Wake up（228）

 

228

 

When human beings are in eternal conflict with reason, emotion has never lost their hand. True feelings come from mutual recognition in the heart. The first meeting between old Chinese medicine practitioner Chai Jianhua and Bai Bingqing, Liu Hanyu, and Qu Ting was to discuss China’s medical system reform endlessly, because they are all practitioners, and the duty of doctors is to save lives and heal the wounded, so how to make the people feel better when they are sick? Getting rid of pain and gaining a new life in suffering is an endless topic.

When Bai Bingqing and Liu Hanyu talked about these things, they did not discuss the cures or diagnosis and treatment techniques encountered in medical treatment. They were more concerned about the national medical system. According to Bai Bingqing, to solve the medical problems of the people, we must prescribe the right medicine. The root cause of the disease lies in the corruption and imperfection of the medical system.

Liu Hanyu believes that the focus of the inland medical system is that the rulers regard people's livelihood as nothing. The three-year rampage of the new crown virus is actually a test of the changes in people's livelihood awareness and a test of the government's prevention and control capabilities. Too many lies have been deceiving the people, but sometimes the untrue contains more truth than the true. Because, when the people wake up, the people's patience will reach its limit.

Veteran Chinese doctor Chai Jianhua has never discussed the inland medical system with anyone in China. He dared not talk about it, and no one talked to him about these sensitive matters. He did not expect that the first conversation he had with his new friend after he arrived in Hong Kong would open his eyes.

At this moment, female nurse Qu Ting interjected. She said to Chai Jianhua: My mother used to work as a barefoot doctor in the inland. Gradually, she gradually lost a lot of knowledge that was too heavy in the brainwashing, and filled it with new knowledge from Hong Kong and the West. She is most concerned about the marketization of public health care in Taiwan. She studied medicine in Taiwan, and she often talked to me about the marketization of public health care in Taiwan.

Qu Ting said: Under the arrangement of my mother, I also went to Taiwan for medical training when I was young. Let me first describe the historical background of Taiwan's marketization.

After the recovery of Taiwan after World War II, the Kuomintang withdrew to Taiwan in 1949. At that time in mainland China, the Kuomintang actually stood with the landlords and financial groups. In contrast, the CCP was of course completely different. The CCP stood with the peasants and workers. Under such circumstances, the Kuomintang gradually lost the support of the mainland people, was defeated in the civil war between the Kuomintang and the Communist Party, and had to retreat to Taiwan. This was a very painful lesson for the Kuomintang. So after the Kuomintang came to Taiwan, it understood that Taiwan was the only place it could inhabit. So, after the Kuomintang arrived in Taiwan, it quickly promoted the land reform. During the period in mainland China, the Kuomintang could not promote the land reform because it stood with the landlords, but it was easier in Taiwan because it had not yet cooperated with Taiwan. The local landlords and consortiums established a cooperative relationship, and because the Kuomintang held absolute power and resources at that time, the Taiwanese landlords had to make concessions. At the same time, the Kuomintang promoted the policies of import substitution and equalization of land rights—this was a slightly socialist-oriented people’s livelihood policy in Sun Yat-sen’s Three Principles of the People. Restraining private capital and capital from developed countries were the main policy guidelines at that time. This is about a decade or two since the Kuomintang established its regime in Taiwan.

But in the 1960s, 1970s, and until the 1980s, it reversed, and one of the big driving forces behind it was the United States. At that time, the socialist camp performed very well in the economy. For the United States, the leader of the capitalist social camp, it was not very happy to see it. It was worried that the good performance of the socialist camp would have a negative impact on the capitalist camp. Therefore, they envy socialism and hope that their society will also implement socialism. That's why the United States promoted the four Asian tigers at that time, including Taiwan, South Korea, Singapore and Hong Kong, and promoted the export-oriented economic policies of these four regions. , against the socialist camp.

Interestingly, the mainland also tried its best to publicize the experience of the four Asian tigers. The mainland has implemented an export-oriented policy, and its economic policy has gradually shifted from controlling private capital and the capital of developed countries to a policy of encouraging the expansion and accumulation of private capital and reducing national capital.

