Keep politics out of the healthcare debate

It turned out to be only a “rumour” that the universal healthcare scheme was to be scrapped, but the outcry it caused served to underline the programme’s importance. Users of the social media raised a roar of dismay and the alarm spread among the general populace before Prime Minister Prayut Chan-o-cha stepped forward on Monday with reassurance that there was no intention to end the “Bt30 healthcare plan”, as it was originally known. 

There has been from the start a group of doctors who have warned that public reliance on government-subsidised healthcare will continue to increase, steadily draining state funds. They have proposed in its place a “co-payment” scheme by which citizens who can afford to pay more do so, lifting much of the weight from the government’s shoulders so that lower-income people can receive healthcare for free. 

Even such compromises fail to assuage critics of what began as a classic “populist” election campaign pledge. They point out that the country is suffering financially in spending Bt120 billion a year subsidising healthcare for almost 50 million people.

Advocates of universal healthcare counter that the government spends just 4 per cent of Gross Domestic Product on healthcare, a moderate proportion that poses no economic threat in the short term or the long term. Japan adopted universal healthcare 50 years ago, when its GDP was significantly smaller than Thailand’s is today. Rights activists add that Thai people are entitled to the state’s care as a fundamental right of citizenship.

For Thais who struggle to make ends meet, the programme has been a boon since its implementation in 2002. They no longer have to worry about money when they are injured or fall ill. Gone are the days when personal dignity had to be sacrificed because they required free medical treatment, when they would be tarred with the epithet “anatha” – destitute patients. 

Like any other socially beneficial government programme that is simple and straightforward in its conception, the Bt30-per-medical-visit scheme has demanded efficient teamwork to keep it sustainable. The task will only become more difficult as society continues to age because of the low birth rate. The cost of running the plan will never stop rising. The government would do well to regard whatever arguments arise now as blessings in disguise – criticism that can be mined for constructive help in refining the scheme and finding ways to keep it going. 

As long as universal healthcare remains in place, safe for now from its detractors, the government should be studying its strengths and weaknesses. It could well combine universal healthcare with the Civil Medical Benefit Scheme, as has been proposed, or seek sources of additional funding outside the state budget to maintain the programme as it stands. 

Currently about five million people are registered with the CMBS, each spending Bt12,000 per annum, far in excess of the average Bt2,700 spent by those relying on universal healthcare.

Further debate – and even the occasional alarmist rumour – ought to do us some good. Debate, however, can only be tolerated if it is free of a political edge. Since it was former premier Thaksin Shinawatra who introduced universal healthcare, the argument over its continuation easily leads into political cul-de-sacs. All that is at stake now is the continued well-being of the public. 

Political agendas must be put aside.