Sun, Jul 14, 2019 - Page 8 News List

Taiwan in Time: Saying no to universal healthcare

Taiwanese may take national healthcare for granted today, but it was a very unpopular policy when it was first passed

By Han Cheung  /  Staff reporter

A photo of the first generation National Health Insurance cards.

Photo courtesy of Wikimedia Commons

July 14 to July 20

The labor group representatives banged loudly on the glass walls separating them and legislators, while other protesters scattered ghost money from the second floor. Several people then barged into the room and charged toward the legislators, only to be dragged out by security. They lingered outside the building, yelling, “The Chinese Nationalist Party (KMT) is a bully, the Democratic Progressive Party (DPP) is a pushover!”

Earlier that day, about 60 labor activists put on three satirical plays in front of the Legislative Yuan. In one scene, an actor, playing then-president Lee Teng-hui (李登輝), ordered the Legislative Yuan and the Executive Yuan to whip the nation’s workers, who held signs that read “robbing the poor to benefit the rich” and “this is an increased burden on workers.” The workers eventually used a large hammer to knock the president out cold.

Despite the disturbances, in the wee hours of July 19, 1994, legislators passed the third reading of the National Health Insurance Act after extending its session for three days to discuss the bill. Universal health insurance is something we take for granted today, but even this policy experienced its share of birth pangs, plagued by lengthy negotiations and robust opposition from various groups.

The protests continued, but even with news of the government not being ready to launch the program, the first version of the national health insurance was officially implemented on March 1, 1995.

DIFFICULT BIRTH

Before national health insurance came into effect, people fell under 13 different insurance policies according to profession and income level that were managed under a number of government entities. All of these had different rules and benefits. About 54 percent of the population had health insurance in 1994, with more than 70 percent of the uninsured consisting of minors and the elderly.

With rising incomes, the government felt it could support a universal system. The original goal, set in 1986, was to implement it by 2000, with preparations commencing in 1988. By 1992 or 1993, the government had moved the deadline forward to 1994.

One ongoing point of contention was the ratio of contribution between employee and employer: in May 1994, labor groups visited the Executive Yuan and demanded a 2 to 8 ratio, while corporate representatives wanted a 5 to 5 split. The government settled on a 4 to 6 split, which did not please either side. Talks with the Legislative Yuan also broke down after the bill’s first reading, and as they prepared for the second reading, labor groups started their “anti-jianbao” campaign, substituting the original jian (健, health) with a homophone (賤, crappy).

Even after the government agreed to pitch in 10 percent, about 100 laborers on July 14 rammed the legislature’s metal doors, unhappy about both insurance rates and the contribution ratio. Even legislators could not agree with each other, but Lee ordered them to push it through the third reading. Strangely, this version actually did not include the clause that made national health insurance compulsory, which was the whole point of the exercise. That would be amended in another session in September.

The protests did not end there. On Sept. 4, the Taiwan Hospital Association issued a statement, noting that universal healthcare would harm the hospital system. Two days later, labor groups took to the streets, asking to reduce premiums, abolish the referral system and further reduce contribution costs. On Nov. 1, about 30,000 workers stopped working for one hour to show their dissatisfaction.

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