[NOTEBOOK]A Sisyphean health care travail

The skirmish surrounding health insurance funds reminds me of the punishment imposed on Sisyphus in Greek mythology. Sisyphus, the cunning king of Corinth, was condemned for cheating the gods by having to roll a huge stone up a hill only to have it always roll down again.

Only a week before the scheduled financial integration of the regional health insurance fund and the employee health insurance fund, the National Assembly standing committee on Dec. 24 passed the opposition Grand National Party's bill, which keeps the two funds separate.

The government, which has prepared for the merger of Korea's two state-run health insurance funds, was thrown into extreme confusion. For the government to pursue consolidation of the funds is now virtually impossible. The merger came close to the summit of completion, but, alas, it has rolled back down the slope.

The health insurance funds were inflicted with the "fate of Sisyphus" in earlier administrations. In 1989, then-President Roh Tae-woo vetoed a bill integrating the funds that had cleared the National Assembly. A competent minister and a vice minister resigned in the aftermath. The current administration enacted the new National Health Insurance Act that supports integration of the two funds' finances and organizations, but its enforcement has been delayed twice. Since the inception of the medical insurance system in 1977, the government has repeated the process of devising a mechanism to improve the system and then falling back to square one at the decisive moment.

The political community, the public sector and academia have been divided into two opposing groups, according to their own interests. Their ideologies are actually simple: One side favors integrating the regional health care fund, whose members are largely low-income people, with the employee fund, whose members are mostly salaried workers; the other side rejects this move. Progressivism and conservatism clashed, and selfish pursuit of each group's own interest held sway, making matters far more complicated.

Public health insurance is a social insurance, so it must meet the test of fairness and income redistribution, which is required for an egalitarian society, in which the well-off help the less fortunate. Public health insurance is by definition not private insurance, which ignores the function of income redistribution. Those who support separation stress fairness: "members should benefit in proportion to the money they contribute." Those who champion consolidation seek the opposite.

The endless disputes over the last two decades have exposed the merits and demerits of both sides clearly. The two groups also have complemented their own theories by co-opting part of the other group's argument. Neither has a perfect theory, nor is one superior in power over the other.

They should not criticize each other, as if choosing one side would push the process to its end. The choice is with each member of society.

What is most necessary is drawing up and implementing concrete measures to improve the funds' financial standing, streamlining inefficient organizations, and enhancing fairness in imposing health insurance premiums. Health insurance funds used to be managed very inefficiently. That was why the argument that a merger is necessary for the two funds' organizations and their finances to cut dissipation has won large support since the late 1980s. The Kim Dae-jung administration decided to go for integration. But consolidation under the current situation would still have huge side effects. The government has not even come up with a solid system to impose health insurance premiums fairly. Involved parties have been interested only in the theoretical battle; they have always been indifferent to practical preparation.

The ruling and opposition parties are discussing compromises to delay financial integration of the two funds for one or two years. We demand that they take just one side, whether it be integration or separation. We ask that the political parties, academia, labor unions and civic groups gather to discuss the matter to produce feasible solutions. Then they should work together to make the solutions reality.

That is the only way we can overcome the "fate of Sisyphus."

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The writer is a deputy city news editor of the JoongAng Ilbo.

by Lee Gyu-youn