Health Care Reform – Taiwan

On Monday, March 26th, the Supreme Court of the United States will begin hearing arguments regarding the Patient Protection and Affordable Care Act, better known as “Obamacare”.  It is a law that has polarized a country, driven on all sides of the debate with misinformation, propaganda and fear-mongering.  It is also, at 906 pages, a massive document, one which Nancy Pelosi even admitted that she, and other members of Congress, would not understand, totally, until it was passed.

At the suggestion of a regular commenter at this blog, who also happens to reside in Canada,  I watched a special on CNN’s “Fareed Zakaria’s GPS” which dealt with this very issue.  The program included comparisons of some of the types of health care systems other countries have adopted.  One of the nations profiled was Taiwan, and it was described as a model for other countries who are in the process of examining and re-examining their own systems.

Taiwan revamped their entire health care system in 1995, and decided to institute universal insurance, better known as the “single payer” system.  A panel of experts was formed and they studied the health care systems of six rich countries – the United States, Germany, Japan, Canada, France and the United Kingdom.  What they agreed on, and what is now being used in Taiwan, was based on the Canadian health care program and the United States’ Medicare system.

The Taiwanese people have a free choice of doctors and hospitals, no waiting periods, preventive care, prescriptions, vision care, dental, mental health and even traditional Chinese medicine, including acupuncture.   Patients are not at the mercy of “gatekeepers”, so they may see specialists without referrals.  The Taiwanese are issued “smart cards” which are swiped, much like a debit card, at point of service.  The cards maintain all of a patient’s history and prescriptions, and payments for their medical bills are paid immediately, through the government insurance office. It also monitors activity on individuals, a measure designed to thwart abuse by following up on those who see a doctor or go to a hospital over 20 times a month or 50 times in three months.

All of the changes were accomplished within a year.  Taiwan has reduced the amount of its GDP expenditures to 6% – the United States spends 17% at present.  The Taiwanese system is, by no means, perfect and the government has admitted that it is running into some problems.  As it failed to pass a provision in the system for automatic premium adjustments, costs are rising and the resources for coverage are being depleted.  This means that the system is running a deficit balance, and in order to balance the books, the government has had to raise premiums twice and borrow money from banks.

Politicians are beginning to realize, reluctantly, that they will have to raise premiums and increase spending – bringing the GDP figure to, perhaps, 8%.  That’s still less than half of what we’re spending.  In general, the people of Taiwan remain more than satisfied with the care they are receiving.  If the government insurance office does increase the premiums, the average single wage earner will pay approximately $61.25 (USD) per month, while the cost for a family of four would amount to less than $80(USD) per month,  or, roughly, 3.5% of earnings.    Those who worked on the study, those who are getting their healthcare needs met and the government of Taiwan are convinced that the only way to have universal coverage along with quality health care is through a single payer system.

I want to compare and contrast another country that was highlighted during the CNN special, so I thought it might be easier and make more sense to provide that information in a separate post.  It’s several thousand miles from Taiwan, so just give me some time to get there.


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11 Responses to Health Care Reform – Taiwan

  1. Viewer 5 says:

    Hi Empress – nice. It would seem to be a plus if those who could afford the small fee could pay it, and there are many, who would otherwise not be able to afford it. But there will still be people for whom 60.00/month is a lot.

    I thought the comparison was from France, which, as of 2008, was #1 in the world with healthcare. People keep their “cadillac” insurance (you know… the kind gov’t workers get that would cost you and me 1,200.00/month unless we worked for an entity employing more than 50 people… then it would cost a lot less than that, depending on the # of employees) and people who can’t afford insurance, use gov’t insurance.

    This also means that you and I, vacationing in France, can get Dr.’s care w/o paying for it. (This happened to a friend of mine who had the flu in Provence… the local Dr. toddled out in the early evening, helped my friend, and charged him nothing.)

    I also had (another) friend who had her neck rebuilt with spacers for 13K in France. Cost of fusing her spine in the U.S. w/ her shitty 250.00/month health insurance that covered almost nothing? 100K deductible. For an operation that ALREADY killed another girlfriend of mine who was the 2nd spinal fusion patient in the country. (She broke her neck from nodding out – I wish I were kidding – she was dead w/in 6 years from the pain of fusion – 1993.) My friend who had her neck rebuilt in Paris was home in (3) days, and still does headstands.

    The whole system is broken – on both sides – in the U.S.

    I think Taiwan has a lovely system that would help people, with jobs, who can afford 100.00/month (or less!) for insurance get coverage. Add in the French system (where I get to keep my Cadillac insurance, and pay for it) and Medicaid system, and you’ve got a winner.

    I’m sick and tired of hearing that Obamacare is like Canadian healthcare. It is not. It’s more like Romneycare in Massachusetts, which is based on the system in France. Try and find anyone who hates Romneycare. They’re no. 1 for children’s healthcare, and vacillate between no. 3 and no. 5 for general healthcare in the fifty states.

    Add in the VA, who totally got their shit together in the 90’s (before getting strung out w/ the current problems associated w/ vets) and insisted on focusing on preventative care. I forget the name of the guy who pulled it together in eight years, taking hold of an incredibly broken system – and improving the care, service, and maintenance (like a car!) of our vets.

