Rx: Health Care Made in Taiwan

A health scare I experienced in Taiwan, only 1/13th the size of the United States, made me zealous for services and benefits we in this country only dream about.

While at dinner with five other American journalists in Taiwan this past June, I felt a stabbing, shooting pain in my lower left arm indicating angina. I tried to deny the pain and dismiss any significance it might have, but my companions were too knowledgeable to fool. Mindful I was going to be in the air for nineteen hours the next day, they insisted I go to a hospital before we boarded our plane for New York.

At 7:30 the next morning, accompanied by Lynn, a colleague, and our Taiwanese guide, Lily, I took a taxi to the Buddhist Tzu Chi Hospital in the coastal town of Hualien. At 8:20 a.m., we entered the emergency area, which bore none of the earmarks or anxieties customary to one. Without wait, I was able to tell a receptionist in English why I was there. I wasn’t asked to fill out any forms. All I had to write was my name, once.

In less than five minutes a young woman doctor walked over to where we were seated and began asking me questions, the right questions. After I described my symptoms of the night before, she prescribed the expected EKG and a blood test, took my blood pressure and listened via stethoscope to my chest. She said I would have the results by ten a.m. In less than another five minutes, I was asked to enter double doors behind the reception desk that led to the emergency ward.

Although I was wearing a surgical mask, I was nevertheless wary of catching something. Patients lay in rows of hospital beds. A nurse, sensing my discomfort, led me to a bed on an outside aisle where I sat facing away from the other patients as she took blood from me. I scrutinized the procedure to make sure she was using a new needle, which of course she was. But I was still uneasy. I asked if I might have the EKG in a more private area, hoping for any unoccupied corner of the room. The nurse did even better; she moved the bed into a separate chamber. I was comforted and thankful.

While I subsequently waited with Lynn and Lily in the waiting room for the test results, Lynn suggested we take a poll on what time we would have them. We all lost by overestimating it. At 9:51 the doctor emerged with the completed EKG and blood test results, which she reviewed painstakingly with me. They indicated the pain wasn’t from angina or anything threatening to the heart. They revealed I had a heart murmur I didn’t have on examination a week prior to going to China. I was offered, and gratefully accepted, print-outs of all my test records to relay to my cardiologist in New York.

When we rejoined our colleagues, they, already informed I was OK, greeted me with cheers and applause. Then, one by one, they sidled over to me, individually expressing envy. I pointed out they had relaxed at a beach while I had spent my last four hours in Taiwan anxious about whether I would be on a flight home that day or not. The response could only come from journalists: “Yes, but you got the story.” And they were right.

It’s a tale of national health care. The Taiwanese government, founded “provisionally” in 1949, faced with entering the 21st century with half its population having no insurance coverage at all, started late and got it right.

The government began by consulting experts from a dozen other countries, cherry-picking and combining their finest features for inclusion in its own nascent system. It wanted one plan that covered everyone, assuring free and equal access to doctors and hospitals for all without waiting lists or “gatekeepers.” To finance it, it opted, in 1995, for a single payer government-run national insurance fund everyone is compelled to join and contribute to based on either the ability to pay or a fixed affordable premium. No Taiwanese citizen ever has to worry again about going bankrupt due to medical bills. Working people don’t have to worry about losing their insurance if they lose or change jobs. Low income households, military conscripts and veterans are 100% subsidized.

Taiwan’s NHI (National Health Insurance) system offers comprehensive benefits you can barely recite in one breath: prescription drugs, vision and dental care, maternity and child care, psychotherapy, preventive medical services, acupuncture and traditional Chinese medicines, kidney dialysis, radiation therapy, surgery, inpatient and home care, and more. Everyone has a smart card that enables a doctor to read the patient's medical history and medications. The patient’s bill, transmitted to the government insurance office, is paid automatically. It’s no wonder Taiwan has the lowest administrative costs in the world: less than 2 percent.

The taxi rides, roughly two hours to and from the hospital, came to $10 more than my hospital visit. The entire bill for my examination and battery of tests was $56.

Back in New York, I reported my experience to my cardiologist, who recommended I have an echocardiogram. The first available appointment for me was in a month.

Scanning the Great Firewall of China

As the nations of the world prepare to mark the Twentieth Anniversary of the weeks-long student-led pro-democracy demonstrations crushed on June 4th in Beijing’s Tiananmen Square, The People’s Republic of China, twelve hours ahead of us, is already suppressing it.

