Local media recently carried a report about an unemployed man who had no money to pay his National Health Insurance (NHI) premiums and had insufficient funds to cover the costs of medical treatment for his illness. The man was eventually found dead on the roadside. This unfortunate case is a huge irony for a health-insurance system designed to look after the nation's people.
The Council of Grand Justices has ruled that the health-insurance program's regulations on compulsory coverage, overdue premiums and temporary suspension of NHI-covered medical services as a means to ensure that beneficiaries' pay do not violate the Constitution.
And for those who cannot afford to pay the premiums -- often senior citizens, the handicapped or the underprivileged that the system was meant to take care of -- they, nevertheless, should not be denied the medical services covered by the insurance program. According to the council's interpretation, the jobless man found on the side of the road should have received medical care under the program. But why did this tragedy happen? What message does this case send to the government?
Looking over the laws and regulations of the NHI program, the medical assistance that an unemployed person can expect to receive can be described as plentiful. To name a few, the Bureau of National Health Insurance's (BNHI) relief fund offers interest-free loans to those who cannot pay their premiums; labor insurance offers a six-month unemployment subsidy; under the Law of Public Assistance (社會救助法), low-income households can receive government subsidies to join the NHI program; and the Medical Treatment Law (醫療法) states that hospitals and medical institutions should not delay any necessary medical treatment to patients in critical condition -- if the patient cannot pay for the medical expenses, the government should subsidize the hospitals.
The key to the smooth functioning of these social support systems does not lie in the rules and regulations, but in whether they can be fully implemented.
European countries, during the dawn of industrial society in the 19th century, established a model for the social welfare system, under which governments played a dominant role. In contrast, East Asian countries have long depended on the care provided by families, community networks and employers. The East Asian social welfare model has taken a considerable load off the state and has been one of the key factors that helped East Asian countries maintain social stability during industrialization.
But when economic prosperity is no longer the case and the structure of traditional societies is in a process of dissolution, the traditional model of social welfare is gradually becoming obsolete. It becomes an inevitable trend for the state to become involved in social welfare, and the national health insurance system is a typical product of such efforts. This involves not just the establishment of a new welfare mechanism, but also the overall adjustment of the government's mind-set and a change in the definition of its role. In terms of administrative implementation, government's responsibility does not stop at publishing notices about various kinds of welfare services. It should actively extend its care to those in need.
So who should be held responsible for the death of that unemployed man?
Perhaps he thought that he himself should be responsible and didn't need to turn to other people for help. But government organizations could have made a difference. The BNHI could have mailed this man information on the relief fund instead of sending a notice for overdue payment, and the Bureau of Labor Insurance could have provided him with information regarding the unemployment subsidy when he lost his job and stopped paying premiums. As well, if one of the man's family members, friends or neighbors had learned about possible assistance and helped the man solve his problems, if the media had let up on coverage of gossip and introduced the social services available to unemployed workers, the outcome could have been different.
These `ifs' show that we have the necessary regulations in place but are unable to implement them. Moreover, they reflected a crisis in which people have become increasingly indifferent to the underprivileged.
The collapse of traditional society has alienated people from each other and frozen their hearts. It has also prevented social resources from performing their functions due to limited access. This is a hurdle that Taiwan faces in developing the social welfare system. In view of this, the government should shoulder more responsibility and set up an active social welfare network instead of waiting for people to ask for help. Should it fail to do so, society's indifference and the government's passiveness will ensure a lack of care for humanity, regardless of whatever lofty rules and regulations are in place.
Shen Fu-hsiung is a DPP lawmaker.
Translated by Wu Pei-shih
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