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POST: The U.S. Should Use Taiwan Health Care System as Exemplar

August 14, 2009

The health care bill in the U.S., sitting up there on Capitol Hill (yes, just like in the old cartoons) is bleeding. And it has been for weeks. The manipulation of its message and falsification of many aspects of its contents has now led to the removal of ‘end of life counseling’ funding. This, in it of itself, is a sad development.

But yesterday, the fight was taken overseas, as British politicians, doctors, academic, and laymen came to the aid of the National Heath System in the UK after scathing comment calling the NHS “evil” and “Orwellian” were made by U.S. Republican politicians. Among those who joined the fray were PM Gordon Brown, who tweeted “PM: NHS often makes the difference between pain and comfort, despair and hope, life and death. Thanks for always being there,” adding to the thousands of Tweets already lighting up #welovetheNHS. Stephen Hawking also lent his two cents, stating he would not have been alive if it had not been for the care of the NHS – a particularly meaningful remark, considering both the complicated (and costly) medical condition which he has and also considering Republican claims that currently ailing Senator Ted Kennedy would be left to die with a brain tumor if he has been a UK citizen.

Sure, there are problems with the NHS. Hospitals are often dirty, lines are long, and some people are left to wait interminably long for special treatments, not to mention the state of child care. But, the bottom line is that everyone is covered. Most Brits I talked to about the NHS during my tenure in London stated that it has its flaws, but it sets their minds at ease that care will always be within their reach and within their means. And, if those flaws weigh on Americans’ minds, it should ameliorate their worries that the U.S. plan has strayed so far from what can be deemed universal care that its a moot issue. (At the end of the day, the US won’t have universal health care for many years, even if this bill passes, due to the concessions Democrats have had to make).

A nurse in central Taiwan cares for a baby...can we get those Hello kitty heath care digs with our new plan?

A nurse in central Taiwan cares for a baby...can we get those Hello kitty heath care digs with our new plan?

So, if the NHS has its flaws that Americans are unwilling to accept, why didn’t they look towards other systems as well? The one that comes to my mind is the Taiwanese system. Developed in the 1980’s after the period of economic boom in East Asia, the Taiwanese system employs the most efficient mechanism – single payer, mandatory health care. This means that the government covers all health care and that every citizen is required to sign up.  Sound scary to Conseravtives?  Well put this in your pipe and smoke it – even if Taiwan increased its health care spending by almost double, to 10% of GDP, it would still be 6% under what the US spends, and with palpable results. That’s right, in 2008 Taiwan spent about 5.5% of GDP on health care and covered 96% of its population…while the U.S. loomed somewhere around 16% with much lower satisfaction.

Taiwan uses a system of ‘smart cards‘ that one carries around, onto which your medical history, medications, and past visits are recorded.  Say you wake up with a bad cold (swine flu, anyone?) and need to see a doctor right away, you are able to do so (that’s right, NO LINES) the same day. The doctor examines you, charges your smart card, and the costs are billed to the government. This way, the Taiwanese authorities save millions of dollars on unnecessary administrative costs (think about all those papers, charts, and the red tape that is required of switching cities, even of switching doctors within the same office?).  Even with these low costs, the Taiwanese system boast a super-high level of efficiency, customer satisfaction (around 70% satisfied), and coverage of 97% of the population. Not only is there a lack of satisfaction in the US, but before the lies began to be propagated anew in this administration’s fight for care, a 2004 poll showed that 1/3 of Americans thought the system needed to be “completely rebuilt.”

I understand that Taiwan is a tiny island and its system still has its problems (which could be remedied by a slight increase in spending, some say) and the US a behemoth. But come on, we’re making the effort enough to change health care domestically, why couldn’t we have considered this paradigm first? Thoughts?

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One comment

  1. The most important thing to know about Taiwan’s excellent system is that because they set up the program in the mid 1990s they had the advantage of studying what one might call “best practices” from around the world and ended up with a very impressive system that I have had the chance to study close up. To get a feel for their program I strongly suggest people view the wonderful PBS Frontline program “Sick Around the World.” It can be streamed easily from the website.



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