Tag Archives: universal health care

Thai NGOs short-sighted because of single-issue politics

Giles Ji Ungpakorn

Recently a number of NGOs in Thailand, including Amnesty International and many local groups, have been announcing “demands” on the military junta. One would have expected that the number one demand would be for the junta to resign and make way for free and fair elections immediately. The Second demand ought to have been the immediate release of all political prisoners. Not so, these NGOs seem to think they can work with the junta and spend time lobbying them like they were a normal and legitimate government. Of course, in the past some of the NGO activists even went as far as to support the overthrow of democratically elected Thai governments.

The first group of NGOs “demanded” that the junta and private businesses respect human rights according to the United Nations Guiding Principles on Business and Human Rights. There was no mention of trade unions or trade union rights among the list of demands.

The second group of NGOs “demanded” that the unelected junta “reform” the police. This is at a time when the police are controlled by military units who act as policemen in local areas and force their way into people’s homes.

It is difficult to know whether to laugh or to cry at such naïve calls from these NGOs!!

The present ruling military junta shot its way to power by murdering pro-democracy demonstrators in 2010, encouraging the judiciary to undermine elected governments and allowing anti-democratic mobs to wreck elections. After taking power, Prayut’s junta has continually detained those who oppose the dictatorship, forcing them to attend “attitude changing sessions” in military camps. More and more people have been jailed under the notorious lèse-majesté law, often after appearing in military courts. Academic seminars and political meetings have been banned or forcibly shut down. Social media and the internet are constantly monitored and the junta has attempted to censor posts and video clips. The junta’s servants have drawn up a new constitution with the specific aim of installing a system of Guided Democracy under the control of the military. And yet there are people who seem to believe that the bunch of thugs now ruling Thailand will somehow respect human rights and reform the police?!

And why should the junta listen to these “demands” by people who cannot or will not build mass social movements? What bargaining power do the NGOs have?

In order to believe the NGO fairy-stories you have to be extremely short-sighted about politics, even to the point of closing your eyes to the real world. This mind-set is helped by a single-issue obsession and a rejection of political and economic theories. [See http://bit.ly/1UpZbhh ]

Another current issue is that the present junta is trying to destroy the universal health care system which was brought in under the first Taksin government. High up on their agenda is an attempt to bring in “co-payments” for health treatment which is currently free. It is good to see that NGO health activists and their supporters have been on the streets opposing this. It is a credit to these groups that they have mobilised around this issue.

Yet, even these NGO activist suffer from single-issue politics and the rejection of theory. One of their demands is to maintain the purchaser-provider split, in other words they support the internal market in health care. The internal market has been helping to wreck the health service in Britain by allowing privatisation and funding cuts and the destruction of family doctor services in local communities. It is also extremely wasteful, leading to the employment of thousands of accountants and administrative staff instead of employing more clinical staff. That is why the British Labour Party is talking about abolishing the internal market which was brought in under Margaret Thatcher.

One particular Thai NGO leader has even called for the private sector to play an important role in health care! This is just aping the right-wing ideology of the neo-liberals throughout the world.

The internal market in health is the opposite to a universal health care system which prioritises the needs of all citizens irrespective of wealth. Profit-seeking by private companies should never have a place in the provision of health care.

The health NGO activists also see themselves as “representatives of the people” without having ever stood for elections. They distrust representative democracy. Yet the real democratisation of health care, with elected representative taking part in the management of local hospitals and health budgets would be a significant step forward in Thailand. Of course, none of this could be achieved under a military junta.

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Why the junta’s draft2 of the constitution should still be opposed

Giles Ji Ungpakorn

If we look at the various attempts by the junta and its acolytes to draw up constitutional drafts which give them power over elected governments, one cannot help feeling that these attempts are the pathetic work of people whose world view is so narrow and inferior that they have no ability or wish to actually draw up some basic democratic political rules which will be accepted by the majority of citizens. Their attempts have range from the extremely childish first draft which talked constantly of the need to elect “good people” to this latest version which is painfully transparent in its attempts to retain the power of the junta. [See http://bit.ly/1Jv5QDC and http://bit.ly/1ScVIR6 …]

This is not a draft constitution; it is a document outlining the prejudices of those who have seized power through the barrel of a gun.

