The legislature passed an amendment to the National Health Insurance Act (全民健康保險法) on Tuesday. Debate over the so-called second-generation National Health Insurance (NHI) program has tended to accept the premise that the program must not be allowed to go bankrupt and that the Department of Health must make up for the financial shortcomings that have been accumulating over the years by adjusting the premium base and premium rates.
The health department’s amendment was clearly based on the same thinking, but that logic is seriously flawed because it prevents Taiwanese from considering broader reforms to the nation’s healthcare system, including areas such as the financial, payment and medical service delivery systems.
Such a macro-perspective suggests that healthcare systems must adhere to the principles of social justice. What exactly these principles are might be disputed, but they clearly do not include a system that was intended to provide equal care services to everyone — including those who cannot pay — but now requires self-financing.
Unfortunately, the concept of self-financing is, for some mysterious reason, deeply rooted in the mind of both Taiwanese officials and the public. This has lead to neverending disputes over premiums and how they are calculated. As a result, the health department is unable to focus on equally important reforms to the payment and medical service delivery systems.
If we must reject self-financing, then social justice dictates that Taiwan’s healthcare system should offer a minimum, reasonable level of universal service, to be fully paid by the government.
What this might include can be publicly discussed, taking into consideration the public’s medical needs, available treatment techniques, efficiency and various costs.
However, it should be made clear that this principle does not touch on how the government procures the funds. That is not to say that financing is unimportant, merely that funding the NHI does not imply that the government should create special legislation to raise the funds independently.
Naturally, if the government pays for everything, that does not mean the healthcare system budget is unlimited or exempt from calculations and controls. The significance of the government providing full coverage is that it establishes the view that providing basic healthcare services to everyone is a matter of social justice.
The government must accomplish this task while undertaking equally important work, such as promoting equal educational opportunity and balanced regional development.
The question of how to obtain sufficient funds from the public for the implementation of policy is a very important issue that the government must solve through tax system reform. This is something that President Ma Ying-jeou (馬英九) should consider if he wants to run for re-election. Even if such reform may not be welcome at first, a true political leader should have the courage educate the public about his administrative and reform ideas. This is the most basic kind of political ethics.
If the government does not do this, the public will know that it lacks determination and resoluteness in its push to reform an unfair and unjust tax system, preferring instead to haggle over every detail regarding the premium calculation base and premium levels for the NHI program.
For example, the latest amendment has caused unnecessary disputes throughout society and no one is satisfied with the final version. The question we have to ask is whether the NHI program remains fair.?
Shei Ser-min is a professor in National Chung Cheng University’s Department of Philosophy.
TRANSLATED BY EDDY CHANG
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