A New Mandala reader has urged us to feature this letter from the Bangkok Post.
Letter writer Mr Warner (”Isan and self-reliance”, Postbag, July 5), who has resided in a small northeast village for five months, cites health care as an enduring gift from Thaksin Shinawatra. Forty years ago, when I first came to Thailand, one of the things that impressed me most was how any Thai could get medical care free at a state hospital or clinic.
That is, Thaksin shamelessly re-branded something already available for decades as something new. What was really happening was that his wife owned the company that produced the tens of millions of cards for his ”30 baht’’scam; he purchased five private hospitals; and he changed the Ministry of Public Health regulations to allow patients to use their ”30-baht” card at private hospitals that would be reimbursed for a set amount, based on what the cost is to a state institution. The latter guaranteed cashflow to his newly-acquired private hospitals, while boosting their profits dramatically and attracting more patients than otherwise.
Yes, northeasteners are wonderfully hardworking, self-reliant people. But they are woefully ignorant – or naive – in thinking that Thaksin ever did anything that did not benefit himself financially. No exceptions. He was just very good at masking his real intentions with well-packaged and well-publicised programmes that ultimately petered out, leaving illusions and dependence in their wake.
A REALITY CHECKER
Some previous New Mandala discussion of this issue is available here.
10 responses so far ↓
1 jonfernquest // Jul 6, 2009 at 10:24 pm
I know of specific instances of medical services available to poor people before Thaksin too. Open heart surgery for a small girl whose mother was a motor cycle taxi driver abandoned by her husband, waiting list at Chiang Mai University hospital.
Then there are the myriad number of things that aren’t free at all. Perhaps 10,000 – 20,000 baht for surgery is cheap, but it isn’t free, and it is little different from the situation before Thaksin.
Then there was the colleague whose wife died of cancer in Roi Et after exhausting probably 100,000 baht in medical expenses and they were informed of the diagnosis after she died. No chemotherapy for her.
Then there is my personal experience (condition from sports a little like a hernia but optional surgery). Present your card at the designated hospital only to have the doctor tell you very indirectly (no doubt within the bounds of the law) don’t expect to get anything with that, come back with your insurance policy card.
I would venture to say the major difference is that some doctors are paid to sit for several hours at the local provincial hospital to take care of universal health care patients (paid per patient) and dispense free medicine.
What is the main point here?
Some investigative journalist should get the low down on what you really get with your “free” healthcare card.
2 Ralph Kramden // Jul 8, 2009 at 11:21 am
Why rely on hearsay or getting journalists to investigate this? There are academic studies before, during and, I suspect (but don’t know for sure) after Thaksin’s health care innovations that reflect on who could or couldn’t get free or cheap health care.
The good folks at Mahidol’s Institute for Population and Social Research certainly produced reports on the pre-Thaksin period. These would have been in the days prior to easy web access, so I am unsure if they are available except by contacting them or through a library. However, they do have a number of PDFs on their website that might be of relevance. e.g. from their journal, this:
Patterns of Household Expenditure on Health Care in Thailand
Woottipong Satayavongthip
“Objective of this study was to investigate the patterns of household expenditure on health care according to region, administrative area (municipal, sanitary, rural), income, and occupation of the household head. The study emphasized on the pattern of expenditure and the pattern of health service purchasing. This study was an analysis of secondary data. The unit of analysis was the household. The Socio-Economic Survey 1996 conducted by the National Statistical Office was the database.
The results showed that there were 71 percent from 25,110 households that had health expenditure in 30 days before the survey. The average monthly health expenditure for the households that paid for health care was 144.05 baht per household. Almost half of the households (48 percent) were in the pattern of self-treatment only, one-third (33 percent) were in the pattern on principal treatment in the private sector and/or health examination, and one-fifth (20 percent) were in the pattern of principal treatment in the public sector. The average monthly health expenditure and health purchasing patterns were different among households according to household characteristics such as region, area of residence, income, and occupation of the household heads.”
There’s more like this.
I also recall that there were a number of academic studies and international reports that examined health care in the Thaksin period. They could be sought out through the usual literature search methods.
3 Sidh S // Jul 9, 2009 at 5:10 pm
Why not investigate the allegations of the original Postbag letter against the Shinawatra clan too? Did they really own the company that issued the card (I will admit to have received one too which I never used)? Did they really buy up private hospitals that directly benefited from the scheme (I have read newspaper articles years ago on this)? I certainly agree with Jon#1 and Ralph#2 that the policy’s implementation needs detailed studies – not only to compare with pre-Thaksin practices – but also for the betterment of healthcare in the longer term, especially for a ‘middle income’ country like Thailand (I see the Obama administration are struggling to reform the US system).
