Even though the current health insurance system needs changing – none of the MPs questioned disputed that – parties do not support the Praxis Center for Policy Studies’ recommendation to give everyone in Estonia health insurance. Estonia has 120,000 people without medical insurance.
“Many people might say that they have worked hard and paid taxes their whole life only to be lumped in with their neighbor who hasn’t done an honest day’s work in ten years,” said Social Democrat Party MP Heljo Pikhof.
Universal health insurance could also impact social and income tax receipt, favor payment under the table and reduce general tax discipline, said Riigikogu Social Affairs Committee member Marika Tuus-Laul (Center Party). Even though the law currently provides 48 exceptions – the latest gave health insurance to nuns who number fewer than 100 in Estonia – giving everyone universal coverage cannot be the solution, politicians say. “Especially since we know there are a lot of people who hide their actual income and only declare a salary to qualify for medical insurance,” Tuus-Laul added.
Member of the Pro Patria faction Tiina Kangro said that Praxis’ study is superficial and only treats with simpler statistical data that makes it look like typical elections propaganda. “I believe this work was ordered when Jevgeni Ossinovski proposed the idea of free medical insurance before he resigned as minister,” Kangro said.
Representative of opposition leader the Reform Party, member of the Riigikogu Finance Committee Jürgen Ligi said the need to “shift tax burden away from labor” is growing. Ligi supports the idea of giving 1 percent of Estonia’s 20-percent income tax to the health insurance fund, with cost-sharing and private insurance remaining parts of the equation.
Finance committee member Martin Helme (Conservative People’s Party) sees greater personal responsibility as a way to shorten treatment queues and address the problem of uninsured persons.
Helme said that shortage of cash in healthcare could be alleviated by throwing capital expenses of hospitals out of the system, moving sick days expenses from the health insurance fund to the unemployment insurance fund and promoting competition between medical institutions.
“If today we use 6.7 percent of our GDP on healthcare, have spent all internal resources and made the system as cost-effective as possible, we cannot continue like that,” said Free Party MP, Deputy Chairman of the Riigikogu Social Affairs Committee Monika Haukanõmm. She said it would be sensible to switch to a system where healthcare is financed, in addition to labor taxes, using state budget funds. Everyone would have minimal health insurance, while those who contribute would qualify for the full package that would be tied to a person’s personal health account.
“Such a system would retain a person’s interest in paying taxes,” Haukanõmm explained.