COVID-19 is a test for the epidemic prevention, medical contingency planning and public policy capabilities of every nation, and has sparked investigations and debate.
Taiwan has a good health insurance system and medical care. Still, in the words of Minister of Health and Welfare Chen Shih-chung (陳時中): “We have done well in the quizzes, but still have some work to do if we are to pass the final exam.”
In the commentary surrounding the efforts to contain the virus, the old debate about overseas Taiwanese and Chinese abusing the National Health Insurance (NHI) system has once again become a source of controversy. Legislators from the ruling and opposition parties should propose legislative amendments or the Cabinet should take direct action to close loopholes in the NHI system.
The system involves disease prevention. In the US, prevention routines seem to be good, but the epidemic continues to spread all the same.
Experts say that the US Centers for Disease Control and Prevention’s (CDC) initial test kits were problematic and pointed to the fact that the US has yet to establish a universal health insurance system.
They also say that 30 million Americans have no health insurance at all and have to pay high medical bills. The result is that there has not been enough testing and the opportunity to prevent an epidemic there at an early stage was lost.
This does not pose a problem for the NHI, which has cards that are used to check people’s travel history and to purchase masks.
The issue over overseas Taiwanese and Chinese using the NHI is the result of China-based Taiwanese, and people with one Taiwanese and one Chinese parent taking advantage of the system.
They might have not lived in Taiwan for many years, rarely pay taxes here, pay the lowest premium and only visit for short periods, but they often abuse the system.
One such person is singer Huang An (黃安), who works in China and claims to have annual earning of tens of million of New Taiwan dollars.
Despite this, he pays a monthly NHI premium of NT$749 (US$24.55). His actions and statements have been a source of controversy, and people say that he only returns to Taiwan to take advantage of the healthcare system.
This makes many Taiwanese who pay a premium based on their income unhappy and legislators are demanding that situations such as Huang’s be stopped.
The same applies to children with one Taiwanese and one Chinese parent, who are also eligible for the NHI and commonly pay the lowest premium. They use medical resources in excess of the premiums they pay. This group is often referred to as “Xiao Ming” (小明) by the media, referring to reports about a Chinese-Taiwanese who took advantage of the NHI.
The dispute over these groups has to do with practical matters of the NHI, which is a mandatory system. All people who are insured under it are divided into six categories based on profession or relationship, and must pay premiums based on their income. The government subsidizes low-income groups, unemployed people and others, and they pay the lowest premium.
The reason the “Huang An” and “Xiao Ming” groups are controversial is that they do not live in Taiwan, so regardless of income and whether they pay tax here, they pay the lowest premium, with the government paying the rest. Paying only NT$749 a month means that for Huang and his ilk, health insurance is welfare.
Legislators should fix this situation.
Democratic Progressive Party (DPP) Legislator Lin Chun-hsien (林俊憲) has suggested that people like Huang should form a seventh NHI category. If they spend less than 183 days per year in Taiwan and do not pay taxes here, their premiums should be based on their income.
However, income reports are not checked — people are trusted to report their income truthfully. If it were found that a person reported the wrong income, they would have to bear the legal consequences of doing so.
The regulations for children of Taiwanese and Chinese parents living in China joining the NHI are too lax due to an administrative order opening a back door to the system, allowing those who visit Taiwan as a dependent or have a permit to visit relatives to be part of it. This is an exception to the National Health Insurance Act (全民健保法), which otherwise requires legal residency for six months.
Above all, as they are in the lowest-premium category, some non-Republic of China citizens can get better treatment than residents.
Taiwan Statebuilding Party Legislator Chen Po-wei (陳柏惟) advocates that proof of residency be interpreted according to the act and that premiums for non-residents be different from residents, which would reduce costs for the government.
These suggestions would guarantee the right to medical treatment for overseas Taiwanese and would not exclude Chinese who have one Taiwanese parent. What they would do is improve its sustainability based on fairness, equality and the law, which is reasonable and would receive widespread public support.
Online opinion polls show that 90 percent of people agree and 40 percent think the regulations should be even stricter.
The image of the National Health Insurance Bureau would also be boosted with such amendments.
However, raising the premiums and making qualification requirements stricter would cause a backlash among some groups, while issues such as those embodied by Huang and Xiao involve China.
The People’s Daily has published articles strongly criticizing the changes that have been proposed.
Nevertheless, opponents are unable to provide persuasive arguments and even call the lawmakers who promote the changes “anti-Chinese,” saying they are using the COVID-19 pandemic to promote Taiwanese independence and exclude Taiwanese businesspeople based in China. Such arguments are unreasonable and unlikely to gain support.
The NHI has run at a deficit for the past three years. The shortfall last year was NT$30 billion, so premiums might rise next year.
At a time when everyone is concerned about the pandemic, it is timely and appropriate for lawmakers to propose reform to close loopholes.
There is no need to name these amendments after Huang or Xiao, and the act has other loopholes that lead to greater losses, but to oppose reform because of claims that they are aimed at individual cases or because the sums are not large is not how the system’s sustainability can be guaranteed.
On the contrary, beginning with obviously unfair and unreasonable examples is how small victories are accumulated toward the overall goal of NHI reform.
What will be the consequences if the loopholes are not closed and a small number of people are not blocked from abusing it while the majority shoulder the burden of raised premiums?
If the system is not reformed, we will find out.
Translated by Perry Svensson
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