The Hospital as a Non-site of Politics
Ko Wen-je recently took to Facebook to rebuke Kuomintang (KMT) presidential candidate Han Kuo-yu for posing for photos in the emergency room of National Taiwan University Hospital (NTUH). Pictures show Han looking dour while standing at the hospital bed of KMT legislator Chen Yu-jen, who was injured during a scuffle with security officers at the Ministry of Foreign Affairs (MOFA).
Han Kuo-yu and KMT Politicians with Chen Yu-jen at NTUH
Chen was part of a group of KMT politicians demanding accountability from the MOFA for the suicide of Su Chii-cherng, then-director of the Taipei Economic and Cultural Office in Osaka. Su hung himself after receiving scathing online criticism for his office’s handling of Taiwanese tourists stranded at the Kansai International Airport after Typhoon Jebi struck Japan. Taipei prosecutors indicted Yang Hui-ju, a former campaign aide of Democratic Progressive Party (DPP) member and current envoy to Japan Frank Hsieh, for spreading false information critical of Su. The KMT believes that Yang used government funding to recruit a pro-DPP cyber army to generate fake news and influence political opinion, including false reports claiming to be from Taiwanese tourists in order to shield Hsieh from criticism.
Han has been widely panned for the hopelessly melodramatic photos taken at NTUH. Ko Wen-je, a former doctor at NTUH and current mayor of Taipei, weighed in with relatively mild criticism on Facebook, suggesting that, “任何政治活動，都應該離醫院越遠越好” (“all political events should be kept away from hospitals as much as possible”).
The Taipei Times reported on Ko’s criticism, however, with the headline, “Hospitals are no place for politics, Ko Wen-je says.” Reading only the headline, one would be forgiven for considering Ko an ignorant oaf. Hospitals have been at the center of political struggles in recent years, generating intense public debates over unionization, working hours, and national health insurance. Ironically, administrators at Taipei City Hospital made news in the days following the publication of the article for falsifying documents in order to reap NT$55 million (US$1.8 million) in government subsidies. By distorting Ko’s words, the article operates on two levels: as a critique of the KMT for the political circus staged at NTUH, and as a subtle potshot at Ko.
Ko Wen-je's Facebook Post
The ding against Ko relies on collapsing the distinction between politics and institutional political activities. Specifically, the headline misconstrues institutional politics, in this case campaigning for the 2020 national elections, as politics in toto.
Reductionism of this sort is typical of hegemonic ideologies. Similar false equivalences confuse law with justice, police with order, and schooling with education. The article says more about the political character of the Taipei Times than it does about the KMT or Ko. Nevertheless, the premise of the article provides an opportunity to reflect on what it means for the hospital to be considered as a non-site of politics.
Treating medicine as a sacred realm sealed off from the messy world of politics mimics the separation of the rational from the irrational in Enlightenment thinking. That Western powers weaponized such binaries to legitimize colonization and conquest, the mass murder of Native Americans, and enslavement of African peoples is irrefutable. The ‘white man’s burden’ was constructed as a defense of colonialism through debates about the morality of genocide, slavery, and theft. Colonizers denied the humanity of ‘darker races’ by arguing that the latter had no rights that the former were bound to respect. According to this discourse of domination, Western civilization has a duty to lead the world as the epitome of modernity, rationality, and progress fundamentally distinct from primitive, irrational, and backward Indigenous populations.
Medicine, understood as a scientific practice, is generally assigned to the sphere of the rational and therefore a monopoly of Western and Westernized societies. Attributing rational scientific thought to the West bulldozes over the vast wealth of knowledge stolen from Indigenous populations through the tremendous violence of settler colonialism. It also obscures the power of profit-oriented pharmaceutical companies in determining what kinds of illnesses to produce medicine for.
Medical knowledge is not the result of a rational process of development, but an outcome of struggle over priorities and resources. In terms of capital-labor relations, the ruling class relies on the ideological separation of the rational from the irrational to oppose the right of healthcare workers to unionize. According to this logic, hospitals should be free from political conflict, which is seen as external to the natural order of the medical profession, in order to provide the best care possible. The separation of the rational from the irrational is thereby intertwined with neoliberal capitalist beliefs in the supremacy of the free market.
"The White Man's Burden (Apologies to Rudyard Kipling)." Victor Gillam, Judge, April 1, 1899. Source: The Ohio State University Billy Ireland Cartoon Library & Museum. Taken from https://apjjf.org/2015/13/27/Ellen-Sebring/4339.html
Healthcare is a crucial domain in Taiwanese society where free market principles have been eroded in recent years. Nearly the entire population of Taiwan (99.6 percent according to a recent estimate) is covered under the government-run National Health Insurance (NHI). Established in 1995, the NHI is a comprehensive universal health care system that provides inpatient and outpatient care as well as access to a range of drugs and services. The NHI has been touted as among the best health insurance programs in the world for the extent of its coverage and the quality and affordability of medical care provided.
The impressive statistics of the NHI mask structural discrimination against oppressed members of society and the gendered and racialized distribution of illness in Taiwan. At a recent campaign event, for example, former premier and vice presidential candidate Simon Chang spoke about how immigrant women often lack health insurance during pregnancy. Discriminatory health insurance policies, however, were overshadowed in media coverage of the event by Chang’s misogynist comments suggesting that, “President Tsai Ing-wen has not given birth, so she would not understand the feelings of a parent.”
It is important to struggle against misogyny. But attacking misogynist comments while soft-pedaling structural oppression and exploitation is disingenuous at best, and a blatant manipulation of public discourse in the interests of the ruling class at worst. Calling Chang out for misogyny targeting President Tsai while giving short shrift to health policies for immigrant women during pregnancy is a cowardly tactic that erases the materiality of gendered violence.
Simon Chang Answering Questions at Campaign Event
The hospital is usually the first destination for migrant workers employed through Taiwan’s guest worker program after arriving at Taoyuan International Airport. Migrant workers who arrive in the afternoon or evening are first taken to overnight dormitories that are often squalid and overcrowded to wait until medical examination hours open the next morning. Migrant workers are required to complete medical examinations 3 days, as well as 6, 18, and 30 months upon arrival.
Labor market policies restrict migrant workers to jobs in manufacturing, domestic care, construction, and fishing/agriculture. These jobs are notoriously dangerous, difficult, degrading, devalued, and dirty – the ‘5 Ds.’ It should come as no surprise, then, that migrant workers are disproportionately victims of occupational accidents. Statistics show that a migrant worker becomes disabled as the result of an occupational injury nearly every day, while every two days a migrant worker is killed on the job.
Even within the same sector, migrant workers are injured at far higher rates than their Taiwanese counterparts. In the manufacturing sector, occupational injuries resulting in disability was 6.7 injuries per 10,000 workers for migrant workers, and 3.1 injuries per 10,000 workers for Taiwanese workers. These figures evidence the brutal consequences of racial/ethnic discrimination against migrant workers.
Graph Comparing 2016 Death Rates for Migrant Workers Employed in Manufacturing and Construction in Taiwan, Singapore, Japan, the US, and the UK. Taiwan has the highest death rates.
Getting sick is a source of tremendous stress for migrant workers. The guest worker program is designed to import labor power, not people. Employers and labor brokers therefore treat anything that interferes with labor productivity, such as illness or mental, emotional, and physical fatigue, as a nuisance and obstacle to the extraction of profit. In the commercial fishing industry, for instance, migrant workers who complain of feeling sick are often derided as being weak or effeminate. Such gendering processes are used to justify paying migrant workers less in share-of-catch bonuses that constitute a significant portion of migrant fishers’ wages.
Migrant fishermen who develop more serious diseases are similarly blamed for their conditions and risk having their employment contracts terminated. As a result, migrant workers lose access to health insurance and must subsequently shoulder the burden of health care costs.
Daniel, a Filipino migrant fisherman, for instance, developed a nagging cough and chest pain while employed on a small fishing boat. He attributes the illness to not being provided with a bed to sleep. While onboard, he would sleep wherever there was a dry spot, which often meant sleeping next to the boat engine.
After complaining about living conditions on the vessel, Daniel and other migrant fishermen lost their jobs. They subsequently moved into onshore living spaces provided by their labor brokers. Although Daniel complained about feeling unwell, his labor broker found excuses to avoid taking him to the hospital to seek treatment. Having lost his job, Daniel also lost access to health insurance. The back-and-forth between Daniel and his labor broker continued for a month before Daniel sought help from a local migrant labor advocacy group. The group accompanied Daniel and another migrant fishermen who felt sick to the hospital with a translator. At the hospital, Daniel’s labor broker showed up and berated members of the migrant labor advocacy for interfering in the situation.
Doctors diagnosed Daniel with pneumonia and recommended that he stay at the hospital. Although he was wary of the costs, he decided to stay on the advice of the migrant labor advocacy group. The alternative would be to return to the living space provided by his labor broker. Daniel spent over a week in the hospital receiving treatment. Without health insurance, the cost of the stay exceeded NT$50,000. Lacking the means to pay, Daniel worked with a social worker at the hospital to defer payment until receiving health insurance with the hope that the NHI would cover the expenses. He developed pneumonia, after all, as a consequence of the living conditions at his place of employment.
Whether the NHI will cover Daniel’s medical expenses is still uncertain. Although Daniel has worked in Taiwan off and on for 8 years, he began his most recent stint after returning to the Philippines for several months. His health insurance card has therefore been valid for less than 6 months and, as a consequence, he is unable to apply for an extension without having an employer. If Daniel is unable to enroll in the NHI before the end of the year, he will be forced to pay nearly NT$70,000 and then apply for reimbursement from the NHI, a burdensome process which could take several months to complete. Meanwhile, Daniel is still recovering his strength, making it unlikely that he will find an employer in the immediate future. His best options are therefore for his former employer or current labor broker to enroll him in the NHI.
Contrary to Ko Wen-je’s alleged statement as reported by the Taipei Times, hospitals are deeply political places. For migrant workers employed through Taiwan’s guest worker program, hospitals are a central site of socialization and social struggle. Laudatory statements about Taiwan’s NHI scheme overlook how access to healthcare continues to be marked by deep inequality produced through discriminatory policies. Access to health insurance is a key arena where migrant workers are made unfree through enforced dependence on employers and labor brokers.