Eero Merilind: Health insurance dilemmas
The debate over health insurance should be about more than taxes or who has to pay how much; instead, it should answer the question of who is responsible for people's health, Eero Merilind writes.
When a person falls ill, they want treatment and everything that comes with it. The demand for medical assistance and better health is endless and is usually regulated in one of two ways: using money by Americans and using queues by Europeans. Unfortunately, there is no system where endless demand can be covered through limited supply to make all services immediately available to everyone.
The term "health insurance" is made up of two opposite halves: if we focus on "health" we could debate universal health insurance, while if we stick to health insurance, that has been in effect in Estonia for many years, everyone who wants treatment should be insured, meaning that a sickness benefit contribution needs to be made.
Looking at figures in Estonia – insured people 1,273,743 (Dec. 31, 2022) and Health Insurance Fund proceeds €1,931,195 (2021 actual), the contribution of every insured and equivalent insured person, together with the state budget portion, comes to €1,500 a year or €125 a month. (The minimum social tax contribution was €192.72 in 2022).
Estonia has 637,336 insured persons who are working (50.1 percent) and 636,407 (49.9 percent) equivalent insured persons. Considering that the latter do not contribute to the health insurance budget (except the state budget portion for pensioners not working), the minimum amount jumps to €215 a month.
The idea of universal health insurance is to make healthcare services available to everyone who needs them. Having around 100,000 uninsured persons (rough estimate) and talking in the health insurance context, around €230 million a year would need to be found for universal healthcare.
A Praxis Center for Policy Studies' 2018 survey found that the current hugely complicated system can be fine-tuned to improve coverage by 1 percent. Forms of work and employment relationships have also changed. Possibilities of employer and individual insurance are taking baby steps, while those for unions or major representative organizations (such as the Estonian Artists Association) to insure their members are still missing.
The health insurance debate should go beyond taxes or who has to pay more and could instead go the heart of the matter: who is responsible for people's health, whether regular checkups are a sensible health investment and whether a doctor's advice is recommended or mandatory to take.
Debates over the availability of health services and their location, as well as compensation for medical aids and medicines would also be needed. The core question needs to be which system gives us the healthiest individual and helps them return to normal life after illness in the shortest breath of time. Good debating!
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Editor: Marcus Turovski