“Obamacare” Vs. “Yudhoyonocare”

On Oct. 19, 2004, a child was born. However, to this day, that child cannot walk. This is not because he suffers from a congenital defect, but because he was made lame by those that opposed his existence.

On his sixth birthday he said, “Father, mother and all: Please help me so that I can carry out my task of protecting and creating social welfare for all the people of Indonesia.” That child is named the National Social Security System (Sistem Jaminan Sosial Nasional: SJSN).

At the end of Megawati’s leadership, Indonesia finally published the 40th Law, No. 40 of the year 2004, which arranged the National Social Security System. SJSN is not only an umbrella law, but also constitutes the core, goal and simultaneously the tool of the country to actualize the people’s welfare, including health insurance, work accident insurance, old age insurance and life insurance.

SJSN’s mandate to shape the regulations of legislation and the regulations of implementation during five years of the Yudhoyono government did not materialize. Even during the second term of Yudhoyono’s leadership, SJSN was still paralyzed.

Various apologies were offered by the government for covering up its unwillingness to run SJSN like the limitation of the budget, being counterproductive to investment, and many other things. The driving debate about the Social Security Organizing Body (Badan Penyelenggara Jaminan Sosial: BPJS) was never able to counterbalance the pressure of the need for basic citizen’s rights.

Yet, poor countries like Sri Lanka and Gabon can do it. Even Vietnam, which 10 years ago learned about social insurance from Indonesia, has enacted it. In developed countries like South Korea, it is proven that countries that carry out social security become stronger. Even the United States, high teacher of capitalism and liberalism, doesn’t want to be left behind.

The Politics of Welfare

It is different with Indonesia, and different again with Uncle Sam. President Obama placed the reform of health insurance (Obamacare) as a prioritized agenda in domestic policy. The cost of health, if not reformed, could become a threat to the economy, burdening families and businesses, and was even predicted to become a time bomb to the national budget and survival of the U.S.

He was sure that a better health insurance system was very essential to economic recovery, making it so that reform could not be allowed to wait any longer. “Health reform will not wait another year,” denoted Obama.

It was not strange that Obama postponed his visit to Indonesia last March to focus on the legislation of the health care reform laws that are nothing but a gamble with vows, commitments and his image in the country.

Although they were opposed by a large portion of the politicians in Congress and also by the industrial sectors, the health insurance reform laws were finally agreed upon by Congress through a narrow victory with votes of 219 to 212. The success of that legislation constitutes a large achievement that provides a historic change for Uncle Sam.

Why not? For a true master adherent of the liberal-capitalist course, health insurance reform is indeed very much in opposition to the spirit of individualism. For the conservative bulwark — the Republican Party — which constitutes the primary opposition, the government is forbidden to meddle in private affairs. Health services are totally submitted to citizens through a private insurance system, while those who are poor receive minimal assistance. The law of the market proclaims that the rich, who are able to pay, have the right to get medical care.

The poor are not allowed to get sick or just die. The rich get medical care; the poor stay sick or die. Nonetheless, for Obama, health insurance reform became the main agenda for giving health insurance to 32 million American people that do not have health insurance. This progressive policy constitutes a milestone for important change that will not be forgotten by U.S. citizens. After waiting 45 years after Roosevelt, Obama succeeded in carving golden ink in history. (The obsession of Roosevelt’s welfare state is covered neatly by the controversial director Michael Moore in his latest film, Capitalism.)

Even Bill Clinton was not able to score in this effort because of a tough political struggle. The realization of reform is a commitment to fulfilling a political promise made to the people during the campaign that must be kept.

Total Paralysis

It is similar, but not the same as Indonesia. Although he campaigned on the issue of welfare, speeding up the enactment of SJSN and health insurance, health insurance reform (Yudhoyonocare) in this republic never became a policy priority that had to be completed. Even though it was already authorized by the House of People’s Representatives (DPR) six years ago, until now, SJSN is still totally paralyzed, enabling the people to feel the cost. Although various road maps and studies have been created, their implementation is like a long wait in darkness.

If it is calculated, it is no small loss that has to be taken due to the stagnation of SJSN — just the failure of enacting health insurance reform.

First: the cost of health. In the year 2009, there were around 134.9 million people that had to pay for their health. In other words, they did not have health insurance because they had not been counted in the Community Health Insurance (Jaminan Kesehatan Masyarakat: Jamkesmas) program and other insurance programs.

With health expenses per capita averaging 40,000 Rupiah each month, the loss that must be borne nationally reaches 5.4 trillion Rupiah each month. National losses per year reach 64.7 trillion Rupiah. In five years, Indonesia’s total loss reaches 323.8 trillion Rupiah. This figure is far more fantastic than the scandal of the Bank Century bailout.

Second: economic productivity. If 175 million people of a productive age are ill 12 days out of a year and the lost earnings average 25,000 Rupiah per day, national economic losses are 52.5 trillion Rupiah. In other words, Indonesia loses huge potential for improving the national economy and pushing quality economic growth. In fact, the costs for actualizing health insurance for the whole population — the universal cost — are not as high when compared to the money in APBN that lies idle each year.

Will Indonesia allow the body of SJSN to be paralyzed forever? Obamacare or Yudhoyonocare, seen from wherever, culminates in the proof of commitment and political will. How far the Indonesian government will go to actualize public welfare, as mandated by the constitution and SJSN, is also not free from the factor of leadership.

That is, unless Indonesia waits for the birth of more Ponaris, the young sorcerer that can heal thousands of people from all illnesses with a magical stone.