This draft, written under the direction of arch-conservative Meechai, has a 3 page prologue which full of lies. The aim of the prologue is to write a script for the king to praise Generalissimo Prayut and all his “achievements”, highlighting the fact that Pumipon is just a tool of the military. The prologue claims that the constitution will prevent politicians seizing power for their own ends, thus justifying the use of coup d’états by the military for its own ends. It talks about “Thai-style” democracy, which history has shown to be the opposite of democracy. It tells blatant lies about how the population has been involved at all stages in drafting this piece of toilet paper. The truth is that soldiers have repeatedly shut down discussion meetings about the constitution and threatened all those who advocate opposition. Finally it repeats the old worn-out lie that king Rama 7th “gave democracy” to the Thai people, when in fact the People’s Party had to put a gun to his head to force him to give up his absolute powers in the 1932 revolution.

Any piece of nonsense with this kind of prologue is never going to build freedom and democracy.

Article 5 of the draft constitution gives special powers to a group of political leaders to determine the future of the country “in times of crisis”. This super body has a junta appointed majority and it will be they who determine the definition of a crisis.

Like the previous draft an opening has been created for a Prime Minister to be chosen from a non-elected person who is not an MP under certain circumstances. Article 5 deals with this, but especially article 272, which “iLaw[1]” has highlighted as allowing a non-MP to be chosen after the first election. If this were to happen and a military man was chosen as the next Prime Minister, they could then entrench military rule further.

According to iLaw, Article 67 gives special privileges to Teravad Buddhism over all other religions and cuts out the sentences in previous constitutions about promoting good relations between religions. In addition to this article 31 only allows religious freedom if it is not a threat to national security. This opens the door to the persecution of Muslims or Buddhist sects which are not approved by the military.

In a new development, this awful draft destroys welfare rights for citizens in a typical neo-liberal fashion so popular with the conservatives.

Article 47 destroys the concept of universal health care by merely stating that the government has a duty to provide the very poor with free treatment. At a stroke the clock is being turned back to the bad old days.

On the issue of free, state education, article 54 in this draft has been roundly criticised by many school student activists because it talks about providing free pre-school education while cutting the aim of free education in the final years of secondary school.

As with the previous draft, the method used to calculate the number of MPs that each party will receive is designed to help middle-sized parties like the Democrats. But the senate is now to be 100% appointed by the military and senators are to hold office for 5 years, 1 year longer than elected MPs. The senate has increased powers over elected governments.

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The junta has made sure that any constitutional amendments will be very difficult to achieve because they will require a majority vote of the two houses sitting together, 20% support from the opposition and support from at least 1/3 of appointed senators.

At the end of this worthless scrap of paper article 16 insults the intelligence of citizens, claiming that they need to be “taught” about democracy, no doubt by conservative military types who hate the concept in the first place.

This draft constitution not only has a prologue but also has an epilogue. Both are equally appalling. The prologue is all about white-washing and justifying the crimes of the junta and about ensuring the continued influence of the military after elections.

On 12th April the blood-stained Generalissimo Prayut admitted that he does not trust the Thai people to elect a “good” government. This was his justification for the draft constitution. We certainly don’t trust him or his allies to bring about political reform or democracy!

Notable supporters of this authoritarian document among politicians include Sutep Teuksuban, Democrat Party mobster leader who violently opposed the last general elections, and highly corrupt politician Banharn Silapa-archa. One would not expect anything else from these two.

This draft constitution needs to be vigorously opposed. Even if it somehow passes in a flawed referendum where all discussion about the document is banned and more and more people are being dragged into army camps for “re-education”, the struggle to overthrow the dictatorship must continue.

[1] http://freedom.ilaw.or.th/en

Latest update: Prayut threatens all those who campaign against the military draft constitution before the so-called referendum with 10 years in jail…. some referendum!!

Thai neo-liberals constantly try to destroy universal health care

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.

The dearth of debate about the free market and economic policy

Giles Ji Ungpakorn

 In Thailand today there is a lack of debate about the free market and economic policy. An important reason is the weakness of the Left. On a global scale, since the neo-liberal consensus of the 1980s, it has been the Left which has traditionally criticised free market policies by posing alternative economic strategies. In Thailand this left-wing opposition has been very weak, especially because the main force on the Thai Left was the Maoist Communist Party of Thailand (CPT). The influence of Maoism has tended to “dumb-down” economic and political theory and led to a failure to understand of the horrors of the free market.

At a gathering of ex-comrades from the CPT some years ago, I was told by a now prosperous businessman that his knowledge of Marx’s Capital helped him in his private business. Another ex-comrade, who was a poor villager, told me that Marx’s Capital showed him how to understand corruption. It is doubtful if either of these ex-comrades had actually read Capital because the CPT never translated it into Thai and discouraged party members from studying Marxism. The only text which comrades were allowed to read were the writings of Chairman Mao.

