A long lasting national social health insurance system – Capitalism at its core

I’ve been trying to come up with a better plan for our Public Health Insurance, or I should call it, our “Social health insurance,” because most of the users are paying far less than it should have cost. The ultimate ideology is to make medical care affordable for everyone. Unfortunately, to reduce opposition during the installation of the system, the overall fee for the insurance was lowered to an extend that’s almost intolerable for the massive running system, that just about everyone is shouldering the price. That everyone includes the medical staffs, the hospital, and the public in general. A general physician could only make around 200 NT per patient for a general check-up, and the hospital has to adopt to various controversial new budget saving plans. In order to save budget and generate income for the hospitals, they needed to cut down the employees (medical staffs, that means nurses and other medical professionals) while shoot up the patient visits. In doing so, the overall patient/med team ratio was increase, and inevitably lowered the quality of medical care. So while the patients (that means the public) are paying less for their visits to the hospital, the loss is on their side as well. Some of the most commonly experienced trips to the clinics are “long waiting time” and “incredibly short evaluating period.” Not to mention those overworked medical staffs. The room to improve remains profoundly enormous.

The roots of all evil is simple: money. Since the docs are getting paid less per patient, the time spent is of course gonna be shortened. The patients ain’t stupid, if they think they’re not getting evaluated/diagnosed properly, they’d go and seek for secondary opinions. Fair enough, since the cost per visit is marginally affordable to make 2 or more trips for most of the patients. Now the government is again trying to solve this problem by raising the monthly fees by adjusting the rate according to a person’s income. While this may sound reasonable, the definition of income is extended beyond the boundary of salaries, in the sense of saving interests, investments, and stock market exchanges. This new controversial plan was doomed to stir the public, and eventually marked another stain on the already rugged dairy of Taiwan Health Insurance.

So why can’t we do it the way like “health insurance” companies are doing? Can’t we adjust the fee according to the health status and number of annual medical cost? Those who visit the hospital infrequently and take very good care of their health to be rewarded with free annual full-body check-ups included in their minimal fees. The ones that eat up massive non-primary diseases  fees (type-II DM, atherosclerosis, hyperlipidemia, to name a few) should be bearing on the higher end of the fee. And of course, other accidental disasters and diseases (hey, they can be calculated according to their risk of onset and so on) can be the main coverage of the insurance package. With that as the central guideline, at least 2 of the most infamous medical behaviors should be vastly reduced: 1) excessive medical visit by the patients and 2) unnecessary prescription by the physicians, since both of these will add to the annual medical cost, which would then be reflected to the monthly fee of the future.

Once again like I’ve always come to believe, altruism and communism only function in small societies. The natural instinct of a human being in a wild world is to survive, and therefore mostly selfish. In order for a national medical system to function in a long-lasting way, the core principle has to follow that of a capitalism, and then assisted by socialism (it’s a system for the whole society, after all). Once again, the evil capitalism prevails.

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