Health Insurance Problems Will Persist Even If Yang Chih-liang Stays

Health Insurance Problems Will Persist Even If Yang Chih-liang Stays
China Times editorial (Taipei, Taiwan, ROC)
A Translation
March 18, 2010

Director of Health Yang Chih-liang has decided to "temporarily remain in office." Yang resigned over the health insurance premiums controversy. President Ma and Premier Wu have persuaded him to stay on. This has granted the Ma administration a reprieve. But the underlying problems remain. One. An increase in health insurance premiums and a change in the way government subsidies are provided. A compromise has been reached between programs offered by different agencies. But the problems underlying the health insurance system remain. Two. The presidential office and the executive yuan have approved a second generation health insurance program to be implemented within two years. But one can only keep one's fingers crossed. Three. Whether Yang Chih-liang will stay on or leave remains unknown. When the current Legislative Yuan session ends, the president and the premier may face another round of resignations.

Over the past ten days, Yang Chih-liang was ostensibly on leave. But he was hardly idle. If anything, he was busier than usual. He had to report to the presidential office twice in three days. Even the KMT party leadership joined in, begging him to stay. He was forced to respond to appeals from the presidential office, the executive yuan and the party urging him to stay. He had to promote a variety of schemes for health insurance premium increases, and report on them to the presidential office. President Ma has yet to approve an increase in health insurance premiums. But he already knows the score. A high-level five-member team will approve a compromise solution. It will draw from the Department of Health's version. It will allow 59% of the public to remain unaffected by the premiums increase. It will meet the standards established by Premier Wu in his "Meat and Potatoes Economics" program. It will allow 75% of the public to remain unaffected. The 16% shortfall will be covered by government subsidies, allowing the proposal to temporarily pass muster.

On the surface, Yang Chih-liang's resignation risked bureaucratic condemnation. He sang a different tune than his boss, both conceptually and even procedurally. Put nicely, taxpayers will foot the bill for the health insurance deficit. Put less nicely, taxpayers will foot the bill for Premier Wu and Yang Chih-liang's "dignity." Substantively, neither Premier Wu nor Yang Chih-liang benefitted. Premier Wu is the chief executive. His subordinates will find it difficult to implement his orders. Yang used his official position to silence his boss. Yang Chih-liang's resignation forced the president to personally mediate between various agencies. Even a program that did not require an amendment to the law, needed presidential intervention to break the impasse, to determine policy, and to convince the director of health to stay on. Yang Chih-liang's resignation rehabilitated the president's image as a man of wisdom and courage. Premier Wu on the other hand, came out looking like a populist panderer who lacked the courage to stand behind his policies.

Do not assume that Yang Chih-liang will benefit because he helped the president. Quite the contrary. As a cabinet member, he must answer to Premier Wu. Yang has agreed to stay on. Will communications between Yang Chih-liang and Premier Wu be tough or tactful? Blunt or diplomatic? Yang Chih-liang said he would "stay on temporarily." He knows he cannot continue defying his superiors, who include the premier and the president. How much trouble will the issue of "face" bring him? All we can do is wait and see. He must exchange time for space. He must pave the way for his retreat on amicable terms.

Yang Chih-liang has agreed to stay on. But before that, he privately confided that "What I want is a system, not a solution." The compromise solution worked out by the presidential office and the executive yuan is not what he wanted. But all he could do was bite the bullet and soldier on. Besides, President Ma agreed to his own prescription: a second generation health insurance system. He does not realize that the program must still undergo legislative review. Whether the legislature will pass it before the current session runs out is uncertain.

Is health insurance medical insurance, or is it a medical benefit? According to the compromise solution, the Republic of China's national health insurance system is the envy of the world. It is virtually a social welfare benefit. Premier Wu understands public sentiment better than anyone. No price increase is ever a good price increase. And so it is with gasoline price increases, electricity price increases, water price increases, and tax increases. Government subsidies may only be increased. They may never be decreased, let alone eliminated. The same is true for pensions. The subsidy to the health insurance system will ostensibly be phased out in two years. The second generation health insurance system will then take over. But whether the second generation health insurance system will be able to take over as planned remains uncertain. If it takes over, but second generation health insurance premiums must also be increased, the public will find it unacceptable. The government is using subsidies to reduce the impact of health insurance premium increases, and to make up the deficit in the health care system. But it has yet to find its way to fiscal solvency.

