Local offices of the UK’s National Health Service in Yorkshire, England, recently announced a proposal to delay non-emergency surgeries for obese people and smokers by a year unless they cut their weight by 10 percent or stop smoking for two months. The rationale for the proposal is that the healthcare budget has been cut and although the service can save people in emergency situations, people also need to look after their own health.
To fund Taiwan’s National Health Insurance Program (NHI), a “health tax” was introduced that is separate from individual income tax. People in Taiwan pay more than NT$570 billion (US$18 billion) in NHI contributions every year to keep the NHI program going. The NHI has survived not by increasing investments, but by suppressing expenditures. Measures taken to this end include an aggregate spending cap, soft caps, case mixed indices, diagnosis-related groups, increased payment denials and broader penalties — measures that a lot of doctors hate with a passion.
Pensions, the NHI and long-term care are supposed to be the safety nets of modern society, not a luxury provision. As well as stable financial resources, these services rely on people’s emotions.
On Sept. 3, anxious military personnel, public servants and public-school teachers held a protest march in Taipei, but just a few days before, nurses had held another protest far from Taipei, outside the Tri-Service General Hospital’s Penghu Branch. They complained that the hospital makes them work excessively long hours for little pay, but the hospital argued that it has not been able to recruit enough nurses. If a hospital cannot recruit enough nursing staff, it should cut back on the medical services it provides rather than asking the nurses to shoulder the burden. The same rationale applies in the case of the measures proposed by the Yorkshire health authorities.
The Ministry of Health and Welfare has promised to subject the work hours of resident physicians to the Labor Standards Act (勞動基準法) starting in 2018. It has also recognized for the first time that there is a shortage of medical students. The ministry plans to introduce a resident and visiting physician system and relaunch the rather ineffective system of state funding for medical students.
The methods used to suppress NHI spending could be a good reference point when seeking solutions for Taiwan’s near-bankrupt pension system. Interest rates are below 1 percent and the economy is sluggish. Under such conditions, the idea of continuing to pay an 18 percent interest rate on part of state employees’ savings is delusional. It is also devoid of generational justice in that a group of retired people draws a considerably higher income than millions of people who are working. Farm workers in their 70s and 80s are slogging away in productive work, while many government and Chinese Nationalist Party (KMT) employees can retire at about 50 years of age. These inequalities give people a strong impression that they are suffering from class exploitation.
Although tens of thousands of people with vested interests took to the streets on Sept. 3, if the pension system is not reformed the nation might see millions of long-term low-paid people in street demonstrations. If that happens, perhaps politicians from the two major parties will be shocked out of their stupor.
When former president Chen Shui-bian (陳水扁) was in office, the Democratic Progressive Party (DPP) said the system needed to be reformed, but he went on currying favor with interest groups and even grabbed some of the goods for himself. Chen ended up under house arrest with a total loss of face.
His successor, the KMT’s Ma Ying-jeou (馬英九), also said that the pension system needed reform and the issue of the KMT’s party assets should be resolved, but nothing came of it. Political novice Ko Wen-je (柯文哲) comfortably won the Taipei mayoral election mainly by mocking Ma’s incompetence.
Now an overseas money-laundering case involving Mega International Commercial Bank has come to light, and the key factor is how much evidence and information the US wants to make available.
As to the KMT’s NT$570 billion overseas holdings, much of them are invested in China. Instead of transitional justice, the nation has achieved transition without justice.
In the past, KMT generals and officials called for eradicating communism and urged loyalty to the party’s leader, but now, ironically, people see an unending stream of them going to the Great Hall of the People in Beijing to get a pat on the head from the Chinese president.
Over the past 16 years, nothing has been achieved with regard to pension reform. President Tsai Ing-wen (蔡英文) was elected partly because of her promise to reform the pension system, as well as the public’s lack of faith in her predecessor, Ma. These factors allowed Tsai and the DPP to gain full control of the legislature and government. Now she wants to convene a national affairs conference on pension reform, giving people the impression that she is shadow boxing.
In politics, those who try to please everyone instead end up offending everyone. Taking the proposed amendments to the Genetic Health Act (優生保健法) as an example, eight years ago the Ministry of Health and Welfare came up with the idea of making women who want an abortion wait and think about it for a few days. Women’s rights groups were completely against the idea, while religious fundamentalists called for a six-day waiting period. As a result, the ministry’s draft was amended and the renamed law adopted a halfway compromise of three days, with the result that both sides were unhappy.
In politics, those who try to please everyone will accomplish nothing — they will be abandoned by the public and forgotten by history.
Pension reform requires accurate data and persuasive arguments. People need to understand the feeling that military personnel, public servants and public-school teachers have of being denigrated on account of their special retirement and pension system.
People serving in the military do need better pay and welfare. However, basic safeguards should be established for people in all sectors to receive adequate retirement pensions, and an upper limit for pension payments should apply across the board.
State employees on the one hand and ordinary workers and farmers on the other should not be classified differently based on the nature of their professions. While those who pay greater pension contributions when they are working should be able to draw somewhat larger pensions once they retire, if one group gets 13 times as much as the other, that is too big a difference.
Nothing is unchangeable in human affairs, except that things are always changing. The pension system is clearly in need of reform. Measures taken to strengthen the NHI’s finances and keep its spending down might serve as a reference for pension reform, since the purpose of both is to ensure the long-term stable functioning of these systems.
Chiang Sheng is an attending physician in Mackay Memorial Hospital’s Department of Obstetrics and Gynecology.
Translated by Julian Clegg
Could Asia be on the verge of a new wave of nuclear proliferation? A look back at the early history of the North Atlantic Treaty Organization (NATO), which recently celebrated its 75th anniversary, illuminates some reasons for concern in the Indo-Pacific today. US Secretary of Defense Lloyd Austin recently described NATO as “the most powerful and successful alliance in history,” but the organization’s early years were not without challenges. At its inception, the signing of the North Atlantic Treaty marked a sea change in American strategic thinking. The United States had been intent on withdrawing from Europe in the years following
My wife and I spent the week in the interior of Taiwan where Shuyuan spent her childhood. In that town there is a street that functions as an open farmer’s market. Walk along that street, as Shuyuan did yesterday, and it is next to impossible to come home empty-handed. Some mangoes that looked vaguely like others we had seen around here ended up on our table. Shuyuan told how she had bought them from a little old farmer woman from the countryside who said the mangoes were from a very old tree she had on her property. The big surprise
The issue of China’s overcapacity has drawn greater global attention recently, with US Secretary of the Treasury Janet Yellen urging Beijing to address its excess production in key industries during her visit to China last week. Meanwhile in Brussels, European Commission President Ursula von der Leyen last week said that Europe must have a tough talk with China on its perceived overcapacity and unfair trade practices. The remarks by Yellen and Von der Leyen come as China’s economy is undergoing a painful transition. Beijing is trying to steer the world’s second-largest economy out of a COVID-19 slump, the property crisis and
As former president Ma Ying-jeou (馬英九) wrapped up his visit to the People’s Republic of China, he received his share of attention. Certainly, the trip must be seen within the full context of Ma’s life, that is, his eight-year presidency, the Sunflower movement and his failed Economic Cooperation Framework Agreement, as well as his eight years as Taipei mayor with its posturing, accusations of money laundering, and ups and downs. Through all that, basic questions stand out: “What drives Ma? What is his end game?” Having observed and commented on Ma for decades, it is all ironically reminiscent of former US president Harry