This ignorance of political economy was inherited by NGO activists who came out of the CPT. In the late 1990s, NGO documents on “reform” would uncritically support privatisation of energy utilities. Those who were “anti-capitalist” advocated utopian village-level self-sufficiency rather than planning modern production for need.

The lack of opposition to neo-liberal market forces in Thailand has meant that the neo-liberals have a near monopoly on policy. Two notable exceptions were the “dual track” policy of the Taksin government, which mixed grass-roots Keynesianism and free-market policies and a national level, and the attitude to drug company patents by AIDS NGO activists. The latter example was a result of learning the nasty reality of the impact of the free market from bitter experience. However, since NGOs concentrate on single issues, there was no generalised critique of the market. Such a critique was only produced by the socialist group of which I was a member.

I once had the misfortune to attend a training session, organised by academics, in order to “teach” villagers about privatisation. All the speakers were advocates of the free market and talked as though it was “common sense” that the market brought about efficiency. This was after the free-market driven economic crisis of 1996. Another glaring example of the result of the free-market is the terrible state of traffic in Bangkok.

When I was teaching political economy and politics at Chulalongkorn University, I asked a colleague about which economic schools of thought he taught when considering hospital and public health administration. “Are there actually different political economy approaches to the management of health care?” he asked me in surprise.

Well, there are. But you would not know it from the glowing reports written in the media about the view of the Thailand Development Research Institute (TDRI). Recently, Ammar Siamwalla, a founding member of the TDRI, criticised the fact that there was no proper separation between “purchaser” and “provider” in the public health ministry. As an employee of the British National Health Service (NHS), I can confirm that the introduction of an internal market into the NHS by Margaret Thatcher, and the continued neo-liberal policies of Tony Blair and David Cameron’s governments have seriously degraded health care in the UK. Millions are spent on employing admin staff like me in the pointless process of accounting. Money that could be used for treating patients is diverted away to administration of market forces. Privatised market competition and devolved budgets have allowed huge cuts in health care funding to be hidden from view. These cuts depress wages and have a negative effect on patient care. The alternative is to plan “need” and then plan a budget based on this need without any internal market. This was how the NHS was originally set up.

When the Thai media report on Ammar Siamwalla they always refer to him as a “much respected economist”. No articles call him a raving free market extremist. A few years ago, when some of us on the Left were campaigning for a welfare state, this “much respected economist” claimed that he could not imagine any way in which a welfare state could be established in Thailand. He obviously was not going to bother to study examples from Europe! Naturally, the TDRI were vehemently opposed to Yingluk’s rice support scheme, which benefitted 3.5 million families, either directly or indirectly. The TDRI is also in favour of extending the retirement age of people who work a 6 day week already and it is against a standard national minimum wage. Each time a TDRI report comes out, it is treated as a “bible”. Homage to the free-market has even been enshrined in all constitutions since 1997, alongside the King’s Sufficiency Economy ideology

In Thailand there are only “economic experts” and there are no debates about political economy.

Guided Democracy Neo-liberal Style

Giles Ji Ungpakorn

We are now seeing the anti-democratic neo-liberals crawling out of the woodwork to help the junta in its road map to “Guided Democracy Neo-liberal Style”.

First, the Permanent Secretary for Health is now suggesting that the 30 baht universal health scheme be scrapped and patients be made to pay up to half of their own health care costs. Dr Narong Sahametapat, the Permanent Secretary for Health, joined Sutep’s mob and called for the resignation of the elected government earlier this year. He is also delaying measures to provide essential drugs to people with hepatitis and cancer.

In my 2006 book “A Coup for the Rich” I warned that the first military junta back then was thinking of introducing “co-payments” for the health service to replace the 30 baht health care scheme.

Secondly, the Counter Corruption Commission is talking to the Election Commission about a plan to force all political parties to submit their manifestos to the Electoral Commission before an election campaign can start. This is so that these unelected anti-democratic neo-liberals can “weed out” any pro-poor policies which use state funds. The neo-liberals hate the use of state funds for the benefit of the majority of people. But they just love the military for vastly increasing its own budget!

Finally, the Thai Development Research Institute (TDRI) has proposed that the minimum wage should not be raised like it was during the Yingluk government because it resulted in raised prices and workers are still poor! Well, given that most workers are too poor, the minimum wage ought to be doubled to 600 baht per day! Most middle class Thais, including the academics at the TDRI enjoy salaries much higher than most workers. What is more, the wage costs in Thailand are very low and could not have resulted in raised prices, but if they did, a pro-poor government could bring in price controls.

The TDRI has a history of opposing the rice price protection scheme which benefitted small farmers. It also opposes the idea of a welfare state.

This only goes to show that neo-liberalism and dictatorship go hand in hand.