The cabinet is undergoing a decision making crisis. Health insurance premium increases are merely the tip of the iceberg. Premier Wu has no shortage of political solutions. He has more than enough campaign staffers. But as premier, he must ensure the nation's long term prosperity. He cannot rely exclusively on political tactics. The more sensitive the policy, the greater the need for both boldness and caution. He cannot count on the president to settle every crisis that arises. Yang Chih-liang's resignation exposed hidden concerns, especially for department heads who value professionalism. Does the premier respect professionalism? The answer will determine whether they are willing to stay on and serve their country. There is nothing wrong with Premier Wu's "Meat and Potatoes Economics." But if every issue is decided on the basis of public sentiment, if every deficit is made up by state subsidies, if every problem encountered is fobbed off on those ministries responsible for economics and finance, given the nation's current financial difficulties, the next official hoping to resign will surface, sooner rather than later.

中時電子報 新聞
中國時報 　2010.03.18
社論－留住楊志良 健保難題還是沒解決
本報訊

轉了一圈，為健保調漲請辭的衛生署長楊志良，在馬總統與行政院長吳敦義強力慰留下，決定「暫時留任」。這固然解除了馬政府的燃眉之急，不過，真正的問題還是未解決，包括：一、健保調漲以及政府補助的方式，在院署不同方案中取得妥協，卻沒處理健保制度的終極問題；第二，府院雖拍板二代健保要在二年內施行，但這個拍板只能是「希望」；第三，楊志良個人去留還是埋了伏筆，立法院這個會期結束，總統與閣揆可能還得面對相同的辭官戲碼。

這十天，楊志良儘管請假，卻沒一天閒著，反而比平常更忙。三天兩頭進府報告，連黨中央都加入勸留行列，他前腳要應付府院黨的留人攻勢，後腳卻必須馬不停蹄地敦促健保局反覆試算各種調漲方案，以備入府報告。在馬總統對健保調漲方案拍板前，他已經心理有數，高層五人小組會通過折衷方案：既要採用衛生署的版本，讓百分之五十九的人不受保費調漲影響，還要滿足吳揆的庶民經濟理念，讓百分之七十五的人不受影響；這中間落差百分之十六，則靠政府補助方式，暫時過關。

表面上看，楊志良辭官冒了官場之大不韙，以烏紗帽硬槓上長官的理念、甚至決策。講好聽一點，健保虧空全民埋單，講難聽一點，吳揆與楊志良的面子，也是全民埋單。至於裡子，吳揆和楊志良都沒撈到好處。吳揆做為最高行政首長，他的指示，部屬不但難以執行，還硬生生用官位堵住長官的嘴。楊志良這一辭，逼著總統親自出馬，與院署協調，連法都不必修的調漲方案，還得靠總統才能快刀斬亂麻，既決定了方案還留下了署長，楊志良辭官難得地重建了總統英明有能的形象，吳揆卻落得趨從民粹、無政策擔當的批評。

不要以為楊志良捧了總統就有了方便，剛好相反，做為內閣閣員，面對的還是吳揆，從點頭答應留任開始，這以後楊志良與吳揆溝通，該硬該軟？該直該曲？楊志良「暫留一會期」的伏筆，多少也清楚自己不能再不給長官面子，長官包括了院長和總統，只是這面子會給自己帶來多少困擾，只能忍一時以靜觀其變，以時間換取空間，為自己將來好聚好散，留個退路。

楊志良接受慰留前，曾私下感慨，「我要的是制度，不是方案。」府院通過的妥協方案，並不是他真心想要的，但也只能硬著頭皮推下去。更何況，馬總統還同意了他自己提出的藥方：二代健保，雖然他完全不知道，這個方案還要提到立法院去審議，立法院能不能在會期內通過，尚在未定之天。

健保到底是醫療保險？還是醫療福利？從折衷方案看來，台灣傲視全球的全民健保，差不多已經成為社會福利了。吳揆最了解民間情緒，但凡涉及漲價者，最好都不漲，就像油電水價與稅；但凡涉及政府補助者，只可增加不可減少，遑論取消，就像老人年金。換言之，健保調漲的差額補助，雖說以二年為期，迄二代健保接手後終止，但是，二代健保到底能不能如願在二年內接軌，還是未知數，即使接手，二代健保的保費若較現制又要再漲，多數民眾亦未必接受。政府用補助方式壓縮健保調漲的社會衝擊，並彌填健保財務虧空的大洞，但還是沒找到健全健保財務的根本之道。

健保調漲只是吳內閣決策危機的冰山一角，吳揆不缺政治手段，選戰參謀綽綽有餘，但身為行政院長，肩負舉國興廢，終究不能只靠政治手腕，愈是敏感棘手的政策，愈得膽大心細，不能事事靠總統擺平。楊志良辭官引爆了內閣閣員潛藏在心底的隱憂，特別對講究專業的部會首長們，一個是否尊重政策專業的閣揆，會是決定未來他們願不願意留在官場為國效力的關鍵。庶民經濟沒什麼錯，但若全照著民眾情緒走，萬事俱由國家補助扛下，把各部會的難題全推到了財主單位，以目前國家財政之困窘，下一個想辭官的首長就快浮上檯面了。