The Chinese Nationalist Party (KMT) and Taiwan People’s Party (TPP) are promoting an amendment to the Senior Citizens Welfare Act (老人福利法) that would exempt people aged 65 and older in a low tax bracket from paying National Health Insurance (NHI) premiums. While it appears to care for the elder generation, it is nothing more than a ploy to exchange health insurance payments for votes. The NHI program is already experiencing severe financial strain. Promoting such a policy would only worsen that financial crisis and ultimately harm all Taiwanese.
While the majority of NHI revenue comes from the wages of young adults, the majority of its expenditures go to elderly people. As the elderly population increases, the burden on young adults grows heavier. Last year, National Health Insurance Administration data showed that the NHI’s revenue growth is limited, while its expenditures are rapidly increasing — the key factor being that the aging population has caused medical needs to surge. Exempting people over the age of 65 from paying NHI premiums is tantamount to digging a bigger hole for a financial pool that is already drained.
Most importantly, that policy would exacerbate generational inequality. The younger generation would become the main force financially supporting the NHI system, essentially forcing them to bear the burden of the entire country, further worsening their economic pressure. That scenario is like that of a family’s older generation refusing to assist with household spending, instead making their children bear the full burden of household costs. Eventually, it would lead the younger generation to lose all trust in the NHI system — they might even decide to opt out.
Exempting people older than 65 from paying NHI premiums also contravenes the principles of ability and fairness. Some elderly folks indeed require economic support, but many of them earn stable incomes — with some even extremely wealthy. If everyone were treated equally and exempt from paying premiums, the economically disadvantaged would suffer.
The most concerning aspect of that policy is that it resembles a ploy to buy votes. Calculations show that exempting people over the age of 65 from paying premiums would cost an extra NT$35 billion (US$1.07 billion). That huge sum would have to be diverted from the resources of other public programs, such as child welfare, women’s protection, and support for people with physical and mental disabilities — it could even impact the development of public education and infrastructure programs. On the surface, that strategy looks like it has elderly people’s interests in mind, but it would only sacrifice the interests of Taiwanese to serve the temporary political interests of the KMT and TPP.
The NHI system is a resource collectively shared by all Taiwanese. Therefore, it must be operated and implemented on the foundation of equality and sustainability — the entire system cannot be sacrificed to earn the votes of specific groups. The KMT and TPP must stop that short-sighted and self-serving political operation and instead place their focus on optimizing the allocation of public resources. We must help the disadvantaged elderly who truly need support while simultaneously pursuing new revenue sources — such as taxes on assets or specific consumption taxes — to stabilize the NHI structure’s finances.
The National Health Insurance system has come to an important crossroads. We must address those obstacles with rational and responsible policies, rather than making empty promises driven by partisan election strategies. That new legislation must be blocked the safeguard public health and ensure the sustainability of the NHI system.
Lu Chun-wei is a dermatologist and assistant professor at Chang Gung Memorial Hospital.
Translated by Kyra Gustavsen
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