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WHO praises Thai Universal Health Care while junta wants it destroyed
Ugly Truth Thailand - September 23, 2018
The success of the Thai Universal Health Care scheme means that ordinary Thai citizens receive better health care than millions of people living in the United States.
It is worth reminding ourselves of the history of the Thai Universal Health Care scheme. It started out as a proposal by progressive doctors like Sanguan Nitayarumpong. Taksin Shinawat's political team who were building the Thai Rak Thai Party in order to fight their first election in 2001, listened to people like Sanguan and took his idea on board to make it an important part of their election manifesto.
After winning the election, Taksin implemented this health care policy which charged everyone a flat rate 30 baht for visits to hospitals. The scheme was designed to cover anyone who was not already part of the National Insurance or Civil Service scheme for employees and resulted in everyone being covered by a health care scheme. It was especially valuable to villagers in rural areas, people in informal employment and their children.
This health care scheme has always been opposed by the extreme neo-liberals in the Democrat Party and within the two military juntas which staged coups against Taksin-led governments.
The Democrat Party spent most of the time during Taksin's first government attacking his pro-poor policies, including the Universal Health Care scheme, as being a waste of government money and against "fiscal discipline". No wonder most working class or poor Thais never voted for the Democrats.
When the Democrats eventually formed an unelected government with military backing in December 2008, they cut the universal health budget by almost a third. The military budget was increased and has continued to increase under the two military juntas that followed the 2006 coup.
Academics like Tirayut Boonmi and Ammar Siamwalla talked about Taksin building "a climate of dependency" with "too much" welfare. Other rich snobs in the academic world claimed that the ignorant poor would just visit hospitals "every day". In fact the health care policy fulfilled an urgent basic need for millions.
After the 2006 coup the military junta announced that they were scrapping the 30 baht treatment fee. What looked like a progressive measure was really an attempt at a neo-liberal trick. The plan was to gradually introduce means-tested fees in the future. For those deemed to be too well-off, a system of "co-payments" or health charges, way above 30 baht, would be introduced at a future date.
Meanwhile the very poor would receive bad quality free health care. Even some members of the Yingluk government toyed with the same idea under pressure from the neo-liberals.
By a slight of hand, the military constitution of 2017 has changed the clause concerning health care. The key word removed from the previous constitution is "equality". The junta's 20 year health development plan also talks about co-payments.
So far the various military regimes have not dared to introduce health charges. But General Prayut and his team keep talking about the health care scheme, which covers 48 million Thais, being a "burden" when the country "cannot afford it". The real burden is actually the role of the military and its huge budget. The Royal Family, especially Wachiralongkorn, are also a useless burden.
Now, once again, voices in the junta's Ministry of Finance are suggesting that anyone earning over 100, 000 baht per year should be charged up to 20% of their health care costs. Workers on the minimum wage earn about 90,000 baht and struggle to make end meet.
This is a serious neo-liberal attack on the Universal Health Care scheme and if it is introduced it would be the thin end of a wedge to create a two-tear system within the scheme, but to also allow for bigger increases in health charges in the future.
We desperately need a mass movement which both campaigns for democracy and against the neo-liberal policies which exclude the majority from fully enjoying the benefits of society.