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Silencing a Health Reformer’s Voice

A Champion of the Public, the Pregnant, and the Press Loses His One-Man Battle

Dr. Liao Xinbo is struggling to square his enormous popularity and thirst for healthcare reform with a recent demotion that, in his words, marked the culmination of his frustrated work life.

Liao served as Deputy Director of the Guangdong Province Health and Family Planning Department for a decade. But in April, superiors stripped the 58-year-old of his administrative responsibilities and moved him to a desk in the inspection office.

Liao was demoted despite—or perhaps because of—his tendency to speak out against the cumbersome bureaucracy at the heart of China's healthcare system. This outspokenness has attracted a huge following to his social media accounts and made him a favorite among Guangdong journalists who cover the medical sector.

Since launching an online blog in 2005, Liao has written about 2,400 entries. They’ve drawn more than 15 million hits. His Sina Weibo account has about 3.6 million followers.

Unlike his peers in the administrative hierarchy, Liao used to feel free to write and speak candidly with reporters and the public. His blogs covered general health topics, academic research, poetry, and literature. And to the delight of his fans, he would boldly comment on the latest news and critique government policies affecting the health care system.

Liao has been called an amicable maverick who neither thinks nor works like a bureaucrat. While serving as Deputy Director, he routinely spoke with anyone who called, with or without an appointment.

Today, Liao is still open and friendly. His new job as an inspector came with a raise. But he’s no longer in the loop. Recently released information about the central government's hospital management policy updates did not land on his desk, as in the past, but arrived second-hand during a chat with a journalist.

Scuffling Mothers

Liao has been friendlier with journalists than most Chinese officials. But his ties to a reporter during an incident involving a group of pregnant women in March may have been the final nail in the coffin for his career in officialdom.

The incident involved a group of expecting women who stood outside Liao’s office building and demanded immediate implementation in Guangdong of a new second-child policy. The policy, which had just been rolled out by the central government, lets qualified couples have two children, adjusting the nation’s One-Child Policy in place since the late 1970s.

A propaganda department official was sent to listen to the women and hear their complaints on grounds that senior officials were not available. The women didn’t like what they heard and tried to grab the official, sparking a scuffle with security guards.

A Caixin reporter heard about the incident and sent a text message informing Liao, who then traveled to the scene to comfort the mothers. One woman said Liao’s presence moved her to tears. Moreover, Liao promised government action on their behalf.

A propaganda official later phoned the Caixin reporter and repeatedly insisted that “none of those promises” Liao had made to the women would stick. “Publish (the promises) and you will make our job harder. And it’s not in Liao's best interests.”

Liao told Caixin he had promised to help the women only after consulting with the director of the health department. He also noted that, despite what the propaganda official had said, the department’s senior officials including the director had been sitting in their offices while the women stood outside.

At least twice in the past, Liao’s sense of personal initiative had strained his relations with other government officials. Critics faulted him for not playing as a member of the team.

In March 2007, while the nation’s top legislators and political advisers were holding annual meetings in Beijing, Liao made comments that seemed to clash with an announcement about health care reform issued by the central government’s Ministry of Health, the predecessor of today’s National Health and Family Planning Commission.

Liao told reporters that the national reform plan could not be completed within “two or three years.” But ministry officials had declared that the reforms would be “ready by the end of the year.”

The next day, health officials were embarrassed to find Liao’s remarks and the ministry’s statement published side-by-side on the front pages of many newspapers.

Liao defended his comments, saying he was merely trying to help the public understand the magnitude of the challenges facing healthcare officials. “Medical reform is extremely difficult because it involves at least 16 (central government) departments,” he said. “Among these, the Ministry of Health does not have a strong voice.”

Liao’s comments stirred another hornet’s nest in 2010 at a time when the health ministry was under pressure for allegedly causing drug prices to skyrocket. While other health officials across the country refused to join the debate, Liao stepped forward to defend the ministry. He said the National Development and Reform Commission and local government agencies that oversee commodities pricing, not health officials, were to blame.

Liao’s comments took some pressure off the health ministry but upset his superiors in the Guangdong government. He got an official rebuke from provincial leaders and later admitted that he had spoken out of turn.

Nothing Liao said about drug pricing had not been said before. But he was the only government official to register a public comment, breaking ranks with the rest of an officialdom accustomed to speaking publicly with a united voice.

“When you’re in the system,” Liao said, “you should speak with one voice, and one voice only.”

Stepping Back

Liao is a physician whose career began at Guangdong General Hospital. He served as an administrator during the latter portion of his 22-year stint at the hospital, rising to Vice President before transferring to a position with the provincial government.

Weibo
A screenshot of one of Dr. Liao Xinbo's posts to the microblogging site Weibo. The translation reads: “I attended the working conference at the Hospital of Sun Yat-sen University for the last time today. Overcome with emotion! I deeply appreciate their support for my endeavor in health care reform in the past 11 years. It's a shame that I'm leaving this post without seeing through two of my proposals being implemented: allowing doctors to work for more than one hospital at the same time and encouraging private investors to financially support public health services.”

Because the provincial job paid less than the hospital, Liao had to carefully weigh the pros and cons before transferring. At first, neither he nor his colleagues thought he should take the government offer. He changed his mind, though, after a discussion with the then hospital President, who said becoming an official would be in his and the public’s best interests.

But Liao said his former boss also warned him that, as a bureaucrat, he would have to keep his personal ideas to himself. Otherwise, he said, “there won't be a place for you in officialdom.”

During his 10 years as a provincial official, Liao failed to win a single job promotion. Meanwhile, he watched subordinates climb the ladder to positions higher than his.

Today, Liao is convinced that his personal drive to reform and his outspokenness—not his job performance—put his career on ice and eventually led to his demotion.

Looking back, Liao has reasons to feel proud of his accomplishments. But some of his work remains unfinished.

For example, Liao is the architect of two key reform proposals that have yet to be implemented but could have a positive affect on healthcare in Guangdong. Under one proposal, doctors would be allowed to work for more than one hospital at the same time. Liao pushed for implementation of this plan last year in Shenzhen before it failed because of lack of support from city leaders.

The other reform would encourage private investors to financially support public health services.

Last November, Liao decided to push harder for these reform plans after a high-level meeting of the Communist Party in Beijing. Indeed, the session provided fresh momentum to the cause of healthcare reform. Fearing that the momentum could wear thin after passing through layers of bureaucracy, Liao took matters into his own hands and posted drafts of his reform proposals online for public feedback.

Liao said he thought he’d better take the initiatives, because “God knows how long it would have taken had I waited for the health commission's order.”

After the demotion, Liao said in a May 31 Weibo posting that not being allowed to see his reforms through to implementation was his biggest career regret.

Perhaps he doesn’t want any more regrets. On June 25, another group of pregnant women gathered outside the Guangdong health department offices, demanding to speak with senior officials. They were denied access. The Caixin reporter texted Liao again, and this time, he replied: “I’m not stepping forward again. Ever.”