The letter’s allegations against the Northeasterners are also worth further discussions, studies and analysis. I am of the belief that they were/are exploited by PMThaksin – although I disagree that they are “naive” or “woefully ignorant”. I am certain that they know he is a cheat – but I suspect it is something in the culture, Thai culture in general and Isan in particular (and a recent survey seem to have said that Thais are “ok” with corruption).
I’ve heard the statement made numerous times over the years (made by people, from Bangkok or urban centers in the northeast, who worked in Isan) – ‘do a favor to the poor Isan villagers once and they’ll love you forever’. The concept and practices of ‘Bhunkhuntong todtaen’, ‘one has to repay good deeds/favors’ (anyone who can give a more accurate explanation/translation please do) runs deep in Thai society – as everyone familiar with Thai society knows – but, from my observation, it is painfully real for the poor folks of Isan (or even the north). This plus the notion that parents have very important places in Thai society and religion, which, for me it is a beautiful aspect of the culture – but its darkest manifestation is in the selling of daughters as sex workers. The thing is those daughters often do not hold grudges or deep bitterness against their parents – on the contrary, they seem to view it as a ’sense of duty’ to take care of their parents and siblings (of course the opposite also happens if the child contact HIV and dies, the grandparents will have to raise the grandchildren).
It seems that rural Isan accept the harsh fact that it is an imperfect world – only that they are more tolerant of imperfections (corruption) than their urban-based countrymen.
4 Ralph Kramden // Jul 10, 2009 at 11:57 am
“It seems that rural Isan accept the harsh fact that it is an imperfect world – only that they are more tolerant of imperfections (corruption) than their urban-based countrymen.”
Another way of looking at this that is not psycho-cultural: compared with their wealthier urban business and middle-class fellows, over decades of exploitation and repression, poor people in the NE have learned how to measure power and know how they are expected to respond and can respond without retribution. They are not necessarily more accepting of corruption but know that the corrupt are immensely more powerful and can wield the coercive instruments of the state against them when they get uppity.
Perhaps this partly explains their dogged determination in voting for who they want in power since the 2006 coup. This is a chance to have a say and they keep saying the same thing. Collective voice.
5 Sidh S // Jul 10, 2009 at 2:39 pm
Ralph#4, if so, that is certainly a positive development for Thai democracy.
6 Rama 8 bridge Tuk Tuk crew member // Jul 12, 2009 at 9:52 pm
“Former Thai Prime Minister Thaksin Sinawatra is reportedly in Vanuatu today, seeking to meet leaders of the Melanesian Spearhead Group (Papua New Guinea, Solomon Islands, Vanuatu and Fiji). In the last week, he has also been to Tonga and Fiji, where he is reported to have met with Fiji’s interim Prime Minister Commodore Voreqe Bainimarama.
Media reports quoting informed sources in Fiji say Thaksin is considering investing $300m in Fiji in return for protection from extradition. ”
http://www.lowyinterpreter.org/post/2009/07/10/Has-Fiji-found-its-sugar-daddy.aspx
7 michael // Jul 13, 2009 at 4:10 am
An ABAC Poll of 1,228 household respondents in 17 provinces across the country at the end of June found that 84.5% of them accept corruption as a normal practice in business and 51.2 percent of them admit they don’t mind if a government is corrupt so long as it manages to bring about prosperity to the country and to improve the livelihood of the people.
Of the respondents, 31.6 percent of them were in the farming sector, 27 of them entrepreneurs, 15.2 percent of them employees and 11.5 percent government officials. Of these, 75 of them had under-graduate level of education.
The poll does not state that Isan has a greater tolerance of corruption than “their urban-based countrymen.” (Sidh #3)
While I cannot argue with your view that the selling of daughters (& I would add sons) is ‘dark,’ I know that practices like these are not limited to Isan, they’re much wider spread. (I include the coercion of young family members to enter the sex trade here & in other countries, in the notion of ’selling.’) And yes, it is the most despicable aspect of corruption in Thailand. But I think that if we focus on that, we are in danger of missing the point that corruption is widely considered to be O.K. The middle-classes accept it, just as the poor rural people do, although the middle classes are much less likely to push their kids into brothels.
At some stage during his premiership Thaksin was quoted as stating that he was going to bring public sector corruption down to an ‘acceptable level,’ 20 – 25% of budget. Imagine what it must have actually been!
