Indonesia Negara Gagal Sistemis?

MUSTANIR.net – Pernyataan Sekretaris Jenderal PBB Antonio Guterres membuat Kemenkeu meradang. Guterres menyatakan bahwa negara yang membayar bunga pinjaman lebih besar daripada anggaran kesehatan atau pendidikan, masuk kategori negara gagal sistemis. Kutipan ini diunggah Managing Director Political Economy and Policy Studies (PEPS) Anthony Budiawan di akun Twitter-nya. Buntut dari kutipan tersebut, juru bicara Kemenkeu Yustinus Prastowo membantah sebutan Indonesia sebagai negara gagal.

Ia mengeklaim anggaran kesehatan masih lebih besar ketimbang bunga pinjaman. Menurutnya, tuduhan tersebut tidak berdasar. Pada 2022, realisasi belanja untuk pendidikan mencapai Rp472,6 triliun dan pengeluaran untuk kesehatan sebesar Rp176,7 triliun. Adapun pembayaran bunga utang Indonesia pada 2022 sebesar Rp386,3 triliun. Namun, sebutan negara gagal makin kentara setelah pengesahan UU Kesehatan yang menghapus mandatory spending (anggaran wajib minimal) di bidang kesehatan sebesar 5% dari APBN dan 10% dari APBD di luar gaji.

Fakta Kesehatan ala Kapitalisme

Mencermati pernyataan Antonio Guterres dan bantahan Kemenkeu, ada beberapa hal yang patut kita garis bawahi terkait penyebutan Indonesia sebagai negara gagal sistemis:

Pertama, jika merujuk pada pernyataan PBB, mungkin ada benarnya Indonesia disebut sebagai negara gagal sistemis. Sebab jika kita bandingkan anggaran kesehatan dengan bunga utang, nilai bunga utang jauh lebih tinggi dibandingkan anggaran kesehatan.

Pada 2022, anggaran kesehatan sebesar Rp176,7 triliun. Nilai ini lebih kecil daripada bunga utang yang mencapai Rp386,3 triliun. Namun, jika anggaran kesehatan dalam APBN digabung dengan APBD, total anggarannya bisa melebihi nilai bunga utang, yakni sebesar Rp426 triliun. Artinya, sebutan negara gagal tergantung sudut pandang perhitungan anggaran.

Ke dua, UU Nomor 36 Tahun 2009 tentang Kesehatan, Pasal 171 ayat (1) dan (2) menyebutkan bahwa alokasi anggaran untuk kesehatan minimal 15% dari APBN dan 10% dari APBD. WHO juga menetapkan alokasi anggaran kesehatan setiap negara minimal 15% dari total APBN atau setara dengan 5% dari PDB.

Sementara itu, dalam UU Kesehatan baru, mandatory spending dalam pasal 171 ini dihapus. Artinya, penghapusan aturan tersebut jelas makin mendorong Indonesia benar-benar akan menjadi negara gagal sistemis. Pasalnya, tanggung jawab pemerintah sebagai penanggung jawab pelayanan kesehatan akan berkurang. Penghapusan ini merupakan langkah mundur Indonesia serta berlepas dirinya negara dari tanggung jawab tersebut. Imbasnya, anggaran kesehatan disesuaikan dengan program yang direncanakan (money follow program).

Di negara low income seperti Tanzania, Rwanda, dan Liberia saja, mereka mengalokasikan dana untuk sektor kesehatan hingga 15%. Bahkan, di middle income country seperti Cile, mereka menganggarkan untuk kesehatan hingga 16% dari APBN. Lah, Indonesia kok malah menghapus ketentuan tersebut di UU Kesehatan yang baru? Gak bahaya, tah?

Apalagi, jika melihat Indonesia yang belakangan naik kelas menjadi upper middle income country, mestinya anggaran kesehatan meningkat dari sebelumnya. Meski dalam APBN 2023 anggaran kesehatan naik menjadi Rp178,7 triliun, kenaikannya tidak terlalu signifikan jika dibandingkan anggaran tahun 2022. Ini membuktikan perhatian negara sangat kurang dalam sektor kesehatan. Bahkan banyak ahli menilai UU Kesehatan membuat dunia kesehatan kian kapitalistik liberal.

Ketiga, sebutan negara gagal sistemis sejatinya layak disematkan pada negara-negara yang mengandalkan utang berbasis ribawi dalam mengerek pendapatan negara. PBB seperti menampar dirinya sendiri sebagai lembaga yang aktif memberikan pinjaman luar negeri kepada negara-negara melalui World Bank.

Kegagalan sistemis kapitalisme sejatinya sudah terlihat di depan mata. Indikasinya adalah sistem kapitalisme rentan mengalami resesi, krisis keuangan, inflasi, dan bertumpu pada pajak dan utang. Mirisnya, Indonesia juga berpotensi menyandang status negara gagal sistemis karena menjadikan kapitalisme sebagai role model berpolitik dan berekonomi.

Sistem Kesehatan Islam

Dalam Islam, kesehatan adalah kebutuhan primer masyarakat. Negara wajib memenuhinya dengan totalitas, baik dari aspek infrastruktur, fasilitas, maupun layanan kesehatan. Prinsip bernegara dalam sistem Islam ialah riayah syu‘unil ummah, yakni mengurusi urusan rakyat, termasuk sektor kesehatan. Prinsip sistem kesehatan Islam terangkum dalam tiga poin berikut:

Pertama, menjadikan baitulmal sebagai role model APBN ideal. Baitulmal memiliki pos-pos pendapatan seperti fai’, kharaj, ganimah, anfal, khumus, jizyah, dharibah, dan kepemilikan umum yang meliputi migas, listrik, pertambangan, serta pengelolaan harta milik negara lainnya. Pos pemasukan ini dapat digunakan untuk membiayai sektor kesehatan atau pendidikan, seperti membangun sarana jalan, air, masjid, sekolah, rumah sakit, laboratorium, dan sarana lainnya yang dianggap penting dan mendesak. Prioritas anggaran negara bertumpu pada pemenuhan kebutuhan pokok publik. Negara tidak akan menjadikan pajak dan utang sebagai sumber pemasukan utama.

Ke dua, negara wajib menjamin pemenuhan kebutuhan pokok seperti kesehatan dan pendidikan. Tidak boleh ada unsur bisnis dan profit dalam menyelenggarakannya. Dalam negara Khilafah, pelayanan kesehatan diberikan secara gratis. Setiap orang berhak mendapatkan pemenuhan kebutuhan asasi ini tanpa dipungut biaya.

Ke tiga, negara akan mengutamakan penyediaan sarana dan infrastruktur kesehatan secara lengkap, merata, dan mudah dijangkau hingga pelosok desa. Ini dilakukan untuk menunjang pelayanan kesehatan dapat berjalan secara optimal.

Negara wajib mengalokasikan anggaran kesehatan untuk seluruh rakyat, baik muslim ataupun nonmuslim. Sebab jika pelayanan kesehatan tidak ada, maka akan menimbulkan bahaya. Oleh karena itu, pelayanan kesehatan yang berbasis pada kemaslahatan rakyat dan nonprofit hanya bisa diterapkan di sistem Islam secara kafah (menyeluruh). []

Sumber: Chusnatul Jannah

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