From Capitalist Thinking to Welfare State Thinking

From Capitalist Thinking to Welfare State Thinking
United Daily News editorial (Taipei, Taiwan, ROC)
A Translation
December 11, 2010

Second generation health care has undergone protracted debate. Yet on the eve of a vote, proponents have suddenly done an about face. They have abandoned the total household income approach for calculating premiums. They have gone back to the first generation method for calculating health care insurance premiums, using six categories and 14 items. This is truly unwise, Society has outgrown its old clothes, which have been patched repeatedly over the years. It finally chose to buy a new set of clothes. But when the time came, it was afraid to wear them. This is truly frustrating.

This constitutes a major turnaround in national health insurance policy. The word is recent clashes between the ruling and opposition parties over the fairness of second generation health care charges were heated. Even Blue Camp legislators described it as "evil health insurance," and "the most absurd health insurance ever." To avoid offending certain voters, Blue Camp legislators rebelled from within, and blocked passage of second generation health insurance without outside prompting. The current vote is over an irrelevant matter. The bill now finds itself stranded, high and dry.

Legislators and the Executive Yuan must try to understand public sentiment. Opposition to the controversial fee-based approach is not the same as opposition to expanding the health care premium base. Opposition to income-based premiums is not the same as opposition to higher premiums. The Executive Yuan jettisoned the entire bill merely because the public demanded more satisfactory answers. It undid half the progress made. It abandoned the second generation core concept of "total household income." It suddenly assured the public that "The older system was better." It handled the matter irresponsibly, and underestimated public understanding.

Letters to the editors of newspapers and online discussions tell a different story. The "Citizen's Oversight Insurance Alliance" has leveled the harshest criticisms. But even it has repeatedly made clear that it supports expanding the fee base for second generation health care. Doing so would bridge the ever worsening fiscal gap that has developed in first generation ealth insurance over the past 15 years. It would also address the problem of unfair burdens. To the public, National Health Insurance is the nation's proudest social policy. It is an important social asset that promotes social solidarity and protects public health. It solves many of the problems poor families encounter when ill. Before health care insurance was introduced, many underprivileged citizens could not afford medical care. Whether they lived or died depended on their economic fortunes. Today the situation is different. Health care insurance has rewritten their life stories. The public on Taiwan knows full well that "National Health Insurance must not be allowed to fail." The public is psychologically prepared to "pay more money to save health care."

Therefore the government must have people pay more, but only in a manner they consider acceptable. As Health Commissioner Yang Chi-liang told the public recently, the NHI program is a form of social insurance. Its purpose is social security. "People with the same income will pay the same premiums. The higher one's income, the higher one's premiums." Recently voices have been raised in opposition. They question the methods used to calculate second-generation health care insurance premiums. They differ from the above mentioned criticisms. A household with the same total income might be forced to pay different premiums because the family includes "virtual income" from a family members who have accrued large capital gains. Capital gains are not included when calculating premiums. But every dime in money earned by the working class is. Health insurance premiums is not the same as tax reform. But inequities in the former will still provoke feelings of "comparative exploitation."

The government should not fear efforts to seek more satisfactory solutions. It should not allow itself to be trapped on the horns of a "damned if you do and damned if you don't" dilemma. Above all it should not throw the baby out with the bath water.

Heated controversy over second generation health care is a clear reflection of our "M-shaped society." The arguments advanced show that the public expects more from the government. People wants to the State to assume greater responsibility for peoples' lives. They want to move away from capitalism and individualism, under which individuals purchase whatever they need, and move toward the welfare state, with its "social solidarity" and "government safety net," Recently calls for public housing, preschool education, long-term care, and the extension of compulsory education have become ubiquitous. Faced with an M-shaped society, the government must think and plan anew.

The fee-based and rate-base debate highlights social and ethical attitudes about how "the rich must help the weak." During the current debate, we have seen how stingy some of the wealthy can be. But we have also seen how generous and compassionate other economically well-off individuals can be. After all, no social welfare state, in Europe or elsewhere, pays for social welfare with "state" money. Instead, citizens who are better off encourage the government to promote social welfare, via policy and taxation, ideologically and morally. Without such public sentiments, no money would be available to support a social welfare state. Citizens would feel no sense of moral obligation, no sense of accomplishment, and no sense of honor. Ultimately, ideological change is a prerequisite for systemic change.