Billions of baht that could be going into improved medical services, education, agriculture, public sector salaries. Sad, eh?
I like Ralph’s comment @ #4. There’s a measure of hope in it. I don’t believe the Central Thais will be the salvation of the nation.
The rural people may be ‘uneducated,’ but I see signs that there are better thinkers among them than the ‘go to shopping’ middle classes in Bangkok. They’re pragmatists, and they are starting to see that they can have power, based on numbers, and they know who in their local communities has kept them under the thumb. If they continue as they have been doing, they’ll have the power before long to give themselves the education they have been denied & start looking after themselves in other ways. I hope that Thaksin will not be a part of that. If he’s not, there will still be corruption problems, but they may be easier (but not easy) to get rid of, over time.
BTW, despite my comments re. the Bangkok middle-classes, I do know a lot of middle-management public sector employees (Ministries of Agriculture, Interior and Education, mainly) who are absolutely fed up with budget money disappearing. And the Office of Public Sector Development Commission seems pretty idealistic. Their charter (a Royal Proclamation) reads almost like an alternative constitution. Their basic task is to re-engineer the public sector, & turn it from an organisaation that told the people what to do into one that asks them how it can serve them.
8 Sidh S // Jul 13, 2009 at 3:56 pm
Michael#7, another interesting ABAC poll results for you:
“เอแบคโพลตกใจคนอีสาน 60%เห็นด้วยอภัยโทษนักการเมืองทุจริต-ใต้ค้านหัวชนฝาร้อยละ80 คนกรุงสูสี” (Title: “ABAC Poll surprise: 60% of Isan agree with pardoning corrupt politicians – Southerners strongly against by 80% Bangkokians even” – my translation, please feel free to check for accuracy)
http://www.matichon.co.th/news_detail.php?newsid=1247389016&grpid=05&catid=01
It does complicate the picture of Thai’s (as measured by polls) perception/tolerance of corruption. If we go by the title, respondents may be thinking of PMThaksin’s particular case. However the findings in the body of the article also points to another interesting pattern, the higher educated the respondents are, the lower their agreement with pardoning corrupt politicians.
To your comments “…Thaksin was quoted as stating that he was going to bring public sector corruption down to an ‘acceptable level,’ 20 – 25% of budget. Imagine what it must have actually been!”
Whatever the exact percentages, urban-based middle-classes seem to have perceived that either PMThaksin bought corruption up to and/or monopolize it to unacceptable levels.
“… I don’t believe the Central Thais will be the salvation of the nation. ” I hypothesize that this is a common belief for foreigners in NM (do correct me if I am wrong) – for me, a conflict among global middle-classes with very similar aspirations, opportunities and lifestyles. Interestingly we (Western and Thai middle-classes) often barrack for the underdog – in this case the Thai poor over the Thai middle class and above.
Otherwise I actually do agree with that statement as I believe the Thai middleclasses and/or Central Thais have done their bit for the broader distribution of political power. I will argue that AjarnPridi and FMPibul are early representatives of the new social group desire for political change with 1973, 1976, 1992, 2006 continuing in that tradition. I see the Reds Riot of 2008 continuing in a tradition begun by the middleclasses by the rural and urban poor in the negotiation for political change in the public spaces of Bangkok. My hunch is that if they can come up with an alternative that is not associated with PMThaksin, the urban-based middleclasses might just go along with it – until the next corruption scandal that is.
On corruption, Bangkok Post’s Voranai Vanijaka wrote an interesting commentary:
http://www.bangkokpost.com/opinion/opinion/20092/corruption-is-but-a-cultural-norm
Consistent with what the article implies, for me, corruption IS Thai Democracy’s major Achilles Heel – recent ABAC polls have only reinforced and confirmed this for me.
9 michael // Jul 14, 2009 at 2:01 am
Sidh #8, I thoroughly agree with your final paragraph. Before posting, I’d read Voranai’s article, & saved it – as I’ve done with several others of his. I’ve been a fan for some time, and I sincerely hope he is allowed to continue. He’s a clear thinker. I especially like his allusion to AA. My post #7 came out of reflecting on his idea that it isn’t productive to always be putting the most shocking examples of corruption in the forefront, when the conduct of the whole society is providing a supportive situation where such extremes are a logical outcome of getting into positions of power.
