Health Insurance Must Not Become the Meat Chopper for Health Ministers
Health Insurance Must Not Become the Meat Chopper for Health Ministers
China Times editorial (Taipei, Taiwan, ROC)
January 6, 2010
Yaung Chih-liang has quit. His departure reveals the cruel logic of Ma administration. There are those officials who have upheld their idealism, have assumed total responsibility, have committed to public policy objectives, and have also earned the public trust. But when push comes to shove, they are left in the cold and decided to step down. How can the public not be disillusioned?
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The Second-Generation National Health Insurance Bill has become law. The Ministry of Health estimates that once health insurance premiums and premium base 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 shortfall in the health care system budget, and to make the system more egalitarian. The amended law gets a passing grade.
But as predicted, Health Minister Yaung Chih-liang has stepped down. Once again, health insurance rate hikes have become an excuse to crucify the Health Minister. The political environment on Taiwan has once again subjected experienced professionals to undeserved abuse.
Seeking new sources of income, Second-Generation National Health Insurance 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 premium base has been expanded. As a result, annual premiums will increase NT$ 20 billion. According to Health Ministry 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 National Health Insurance 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 insurance system's limited resources. For underprivileged families and victims of domestic violence, Second Generation National Health Insurance will continue to honor their cards so that they can get medical attention when ill even if they cannot pay the premiums, or they are late in their payments.
Yaung Chih-liang and other medical professionals had certain ideals. For them, Second Generation National Health Insurance failed to adopt a "total household income" policy for calculating premiums by nullifying six categories and 14 items defining the status of policyholders. For them, this amounts to a major failure. Nevertheless, it mandated increased premiums. Health insurance rates for the majority of salaried and working class policyholders were reduced from 5.17% to 4.91%. Approximately 83% of all policyholders will have their premiums reduced. This is probably the best compromise possible between ensuring a solvent health insurance system, and minimizing the financial burden on the public. It was also a major achievement for long-suffering Health Minister Yaung Chih-liang. Unfortunately, he still decided to step down.
Look back at the history of health insurance. Every Health Minister understands that when the NHI was created, no one had any experience with national health insurance. 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 Minister 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 Yaung Chih-liang, and health insurance rate hikes have become synonymous with Health Ministers stepping down!
But the most ridiculous aspect of Yaung Chih-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 hike was proposed. Concerned about the five cities elections, Premier Wu Den-yih pressured Yaung Chih-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 Yaung Chih-liang stay on. Their two-faced behavior was truly disgusting.
Li Ming-liang defended Yaung Chih-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 Yaung Chih-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.
Yaung Chih-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 Ministers of Health in rapid succession, including Lin Fang-yu, Yeh Ching-chuan, and Yaung Chih-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 Ministers of Health are being used up.
Yaung Chih-liang has quit. His departure reveals the cruel logic of Ma administration. There are those officials who have upheld their idealism have assumed total responsibility, have committed to public policy objectives, have also earned the public trust. But when push comes to shove, they are left in the cold and decided to back down. How can the public not be disillusioned?
(Courtesy of China Times)