The healthcare scheme - one of the world's most generous because it covers complicated and costly treatments such as heart bypass surgery and cancer - was the brainchild of public health reformers, who had long tried unsuccessfully to convince political parties to adopt it as part of their policy platforms. To its credit, Thaksin's Thai Rak Thai Party was the only one that recognised the great opportunity to be found in such a scheme.

This makes Thaksin's sins in this area that much more glaring. He was dishonest with the public and grossly mishandled the programme by not putting money where his mouth was. The ambitious scheme required adequate funding from the very outset to ensure smooth functioning and a high level of service quality, but Thaksin left it persistently under-funded and understaffed. That was because he had to divert taxpayers' money slated for this scheme towards other wasteful populist projects.

As a result, many government hospitals now teeter on the brink of bankruptcy. Government hospitals, which are the main healthcare providers of the universal medical service, have often had difficulty getting reimbursed for costly medical treatments and medications that they provided. A large number of public healthcare providers have veered in and out of debt. They have been threatened with water and power cuts because they've been unable to pay overdue utility bills. The quality of healthcare has been compromised, and the morale of doctors and nurses at state hospitals is at an all-time low.

The new government must take drastic action by injecting a one-off burst of emergency funds into the universal health scheme so all indebted service providers can pay off their debts. They should also receive service fees that the government owes them and replenish their drug inventories. In other words, all financially ailing health providers must be bailed out and restored to financial health. Then the government must come clean on the real costs of universal healthcare and how those costs tend to escalate over time. It must be made clear to the public that this programme will not be sustainable in its present arrangement.

The public must be told that rising costs, which constitute a long-term financial liability, must somehow be contained and more viable and sustainable financing options be found if the programme is to continue to provide high quality healthcare to the Thai people.

Even if the programme is operated at a high level of administrative efficiency, at some point in the future the programme will have to undergo drastic reform that may require a judicious cut in the benefits on offer or a sizeable increase in co-payment from the current Bt30 to ensure its economic viability and sustainability. Failing that, the system could face financial ruin over the long term.

This government owes it to the public not only to ensure the healthcare scheme serves people the way it is intended, but also to set a high standard of operational efficiency and sustainable financing based on sound governance. The programme must be handed over to the next democratically elected government in good shape, and should become a permanent part of the country's welfare for all citizens. A healthcare programme this good must never again be allowed to be manipulated by irresponsible politicians for short-term political gains.