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Jakarta post

by Jennie S. Bev

The Indonesian Health Ministry claims to have spent eight years drafting a universal healthcare bill, but has been facing a series of hurdles: lack of funding and other technical issues. The 2008 health insurance scheme for the poor, Jamkesmas, is notorious for its complex procedures and documentation requirements.

For Indonesia to pursue universal healthcare is constitutional, as it is stated in the 1945 Constitution amendments of Article 28H and Article 34 (2) and (3), as the poor’s healthcare is assured by law. The underlying premise is the financially able should assist those who are not.

The notoriety in defining “poor” in Indonesia is: it is based on a local authority’s letter stating one’s poverty (surat pernyataan miskin). Compared with the USA, where one must show annual tax report statement that quantifies the exact taxable earnings. Such a subjective statement of being “poor” in Indonesia must be revised, which brings with it implications for tax-reporting procedures.

What is exactly “universal healthcare”? Why is it appealing? Is it the answer to all healthcare issues? Is it the same as America’s forthcoming healthcare system, known as “Obamacare”? What are the issues surrounding healthcare systems in general?

Universal healthcare is a system of organized healthcare for all citizens in a country. The funding comes from both, or either, taxation revenues and private contributions. Countries using taxation revenues to finance the system entirely include the UK, Italy, Spain and Scandinavian. The Canadian government pays for 70 percent of its citizens’ healthcare, with the other 30 percent coming from private insurance. The Canadian government, however, manages the overall system, while the private insurances’ roles are minimized as healthcare providers.

The appeal of universal healthcare is that every individual is promised adequate healthcare.

The big question is how adequate is “adequate.” As a minimum, universal healthcare promises minimal healthcare. Now, what is “minimal” healthcare? Does it mean a patient is given painkiller medicine for throbbing pain in the stomach? Or, does it mean a patient is given the best therapy and the most appropriate treatment available for his or her stomach pain, which might turn out to be colon cancer after proper screening using the latest technology available?

Healthcare is no laughing matter. It is a serious life-and-death issue, requiring very careful handling using the most humane approach. Above all else, humanity must be upheld, which is the greatest challenge.

A major downside in universal healthcare, alas, is limited funding, especially when the government is in charge of everything. This results in a lower quality of services provided and insufficient incentive for medical scientists to work on cures and new technologies.

In Canada, for instance, patients with rare and advanced-stage diseases are referred to US hospitals, because they do not have the specialists, medicines and technologies for curing and treating them. It is also common knowledge that the waiting list for surgery within a universal healthcare system is extremely long, which may result in unnecessary deaths. An issue of “who should be treated first” also occurs whenever two or more individuals are equally sick but the funding is limited.

Obamacare can be summed up as the tightened version of the existing healthcare system. Starting in 2014, all American citizens will be required to purchase minimal health insurance coverage. Failure to do so will result in fines. Government subsidies will be given for those who cannot afford insurance.

Health exchanges between US states will come into operation and insurance companies can no longer deny coverage for those with pre-existing conditions and children born with specific needs.

US government subsidies will be funded with higher taxes for those earning more than US$200,000 annually (an increase of 2.35 percent of the Medicare tax rate and 3.8 percent of dividend and interest “unearned” income); from drug manufacturers (will pay $16 billion); from insurance companies (will pay $47 billion); and from medical device manufacturers (a 2.9 percent excise tax).

Before Obamacare comes into effect in 2014, the US has an almost non-existent healthcare system for the middle class, only for the poor and the old, who are protected by law and eligible for government-assisted health insurance premiums. The poor and senior citizens in my county, for instance, are guaranteed by Medicare (federal), Medi-Cal (the state of California) and Medical Assistance Program (San Joaquin county). To qualify for Medical Assistance Program health coverage requires proof of gross income of less than 300 percent of the Federal Poverty Level.

When dealing with healthcare systems, patients’ wellbeing must be placed at the top of the agenda. Doctors and medical scientists must receive adequate incentives to keep up their high standards and morale. Other healthcare providers, such as hospitals, clinics and medical technology suppliers should be equally respected to ensure high quality of services.

It remains to be seen how Indonesia is handling this complex issue. Play not with people’s health and life.[]

The Jakarta Post, August 31, 2010

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