FEBRUARY 2 — Bank Negara Malaysia’s (BNM) MHIT White Paper has sparked debate over its scope and ambition.
The most common criticism of the Base MHIT product is not subtle. It is “too modest”, “not ambitious enough”, “structurally insufficient”.
Some go further: without subsidies or a national health insurance scheme, it is dismissed as tinkering at the edges of a broken system.
It sounds persuasive, until we stop and ask what is actually being assumed.
Are we criticising Base MHIT for what it is, or for failing to instantly deliver what the system has never had?
Are we demanding ambition, or are we demanding immediacy dressed up as moral urgency?
Because those are not the same thing.
There is an unspoken belief running through much of the opposition: that bigger schemes are automatically better, that once the state steps in at scale, discipline will follow, and that generosity creates order rather than the other way around. It is an appealing belief. It is also one we rarely test.
If higher coverage limits guaranteed affordability, Malaysia would already have solved medical inflation.
In fact, the very reality we face today stems from coverage limits set so unsustainably high that they produced an equally unsustainable claims experience.
Generosity, untethered from cost discipline, did not protect patients; it distorted prices, widened utilisation, and normalised a level of spending the system could not carry.
If public money alone tamed prices, countries would not spend decades refining benefit design, provider payment systems, and cost controls after introducing national schemes.
Cost containment did not emerge automatically with public financing; it had to be engineered, renegotiated, and politically defended over years, often painfully.
Some quarters have even suggested a so-called “Tobin Tax” on insurers or financial transactions, as though a new levy could substitute for structural reform.
The logic is revealing: when costs feel out of control, the answer is not to ask why prices behave the way they do, or how incentives are misaligned, but to look for another revenue tap.
As if healthcare inflation were a funding problem rather than a design problem. As if taxing intermediaries harder could correct a system that has never agreed on what “basic”, “reasonable”, or “standard” care actually costs.
And if calling something “national” was enough to impose discipline, healthcare would be the only sector in history where scale corrected inefficiency by default.
So, let us ask a harder question: what exactly are we proposing to subsidise today?
The current healthcare financing landscape is fragmented, opaque, and wildly inconsistent. Prices for the same procedure vary dramatically.
Benefit designs differ across insurers. Billing practices are difficult for patients to understand, let alone compare. There is no widely accepted reference point for what “basic” coverage actually means.
Into this system, critics argue, we should inject large-scale public funding or roll out a national health insurance scheme.
What happens next?
Do prices fall, or do they simply migrate upward to meet the new payer? Do providers suddenly standardise, or does bargaining power shift further away from patients and regulators?
Does fiscal exposure shrink, or does it expand in ways that are politically impossible to unwind?
These are not ideological questions. They are mechanical ones. And they are precisely the questions Base MHIT forces the system to confront, instead of skipping past.
National health insurance, often invoked as the obvious alternative, is not a switch that can be flipped.
It is a complex architecture. It requires defined benefits, clear limits, enforceable pricing discipline, and administrative coherence.
Without those, it does not become universal protection, it becomes universal liability.
This is why the argument that “we should just do NHI first” sounds bold but rests on fragile logic. It assumes that cost control can come later, once generosity has already expanded.
History suggests the opposite. Once expectations are set, once entitlements are politically locked in, discipline becomes harder, not easier.
Every attempt to rein in costs is framed as a cut. Every boundary becomes a betrayal.
Is that really the more responsible path?
Base MHIT is uncomfortable precisely because it refuses to indulge that illusion. It does not promise everything.
It standardises instead. It draws a line and forces the question policymakers often avoid: what can be made affordable, understandable, and sustainable right now?
Critics often point to the coverage limits as evidence of failure. But that assumes the purpose of the product is generosity rather than structure.
A floor will always feel unsatisfying if one is expecting a ceiling. Yet without a floor, there is nothing stable to build on.
No one judges a foundation by how luxurious it feels. They judge it by whether it holds when weight is added.
Base MHIT creates a reference point where none previously existed. It establishes common benefits, comparable pricing logic, and shared trade-offs across the market.
It generates data. It disciplines expectations. And crucially, it limits downside risk while the system learns how to function under constraint.
This is not a rejection of equity. It is a recognition that equity without cost discipline is not protection, it is exposure.
To be clear, acknowledging this does not require dismissing those who advocate for national health insurance. Many are right to focus on universality and fairness.
A well-designed national scheme can be a powerful tool. But it is not an inevitable end-goal, nor is it automatically appropriate in the immediate term. Treating it as such shortcuts the hardest work of reform.
The real disagreement is not about values. It is about sequencing.
Do we want to build the capacity to manage costs before expanding public liability, or do we want to hope that liability itself will somehow impose order?
Do we want to define benefits clearly before subsidising them, or subsidise first and argue about limits later?
These choices matter. They determine whether reform compounds over time or collapses under its own promises.
Base MHIT is not small because it lacks vision. It is small because it refuses to pretend the system is ready for everything critics want it to carry.
It is an admission that reform is not a leap of faith, but a process of constraint, standardisation, and institutional learning.
Perhaps the most revealing question, then, is not whether Base MHIT is “enough”.
It is whether we are prepared to discipline healthcare costs, or whether we simply want the state to absorb them, and call that ambition.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