Qu Ting said: I went to Taiwan to study medicine in the mid-1980s. Corresponding to the international situation at that time, in Taiwan it was the rise of "neo-liberalism", deregulation, and privatization. In Taiwan, there was another word called "organizational reengineering", which was market-oriented reform: weight loss, layoffs, more and more more market-oriented. From the 1960s to today, Taiwan's marketization is a historical development process.

Under such a market-oriented economic development, Taiwan’s public health policy from the 1950s, 1960s, and mid-1970s focused on prevention over treatment. building. This policy clearly began to reverse in the late 1970s and 1980s. With the reversal of this economic and public health policy, the public health system began to be medicalized—the so-called "medicalization of the public health system" means that in the two major departments of the public health system, the prevention and medical treatment, the medical department has no financial or human resources. Accounted for the vast majority of the proportion, while the prevention sector is relatively very low proportion. During this period, the government and private capital began to invest heavily in the medical sector, and the government also began to encourage private capital to invest in the medical field. Coupled with the law that private capital will continue to expand and accumulate, the medical sector will continue to expand. Relatively, the government’s investment in the prevention sector is weak, and it has not responded to the shift in the form of disease among Taiwanese people from infectious diseases to Changes dominated by chronic diseases have increased. Not only has this change occurred in Taiwan, but the mainland has also experienced this change.

Qu Ting continued: Let’s analyze the difference in commercialization between the medical department and the prevention department. I think the medical services provided by medical institutions are relatively easy to convert into commodities, because most of the medical services are personal, that is, they can be standardized and quantified for individual needs or needs, so the services provided by the medical sector are relatively It is easy to be commercialized, and after commercialization, it will be marketized. On the contrary, the services provided by the prevention department, such as environmental sanitation and prevention and control of infectious diseases, are not personal but public. For example, the work of environmental sanitation is for the collective rather than the individual, and most of them are not easy to standardize or Quantification, so most preventive services cannot be converted into commodities, cannot be bought and sold, and therefore cannot be exchanged for equivalent value in currency. Therefore, the preventive sector, in contrast to the medical sector, is not easily commoditized and therefore not marketable. Then, on the one hand, the government has not increased too much funding and manpower input to the prevention department. On the other hand, the prevention department has no incentive for private capital to produce goods, so it will not invest capital. Therefore, compared with the private capital of the medical department, the continuous increase Expansion and accumulation, the prevention sector does not have the phenomenon of continuous expansion and accumulation of capital. We have seen the development of Taiwan's public health system after the 1980s. When the medical department continued to expand, the prevention department did not expand or even shrunk. The situation, this process, the Taiwanese call the "medicalization" of the public health system.

Because after the mid-1980s, there was a big reversal in the entire economic policy, that is, obvious marketization and neo-liberalization, and this policy reversal certainly began to affect the public health and medical system. Then in 1995, Taiwan began to implement national health insurance. We must know that Taiwan's national health insurance is a kind of social insurance, not a social welfare system, and the medical sector is still commercialized and market-oriented. The launch of the national health insurance has made public and private hospitals alike. The government treats public and private hospitals equally, and pays you as long as you provide services, regardless of whether you are a public or private medical institution. The government used to strongly support public hospitals, but later it became less and less supportive, because the government tax revenue has also been reduced, and there is no sufficient funds to subsidize public hospitals. Therefore, the government requires public hospitals to be responsible for their own profits and losses, which in turn encourages private capital. into the medical field. Therefore, the public health system has become the result of "the marketization of the medical department, the dwarfing of the prevention department, and finally the medicalization and weakening of the public health system".

Mainland China’s policies on private capital investment in the medical system are similar to those in Taiwan in many respects. It is a policy to encourage private capital. For example, Taiwan offers tax incentives, medical development fund assistance, public and private sharing of national health insurance funds, and stimulates and encourages private or consortium capital. Into the construction of the hospital. The same goes for the mainland. In the 1980s, private hospitals continued to rise, and public hospitals basically failed to catch up with private hospitals.

