Mandatory health care has flaws

Nicole Idanna Alpert (The Standard, 8 April 2008) 

No health-care system is perfect – they all have their flaws. Mounting criticism of our mandatory health-care report illustrates many.

York Chow Yat-ngok, Secretary for Health, Welfare and Food, has said: “The middle class is the main contributor to the economy, bolstering the health-care system. They deserve to get more than they are getting now.”

How will the middle class get more if they face higher mandatory taxes? Questions like these illustrate the many contradictions in the report.


The most problematic aspect is the lack of information on the most fundamental levels, such as which tier system, what kind of care and how many insurers will be used. Most importantly, the direction we will move in is not indicated. Are we looking toward solidarity or self-reliance?

Various groups report that the middle class opposes the “de facto tax,” and instead favors purchasing insurance independently, a bold preference for self-reliance.

Why place mandatory tax as an option, signaling solidarity, when the middle class prefers self-reliance? This is one of the most unashamed contradictions.

While the Permanent Secretary for Food and Health, Sandra Lee Suk-yee, has said the report was released to promote discussion, it is a challenge in itself to discuss with necessary information and consistency absent.

Contradictions are rife, the most blatant being the word “choice” used many times in the report. Mandatory is not a choice – you must comply.

The government wants to regulate the insurance market. However, regulations usually slow productivity and create inefficiencies, meaning less choice for consumers, and may indirectly cause inadequate coverage.

While the insurers will make little profit out of the basic scheme and earn revenue through “top-ups,” after regulation, the top-up rates may be expensive and those interested will end up paying a great deal more than the 5 percent mandatory tax.

In the end, citizens are forced into purchasing health care that is not worth the price they pay for it.

Also left unnoticed are the problems that will arise when insurers are marginalized – it is hard to imagine how all can take part – as well as the competition between the private and public sectors.

The private sector, lacking the same government funding that the public sector receives, will not enjoy a level playing field, further supporting the fragmentation that impairs the continuity of care.

There are holes in the system, but must we plug them with another 5 percent? Other solutions exist: Hong Kong can open its doors more to immigration, raise the retirement age, fix problems located on the supply rather than the demand side, and outsource, only to name some.

The public health-care system is respectable, but still wasteful areas exist. Eliminating these would lead to the better use of taxpayers’ money, and outsourcing often reduces costs and is more effective.

The closure of the government- funded Family Planning Association’s sperm bank serves as an example. The FPA correctly predicted the move to a private hospital would benefit the end user with better technology, higher success rates and comparable costs.

We cross the Rubicon with any health-care reform, thus any decisions will need close scrutiny. Before the government takes another 5 percent from citizens’ bankbooks, they should look to their own, turn over every stone and examine all the possibilities.



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