Health Insurance Problems Will Persist Even If Yang Chih-liang Stays
China Times editorial (Taipei, Taiwan, ROC)
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.