Giles Ji Ungpakorn
The latest attack on the Taksin government’s universal health care policy has come from the junta’s health minister Beeyasakon Sakonsatyatorn. He is the latest in a string of free-market fanatics to propose reintroducing health care charges for the poor under the spurious excuse that the government cannot afford to keep it free. Naturally, Generalissimo Prayut, and the rest of the military dictatorship gang, agree with him.
Before the election of the first Thai Rak Thai government under Taksin, Poor people in Thailand could not afford proper health care. They were either forced to fall into debt, depend on relatives or grovel for scraps of charity. If all that failed they just suffered or died. Dr Sanguan Nitiyarumpong, and others, campaigned to encourage the Taksin government to introduce the first ever universal health care scheme. People were charged a token 30 baht for each hospital visit and they were then entitled to almost all treatments at no extra cost to them. The idea was to modernise Thai society and include all those who were not covered by any health insurance scheme in a basic universal health policy. The vast majority of those who received 30 baht health care cards were rural people working in the agricultural sector, the self-employed and the unemployed. The scheme also covered children and the elderly. It also benefitted urban workers who already had health insurance but had previously been responsible for the cost of their rural relatives’ health care.
From its very first introduction, the free-market neo-liberal fanatics started to criticise the idea that all citizens should be entitled to health care. Foremost among the critics were Democrat Party politicians like Abhisit Vejjajiva and various right-wing economists. The entire old guard of the un-elected elites were, and still are, strongly opposed to spending state money for the benefit of most citizens, especially the poor. An ugly and reactionary chorus complained of a “lack of fiscal discipline”. Naturally, no such terms or complaints are ever directed against increased military spending or lavish spending on the royals.
After the 2006 military coup, which overthrew the Taksin government, the Bangkok Post reported that the Budget Bureau cut the budget for Thai Rak Thai’s universal health care scheme by 23% while increasing military spending by 30%. The military budget had started to fall under the Taksin administration.
The military junta at the time decided to scrap the 30 baht charge, but this was a double-edged sword because many members of the junta and their advisors had a nasty hidden agenda. They had long made it clear that they wanted to introduce so-called “co-payments” at a later date which would have far exceeded the original 30 baht fee. These co-payments would be charged according to income with only the poorest of the poor being given low grade free health care. Fortunately they could not immediately achieve their warped dream. This is mainly because the ruling class is wary of destroying this popular policy.
The term “co-payment” is a dishonest term. All Thai citizens pay tax to the government and this is used for state spending. Even the poorest people who pay no income tax are still forced to pay indirect taxes such as VAT. In fact, while many of the rich avoid tax, the poorer sections of society pay more in taxes than the rich when compared to their incomes. This is due to an over-dependence on indirect and regressive taxation. So-called “co-payment” is nothing but the state’s withdrawal from the responsibility to provide basic services in health care.
The degeneration of politics under the Yingluk government was exposed by its frantic use of the lèse majesté law, but also by the fact that the minister of health in that government reintroduced the idea of co-payments in May 2013. Fortunately it also came to nothing.
After the Prayut military coup in May 2014 the permanent secretary for health, Dr Narong Sahametapat, suggested that the universal health scheme be scrapped and patients be made to pay up to half of their own health care costs. Narong Sahametapat had been part Sutep’s violent middle-class mob which eventually wrecked the February 2014 elections. He later joined the junta’s anti-reform committee. Naturally the military budget shot up to unprecedented levels after the coup and the health care budget was cut back.
Now these creatures are again claiming that there is no money for health care. The truth is the exact opposite. There is plenty of money in Thailand but the problem is that it is concentrated in the wrong hands.
Health activist Nimit Teanudom has pointed out that since the Prayut coup, new bureaucratic regulations introduced by the junta have made it harder for hospitals to use funds from the “30 baht” scheme for many vital activities. The junta has also restricted the role of the state pharmaceutical organisation in supplying drugs to hospitals. It seems that they are quietly attacking the system through the back door in order to claim that the scheme, as it stands, needs to be abolished.
Never the less, past experience shows that public criticism of schemes to roll-back the “30 baht” system have forced government officials on to the back foot. We must increase this criticism.
An essential part of the struggle for democracy is the need to destroy the power and influence of the military. The military and royal budgets should be slashed. Progressive taxes should be levied on the rich and the large corporations. State pharmaceutical companies should break the oppressive drug patents controlled by big pharma in order to lower the cost of essential drugs. There cannot be democracy without the right of all citizens to access free decent health care and education.