Health Care Must Be More Than a Pretext for a Crucifixion
China Times editorial (Taipei, Taiwan, ROC)
January 6, 2011
The Second Generation Health Care Bill has become law. The Department of Health estimates that once health care premiums and coverage are adjusted, the health insurance system will remain solvent for the next five years. It will not have to raise premiums. The main intention of the bill passed by the Legislative Yuan was to make premiums fairer, to cover the shorfall in the health care system budget, and to make the system more egalitarian. The amended law gets a passing grade.
But as predicted, Director of Health Yang Chi-liang has stepped down. Once again, health insurance rate hikes have become an excuse to crucify the Director of Health. The political environment on Taiwan has once again subjected experienced professionals to undeserved abuse.
Seeking new sources of income, Second Generation Health Care has undergone a major change, from a single-track system to a dual-track system. The current system calculates monthly premiums entirely on the basis of income. This is the standard premium. The new system calculates monthly premiums on the basis of dividends, interest, and business income as well. This is the supplementary premium. The fee base has been expanded. As a result, annual premiums will increase 20 billion NT. According to Department of Health estimates, the dual-track system will obviate the need for health insurance rate hikes for the next five years. As a result of the new supplementary premium system, highly-paid professionals, major investors in the stock market, company bosses worth hundreds of millions of dollars, highly paid performing artists, and highly-paid talking heads will have to pay higher premiums. This is consistent with public demands for social justice.
In addition to increased premiums, Second Generation Health Care includes other reforms. For example, expatriates usually do not need to pay premiums. But they often make special trips to Taiwan each year. They renew their policies, pay the premium for one month, and immediately begin enjoying exactly the same benefits as everyone else. The new system requires expatriates to return for a six-month waiting period. Only then can they begin receiving benefits. These reforms will reduce the extent to which people exploit the health care system's limited resources. For underprivileged families and victims of domestic violence, Second Generation Health Insurance will continue to honor their cards even if they cannot pay the premiums, even if they are late in their payments, and if they are sick and unable to receive medical care.
Yang Chi-liang and other medical professionals have certain ideals. Second Generation Health Insurance failed to nullify six categories and 14 items defining the status of policy holders. Instead it adopted a "total household income" policy for calculating premiums. This amounts to a major failure. Nevertheless it mandated increased premiums. Health insurance rates for the majority of salaried and working class policy holders were reduced from 5.17% to 4.91%. Approximately 83% of all policy holders will have their premiums reduced. This is probably the best compromise possible between ensuring a solvent health care system, and minimizing the financial burden on the public. It was also a major achievement for long-suffering Director of Health Yang Chi-liang. Unfortunately, he was still forced to step down.
Look back at the history of health care. Every Director of Health understands that when the NHI was created, no one had any experience with national health care. Estimates for premiums, for dependents, for fees and other items were still very rough. They soon had to be adjusted upwards. But no one dared to make the first move. Anyone who did, would be blasted by the Legislative Yuan. The Executive Yuan, needless to say, cowered and did nothing. In 2002, Li Ming-liang was the only Director of Health who dared call for a rate hike. But as soon as it was passed, he too had to step down. Add to this the example of Yang Chi-liang, and health insurance rate hikes have become synonymous with Directors of Health stepping down!
But the most ridiculous aspect of Yang Chi-liang's resignation was that he was not forced to step down due to pressure from the opposition party or the public. He was forced to step down because he was sabotaged and attacked by the ruling party executive and legislature. The most popular official in the cabinet was forced to tender his resignation. Last March, health insurance premiums were hiked. Concerned about the five cities elections, Premier Wu Den-yih pressured Yang Chi-liang not to increase rates as much as planned. In November, the Second Generation National Health Insurance Bill was submitted to the Legislative Yuan. Amazingly, KMT legislators were the ones who blocked the bill. Then, over the past two days, KMT legislators were the ones who asked teary-eyed, that Yang Chi-liang stay on. Their two-faced behavior was truly disgusting.
Li Ming-liang defended Yang Chi-liang. Li said that when he proposed dual increases in health insurance premiums, there was a public outcry, A number of NGOs and trade unions took to the streets. The pressure was immense, and hard to imagine. But at least he had the support of the Presidential Office and the Executive Yuan. Public opposition to the current increase was comparatively mild. But ignorance on the part of the ruling party and deliberate distortions spread by the opposition party left Yang Chi-liang all alone, hung out to dry, surrounded by enemies, front and rear. He had no choice. Not leaving would merely have made him a glutton for punishment.
Yang Chi-liang's resignation has been approved. He asked to be relieved, and he was. The public sees him as a man with the courage of his convictions, as a political appointee with the guts to defend his own policies. Over the past two years, the Ma administration has used and abused three Directors of Health in rapid succession, including Lin Fang-yu, Yeh Ching-chuan, and Yang Chi-liang. All three were well thought of by the medical community. All three were capable professionals. Yet their average tenure was less than one year. They did not step down because they committed major errors in medical policy. Yeh Ching-chuan was ordered to resign and wage an unsuccessful campaign for elective office. This underscores the alarming rate at which Directors of Health are being used up.
Yang Chi-liang has quit. His departure reveals the cruel logic of Ma administration rule. It persistently trumpets its idealism, its assumption of total responsibility, its commitment to public policy objectives, and to cabinet officials who have earned the public trust. But when push comes to shove, all it ever does is back down. How can the public not be disillusioned?