What The West Needs To Learn About Democracy From Thailand

[plachon]

The point missed by the OP is that the problems being faced by the current Thai government are a direct result of the poor in Thailand having democratically elected a government that is (like it's predecessor TRK) poised to shift the balance of power in Thai society.

It is a direct failure of an assumed understanding of how the Poor in Thailand would vote (shock horror they got it wrong) that has lead to the demonstrations and it is the demonstrations themselves that are an attempt to remove a legitimately elected government - and therefore by definition an attempt to install a tyrant. Democracy has let the poor out of their place, it is the attempt of tyranny to put them back again.

THe ironic thing with this is people believe there is some massive shift, that suddenly the rural poor are choosing a new type of MP to represent them.

The reality is for most rural areas, the same political clan is in power now that was in power in the Baharn govt, the Chavalit govt, the Chuan govt and the TRT and PPP govts. The faces are the same, or if banned, the last name is the same and the face is the wife/husband/child or the previous MP.

How can this possibly be any sort of change when the rural poor are voting exactly the same way as they did before?

The only real difference is that the ways in which the factions are brought together and funded to form a government has changed, and the amount of skim needed to keep each faction happy (thanks to the extra layer of administration cost) has increased. In addition, the ability to use marketing and government money as incentives to get the rural poor and the city folk to vote one way or another has increased, while the actual direct handing out of cash is still very popular but arguably has decreased.

The problem is the elected government are attempting to circumvent the law; using the doctrine of 'well they were the elected majority' was the approach TRT took in completely reducing the free press to free coffee and AIS SIM cards for favoured members of the press with law suits and ruin for the ones who didn't tow the line. Ditto for the Muslim lawyer, the entire southern 3 provinces and every independent non elected body.

The question arises, if they cheated should PPP or any other parties be allowed to stay? Their answer....let's change the rules. Why? Because we were the elected majority.

Samak has entirely brought this on himself; had he even shown the slightest talent at being a PM, we would be in the first year euphoria of TRT again....instead..... he has shown himself to be totally incapable of governing. State of Emergency, what a joke.

Of course, all PPP supporters like to remind all that this is a Bush style us and them; there is in fact a sizeable group (me included) that consider a middle 3rd path to be key to solving the current issues.

It Charoen wanted to become PM tomorrow, he could easily do so, as the cost per MP in the ruling majority at the moment is (my estimate based on gut feel and past experience) in the realm of 60-100m baht per person.

Therefore, with an investment of something like 18 billion baht, I can be PM. And I don't have to care less what a single rural person thinks, I will just use the exact mechanic that TRT/PPP do now; invest that in becoming govt, and then milk that amount back through a variety of policies and means thereafter.

It is like a casino paying out jackpots.

All I would then have to do is ensure i could not be elected out, so I give away free stuff and more importantly keep my MPs happy; I remove all ability to be judged by any independent bodies (NGOs, media, comissions) and put my own guys into the army and police just in case.

How this is in any way more or less reflective of what the poor want who knows; they just keep voting for the same people, and they get paid to protest a bit and hit some people with sticks from time to time.

This in a nutshell just about explains the workings of Thai-style "democracy" perfectly. Well done Steve!

That a sizable bunch of foreigners and rather conservative publications like the Economist, continue to defend this democracy myth and put down a courageous bunch of ordinary Thai citizens who dare to say enough is enough to the status quo, tends to reinforce the view of many Thais that most farang just don't understand Thailand and the idiosyncratic "Thai way". It comes down perhaps to very different worldviews which Rudyard Kipling knew a thing about. It was encapsulated perfectly by the desire of some of the PAD to turn a bit of the Govt House lawn into a rice paddy. Brilliant! The King should be proud of them applying his Sufficiency Economy principles in a very symbolic way. A move that will no doubt be sneered at by the sceptics on this thread who fail to see the significance of such peoples' democracy and sustainable development at work!

[citizen33]

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If we are to discuss in more detail, then I am sure it would help many that you explain more fully the actual system of funding involved that made the 2001 scheme function and the differences to the 2006 scheme. Actually, I did see the TOR or RFP for the IT system of the healthcare system back in, must have been 2001 or 2002. Not being so familiar with IT TORs or RFPs (can't remember which ) I do recall thinking it was pretty light on detail compared to speccing a billing system for an energy company or the few projects of that sort I had been involved with in the past.

Probably most people will find this note on the Thai health reforms boring, but I have risen to the bait on the theory that expats are surprisingly ignorant and really should make the effort to learn more about Thai health care. Actually the system did not change in much other than name in 2006. The big changes have been concerned with the working through of planned reforms in a phased way, and with some repair work to counter emergent problems. As I have dashed this off quickly, there may be some errors and I would be happy to be put right by anybody with a better understanding of the detail.

