From Capitalist Thinking to Welfare State Thinking
United Daily News editorial (Taipei, Taiwan, ROC)
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.