The issue of whether Chinese students in Taiwan should be included in the National Health Insurance (NHI) program is like a political barometer for measuring the state of Taiwanese society, and it can serve as an indicator of the nation’s development as a society.
Addressing the issue three years ago, Democratic Progressive Party (DPP) presidential candidate Tsai Ing-wen (蔡英文) said that the focus should be on reciprocity, which was a tactful way of opposing NHI coverage for Chinese students. The medical systems on the two sides of the Taiwan Strait are at different levels of development; China does not have the same kind of health insurance program that Taiwan does. Stressing reciprocity when China does not have a corresponding system is a roundabout way of rejecting the idea.
With the legislature reviewing related legislation on Dec. 5, Tsai said that the DPP was not opposed to NHI coverage for Chinese students. She also said that based on human rights concerns and what society could accept, the party wanted to find a comprehensive solution that would provide the most effective and fair distribution of health insurance resources and government finances. It seems that the answer to the question of to what degree Chinese students should be included in the NHI program is either Tsai’s Achilles heel or a matter of political language.
The issue of NHI coverage has become a convenient vehicle for nationalism. It is a magic “monster-revealing mirror” to parties and politicians that used to uphold fairness, justice, the welfare state and human rights. Voters who have been lured by slogans and passionate appeals and are under the illusion that political parties and politicians are on the side of the disadvantaged can now have quite a laugh at themselves while ridiculing those degenerate parties that rely on Chinese or Taiwanese nationalism.
From a logical perspective, Chinese students are also foreign students, so it is rather odd to include foreign students while excluding Chinese students in the program. Taiwan should have the same standard for all foreign students within its jurisdiction. This is a quite simple principle, and any violation to fairness and consistency is likely to further complicate the issue.
Taiwanese hospitals and doctors generally follow the civilized rules of medical practice, and they would not allow any religious, national, racial, political or status factor to intervene with the doctor-patient relationship.
From a pragmatic perspective, foreign students are young people, and data show that they are actually the group consuming the least medical resources. Furthermore, foreign students who pay tuition and spend their money here are creating job opportunities and economic development, while at the same time promoting cross-cultural understanding. To be a bit blunt, Chinese students are not only a target for top foreign universities, they are also an asset that Taiwan wants. Advanced educational systems around the world are striving to attract international students. Taiwan should be careful not to make a fool of itself by pushing the NHI issue to the point of discriminating against a small minority.
The NHI program is part of Taiwan’s basic infrastructure. During Tsai’s school years in the UK in the early 1980s, the British government protected her right to free healthcare, even though Taiwan did not have a national health insurance program at the time. Yet, she still proposed reciprocity and equality between Taiwan and China as if she had never studied in the UK. At least 20,000 Taiwanese students in the UK are covered by its health program, and not one of them has to pay taxes there.
Just like the NHI program in Taiwan, the British program is suffering financial difficulties, and young doctors are planning a strike due to their long work hours. Despite the British government’s past generous policy toward foreign students, they now have to pay a small fee, but Britons have never vented their anger over past battles by discriminating against foreign students from Germany, Argentina, Serbia, Afghanistan or Syria, because pragmatism is in the UK’s best interest.
The issue of NHI coverage for Chinese students is not a matter of whether you are a citizen or resident, nor is it an issue of whether you are a taxpayer or not, or a generous gift. What should really worry us is the erosion of the values that lie at the core of the NHI and medical care that could result from discrimination against Chinese students.
Chiang Sheng is an attending physician at Mackay Memorial Hospital.
Translated by Eddy Chang
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