Key features of 2001 30 baht project

Every citizen is entitled to register with their local health care provider (Contracting Unit for Primary Care - CUP) after establishing eligibility by presenting a house registration document. Members are issued with one of two types of gold card – the standard one requiring a 30 baht co-payment for every course of treatment; the Taw Tahaan version providing free care.

Each CUP was to be funded by central government according to the size of its registered population (the annual payment per member was 1202baht in 2001 rising to 1899 baht in 2007).

The CUP in most cases is based in a community hospital. In theory it uses its capitation-based funding to pay for referrals to secondary care (i.e. hospitals) based on weighted DRGs, to support the costs of outpatient clinics, and also to finance the community-based health units – the health centres and primary care units (PCUs). The UC funding stream consists of the three categories of inpatient, outpatient and prevention and promotion budgets. There are some problems because the doctor directors controlling the CUPs do not pass on the money (mainly IP and P&P) to other parts of the system.

The original aim was to move to a single health insurance fund but in the end there proved to be too much opposition. The 30 baht project replaced the Voluntary Health Card and the Medical Welfare Scheme + Type B exemption (for poor people), so as to fill in the gaps in coverage. However the Social Security Scheme and the Civil Servants Medical Benefit Scheme remained in operation, mainly because the members did not want to lose their superior benefits.

Strictly speaking the UC system as a whole comprises three schemes – the SSS, the CSMBS and the 30 baht scheme. Each has a different level of entitlements and a different funding mechanism.

The money for salaries of MoPH staff is included in the capitation payment. This was seen as a mechanism to redress the mal-allocation of the professional workforce across the Kingdom. In theory populous rural areas would now be able to recruit extra doctors and nurses (with the funding based on the number of insured members in the area) and end the old situation where there was an over-concentration of professionals and medical infrastructure in central region.

The funding system for the UC component (the 30 baht scheme) was set out in the National Health Security Act 2002, which made provision for a purchaser/provider split system in which a new entity – the National Health Security Office (separate from the Ministry of Public Health) - channels money to the CUPs (and on to the hospitals). The idea of a separate body was intended to allow a move away from the vested interests of the old system, but the MoPH fiercely resisted the plan. The compromise that was agreed involved a transitional period during which the MoPH handled the UC money until 2006.

Evolution and Change.

Due to the alleged shortcomings of the CUPs in allocating money but also opposition from the capitation-losing hospitals and regions, capitation funding was watered down dramatically from about 2003. In most areas the IP budget was taken away from the CUPs and handled by the health insurance division of the Provincial .Health Office (in the section usually known as the Provincial Clearing House). Even more significantly the salaries element of the budget was taken back to the MoPH and reallocated to the provinces on something other than a capitation basis. This meant that almost all the extra money Isaan and Northern Region had gained was lost and came back to Central Region. The idea of reallocating the workforce from over-served to under-served provinces largely disappeared from the policy discourse.

In 2006 the 30 baht co-payment was dropped and the name of the scheme changed, but the main changes continued to be evolutionary. It was estimated that the co-payment provided less than 2 percent of total receipts to the system, and so was not administratively efficient.

From 2006 the National Health Security Office started to oversee of the UC budget in line with the 2002 Act and became the purchaser. Actually it has behaved more like a manager than a purchaser and it is now clear that the original purchaser/provider split design is unlikely to operate as planned. The NHSO channeled the money to 13 regional offices, which in turn passed on money to the hospitals and CUPs. The practice whereby the CUPs got only a fraction of the UC funding rather than the whole is now well institutionalised, so that the idea of the primary care-led service has been de-emphasised.

In line with the requirements of the Decentralisation Act 1999, there is a perceived need to transfer a percentage of health care funding to local government. This is one of the current hot issues but is only going ahead slowly and currently mainly affects part of the P&P budget. By 2007 only 26% of public funding, including some of the UC fund, had been transferred against the 35% stipulated in the 1999 Act. At that stage only 22 health centres nationwide had been transferred from the MoPH to local government. However, local government organisations (tessabaan and ABD) have been invited to apply to set up local health funds, through which some of the UC funding will be channelled. This is now happening with several hundred funds set up across the country. These are used mainly to pay for P&P work. In the MoPH system at local level there have been attempts to strengthen services by creating new local medical units.

The 2007 Constitution appears to continue support for the reforms. Section 80 requires among other things that the State shall provide and promote a standardized public health service to people universally and efficiently. Recently policy makers in the NHSO and MoPH have been considering further harmonization of the three main schemes (UC (76%), SSS (15%), CSMBS (7%)) to try to reduce differences in funding mechanisms and entitlements. Thus the CSMBS switched from fee-for-service payment to DRG payments for hospital care in 2007 and the SSS payment mechanism is under review. Currently a consortium of the NHSO, the Social Security Office and the Comptroller General's Department oversees health financing policies, but there are still some who hope to realize the ambition of a single purchaser.