    I think that bears repeating. Watch all the severely overweight people on Biggest Loser come to the show on (12-15) prescriptions, and leave the show on less than (5) prescriptions. Our whole system is broken from the top, down. And until people take responsibility for themselves and their health as a national “concept” of healthy ageing, we are fucked no matter who pays how much and in what way for their health care.

    Sorry to go on. This is an area that’s gotten my goat for a long time. I have battled an insurance company in 1996 through ny state b/c they didn’t pay. I have battled another insurance company, just two years ago, b/c they tried to NOT give me a “conversion” plan (continuing health care) after COBRA – which they were LEGALLY obligated to do here in FL. These people fuck with you however they want, and I must say they really LIKE telling you that you can’t have insurance. I’m lucky. Not only can I can afford it, but I know who to contact in state gov’t when I’m being fucked. But what about people who can’t, and don’t? W/ a 500.00 emergency room deductible and a 1,200.00 overall deductible, and other weird bills (like MRI’s) that keep coming up as “you’re responsible to pay” – let me calculate this for you… (a lot of weird stuff happened last year) I paid 8,400.00 in premiums, went through my deductible for both healthcare and emergency room care, and still wound up with $1,400.00 in bills for all kinds of bullshit. That’s almost 1K a month.

    • The description of Taiwan’s system being part Canadian- part US Medicare was taken, in part, from articles by and about William Hsiao, a professor of economics at the Harvard School of Public Health and a member of the panel of experts charged with the task of reforming Taiwan’s health care system. I also looked at some remarks made by others who were involved in the study, including Taiwanese official Hongjen Chang and economist Tsung-mei Cheng. There are a number of aspects of their present program which were gleaned from the French model, but I think Hsiao and the others were speaking and writing, in some instances, in the most general and simplistic terms. I tried to avoid basing my post entirely on CNN’s report, and it has had its share of critics since it aired.
      As for affordability, at least for the Taiwanese, the average per capita income is approximately $30,000(USD) with an unemployment rate of 4.2% – a decline from 5.7% in 2010.

  2. Adgirl says:

    I’ve been lucky to have excellent total care coverage with Kaiser here in CA. They’ve taken excellent care of me, my husband, my children and my parents through countless expensive and serous treatments. Dozens of surgeries, long term in patient stays and current technology were completely covered. We each selected our own doctors and were referred to specialists. No denial of coverage. Not one bill issued to us.
    Kaiser is a big enterprise and I understand some people complain about them – but if “Blue Cross” operated their own hospitals then a certain number of people would be unhappy with “Blue Cross” medical care.
    I know I may sound like a commercial for them – but it’s for real. They aren’t scary – they are efficient. The key is to be proactive and involved with your healthcare.

    My only fear with our new HC is … what the heck IS our new HC? I didn’t like the lack of transparency or debate when the bill was passed.

    As for cheaper care outside of the US … I have read a good portion of our medical care costs are due to the high price of developing new medical technology and pharma products in the US. I’m unclear about how single payer will impact this.

    • We’re lucky as to our insurance, too. Our union has a contract with Anthem BC/BS of Connecticut. Retirees, such as hubby (up until he had to go on Medicare) and I pay no premiums. What the town did for him at 65 was pick up his Part B Supplemental . We realize how very fortunate we are.

  3. Adgirl says:

    I highly recommend this article about how doctors themselves avoid costly& painful end of life treatments. Obviously they know more about the value of treatments than we do.

    Why Doctors Die Differently

    • codystl says:

      Great article! My sister-in-law was a nurse practitioner in a pancreatic oncologist office and we discussed how patients make decisions when they know that a treatment really isn’t going to extend or give a better quality of life. I think we, as a society, believe we have to fight, no matter what until the end. It’s a hard decision to make.

  4. codystl says:

    Probably what frustrates me the most is politicians using our healthcare as political maneuvering and trying to score points. Also, trying to slap labels on practices that sound bad, but really isn’t.

    Another point is how back-asswards they look at insurance in general. There’s talk of raising the age or limiting the eligibility of those approaching their medicare years. To keep a health plan afloat, you need more healthy people than sick. (I have work in corporate benefits with a self-insured plan). When you eliminate the healthy (generally younger) then all you have are sick people in your plan which generate higher expenses.

    Another point, the label of “socialized medicine”. Ooooooh. People’s knees start shaking when they hear those words. But in reality, we have socialized medicine, in a way. Hospitals cannot refuse care to anyone. That is why people go to ER’s. They can’t pay their bill so who do you think is picking that bill up? We are as in higher costs to those who can pay vs. those who cannot. Hospital write off very large sums of money because of those who cannot pay. And in one form or another, those costs are passed on to everyone. In the long run, health care would be cheaper if the poor could afford to go to a PCP and get preventive care rather than waiting until they are so sick, they have to go to the ER.

    Regarding other countries’ health care, I wish I was more educated in that. Most (not all) Canadians, English, etc. are happy with their care. If it was so bad, they would be clamoring to get to their politicians to switch to a model like ours. Why doesn’t everyone want to be like us? I have a friend who relocated to Switzerland. While on holiday, they were in a bad automobile accident. I asked about how their treatment was. She said one country was terrible and she hopes she never becomes ill there (Italy) and later, in Switzerland, it was great. I’m sure there are both good and bad care anywhere.

    Sorry about the rant. Currently, I am uninsured and cannot get affordable health insurance due to the fact that I had breast cancer 14 years ago. I’m perfectly fine now, under the age of 50 and nothing is wrong, Breasts and ovaries removed so low risk of recurrence, but underwriters still do not want to take the risk. Personally, I was hoping that Obama would have been a little stronger when he was looking at reform. But, I’ll take what I can get… in 2014.

    By the way, Empress, I am enjoying your blog. When Quincy (I don’t know if you knew her writing) stopped, I was hard-pressed to find another thought provoking blog and I look forward to your posts everyday.

    • Viewer 5 says:

      Hi Codystl!

      Hope all is well. Isn’t that “sorry, we can’t insure you” a load of crap? Please. Makes me want to vomit. I know in NY state, they have to insure you. No such thing as “pre-existing conditions” there. It goes by state. Disgusting.

      Glad you’re well, and nice to “see” you. Hope you have a lovely weekend.

    • I’ve spent the better part of the last two weeks slogging through mounds of articles trying to figure out the various healthcare systems, and it seems that the more I read, the bigger migraine I develop. If you look at 5 different authors, you get 5 different explanations. PPACA (Obamacare) is a conglomeration of a bunch of systems, and I’m not finding much in the way of reform – at least what we thought would be reform.
      Talk of privatizing Medicare, and raising retirement ages is not going to be the answer. I can’t even imagine what retirement and healthcare will look like, or cost, for those who still some 20 years away.
      Thank you for following me, and yes, Quincy’s departure from the blogosphere did leave a void. 🙂

  5. thedesigndiva2 says:

    Codystl… I hear you about “pre exisitng ” conditions… I have been cancer free..knock on wood, since 1989 when I had my cervical cancer issue taken care of..Complete radical roshine hyst. In order to get insurance my premiums were close to 3k a month…EFF THAT….
    So until something is done to help those less fortunate..if I should ever have a life altering illness again..and they figure out I cant be DIVA…then off to whatever Country allows for you to end your life on your terms……. If I cant dance…I’d rather be dead than suffer……

  6. In New Jersey it’s against state law to refuse to insure someone for pre-existing health issues. However, it’s still a good idea to not let your health insurance policy ever lapse. We have changed health insurance companies several times since my husband became self employed & I’ve got lots of health issues. We would be paying over $1700 a month for a plan that we were paying around $1100 for a few years ago…what a mess. Now we pay $1200 a month for the “cheap plan.” It’s not fair that we are in a “pool of 1” because of being self-employed. How about we all are in the same pool? Just isn’t right to give large companies a break because they have tens of thousands of workers….don’t we all need healthcare, which to me means put everybody in one big pool.

    Here’s another problem – our cheap plan only pays $500 worth of diagnostic tests per person per year. Once you exceed that amount, now the doctor can charge what ever they want, instead of the pre-negotiated insurance amount. Here’s the kicker, the doctor’s office wouldn’t even tell me what they charge for the echocardiogram & stress test that I had done a week ago. I told them I would not do the test if it exceeded my $500 amount. I was so mad, I’m sure my blood pressure was thru the roof. Well they finally told me not to worry….it would not exceed $500. Now I have to find a better plan, imagine what would happen if I did have a coronary. The hospital & doctors would have a party charging me the maximum, because diagnostic tests are now not covered by my plan.

    I will never move to a state that allows insurance companies to deny coverage. You even have to be careful about medicare – each state is different. I’ve heard that from people who moved to Arizona, not realizing the medicare coverage there wasn’t as good as NJ (maybe they were discussing medi-gap coverage, not sure what the exact issue was).

    Massachusetts seems to be working. They went ahead with their state health care plan that covers everyone & according to my sister who lives in MA and works in a doctor’s office it is okay.

    All the big hospitals in LA went bankrupt due to the overwhelming number of people without insurance that went to their emergency rooms. Add in all the kids they have to educate whether or not the parents pay taxes or are legal, and that’s how CA went bankrupt. Not to mention the state employees that are getting retirement salaries of over $80,000 plus healthcare benefits.

    You have to be able to pay for the system in order for it to be self-sustaining. We are all going to have to tighten our belts, make due with less, and yes ration health care to make it work. Then if you can afford it, buy a better policy. In England, people wait for years to get knee replacement surgery etc. However their basic healthcare & especially preventative health care is way better than ours because everybody is covered. Funny, you see far fewer fat people in Europe. Maybe you pay more for coverage if you are overweight & smoke?

    Ahhh France. My cousin recently moved to Geneva to retire (she’s not American – born in France & she has Swiss citizenship thru her parents), told me the healthcare in France was better than Switzerland. However she also never worked in France because for every franc that she would have earned, 90 % of it would have gone to taxes. Her husband worked. But they do have really great healthcare & all kinds of benefits. Like free childcare for working moms.

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