I recently met Dr Jadej Thammatacharee, secretary-general of the National Health Security Office (NHSO), at the home of a mutual friend to ask questions, of which I had many, about the so-called 30-baht scheme -- also known as the "gold card" scheme.
The doctor was generous with his time, clear and logical in his presentation. I came away with a better appreciation of what the programme means for Thailand and what it hopes to be, where it came from and where it is going.
The NHSO, the organisation responsible for extending affordable, if not free, health care everywhere in Thailand, was established under the National Health Security Act of 2002. It is now one of the best-funded government bureaucracies, responsible for subsidising national health care in keeping the populist premise that people of limited means should pay no more than 30 baht per doctor's visit.
Dr Jadej credits the simple but somewhat revolutionary idea behind the programme to public-health civil servants such as the late Dr Sanguan Nitayarumphong, who had been looking to implement variations on universal health care since the 1980s. Dr Prawet Wasi, the constitutional reformist popularly known as "Mo Prawet" was also an early pioneer.
The seemingly arbitrary political tag "30 baht" has had unusual staying power, and still represents the nominal fee per visit for health care. The tag, popularised by political consultant Pansak Vinyrat who is now an adviser to the prime minister, was formally launched during Thaksin Shinawatra's term as premier.
It is perhaps one of the most profound and lasting positives from a period that is chiefly remembered for its political divisiveness.
The modest fee, which critics scoffed at because 30 baht sounded implausible, unworkable and deceptive, like a political slogan or rhetorical sleight of hand, still applies, and in some cases is not collected at all.
There's no doubt that opening the floodgates to affordable care has put enormous pressure on state hospitals and increased the workload of healthcare professionals.
Recently, critics and some doctors have warned the 30 baht scheme will face an existential crisis caused by an overbearing workload on state hospitals and staff as well as financial problems. Yet Dr Jadej says these issues are being addressed through a combination of increased funding and finding creative and innovative ways of sharing the workload.
The programme is expensive, comprising roughly 4% of the national budget, but is still less than the state expenditure percentage in other countries where coverage remains ad hoc and far from universal. And inasmuch as the programme is credited for raising life expectancy in Thailand to one of the highest levels in the entire world, there's something to be said for money well-spent.
All state hospitals are in the programme, and private hospitals, which have more downtime and less crowded facilities are encouraged to take part as well in addition to their normal load of paying patients. It's to the benefit of private hospitals to embrace the extra workload, with reimbursements, during downtime, and good for the purposes of training and specialisation of private sector doctors.
The programme is supported by a national network of pharmacies, about 5,000, which are offered training and certification. The idea is to save on hospital visits by allowing prescription drugs to be distributed by knowledgeable personnel in pharmacies across the country.
Administrators of the programme have tried to reduce costs, pressure and workloads by emphasising local care for less serious ailments, including the popularisation of nurse care, and tambon-level care for fevers and routine ailments.
Dr Jadej compares the programme to National Health Care (NHC) in Britain, but he says it is not as bogged down by red tape as in the UK, where, for example, a 15 minute per patient mandate means a doctor can only see four people per hour, resulting in long waiting times and wait lists.
He acknowledges that Japan, known for its high life expectancy, has a fairly comprehensive programme, but it is not a direct model for the Thai programme and is not run centrally as is the case in Thailand.
As for China, it has excellent health care in cities but lacks doctors in proportion to its population, especially in rural areas. In earlier days this discrepancy led to the call for barefoot doctors, but such socialist schemes are not in favour now.
Hospitals are increasingly well-equipped and doctors, accustomed to seeing hundreds or patients a week, are experienced, but the unreasonably long waits and delays opens up the opportunity for bribery and line-jumping schemes for those with money to pay.
Rwanda, the Thai administrator pointed out with a contrarian's delight, has a superb health care model -- an innovative and fairly comprehensive programme -- all the more remarkable for a poor African country that not too long ago emerged from a genocide
I was surprised to hear Dr Jadej point to Cuba as a model, but he's been there and seen how it works up close. Fidel Castro gave his word to produce doctors and the country's medical colleges churned them out to the point of having a surplus, or at least sufficient medical expertise that Cuba has on occasion been able to export doctors to poor nations in Africa and Latin America.
Dr Jadej likewise credited the controversial and now defunct Communist Party of Thailand (CPT), which waged guerrilla war on the military establishment from remote bases in the mountains during much of the 1960s and 1970s, for good healthcare. The CPT was small, and ultimately ineffective as it limped from one remote rural base to another, and got caught in the crossfire of the Sino-Soviet split, but the rebels had many doctors in their jungle camps, many of them trained at Mahidol University, and the level of healthcare was good considering the circumstances.
Thai people now enjoy one of the best health programmes in the world, Dr Jadej asserts with pride. Another plus for Thai public health, he says, is the native Thai social structure by which the elderly are not shunted away to old age homes but live with their extended families and continue to interact with the community.
The NHSO secretary-general acknowledges that some right-leaning politicians have tried to cut the programme back since 2014, which he compares to similar efforts by Republicans in the US, but the attempts to rollback the programme have been effectively halted because of its popularity, its many stakeholders and widespread political support across the political divide.
People who are beneficiaries of the programme are the best supporters of universal healthcare and they can be heard speaking up all over the country. There are people who are alive today because of comprehensive medical intervention that was beyond their financial means.
Studying medicine is popular and Thailand continues to produce many doctors, often the best and brightest among their school cohorts. He went on to say he didn't like the Bumrungrad model of medical tourism, but would rather see the best hospitals included in an equitable national system by which reasonably priced care is made available to Thais, foreign tourists and foreign residents.
He cites the example of a fast-growing hospital in Ubon that not only serves the province and all of south Isan, but is also a key medical hub for southern Laos and Cambodia as well.
Contrary to the nay-saying at its inception two decades ago, the programme functions well and has extensive reach across the nation.
Thailand's journey to something akin to universal healthcare in a matter of two decades is nothing short of remarkable, but it is still not fully appreciated in Thailand, let alone abroad. Dr Jadej notes that UN agencies and the World Bank have taken an interest in it, and he ardently hopes the achievements and underlying philosophy behind universal care will be better understood in the future.
Philip J Cunningham is a media researcher covering Asian politics. He is the author of 'Tiananmen Moon'.