The National Health Act 2007 sets up some additional supporting institutions but does not change the basic funding mechanism. It sets up a National Health Commission with the Prime Minister as chair person, a National Health Commission Office, a Health Assembly with National and Local tiers, and requires the preparation of a National Health System statute. Some anticipate that this will pick up some of the proposals contained in a draft Bill pushed forward by civil society movements at the time of the original reforms, but never enacted.

Edited September 9, 2008 by citizen33

[steveromagnino]

it's all a bit academic now though, since the cooking show was a clear breach of the law (as have been a few other actions by PPP as a party) so it is election time again.

UNlike the PAD I believe that Isaan and northern voters actually have tasted what it is like to have a twit, and since they know their saviour is not coming back for now, they may actually vote for someone decent.

i.e. the same political clan they always vote for, but the clan may actually choose a better party to be part of.

this must have been fairly expensive, at a cost to get elected of say 20m baht, having only been in power a few months what possible chance would there have been to get a payback on that investment to get elected?

I think more than a few will be looking at their options and considering if they can get a party that will be able to hold a govt together at least close to a few years.

in recent years only Chuan and Thaksin were able to do that.

Citizen 33

thanks! that's awesome, might need to re-read a few times to digest it all :-)

Edited September 9, 2008 by steveromagnino

[willy1957]

In Belgium there it is your duty to vote,so there they count with all people no matter the social background, intellectual or not. If the rule is you are free to vote, than you have only people voting who have intrest in doing so. I think if you want democracy, than voting should be a must do and not for free to decide yourself. Take the US, if you would have a system similiar to belgium, Bush would nver have won, but as you said in the US only a certain percentage of people going to vote, and this gives a false idea of the political reality, and so can criminals like Bush leading the country to bankrupt and sending kids to the wars to get killed or to come back handicapped and with no hope on a normal future.

I think voting in return to say thanks that you live in a democracy isn't a hel_l of a job,is it? A good democracy can never function good if the votings are "free" and if the people not come out of the population, but selected by political groups or gouvernments.Every normal citizen should get the chance to involve in politics to be able to serve his or her country.Belgium has one of the best democratic systems in the world and is one of the richest countrys in the world but not on the back of the poor like in other so-called democracys.Social wellfare can't be done if not everybody is involved.That is the key for democracy, not a selection of extremely rich people who talk about "freedom" because the freedom they talk about is the freedom to take advantage of the poor and to keep them under with relegious dogmas and lies. 120 years ago, people came on the streets to protest that they could not vote, now a lot of people don't want or like to vote, but I would recommand to see the Belgian movie "Daens".

Not voting means that you give power to people you actually don't want but many are not aware of that. Democracy should be "learned" at the school, as well as what "solidarity" means.You don't have to be intellectual for that to understand, just thinking social and not only about yourself. Changing the world begins with changing yourself, but I understand that this is difficult as the people in power do everything to keep domination over the population. In the US they did use religion and fear to do so, not very different from the countries they are fighting against, altrough there are other reasons for that, but that is a different story

[Tod Daniels]

I think the most important lesson America could learn about "thai democracy" (if there is such a thing) is:

Don't host a cooking show while your Prime Minister

[dee123]

Several hundred years from now, history will define democracy in the 20th and early 21st century as "tyranny imposed by manipulating poor and uneducated voters."

What we need is a realistic alternative to democracy. Thailand has an excellent chance hear to be a beacon to the world right now, by abandoning democracy and putting something better in its place. Much like the American revolution 200+ years ago, it is time for another great experiment. The West will suffer this same fate as Thailand eventually as the deindustrial age ensues tracking down the energy depletion curve. As per capita income decreases, there simply is no ability to look beyond immediate survival needs. The human brain's discount function guarantees that all will be abandoned for immediate needs, and the future will be sacraficed in the process. It is at this point when the poor can be manipulated to give their votes to tyrants, as has currently happened in Thailand. If it can happen in Thailand today, it can happen in the West years from now when incomes have collapsed.

The only thing that saves countries like the US right now from this fate is that poor people don't vote as a rule. As the middle class who is used to voting becomes the poor who vote out of force of habit, you can expect a similar situation to arise.

I applaud the PAD for recognizing that democracy as it is implemented today is a sham, and we need a replacement system that is workable for the future.

Comments? (Hoping for a lively discussion..)

Don't tell me they sell scrumpy in Thailand !

[thaihome]

In Belgium there it is your duty to vote,so there they count with all people no matter the social background, intellectual or not. If the rule is you are free to vote, than you have only people voting who have intrest in doing so. I think if you want democracy, than voting should be a must do and not for free to decide yourself. Take the US, if you would have a system similiar to belgium, Bush would nver have won, but as you said in the US only a certain percentage of people going to vote, and this gives a false idea of the political reality, and so can criminals like Bush leading the country to bankrupt and sending kids to the wars to get killed or to come back handicapped and with no hope on a normal future.

