Wednesday, October 7, 2009

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.


  1. Way to go Ray. This is an important issue. Maybe your blog will wake a few more people up to the sad state of affairs of health care in the USA.

    Ms Anonymous

  2. Hilarious and f-ing sad, too. I am beginning to wonder why so many people want to immigrant to America. If I were not so old and decrepit, I would gladly leave this country. After working toward and contributing to progressive causes most of my adult life, I am growing increasingly weary of seeing so little change for the better. And so goddamn much for the worse.

  3. So you’re saying that in Taiwan, taxi drivers earn more than health care professionals?

    Some key points on the Taiwan NHI:

    • The CEO of the Taiwan NHI studied Health Policy and management at Yale. So the U.S. must have the intelligence to implement a comprehensive health care program.
    • Health care in Taiwan is efficient – not you never saw a doctor while in the hospital.
    • Every resident and alien is taxed from cradle to grave. Convicts excluded.
    • Taiwan NHI has exclusions i.e.war, plague, earthquake, typhoons etc.
    • The Taiwan NHI is 14 years young. New Zealand’s national health care was supremely effect since 1935 until administration slowly started to eat into it. Let’s give Taiwan a shot and see what happens in the next 50 years. U.S. Social security was great until greed, fraud and red tape started to devour it.

    Some suggested steps USA would need to take to procure a national health system.

    1) Drop the Farm bill in its entirety other than food stamps - $200 BILLION.
    2) Extremely high tax on all products that cause illness i.e 1000% tax on cigarettes.
    3) Invest more resources in fraud prevention.
    4) Simplify the Medicare’s bureaucracy.
    5) Eliminate personal injury lawsuits.
    6) Outlaw health insurers. Health insurers will lose substantial profits unless included in the program – thereby by definition perpetuating greed and fraud.

    None of this will ever happen in a capitalistic society.

    Rik Misiura PT, GCFP
    Central Park Physical Therapy