An elderly shows a pamphlet explaining the Chinese media insurance reform when he was protesting in Wuhan on February 15, 2023. Screen capture from Twitter user @GaoFalin

After the round of white paper protests driven by Chinese youth led to the end of China's zero-COVID policy last December, the country is experiencing another wave of protests, this time led by white-haired older persons who are opposing the national medical insurance reform.

Since early February 2023, Chinese retirees in several cities, including Wuhan, Dalian, and Shanghai, have been protesting against the country’s medical insurance reform, which was announced in May 2021 to address the medical needs of the aging population. Yet, the protestors believe the move will harm them in the long run as it will reduce the money flowing toward their personal insurance accounts to subsidize public medical expenses under the pretext of reform.

The following video, via Twitter user @GaoFalin shows the protest in Wuhan on February 15, 2023:

2月15日，从武汉传来铺天盖地的视频，过去人们拍照片，现在都升级了。都是这天武汉老人抗议削减医保福利的场景。这天的抗议，我读外电报道，有的说“几百人”，有的说“数千人”，但从视频看，好像远远不止。
习近平这句话没说错：中国人民是惹不得的，惹翻了，是不好办的！ pic.twitter.com/OzFkLnL2uJ

— 高伐林 (@GaoFalin) February 16, 2023

A large number of videos were sent from Wuhan on February 15. People used to take photos. Now they're upgrading to videos. They show Wuhan's old people protesting against the cutting of medical welfare. Foreign news agencies said there were hundreds or thousands of protesters. But from the videos, the number is much larger. Xi Jinping is right about this: Chinese people cannot be angered or the consequence are huge!

The history of the Chinese medical insurance system

Chinese medical insurance system was established in 1998 for workers in the private sector. The insurance system has two components; one is a public insurance fund, and the other is a personal mandatory medical saving plan. All corporations and businesses have to pay monthly medical insurance for their workers. The amount is deposited into both the public fund and their personal accounts. The workers also have to contribute to their insurance, but their contributions are saved in personal accounts for medical purposes. They use the money in their personal accounts for minor illnesses and then are reimbursed from the public fund for serious illnesses which require hospital treatments.

Under the 1998 system, about 58 percent of the insurance money was deposited into citizens’ personal accounts and 42 percent into the public pool. 

There have been periodic criticisms about the health system as government employees enjoy full medical protection. Plus, under the insurance system, the redistribution effect is limited as more than half of the insurance money is saved in personal accounts, and the poor remain less protected. Moreover, the public health sector is stressed due to a rapidly aging population.

Thus, in April 2021, the Chinese government announced the medical insurance reform. In short, corporations’ contributions would be reallocated to the public fund to support the country’s public health system. 

Then a more urgent need emerged — the country has to solve its medical infrastructure problem, which was exposed by the nationwide COVID-19 outbreaks in the last few months, as citizens experienced huge wait times, a lack of resources, and limited state medical support. 

Although the national medical insurance income RMB 2,657.6 billion yuan (USD 385.2 billion) was still higher than expenses RMB 2,130.2 billion yuan (USD308.8), between January to November 2022, the majority of the money was saved in personal accounts, which cannot be used to cover public spending, meaning the government will have to tap into insurance reserves, which will dry up quickly if costs from the COVID-19 pandemic linger. 

White hair protesters

After the reform was launched, residents found that about two-thirds of the monthly deposits to personal accounts were allocated to the public fund. 

Pro-government influencers on Weibo explained that the new system would benefit the elderly as the healthier and younger contribute more to the public fund and support the less healthy elderly who can have their medical expenses reimbursed from the public fund when visiting clinics and hospitals. But the protesting white hairs disagreed. 

Instead, they accused the government of stealing from them, as their personal accounts were presented to them as “private medical savings” when the government introduced the medical insurance system in the late 1990s.

