Healthcare Policy Forum Newspaper Article Series:
The injustice of the proposed private healthcare insurance scheme
George Cautherley, Convenor, Healthcare Policy Forum
In the recently-released healthcare financing consultation document, the government says it has listened carefully to society's views: that people value "voluntary choice for public or private healthcare" and that they want "more choices and better protection in private healthcare". In the government's perception, citizens are all classical utility maximizers - they all want to maximize their own healthcare choices and protection through being able to switch between the public and private healthcare sectors at wish. How far this understanding of citizens' preference on healthcare is accurate we do not know. There must however be not a few people who treasure the public healthcare system and its underlying principle of equal access to healthcare, and as many who do not wish to count on the private sector.
Be that as it may, the government says it can play an "active role" in helping maximize citizens' choices and protection. The proposed private healthcare insurance (PHI) scheme is said to gear towards providing us with "better choices for lifelong protection". The government claims that it will be our "lifelong health partner" and will consider providing financial subsidies to assist us to uptake PHI so that we will have more choices and better life-long protection.
Nominally, the scheme and the subsidies are for every citizen. But the truth is that not every citizen can afford PHI. The "we" in the PHI scheme does not really include everyone. The government knows well that the PHI scheme and the subsidies are in fact for those who are able to pay for PHI only. Specifically, according to a consultancy report commissioned by the government, the scheme actually targets individuals with monthly incomes over $10,000 and those who currently have PHI. Official statistics have shown that the higher one's income, the more likely one can afford and will purchase PHI. Under the proposed scheme therefore, it becomes that the higher one's income, the more likely one can enjoy better healthcare choice and protection, the privilege being supported by taxpayers' money. In short, the PHI scheme provides disproportionate benefits to those on higher incomes. This raises the issue of justice in using public money.
Justice demands that everyone be treated equally unless there are good reasons for doing otherwise. Applying this principle to our context means that the better healthcare choice and protection supported by government subsidies should be made available to every citizen unless there are justifiable reasons for conferring the benefit on high-income people only. In theories of justice, two common arguments for differential treatments are needs and merits. But neither needs nor merits justify giving more publicly-supported benefits to high-income people in our case. There is no reason why the need of those on high incomes for quality healthcare protection should or could trump the same need of others and can have greater claims on public money. Likewise, it is counter- intuitive that people on higher incomes deserve better healthcare protection and more government subsidies simply because they earn more.
Quite the contrary, our moral intuition enjoins that given the same healthcare need, no individual's need should have higher priority or a greater claim on public money over the need of others. In this connection, it is worth recalling that equal access to healthcare - healthcare distributed on the ground of healthcare need only - is the fundamental value of public healthcare systems in many advanced countries. In our view, instead of supporting high-income people to purchase PHI, a just use of public money should be on improving the public healthcare system so that better protection can be enjoyed by every citizen.
Even if the government thinks it has good reasons for giving PHI subsidies to the relatively well-off, there is little explanation for such a position in the consultation document. The only guiding value for using public money is "cost-benefits" - that public money should be used to achieve the objectives of the PHI scheme in the most cost-effective way. The government is however totally silent on the justice of the objectives now proposed. As it stands, the PHI scheme will only move our healthcare system in the direction of greater inequality. Those on higher incomes will have improved access to healthcare - they will be able to access both private and public healthcare as suits their needs. Such inequality is now being advocated and proposed for institutionalization by our government, using public money!! The government may reply that the relatively less well-off will also benefit as the PHI scheme relieves pressures on the public system. Even if this projection is correct, which we have ground to doubt very much, the problem of inequality in the access to healthcare supported by taxpayers' money remains. We await the government's engagement on the fairness of its proposed scheme.
The Chinese version of this article was published in Hong Kong Economic Journal Daily on 6 January 2011.
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