Allying for a “Big Bang” Reform: Progressive Bureaucrats and NGOs in Thailand

Abstract

The legislation of the National Health Security Act in 2002 was the culmination of a long-cherished dream for a group of bureaucrat-physicians in Thailand’s MoPH. For over a decade, these progressive civil servants had steadily nurtured their vision of a universal health coverage program that would deliver equal health benefits to all Thais. Although their efforts to attract political support for the project were repeatedly rebuffed by both conservative opponents within the MoPH and party politicians, the bureaucrats met with an opportune political moment in 1999 in the form of Thaksin Shinawatra, a tycoon-turned-politician who formed a new political party, the Thai Rak Thai (TRT) Party, to run in the 2001 elections. Through their network of student activist contacts, the inner circle of bureaucrat reformers, many of whom had been participants in the 1970s student democracy movement, was introduced to Thaksin and his close advisors in the late 1990s. Canvassing for new ideas to kickstart his campaign, Thaksin swiftly grasped the political promise of universal health coverage and decided to feature it as a prominent element of the TRT’s platform.