists come from Indonesia.

Such privilege also extends to SBY's family, with first lady Ani Yudhoyono traveling to Pittsburgh for neck surgery that the president himself claimed could not be performed in Indonesia. Even the long arm of the law isn't enough to keep well-to-do Indonesians in the country, with the likes of graft convicts Muhammad Nazaruddin, Nunun Nurbaetie and others seeking treatment abroad for sometimes dubious (and sometimes legitimate) health concerns despite the protestations of law enforcers. Fleeing to Singapore seems to be a consistent theme among persons of interest in Indonesia, a fact that definitely has nothing whatsoever to do with the Indonesian legislature still refusing to ratify an extradition treaty it signed with its neighbor in 2007. After all, only a fool and a communist would see a link between that and Indonesian corruption suspects (an increasing number of whom are lawmakers) using Singapore as a convenient place to stash their assets and themselves.

But what about those who don't have the means to seek treatment abroad? Roadshows by Singapore doctors won't have much effect on the vast swath of the Indonesian populace that still lives on less than $2 a day, and the options available to the average Indonesian don't make for pretty reading. Less than half the 1,523 hospitals in the country can pass government certification standards. There is huge demand for doctors, but the level of trust in them is lacking and one does not need to search far for horror stories of medical malpractice here. While politicians furrow their brows and bicker about building more hospitals or undertaking reforms to benefit the overall public health, the poor and the desperate take matters into their own hands by using odd and sometimes dangerous pseudoscience such as "railway therapy" -- laying down on railroad tracks in the belief that electrical energy emanating from the tracks will improve their blood circulation and cure all sorts of ailments.

Even if it's not quite a paradox, it's odd nonetheless. Governments at every level are increasingly willing to provide free health care and education to the poor, placing further burdens on state coffers already strained by skyrocketing spending on fuel subsidies. Meanwhile, the well-off send their children abroad to study and spend hundreds of millions of dollars seeking VIP health care overseas. To restrict the elite's ability to do either of those would be self-defeating and needlessly intrusive, of course, but how sustainable is a system where the rich can (and do) opt out and the rest are left choosing between a bunch of unappealing options? Difficult decisions must be made as Indonesia tries to reform and modernize its services, and it's hard to see that kind of bold, far-sighted leadership coming from a regime that is so willing to call upon the people to make sacrifices it won't make itself.