This summer's debate over health insurance has been valuable, bringing attention to an issue most people rarely think about. For many, coverage is automatic through their job or guaranteed by age (children and seniors). But for some members of society, it is a painfully urgent problem. Our health care system lacks a large amount of funding, and I am quite sure this will become a major topic in the upcoming parliamentary election campaign.

About seven percent of the population struggles with the health insurance problem. This may seem marginal, however, that means 90,000 people — not a small amount. Among working‑age people, the share of those without insurance rises to 10 percent for women and 14 percent for men.

Some of them may not worry much about the issue, but unfortunately they are often the ones who need social services the most — for example, emergency medical help in public places when they are unconscious or behaving erratically. The reason is often obvious, even if the bottle with the twist cap is not visible. Deciding who should deal with them or where they should be placed after an emergency call is a headache for everyone involved, but that is another topic. These people will not be able to pay €100 a month for health insurance anyway.

Even €10 matters at the end of the month

Therefore, the proposal from health economists to make health insurance mandatory — requiring people to pay €115 each month — would mainly affect those with some income. Usually irregular income, because otherwise they would not have insurance problems. The more irregular a person's income is, the harder it is to plan expenses. Winter months, with rising housing costs and today's energy prices, can stretch a family budget to the breaking point.

The current system, where a significant part of society lacks health insurance, is also a heavy burden on the health care system, because these people eventually end up using expensive emergency services. And the trend is worsening. We see companies like Bolt that do not want the people providing their services to be "employees," because they do not want to pay social taxes that contribute to society.

Mandatory health insurance, as proposed by experts, is also dangerous because it could push people deeper into financial hardship. The discussion involves a three‑digit monthly payment, but in today's difficult economic situation even €10 matters at the end of the month, let alone €100. I remind readers that the current government also removed health insurance from mothers raising children at home.

I believe it would be wrong to declare one solution absolutely correct or dismiss another entirely, because we know the state budget is in poor condition. Isamaa's position is that even when looking at one specific problem, we must keep the bigger picture in mind — what other dominoes will fall after one decision. In this case, the government's decision to remove health insurance from mothers raising children at home has worsened the current problem.

Emergency care is available to everyone

The current voluntary health insurance based on average wages (€272 per month) is clearly too high given Estonia's income levels. The €115 calculated from minimum wage is significantly lower and more humane, but still not truly reasonable, considering many families lack both social guarantees and savings.

Imagine having to choose between buying food, school supplies, paying the electricity bill or paying social tax to get health insurance that you might need this month — or might not. It is not hard to guess which option would be the lowest priority for a family living near the poverty line, even though the lack of insurance adds stress for the uninsured person and the entire family.

Health economists wrote that, to their knowledge, no comparison has been made between the health of insured and uninsured working‑age people. It is likely that an uninsured person with a non‑acute health issue simply will not go to the doctor until the situation becomes serious. Emergency care is available to everyone regardless of insurance status, but the question is what happens after the patient is discharged from the emergency department.

I fully agree with the claim that "by leaving a significant part of the population without stable insurance coverage, we lose valuable healthy years." Simply knowing that health insurance exists can give a person confidence that they can get medical help when needed, reducing mental stress and positively affecting both their physical well‑being and the well‑being of those around them.

Freelancers are hit the hardest 

Society is moving toward giving people more freedom, including in work life. In the cultural sector, many actors, artists or writers prefer to work as freelancers and choose their own roles rather than depend on what is offered or whether they have time to write a book alongside a daily job in a completely different field.

In the arts, there is not always enough work to guarantee a nine‑to‑five job with all benefits, and many choose the field precisely because they prefer a different work rhythm.

Freelancing often means irregular income, which puts social guarantees at risk. To help creative professionals focus more freely on their work and create culture — which society also needs — Estonia has introduced writer and artist salaries. But these do not cover everyone who needs health insurance. Nor should they, because they are not social guarantees but recognition and encouragement meant to give top creators peace of mind.

To obtain health insurance, a person must earn a certain amount in one calendar month, which rises slightly each year. In 2025 it was €820; in 2026 it is €886.

The most difficult situation for freelancers often arises in January, when the year changes — especially if a project‑based employer fails to pay social tax in December. This can mean the person goes without health insurance for the next month and a half, because payment deadlines fall just before mid‑month.

Monthly worry about whether the new month will bring insurance is mentally exhausting and makes it harder to focus on daily work, which in turn reduces a freelancer's income, since it depends directly on how much work they can do.

I have heard stories of officials — who have always had social guarantees and cannot imagine otherwise — treating freelancers as troublesome exceptions who disrupt their system. In the worst cases, one official gives one answer and another gives a different one, solving nothing.

It can also happen that a person has had 90 percent of the required amount paid to the state by various employers in one month, but because of a small shortfall, insurance still does not start — even though the state has received a significant sum in taxes for the person's work. For what, exactly?

For freelancers whose overall income is not actually too low to meet the required threshold — but is simply irregular — an annual calculation could be a better solution. This would eliminate monthly stress and uncertainty, reduce administrative burden for officials and perhaps even reduce their numbers.

Estonia is undoubtedly in a difficult situation and must find solutions in the coming years to improve it. But we must not forget that the state exists for people, not the other way around. The state's primary task is to help its citizens, not find ways to squeeze more money out of them. The worst place to do that is through a person's health.

When a person's income is already chaotic, adding extra burden is unfair. Health insurance is not a place for the state to profit off its people — or to strip away the last bit of security they have left after rising food, housing and other costs. Approaching the issue this way will soon leave us without people. The state is for people, not people for the state.

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