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.