Chapter 406: Medical Insurance and the Provincial-Hong Kong Hospital

Shi Niaoren’s cabin was located at the end of the ship, far from the engine room. The wall facing the engine room was piled with large bags filled with coconut coir—a better-than-nothing measure designed to protect the leader in case of a boiler explosion. In the eyes of the Senate members, a series of domestically produced steam-powered ships, including the 854, 901, and others considered the “pride of Lingao’s industry,” were all in this state of safety, and this was indeed the reality.

At this moment, Shi Niaoren was sitting at the desk in his cabin, flipping through a thick book with a gloomy expression. His face had been grim since the journey began. It wasn’t because of seasickness, as he had explained to his entourage, but because the book before him was actually a draft of the detailed regulations for public medical care for naturalized citizens, which the Civil Affairs department had given him to review—or rather, to accept—when he returned to Lingao to rest after his last regional tour.

In his daily conversations with doctors from his original world, Shi Niaoren would often casually mention, “Back when I was in the States…” But he never mentioned how he had been constrained by medical insurance when he practiced medicine in America. He never expected that, having traveled back in time to more than a century before the founding of the United States, he would still be tormented by medical insurance—and a brand-new, self-inflicted form of torment at that. The thought put him in a particularly foul mood.

In the second half of last year, at an expanded meeting of the Executive Committee, the Finance department proposed implementing a monetized settlement system within the health system. Free allocation of drugs and equipment would cease, and all health services would be assigned specific prices.

This wasn’t aimed solely at the Ministry of Health. The Director of Finance, Cheng Dong, had repeatedly proposed the policy of implementing monetized accounting in all government agencies, enterprises, factories, and commercial units. This was the initial rollout, with the Ministry of Health as the pilot unit.

Minister Shi had no objection to monetized accounting itself. After all, without it, a whole host of figures from the Finance department—total currency issuance, economic output, fiscal expenditure, and so on—would be a complete mess. But what followed was unexpected.

Implementing monetized accounting was not difficult in itself; it just meant more financial bookkeeping. In the past, the health department only had to requisition supplies, produce things, and treat patients. Whenever they needed something, they just had to file a report. Now, in addition to filing reports, they had to calculate the cost in circulation coupons based on a price list. Of course, the money was just a figure on the books, processed through Delong Bank. The only impact on the Ministry of Health was the addition of a few more accountants, cashiers, and tellers.

Getting medical treatment also became more complicated for both Senators and naturalized citizens. In the past, a visit to the doctor simply required registration. Now, a triplicate form had to be filled out, itemizing the costs of drugs and treatment, which were then submitted to the Ministry of Civil Affairs and the Ministry of Finance, respectively. The three hospitals under the Ministry of Health even hired a batch of cashiers specifically for this purpose.

However, the trend then took a wrong turn. The Ministry of Civil Affairs subsequently requested that the Ministry of Health formulate a clinical pathway for common diseases among naturalized citizens, to guide the diagnostic and treatment activities of naturalized medical personnel. At the time, the Ministry of Health didn’t think much of it. Apart from a few large hospitals staffed by Senator doctors, the medical services for naturalized citizens were basically at the level of treating minor injuries and common ailments like headaches and fevers, in addition to public health and epidemic prevention work. The Ministry of Health simply reorganized the contents of the common disease manual used by naturalized medical personnel who had gone through a few months of crash courses and submitted it to the Ministry of Civil Affairs.

Unexpectedly, a few months later, the Ministry of Finance and the Ministry of Civil Affairs jointly issued a document based on the clinical pathway submitted by the Ministry of Health, guiding the diagnosis and treatment of naturalized citizens covered by public medical care. To be precise, it used the clinical pathway to guide and limit the costs of treatment. Unless there were special reasons, if a patient’s treatment deviated from the pathway, any expenses exceeding the limit would be borne by the medical institution itself; public medical care would not cover it.

The Ministry of Civil Affairs’ reasoning was that modern medicine is built on huge investments in high technology. Based on experience from their original world, medical costs generally grow faster than the economy and residents’ income.

Currently, all medical treatment for the Senate’s naturalized soldiers and employees was covered by the public medical system, provided free of charge. Medical care provided to non-employee naturalized citizens within the areas controlled by the Senate’s modern system was also essentially half-price. This was a demonstration of the Senate’s political superiority.

The Ministry of Civil Affairs argued that although the overall medical system was still rudimentary, if payments for public medical care were not restricted, the empire, which was experiencing technological leaps at every moment, would likely form an unwieldy welfare burden too early, affecting its long-term rule in the future.

Upon hearing this reasoning, Shi Niaoren immediately retorted to the Ministry of Civil Affairs, “Does a starving man need to worry about obesity?” He then had a “frank conversation” and “fully exchanged views” with the relevant officials from the Ministry of Civil Affairs and the Ministry of Finance they had brought along. They “enhanced mutual understanding,” the “talks were beneficial,” and both sides “fully reserved their opinions.”