Further, I’ve long held the view that the extremely patronising & xenophobic attitude of many Central Thais to North-Easterners is fueled & justified by a focus on the unfortunate practise of sending young people into prostitution, as well as that of alleged ‘vote-buying.’ Both of these are dishonest prejudices, although based to a limited degree on truth, because both are gradually diminishing. (In the case of vote-buying, there’s a pretty good case for arguing that ‘bribes’ haven’t changed preferences recently; rather they’ve set up a ‘contract’ that ensured the recipients got to the polling booth.)
My statement re. “the salvation of the nation’ should have been more specific (& pointed towards the PAD masses and their weird neo-fascist politics), but I’m not backing down. It has been demonstrated over & over just who the Central Thais will look after & who they will continue to ignore as long as they have the upper hand. They bleat about the ‘uneducated masses’, thus identifying a glaring problem, yet do nothing to rectify it. It’s not as if the peasants aren’t interested in coming into the real world.
Yes, Pridi & other middle-to-upper class people got the ball rolling. But it’s been a long, slow roll in an otherwise fast-moving world, & it’s time for the people to get a piece of the action. If they don’t, there could be a violent process that sets things back for years, whichever way the outcome goes.
Re. the Matichon report of the new ABAC poll – I don’t read Thai, so I won’t be able to avail myself of that. To tell you the truth, I’m wary of polls. I only mentioned the other one because you brought it up in #3, in a way that I feel was rather misleading, and I’d read 4 articles which resulted from it. I’m not surprised that Isan agrees with pardons (they want Thaksin back, because they believe he did good things for them, & there’s no evidence anybody else will- & they’re right. ), or that people with higher education don’t agree with them (so, educate the uneducated!).
BTW, I see the Thai middle-classes as underdogs too. I’m appalled with what they put up with. The problem is that they can’t see it clearly – bread & circuses!
Most of my friends are PAD supporters (not hard-core) & I avoid discussing politics with them. In Australia I wouldn’t mix with people who have opinions like them, but my Thai friends have been brainwashed. They are basically good people, kind & well-intentioned, who don’t understand the implications of the beliefs they have never had to question. They support PAD because they have been misled: they believe that the Redshirts are a genuine threat to national security, including the King. I do agree with them, looking at the evidence, that Thailand would be a much worse place if it had not been for his influence. But then, all my Redshirt friends believe that too.
10 Sidh S // Jul 14, 2009 at 10:33 pm
Michael #9, a lot of reflexive, complicated thinking going on there and I sense we agree more than disagree. I certainly wish that the government and bureaucracy, of any political color, are more sincere in addressing the sufferings of the rural and urban poor. Don’t get me wrong here, there have been many good policies and hard working bureaucrats – and by many international measures, there have been marked improvement in the socio-economic conditions of the Thai people over the years. But clearly much more could be done – and important policies such as land reform and agriculture produce mortgage (which I don’t fully understand yet) seems to be consistently exploited by the politicians.
There is also the unprecedented challenge of becoming an agriculture-based ‘developed’ society – as it is arguably much easier to focus on industrialization on a path to higher incomes and better quality of life (path of the ‘Tiger Economies’). I am not sure if this is even possible. On the other hand, this path of industrialization seem increasingly hard with China (and India) as competition, quickly taking over in becoming the world’s factory.
Would PMThaksin be the man, the only person able to negotiate a future rosy economic path for Thailand? I strongly doubt it as he was prime minister when the world economy was expanding. It seems to be the fate of the Democrats to take the rein during economic crises.
Is PMThaksin sincere with rural poor? That I also strongly doubt as evidences abound that he seemed to be consistently driven by self-interests more than anything else – and arguably more than any politicians before him and since (Mr.Newin is also on this path, I suspect). This did not come as a surprise for me as at the end of day, he is a business tycoon, first and foremost. It actually took some years of training at Palang Dharma Party before he found his political footing…
On the issue of “brainwashed Thais”, we can safely say that both the Reds and Yellows have been pretty much radicalized and brainwashed by their respective elites (led by master manipulators par excellence, PMThaksin and TycoonSonthi). Any politician who can re-create the common, middle space will be able to set society back on a stable path. However, any politician trying to position themselves in the middle could easily end up with enemies on both sides (as the PMAbhisit and the Democrats are quickly finding out). On the other hand, these conflicts will remain as long as PMThaksin is active – and a possible scenario is that, with time, this becomes ‘normalized’ and Thais, of all shades, just gets used to it until PMThaksin retires. I suspect that life will carry on – unless PMThaksin makes a killing in one of his worldwide investment ventures.
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