A comparative analysis of the history of the public health systems in Taiwan and the mainland can give us a lot of inspiration. Looking at the development of the public health systems on both sides of the strait from an international and historical perspective, we can understand that the two sides actually share a common destiny. . Whether it is Taiwan's universal health insurance or the mainland's universal basic medical insurance, it is helpful to the public's financial burden on medical care. For example, at least the public is less likely to go bankrupt due to serious illness and pay high medical expenses. The essence of medical insurance is the sharing of public medical risks. For example, when a public suffers from a major disease such as cancer, they need high medical expenses, and this risk is shared with other people through insurance.

However, after 20 to 30 years of development, the medical departments of the public health system in Taiwan and mainland China have been commercialized and marketized. Investment in medical departments or institutions and capital for the production of medical products will continue to expand and accumulate. The medical sector will also continue to expand. Therefore, in turn, such capital accumulation will make Taiwan's universal health insurance or the mainland's universal basic medical insurance system unable to pay for the medical goods provided by the continuously expanding medical sector. cannot continue to operate indefinitely.

The proportion of government subsidies to the total revenue of public hospitals, that is, the degree of government support for public hospitals, has been declining sharply in the past two or three decades, whether it is Taiwan or mainland China. The mainland government's subsidy to public hospitals has dropped significantly since the reform and opening up, and it has been very low since the 1990s. Government subsidies only account for about 10% of the income of public hospitals. The proportion in Taiwan is relatively high, but it began to decline significantly in the 1980s and 1990s. Over the past decade or so, government subsidies have only accounted for less than 20% of the total revenue of public hospitals. Public hospitals on both sides of the strait have to seize the medical market just like private hospitals, so marketization is becoming more and more serious. This is a trend of medical marketization that societies on both sides of the strait have experienced.

After the mainland's reform and opening up, the government promoted the "paid service" policy of the prevention department, pushing the prevention department to the market, and greatly reducing the role of the government, which has become a very rare exception in the world. Although Denmark and other Nordic countries and the United Kingdom are capitalist countries, the governments and most people in these countries do not believe that the public health care system should be market-oriented.

Bai Bingqing and Liu Hanyu started discussing again.

For more than three years, we have seen that the new type of coronavirus has brought great harm, not only to our physical and mental health, but also to the medical staff. It also makes our lives very uneasy, and also affects our economy, society, Culture...wait a minute, it affects everything. Why do we all have to bear such a terrible harm today? One of the most important reasons is that the public health and medical system is not doing well.

Bai Bingqing said: I think people on both sides of the strait should reflect, and this reflection should be analyzed from the people's point of view, the people's standpoint, and from the fundamental direction. The capitalists in Taiwan definitely oppose, disagree with, or take this kind of analysis seriously, because we are not doing the analysis from the standpoint of medical capitalists, but from the standpoint of ordinary people, even the people at the lower levels. But with such a point of view and this standpoint for analysis, the mainland will not agree. The mainland always believes that their policies are the most respectful of the people. For example, the dynamic clearing. We have seen the most fundamental problem: that is the marketization of public health care. We have to ask, if the public health system cannot successfully prevent and control the tragic consequences of the new coronavirus infection epidemic, should the public pay the bill? Now all the costs are borne by the public. Do we have to continue to pay the bill in the future? The world has changed, and people don't know what to do.

Liu Hanyu sighed: Fame is related to several factors, and success is always the most important one. When the sense of responsibility that binds one's behavior disappears, one can do as one pleases and do whatever one wants. The imagination of the people is actually the power base of politicians. Politicians always like to confuse the people under the banner of being close to the people. The replacement of the conscious action of the individual by the unconscious action of crowds is one of the most striking features of the modern age. A group will make everyone's mistakes smaller, and at the same time let everyone's malice be infinitely magnified.

Bai Bingqing said: The "medical troubles" in mainland China shocked the world, but the government did not reflect on the public health system, but only regarded those "medical troubles" as rogues and criminals, which can fundamentally solve the "medical troubles" question? What plays a greater role in determining people's historical status is not the "true" faces of politicians and profiteers, but the understanding and feelings of future generations.

Qu Ting smiled and said to Chai Jianhua, an old Chinese doctor: "Old Chai, you have been a doctor all your life. You used to save lives and heal the wounded. Now you should think more about how we practitioners should treat this society. The world is suffering from depression. Let us It's becoming more and more incompetent."

Chai Jianhua smiled wryly but was speechless, the world is indeed sick.