Minister Shi was well aware that behind this matter were the dark hands of certain people in the finance and economic departments. As for their purpose, it was nothing more than the “sound social insurance system” they had been actively promoting.

Shi Niaoren’s opinion was that the Senate’s health system’s medical activities for naturalized citizens were still very primitive—so primitive that, in the Senators’ view, half of the common internal medicine treatments were placebo therapies. It was in urgent need of vigorous development. Placing economic restrictions on these primitive medical activities so early would certainly limit the progress of the Senate’s medical cause. Medicine is a highly practical science, and tying the hands of practice too early would be detrimental to improving medical standards.

He was too embarrassed to say that doctors are essentially skilled workers who get better with more practice. So, Minister Shi particularly emphasized the great truth that practice leads to true knowledge. He then went on to argue that relying solely on medical activities serving the Senators would not provide enough practice, and the development of the Senate’s medicine would inevitably stagnate—and in the future, when the Senators…

Moreover, the modern materials and drugs required by the medical institutions under the Senate were all allocated through planned distribution. Although it had now switched to monetized settlement, it was still essentially a full-appropriation system. If public medical care refused to pay, where would the deficit be covered? An expanding financial gap would inevitably affect the maintenance and self-upgrade of the entire health system. At that point, it would be difficult for the health department to “serve the Senate wholeheartedly.”

This speech clearly attracted the “high attention” of the Senate, so the matter was currently shelved. But Shi Niaoren was still unhappy—it seemed the finance and economic departments were determined to get their hands on medical insurance.

After leaving the Qiongzhou Strait, the Octopus rendezvoused with two patrol boats from Haikou, forming a small escort fleet to Hong Kong.

According to the plan, the Octopus would dock in Hong Kong for several days to clean out ash and cinders and undergo final cosmetic touches. Then, on an auspicious day, the Octopus would sail up the Pearl River to the White Swan Pool and be formally handed over to Guo Yi as his yacht.

According to the plan, the Octopus would be moored in the waters of the newly built Guangzhou Grand World, serving as a display and symbol of Australian civilization and lifestyle.

After the Octopus dropped anchor, all the Senators at the Hong Kong base came to the pier to welcome them. Although the Central Political Affairs Council, the General Office of the Executive Committee, and the Cheka had jointly issued several documents requiring overseas Senators to reduce welcoming and seeing-off activities for visiting and passing-through Senators and to drastically cut “three public” expenditures, the overseas Senators all held the belief that “one can’t be blamed for being too polite” or “the monks from the capital recite the sutras better.” The trend of entertaining “fellow Senators” grew stronger and stronger. Grand feasts and various local gifts were indispensable. For a time, the trend of “looking forward to business trips” and “begging for business trips” was rampant.

The solution in various places to the spending cuts was also simple: Senators had large annual dividends, which were just numbers in the bank. If they took them out for personal consumption, neither the finance department nor the Cheka could say anything. For this reason, Wu Nanhai’s coffee shop had to send out large quantities of “special supply mailbags” of high-end consumer goods like kvass, rum, and cigars to various overseas stations every month.

The Hong Kong station was no exception. Due to Operation Engine, there were many Senators in Hong Kong, including those from the Planning Commission, the Ministry of Civil Affairs, and the Army and Navy. However, they were all on business trips and didn’t need or have to come to welcome them. Appearing at Central Pier No. 1 were the two permanent Senators in Hong Kong: leading the way was Luo Chen, the commander of the Hong Kong Agricultural Reclamation Joint Team, and beside him was Hong Shuiyin, the Hong Kong commercial representative. Besides the two of them, there was an unremarkable young man, dressed in a crisp cadre uniform, carrying a briefcase.

Shi Niaoren came down the gangplank and shook hands with Luo Chen, Hong Shuiyin, and the others, exchanging pleasantries. The two were very warm and attentive. Minister Shi knew very well that their enthusiasm was not just because he was a “monk from the capital,” but also because they wanted to lobby for a project: the planned “Provincial-Hong Kong General Hospital.”

The idea of building a Provincial-Hong Kong hospital in either Guangzhou or Hong Kong had been around in the Senate for a long time. It had recently been put on the agenda.

This was partly for economic reasons, and partly to expand the influence of the Senate and modern medical care—similar to dispatching mobile medical teams.

However, for the Ministry of Health, the main benefit was having a large number of patients who could pay their own fees, providing practice for the department’s newcomers. At a time when the dark clouds of the medical insurance system were beginning to gather, this plan was very tempting for Minister Shi.

“Shi Jiantao is such a jerk. I asked for a horse-drawn carriage, and he said there were no horses—where else on this Hong Kong island are there horses besides the shipyard…” The voice was followed by a short, stout figure. This was the only Senator in the medical and health department who had no degree in medicine, pharmacy, health, nursing, or biology—in fact, no degree at all—the head of the medical affairs department of the Ministry of Health’s Bairen General Hospital, Deng Bojun.