Society is becoming increasingly M-shaped. Disputes over second generation health insurance remind the government and society that they must move from capitalist thinking to social welfare state thinking. The government and the public must change their thinking. Everyone must be onboard.

從資本主義思維轉向福利國家思維
【聯合報╱社論】 2010.12.11

吵嚷多時的二代健保修法，在表決前夕，突然大轉彎。放棄研議經年的家戶總所得保費計算方式，又回到一代健保的六類十四目投保方式。這結果著實不智，明明是一件長大的身軀早已穿不下的舊衣，多年來修修放放，終於下定決心做了件新裳，到頭來卻還是沒有勇氣穿上身，豈不令人氣結？

健保出現大轉彎，據說是近日朝野對二代健保收費的公平性抨擊砲火太猛烈，連藍營自家立委都說是「惡代健保」、「最扯的法案」。為了不得罪部分選民，藍委窩裡反，自動把二代健保給封殺，日前院會只表決一條無關痛癢的條文，全案擱淺。

但是，立委們與行政院務必弄清楚廣大民眾的心情：反對二代健保裡有爭議的擴大費基執行方法，並不是反對擴大費基；反對二代健保裡的所得定義，並不是反對多交保費。由於民間有求好的批評聲浪，行政院就翻案如翻書，抹掉下了一半的棋局，棄守二代健保的「家戶總所得」核心概念，突然跟民眾說：「舊的比較好。」這種作法除不負責任之外，也顯示將民心看得太過膚淺。

由本報民意論壇投書、民眾、網路的討論可知，即使抨擊最力的團體「民間監督健保聯盟」都一再表明，支持二代健保的改革理念──擴大費基，解決一代健保實施十五年來不斷惡化的財務缺口，並杜絕負擔不公平的沉痾。因為台灣民眾知道，全民健保是台灣最值得傲人的社會政策，是促進台灣社會團結、維護人民健康權的重要社會資產。解決了無數因病而貧的家庭難題，尤其是社會中的弱勢者。在沒有健保的時代，多少弱勢者因貧無力看病，死活就看造化。如今不同，健保改寫了這些生命劇本。台灣民眾非常明白「健保不能倒」，老百姓早有了「多繳錢，救健保」的心理準備。

因而，政府此時須為應為之事就是：讓民眾多掏錢，但掏得心甘情願。如同楊志良署長日前向民眾喊話時說的：全民健保是社會保險，目的在於追求社會安全，「同樣的所得，負擔相同的保費；所得較高者，負擔較多的保費」。近日反對的聲浪，也就是質疑二代健保在新的計保方式上，與上述的承諾相違──同樣所得的家戶，可能因為家中有被設算「虛擬所得」的人口，而負擔了不同的保費；所得較高的許多「資本利得」者，錢滾錢的所得未列入保費計算，但靠勞務賺錢的受薪階級，卻一毛錢都跑不掉。當然，健保收費與「稅賦改革」是兩回事，但仍須顧慮可能引發的「相對剝奪感」。

其實，政府不該害怕這類「求好心切」的辯論，而陷入「父子騎驢」的窘境，更不該最後竟把驢給殺了。

此次二代健保引發的激烈爭議，可說是反映了Ｍ型社會一場具體而微的社會辯論。種種爭論正顯示台灣民間對政府的更大期待，要求國家對人民的生活照顧負起更大的責任；由「一切靠自己購買服務」的資本主義、個人主義思維，往「社會互助」及「政府讓你靠」的福利國家思維前進。近期民間提出的社會住宅、公共托育、長期照護、延長義務教育等等的要求，無一不是呼應這種大趨勢而興的社會運動。政府面對Ｍ型社會，須有新的思維，拿出新的政策。

相對而言，在費基及費率的辯論中，也凸顯了「富者應當幫助弱者」的社會倫理思維。在此次辯論中，我們看見了有些富者的吝嗇，但也發現了更多的經濟條件較佳者的慷慨及熱情。畢竟，任何社會福利國家（如歐洲）皆不是「國家」出錢支付社會福利，而是優勢公民在思想、道德、行動及納稅上，支持政府推動社會福利。若無此種民胞物與的情操，社會福利國家就不可能有錢推進，其國民更不可能有道德感、成就感與光榮感。畢竟，思想改變是制度改變的前提條件。

在社會日趨Ｍ型化的走向中，二代健保的爭議，提醒政府與社會，必須從資本主義思維，轉向社會福利國家思維；政府及人民均須調整心態，缺任何一方皆不可。