The National Health Insurance (NHI) system has been in deficit for three years in a row since it dipped back into the red in 2017.
As pressure grows for the government to raise NHI premiums, it is widely hoped that Minister of Health and Welfare Chen Shih-chung (陳時中) can apply the expertise and the political capital he has gained from fighting COVID-19, along with his gifts for communication and mediation, to guide Taiwan’s first steps on the arduous road to NHI reform.
Government departments concerned with the NHI have long followed a policy of reducing the deficit by cutting costs.
To this end, they call on the public to cherish NHI resources so that they can be used effectively instead of being wasted. They tend to avoid the alternative approach of generating greater revenue by adjusting the burden of NHI premiums, for fear of provoking a public backlash.
Over the years, quite a few political appointees have stumbled over the issue of adjusting NHI premiums.
Adjusting the rates risks intergenerational tensions and the shockwaves caused by the pension reforms over the past few years are still fresh in people’s minds.
Such issues can easily be manipulated, especially because of the sense of relative deprivation felt by different generations.
The first point to make about this is that older people tend to use more medical resources and have come to rely on the easy access to such resources.
If the government implements a user-pays policy, using those resources would become a greater mental and economic burden for older people, making them feel deprived relative to the time before such a reform was adopted.
In contrast, young people are less likely to use medical resources, so raising insurance premiums would make the ever-shrinking working population pay to support the ever-growing elderly population. This would likewise give young people a sense of relative deprivation about a system they see as unfair.
Getting locked in a confrontation can easily make people overlook the one thing everyone agrees on, which is that the NHI must be saved from bankruptcy.
Many experts have suggested ways of reforming the system. Chen has called for measures such as guaranteeing disadvantaged groups the right to health services through complementary measures that embrace the ability-to-pay principle alongside the user-pays policy.
The next step would be for related departments to use transparent communication, rational analysis and humanistic policymaking, as they have done while fighting COVID-19, to get people to see the bigger picture and realize that sustainable use of medical resources is the only way to ensure that different generations can all enjoy the benefits of the NHI.
This might encourage people to engage in thoughtful dialogue about this sensitive issue and abandon the vested interests of different generations. It would promote intergenerational cooperation so that people of all ages can face the task of NHI reform together.
Chan Yi-wen is a political commentator.
Translated by Julian Clegg
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