Over the years, PPT hasn’t said much about health in Thailand unless it has had to do with royal health as the king and queen have aged and the Royal Household has obscured and fabricated. At times we have posted on royalist-inspired efforts to roll back the Thaksin Shinawatra universal health care program. We have mentioned independent assessments of the success of that program.
A reader has now pointed us to a short paper at East Asia Forum that assesses some of the recent politicking over the scheme. Published two weeks ago, the report is authored by Bo Kyeong Seo, a postdoctoral fellow at the Free University of Berlin. It begins:
Thailand’s current democratic crisis sits in stark contrast with its greatest achievement this century: universal health coverage. This achievement is also a prime example of the ideological disagreements on the value of populism in Thai politics.
The author notes that, by “2014, 99 per cent of the total population was covered by three public insurance schemes. Universal health coverage has ensured increased access to healthcare for the poor and a significant decrease in infant and child mortality. Advanced medical treatments such as basic chemotherapy, open heart surgery and dialysis treatment are also widely available.”
But as Bo Kyeong Seo notes, the response to this successful program has been as polarized as Thailand’s politics: “It has been praised as an ideal policy for the poor and dismissed as a populist charade.” The attacks on “populism” – apparently any program that delivers social goods to the poor or that is redistributional – have been vicious under the military dictatorship. The aim has been to reverse the Thaksin revolution. Even so, after some debate, The Dictator stated that the “30 baht health program” would be maintained.
However, Prayuth Chan-ocha has made other suggestions that show he doesn’t understand universal programs: “He proposed that the rich should give up their membership in the universal health coverage scheme, so that a bigger health budget could be given to the poor.” As the author notes, this “distorts the very meaning of universal access that is deeply attached to democratic values.” The author states:
The basic philosophy of ‘universal access’ is to entitle all citizens to healthcare regardless of their income level, social status or residency. It is true that the poor are the largest beneficiaries of this public policy, but — in principle — it is for everyone. The reason that this policy has been so appealing for the majority of Thais is because it does not segregate and target the poor but incorporates them into the realm of public good.
The author asks: “Is universal health coverage ‘populist’?” The answer is: “No. Branding universal health coverage with the derogatory label ‘populist’ allows a group to benefit from anti-populism discourse.” The author astutely observes:
As ideological battles around populism continue in Thai politics, universal health coverage offers a different political horizon. While this ‘populist’ plan sounds dangerous, unsustainable, or wasteful, it indeed has proved a fundamental value. All citizens have the right to access public healthcare and the state is obliged to ensure these rights.
The very idea of universal access has a constructive function in the formations of democratic values. As ordinary Thais have already experienced such social force and feasibility of making claims of their rights to health as a universal value, then why not their political rights? The anti-populist stance is hindering access to basic democratic procedures.