I think voting in return to say thanks that you live in a democracy isn't a hel_l of a job,is it? A good democracy can never function good if the votings are "free" and if the people not come out of the population, but selected by political groups or gouvernments.Every normal citizen should get the chance to involve in politics to be able to serve his or her country.Belgium has one of the best democratic systems in the world and is one of the richest countrys in the world but not on the back of the poor like in other so-called democracys.Social wellfare can't be done if not everybody is involved.That is the key for democracy, not a selection of extremely rich people who talk about "freedom" because the freedom they talk about is the freedom to take advantage of the poor and to keep them under with relegious dogmas and lies. 120 years ago, people came on the streets to protest that they could not vote, now a lot of people don't want or like to vote, but I would recommand to see the Belgian movie "Daens".

Not voting means that you give power to people you actually don't want but many are not aware of that. Democracy should be "learned" at the school, as well as what "solidarity" means.You don't have to be intellectual for that to understand, just thinking social and not only about yourself. Changing the world begins with changing yourself, but I understand that this is difficult as the people in power do everything to keep domination over the population. In the US they did use religion and fear to do so, not very different from the countries they are fighting against, altrough there are other reasons for that, but that is a different story

You failed to admit was that Belgium had for most of it early history a voting eligibility system that allowed wealthy landowners to have multiple votes giving them virtual control over the government. It was only after the constitution reforms of 1921 that a one man one vote system was put into place. Virtually all mature, stable democratic counties originally had systems in place that favored a wealthy elite which were gradually replaced over many years with more equalitarian voting rights. This is what the PAD asking for. The one-man one vote system, prematurely put into place in Thailand has led to the shambles we see today.

TH

[permanent_disorder]

Several hundred years from now, history will define democracy in the 20th and early 21st century as "tyranny imposed by manipulating poor and uneducated voters."

What we need is a realistic alternative to democracy. Thailand has an excellent chance hear to be a beacon to the world right now, by abandoning democracy and putting something better in its place. Much like the American revolution 200+ years ago, it is time for another great experiment. The West will suffer this same fate as Thailand eventually as the deindustrial age ensues tracking down the energy depletion curve. As per capita income decreases, there simply is no ability to look beyond immediate survival needs. The human brain's discount function guarantees that all will be abandoned for immediate needs, and the future will be sacraficed in the process...

if you have visions you need to see a medico or is that some kind of sophisticated joke?

like you take a speech of mussolini, pol pot, kim il, mao, goebbels or of some other "great experimentators" just change few words a little bit to make it more thailand related. and just wait now for the applause from the proPAD cultists. as a political theory is nothing new about. histories and the past is full of experiments like this, complete and utter failures. no reason to retry it.

it was fun to see how you can fool proPAD cultists. now it's time to give the riddle's answer. who said or wrote that in original?

“But of all political ideals, that of making the people happy is perhaps the most dangerous one. It leads invariably to the attempt to impose our scale of ‘higher’ values upon others, in order to make them realize what seems to us of greatest importance for their happiness; in order, as it were, to save their souls. It leads to Utopianism and Romanticism. We all feel certain that everybody would be happy in the beautiful, the perfect community of our dreams. And no doubt, there would be heaven on earth if we could all love one another. But, as I have said before, the attempt to make heaven on earth invaliably produces hel_l."

Karl Popper

[khunjamespittman]

I believe the actual intent was a Democratic Republic and that's what was formed.

gregb , your post is nothing but a crock of delusional madness , the sort of rubbish put together by people who imagine themselves to be brave new revolutionaries but who are in fact dysfunctional loners with skin conditions stuck in sticky bedsits in wolverhampton or walsall.

Well, I have to admit, the vitriol here isn't quite as bad as I was expecting, however may I suggest it is the cultural narratives and myths we have been raised with, rather than any individual, that is dysfunctional and delusional.

While this may be difficult, try to step back and see what is really there. Democracy today as a form of government is broken, and needs to be reformed. Some of the ideas are not necessarily bad, but they won't work in practice during the coming era of energy depletion. Communism (as implemented) as a form of government was also a laudable goal, but it didn't work either and for the most part has been abandoned. Democracy will follow the same path eventually.

BTW, the original intent of the framers of the US Constitution was that it would be a republic, NOT a democracy. There is a big difference. And there is alot of value in studying history and understanding this point.

We do have a problem here, and one point of this thread was to hope to find some of the more interesting ideas people may have about ways to fix the problems. Granted, I intentionally chose a rather provocative way to begin it. I will defend the statement to any of you who care to discuss.