Middle class ripe for health care reform

PUBLISHED : Sunday, 23 March, 2008, 12:00am
UPDATED : Sunday, 23 March, 2008, 12:00am

The government has its best chance in 20 years to win middle-class support for reforming the financing of health care.

Big budget surpluses in the past two years have allowed the administration to return billions of dollars to taxpayers. The middle class has been the biggest beneficiary.

With the job market booming, wage levels rising and ever fewer homeowners stuck in negative equity, there is good reason to believe the middle class is content -and that it is likely to stay that way for a while.

It was not always so.

In the 1990s, with the city's political and economic outlook after the handover uncertain and property prices rocketing, the middle class, understandably, had bigger things on its mind or was plain bewildered by proposals to reform health care financing.

In the first decade after the handover to Beijing, political and economic turmoil left the middle class in no mood to join in a discussion about such long-term issues as health care reform.

Worried about the frustrations and sense of grievance prevailing among the middle class, the government tweaked its reform agenda even before Donald Tsang Yam-kuen took over as chief executive. Policies on education - such as the 'fine-tuning' of mother tongue teaching - universal suffrage, air pollution and heritage conservation have evolved to ease discontent.

Given that the middle class is in a better mood, reaction to the publication of the government's latest consultation paper on health care reform - though it contains controversial options such as a mandatory insurance plan - has been fairly mild, so far at least, even though it could lead to the middle class paying more.

True, there have been complaints that the paper targets the group. There is some truth to this.

Political parties and most mainstream news outlets have adopted a wait-and-see attitude. One big reason for this is that the document contains six options, including higher taxes or higher fees for medical services, voluntary or mandatory health insurance or health savings plans, or a mix of both. The government will only narrow down the choices to one or two detailed proposals after the first round of consultation.

Because of the complexities of the issue, people have found it difficult to get a grasp of what is at stake.

It is human nature for people to focus on the near term. With no clear timetable yet for reforming health care financing, people have not turned their attention to the issue.

That should be no cause for alarm, however. The government should know by now that applying the hard sell to its preferred option can be counterproductive. It makes people question the government's sincerity. It also defeats the purpose of engaging, and tapping the wisdom of, society to help resolve such chronic problems as health care financing.

Given that the rich can afford to pay more for medical treatment and that the poor and underprivileged will always be taken care of, there is no doubt the middle class will be affected most by any reforms.

This class may be feeling happier with its lot, but many of its members still feel strongly that the government and the rest of society are not paying enough attention to its interests, aspirations and concerns.

As more middle-income earners start thinking about the quality of life they will enjoy once they retire, and worry about how sustainable the public health system is, the middle class has become more receptive to the need for reform.

That said, its needs and aspirations are varied, and its members have diverse views about the role the government should play in delivering health services.

They want to make an objective decision taking into account their own - and society's - needs. Their bottom line is that the new system be fair and provide genuine choice.