Discussion about the draft long-term care insurance act and the draft medical malpractice, malpractice resolution and compensation act has been lively in the legislature this session, the penultimate session of the eighth legislature. Politically speaking, the Democratic Progressive Party is in a rush to block the long-term insurance act that the current caretaker government has proposed.
In terms of medical services, frontline medical workers are joining to show their dissatisfaction with the Cabinet’s and the legislature’s slapdash handling of the draft acts, which is destroying emergency medical services. As far as Taiwan is concerned, the long-term care system and medical compensation are both advanced concepts, but why is there no grassroots support?
“Social solidarity” is an important concept as we advance toward becoming a welfare society, and it should be constantly reviewed as social reform progresses, because in a modern country, everyone should take responsibility and share the risks facing the old, disabled, poor and sick and everyone should also share in the fiscal burden through a progressive tax system.
However, the development of Taiwan’s social security net has always been geared toward consolidating social classes and striving for political stability within the party-state framework. From the very beginning, the design of the whole system for civil servant, labor, health and long-term care insurance has been based on income calculations.
This is why the National Health Insurance Act (全民健康保險法) stipulates that the upper limit for government financing of the insurance is 36 percent, and this is also the planned upper limit for government financing of long-term care insurance. The only component of social solidarity in this social security net is risk sharing, and it includes nothing about the state using progressive taxation and capital gains tax to share in the financing.
At the same time, income tax is the main source of government revenue, but the design of the tax system completely ignores the social responsibility of capitalists, and the government should therefore take an active role in wealth distribution.
The financing of Taiwan’s future social security system should turn to non-income taxation, such as housing tax, securities income tax, tax on income from interest, vacant land tax, company tax and business tax, including capital gains, instead of just demanding that income tax take on a larger part of the financial responsibility as part of social solidarity.
Meanwhile, advanced countries’ definition of healthcare follows their definition of education, saying that the healthcare field should not be treated as a fully commoditized free market economy. Taiwan’s current healthcare system stresses an orientation toward treatment and market competition.
Even if Taiwan is proud of the accessibility of its medical care, the national health insurance system is unable to raise health literacy among the public, and it has not managed to resolve systemic problems, such as the high number of clinic visits, the high number of days spent on long hospital stays, ineffective treatment and overwork among doctors and nurses.
Today, the draft medical malpractice, malpractice resolution and compensation act — which the Ministry of Health and Welfare and some legislators believe is so advanced — will create an even more difficult situation for the emergency medical system.
On one hand, the ministry is in breach of the law by not enforcing Article 43 of the National Health Insurance Act, which stipulates the proportion of expenses to be paid by patients if they visit outpatient departments of district hospitals, regional hospitals and medical centers directly, without a referral.
On the other hand, the National Health Insurance Administration completely ignores concepts that support a sustainable healthcare system, like the view that medical care is not a commodity, that the medical sector is not a service industry and that the national health insurance is a public good.
The Taiwan Medical Alliance for Labor Justice and Patient Safety is calling for reform of Taiwan’s healthcare system. Taiwan’s medical field stands on the side of a sustainable Taiwan and wants to protect the health of all Taiwanese.
We ask the public and the two main political parties to support such concepts as social solidarity and the view that medical treatment is a public good and that they value Taiwan’s medical and human resources.
Twenty years ago, the Chinese Nationalist Party (KMT) rushed out the National Health Insurance Act in an attempt to hold on to power, in the process creating a host of systemic problems that remain unresolved. Late last year, the party lost four special municipalities due to its lack of civic awareness and social justice.
The current caretaker government should not abruptly initiate a long-term care insurance act that assigns little responsibility to the government and a medical malpractice, malpractice resolution and compensation act that would destroy the emergency medical care system, and thus continue to harm Taiwan and its people.
Translated by Perry Svensson
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