Estonia is one of the few EU countries where the entire population is not covered by health insurance. Compared with some more distant countries, we are doing reasonably well — for example, pensioners, minors, and unemployed people are insured — but there is still significant room for improvement, because those without insurance may be left without necessary medical care.

A large number of uninsured people is not the only problem in our medical system. Even insured people often have to use paid medical services, because waiting times in the public system can be very long. This has led to major inequality in access to healthcare, depending on whether one has insurance and how much money one has.

The root of the problem seems to be that our so‑called solidarity‑based system leaves many people out.

In some cases, eligibility for state health insurance depends rigidly on paying fixed amounts, without considering a person's actual income or overall tax contribution. Everything depends on the social tax, which is paid for most people by the state or employer. Those in weaker positions — especially low‑income workers (and work should include, for example, raising children) — may simply be left without both healthcare and basic rights. The rights to life and health protection are fundamental rights in Estonia and throughout the EU.

The problem and possible solutions have been discussed for decades, but universal health insurance has still not been achieved.

Now health economists have proposed making health insurance mandatory in Estonia. What I like most about this proposal is that it once again aims for universal coverage.

However, the proposed method raises questions — the obligation is placed on individuals, not the state. The suggested insurance payment is much lower than the current voluntary state insurance, but nearly €1400 per year is still a very large sum, even compared with some wealthier countries. As several commentators have noted, this additional obligation, on top of existing taxes and expenses, could put low‑income people in a worse situation than today.

Of course, everything can be adjusted as needed, but so far, voluntary state health insurance has not considered people's actual incomes — it is rigidly tied to the average salary, while many people earn far below even the minimum wage.

This is why the proposal understandably causes fear. The mere idea that a "small person" could end up owing the state money for basic rights — and that the state might aggressively collect it — sounds dystopian and chilling.

When comparing medical systems, European countries — including our closest neighbors — are often cited. All our neighboring countries have found ways to ensure health insurance for essentially all residents, giving clearly better access to healthcare. They have solved this through reasonable insurance payments or broader tax bases, which does *not* mean adding separate social taxes to every type of income. It is enough to use existing funds more effectively — which the Ministry of Social Affairs has now set as a goal.

We could also take inspiration from a country much farther away — one that shares European values, values every human life, and has participated in Eurovision for about a decade. If there were a Europe‑wide competition in healthcare access, Estonia would unfortunately be near the bottom, while Australia would shine at the top.

If the goal is to ensure healthcare access for everyone, Australia is an excellent example. Low‑income people (recently below about 28,000 AUD or 17,000 EUR per year) do not pay a separate health insurance tax (the Medicare levy); general taxes are enough. Those with higher incomes pay up to two percent, but there are still exemptions — for families, for each child, etc. Very high earners are expected to use private insurance more, otherwise they pay an additional levy, but even that is not high.

It is clear that the main goal is truly universal access to healthcare. The financial structure is built around healthcare needs — not the other way around.

This shows the advantages of a broader tax base: money flows in from all taxes anyway, and it is allocated to essential services. These services are not made inaccessible to the most vulnerable through high prices or restrictive conditions.

Estonia has not reached this point. A major problem is that voluntary state health insurance — theoretically meant to help those excluded from the system — is not tied to actual income. At the start of this year, some restrictions were removed, but the most important one — the high price — remained and even increased on July 1, rising to €3264 per year.

It is no surprise that forecasts for how many people would join the updated system were not optimistic. In reality, the number of buyers has increased by a few hundred, which is good, but this is still fine‑tuning — not a real solution. Currently, about 90,000 people in Estonia lack health insurance, and over the years the number has reached hundreds of thousands.

At the end of the year, the Ministry of Social Affairs will present proposals to expand health insurance. This is far from the first time, but hope remains. If the goal is for everyone to receive necessary medical care, we can look to Europe — or farther. We could adopt a broader tax base, long discussed, and tie health‑related taxes to actual incomes — basic rights should be accessible to everyone.

If solutions continue to stall, temporary measures could be used — many have been proposed and are inexpensive or require no additional money from the state or citizens, such as harmonizing visit fees, improving access to primary care, or easing access to prescription medicines.

It is clear that if universal health insurance is not truly set as a goal, it will not be achieved. But if it *is* set as a goal, the rest becomes much easier, because the solutions exist, they are not expensive, they have been tested elsewhere, and they work. There is no real reason to leave anyone out.

Allan Eichenbaum is a translator and civic activist who has worked on health insurance issues since 2017. The author thanks everyone who contributed to the article.

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