As explained in a viral recording in which an older woman complains to a mayoral hotline about the reform, if they want to enjoy a higher ratio of reimbursement, they must visit hospitals, which are inconveniently located, have long queues, and have higher fees than clinics. Yet, for a clinic visit, they have to pay a minimum cost (門坎費) before they can request reimbursement for about 60 percent of their expenses. There is also an annual cap for clinic reimbursement.

Public trust at stake

Others have pointed out that the public resentment was largely related to the timing of the reform — after three years of zero-COVID restrictions, the public fund for supporting medical services has been drained. During the overwhelming outbreak of COVID variants over the past few months, people witnessed the collapse of the public medical sector, and the majority of them were treated at home. As a Weibo user expressed: 

疫情刚爆发的2020年我就感觉中国医保肯定难以为继。我当时就觉得应该废除这种不同阶级不同待遇的医保政策，以个人所得税为税源建立一个全国民免费医保。当时就被无数人围攻，还有人来我微信骂我。现在我们错过了最好的改革时机，医保基金枯竭，不但不动某些人的蛋糕，还要继续砍老百姓的待遇，真的是一声叹息。

Since early 2020 when the pandemic emerged, I had the feeling that the Chinese medical insurance system was not sustainable. I believed that China had to abolish a medical insurance policy that categorized people according to their social and economic status and established a universal medical system for all. I was attacked when I proposed the idea. Now we had missed the opportunity for reform, our medical insurance fund is drying up. Instead of redistribution, we're reducing ordinary people’s benefits.

Despite huge efforts by official media outlets to highlight the positive side of the medical insurance reform, public distrust continues spreading. Even state-affiliated Global Times’ commentator Hu Xijin admitted that the issue at stake was the lack of public consensus on the reform measures:

不知道这次医保改革有无更多资金投入，如果没有的话，就要充分认识它的难度，下大力气做“短期受损者”的思想工作。做人心的工作不是单向的宣讲，不能认为政府说什么，大家就必须信什么。还是要把群众路线真正走通了。

I am not sure if [the government] could inject more money into the pool for the medical insurance reform. If not, we have to acknowledge that [consensus building] would be difficult. We have to pay more effort to persuade those who would lose their interest in the short term. We can’t just propagate one side of the story and expect whatever the government says people should believe. We need to find the right way to address the masses. 

Meanwhile, public distrust is extending to other sectors. Recently, many young people in China have been talking about cutting their social security insurance amid state discussions to extend the retirement age from 60 to 65.  User @jacklee7281 explained his reason for canceling his social security insurance:

民众的另一个选择，养老保险不交了。 pic.twitter.com/TDWtsLh4dI

— 李军 (@jacklee7281) February 19, 2023

I am a freelancer, and from this month on, I would cut my monthly 1,492 yuan social security insurance fee[…] I have paid for three years and if I want to get my pension after retiring, I have to pay for 17 more years. Let me calculate.
If I pay for 20 years, the total amount is more than RMB 300 thousand. This is quite a big amount. If the retirement age is 65, I will only get the pension at 65. If I get 2000 per month, I have to live till 80 to get what I have paid for. The average life span is 75 in China. Can I live till 80? It is difficult to tell, so many accidents can happen.

One Weibo user described the public sentiment in China as a classical Tacitus Trap, which means an unpopular government is hated no matter what it does — whether it is right or wrong:

医保局典型的遭遇了“塔西佗陷阱”。一群吃过亏的人，最近又吃了一亏，有个风吹草动就杯弓蛇影，怕再吃一亏。偏偏这群人又有闲又有微信，还会刷短视频，他们的不信任感很容易聚集在一起。我看以后把4G5G都禁了吧，2G就够了。

The medical insurance reform falls into a classical “Tacitus Trap.” The group of people suffered [during the pandemic], and then recently they fell into another unfavourable situation again. They fear that their interest would be harmed whenever they spot a sign. They have the time, they have WeChat and they know how to take short video clips. Their distrust aggregate quickly. Have to ban 4G and 5G [to stop this], 2G should be fine.