The news is not controlled, it’s stifled. Television crews are banned from the Square. Access to Internet sites is blocked. Popular social networking sites such as Twitter, Flickr and Hotmail are effectively shut down. The Great Firewall of China has wound its way through the inroads of progress, ostensibly rendering modern China impregnable again. But for how long?

“Something there is that doesn’t love a wall,” wrote U.S. Poet Laureate Robert Frost. Will it be Chinese students again? Or the offspring of the workers who supported them so ardently twenty years ago? Whatever it is “That sends the frozen-ground-swell under it,” as Frost has it, will invariably have to surface from Chinese soil. What we know, from Jericho to Berlin, is that even in the face of the seemingly impossible, unwelcome, untenable walls come tumbling down.

Two Chinas, the mainland and Taiwan, are slowly, but no one will say surely, becoming one China—aren’t they? Invisible walls prevail. Ten days ago, I was one of six journalists invited to fly from mainland China to Taiwan for the first time in sixty years. More was made of it here than in China. Applying for a visa in New York, I was told that being a “writer” was a problem—“We don’t want you to write anything critical of us.” I was up against a wall—until I asked why they would expect something critical. I got the visa. So nothing I say is critical.

BUT. Here’s where the information factor becomes critical. I have seen first hand what a communist-controlled education can do to people, in the Former Soviet Union, in Mongolia, and in [censored]. It deprives them of the ability to think for themselves, to make decisions and to take responsibility for them. It primes them for taking orders and strips them of any notion under the sun of not following them.

Still, contradictions abound. The educated are super-educated. Three consecutive guides learned English in Chinese schools and spoke it better than many an American I’ve heard. When someone used any English word they didn’t know, they took a small electronic gizmo out of a pocket or pocketbook, entered the word, read the definition provided on the screen and “saved” it. The management and staffs of the hotels we stayed in, the grandest of Grand Hyatts in Beijing, Shanghai and Taipei, were fluent, fast on the uptake (and we gave them plenty to take up, and in) and charmingly, often wittily, responsive.

All things computed, the “new” China is better served without firewalls.

Sino Sign Language

May we remind you: please be self-restraint and be a good tourist to mold a well-mannered imagination.

So read the sign welcoming me to Beijing’s Jingshan Park. To the degree I understood it, I honored it. My “well-mannered imagination,” however, had unruly ideas of its own.

If China is a nation of 1,330,313,812 people, where were they? If one in every five people on the planet is a resident of China, did they prefer to reside indoors? While Japanese and Korean tourists abounded, with touring Chinese supplementing their numbers, the locals were notably scarce. Our small gaggle of journalists looked for telling signs—pets, children, laundry, waiting lines, wild life and indigenous music—and came up with vendors and trinkets, service people and shop clerks, humming bikes and still waters. When the loudest sounds in a country emanate from Buddhist temples, a New Yorker has to ask: is this Nirvana or Neurasthenia?

The plaque, above, urging the reader to “Take the initiative to classify discards of paper… or gourd skin,” also tells him or her to “Cherish the resources,” “Don’t talk or laughter loudly in the scenic area,” “Don’t shin or overstep the rockery” and “Don’t urinate or defecate.” No one in my company did any of the latter things in my presence.
 
Not with reminders like these:

China teems with culture on the calm. Tiananmen Square is a procession of the orderly. The Chinese have become Olympic smilers. I didn’t hear raised voices. Everything is a negotiation. Even navigating large vehicles in heavy traffic is a negotiation. 

 

If any sign exists that says “No raised voices,” I didn’t see it. So I raised mine. I sent a pair of cotton slacks to be washed and ironed at the Grand Hyatt, Taipei. I told them the bottom hems were frayed before they told me. “Just do the best you can and don’t worry about it,” I said. Over the next six phone calls from housekeeping and the laundry, I found half a dozen additional ways to tell them the same thing, not to concern themselves with the pants, just do the best they could, that would be fine. When I returned to my room at 11:30 that evening, my phone was ringing. The seventh person was calling to tell me my pants were damaged. Is it possible the “Banana Republic” label intimidated them? I certainly didn’t. A gentleman came to my door. Out of patience, I raised my voice. He smiled. And they did a beautiful job.

 
Maybe this sums it up: