Armenia’s Ministry of Health has proposed an ambitious program for implementing a mandatory, universal health insurance system in the country. But many Armenians are balking at the cost, which the ministry said would require a 6 percent income tax on every working citizen.
The ministry published a draft of program on November 22, resulting in much social media grumbling. On the website where the government proposes bills, citizens can vote whether they support or oppose the proposal; this one got an unusually high number of responses and 56 percent were against as of the time this post was published.
Several days after the draft appeared, Health Minister Arsen Tonosyan was forced to respond to the criticism.
“This proposal is based on an analysis of the entire experience of the history of independent Armenia, the best international experience and the reality in which we live today,” said Health Minister Arsen Tonosyan, in a Facebook broadcast from Copenhagen. He said that 85 percent of Armenians currently pay for health expenses out of pocket, and that “these expenses lead to the impoverishment of our citizens.”
The program would cost about $525 million per year, according to the ministry’s calculations; the ministry would cover about half that from its budget and the rest would be collected by a new tax, a flat 6 percent on every Armenian who is formally employed. One representative of Armenia’s prominent tech sector said that targeting employed people was unfair: “The minister thinks that ordinary, white-collar taxpayers have to provide health insurance for everyone?” asked Levon Harutyunyan in an interview with RFE/RL. “Working people are not slaves of the state.”
According to the World Bank, in Armenia 45 percent of the population is informally employed and 18 percent unemployed.
The program wouldn’t cover all medical procedures: the ministry specified that it would include treatment of cardiovascular diseases including surgeries, as well as treatments for cancer including surgery, radiation, and chemotherapy. It wouldn’t include dental care and some specialized, expensive services like organ transplants.
Some objected that the expensive treatments that most often bankrupt Armenians aren’t in fact done in Armenia, as the quality of care here is low and so many people go to Europe or Russia instead for treatment.
Journalist Artak Hambardzumyan compared the health care proposal to the “50-dram” protests of 2013 against a fare increase on public transportation from 100 to 150 drams. “Then, they argued that you need to pay more to improve the quality. I think this is the wrong approach,” Hambardzumyan wrote on Facebook. “I have to be sure that I will get quality service and that the money will be spent effectively. As in the case for the struggle for 100 drams, that confidence is still not there yet.”
Torosyan’s allies suggested that opposition to the plan might stem from a lack of sophistication. “I’m sure the people who think that 6 percent is too high for healthcare, if you tell them that we will give that money so that they can eat khash (a traditional Caucasus soup) twice a month, they will support it,” wrote ministry employee Hayk Grigoryan on Facebook.
And Torosyan himself later posted a chart on Facebook showing a list of countries that offer universal healthcare and how much they paid in taxes. The chart included mostly European countries far richer than Armenia, leading to objections that they were not good comparisons. The top-rated comment on the post was a list comparing Armenia’s incomes to the countries in Torosyan’s list.
Ani Mejlumyan is a reporter based in Yerevan.