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.

Recalling Michael Jackson

Continuing Moshe Alon’s recollections of Michael Jackson [please see the previous entry if you haven’t]:

Moshe never heard Michael Jackson raise his voice or give a command. “He was very shy,” he says, confirming widely held perceptions. At an event where Moshe wore a black tux, he heard Michael whispering softly from behind him. When he realized the words were for him, he heard Michael trying to tell him, “There’s something on your shoulder.” Had he been facing Moshe, he probably would have been silent rather than helpful.

Shy as he was offstage, when Michael Jackson was anywhere near a stage, according to Moshe, “He controlled everything. He was a showman,” says Moshe unstintingly, as if in admiration of an amalgam of P.T. Barnum and Al Jolson. During performances of super-stellar clients, Moshe is on the front line protecting them from fans who rush the stage. But Jackson selectively discouraged him from stopping them. “He let fans run onto the stage. He knew what they wanted.”

He was shy, he was savvy. He was in control or out of control.

“Other than his music and concerts, kids meant the most to him. He would take them to record stores, clothing stores, where they’d buy them up… anything they wanted.” On Jackson’s credit cards.

The kids Moshe had in mind traveled with them to Taiwan and Israel. “Kids ran around with bodyguards like kings and queens.” Moshe is critical of the parents who sent their kids unaccompanied—but for Jackson and his bodyguards—for three months. “Kids didn’t recognize their parents after that.”

As for the man whose care they were under, “He was like a child. He loved games”—so much, he had pinball games around the stage. Moshe recalled when Jackson was in group therapy. “His job was to vacuum-clean, but he didn’t know how to use a vacuum! My men had to teach him how. He went around vacuuming… vacuuming everything. He had such a good time.”

“He was not comfortable around adults. He was comfortable around Elizabeth Taylor. She understood… she was a child star too.” And the kids around him, I asked? Moshe’s answer was unequivocal. “I don’t believe he did anything wrong.”

“He trusted people.” And according to Moshe, they all took advantage of him. Not only the kids, but older people who were supposed to be friends. Not only them, but “managers and agents… anyone… everyone ripped him off.”

Moshe rented a helicopter for him for $10,000. Jackson’s representatives said, “No, Moshe, it’s $100,000.” Moshe corrected them, but they repeated the price was $100,000. Moshe told them he wouldn’t go along with them, he didn’t do things that way. They said his cut would be $20- or $30,000. When Moshe said no to them again, they said it doesn’t matter what you say, his cost is still going to be $100,000.

He said it was the same with Jackson’s doctor bills. Inflated. The same with his credit cards—they’d load charges for their own purchases on them. Those so-called friends of Jackson’s would get pills in their names to supply him with. Getting pain killers for him in places like Mexico was much easier, he added. I asked what they gained from it. “Power. And loads of money.”

Moshe says he has nothing against stars. But the people around them—“they make you sick.”

Moshe’s credibility? Elizabeth Taylor told him, “I’m never gonna ask you how I look because you tell me the truth.”

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.

Three Guides and One Twilight Zone in the Two Chinas

Sabbath in the Lama Temple with Zion

When the professor escorting an irreverent band of six journalists through Beijing says it's time to return to Zion, he's not thinking of the Holy Land or Zionism—he's trying to collect us and shepherd us back to our touring van and our Chinese superguide, Zion Zhu.

Zion, the son of missionaries, knows everything there is to know about: the Ming, the Qing and every other dynasty in China's long history; Nyngmapa and Galupa and presumably any other kind of Buddhism; and Hollywood movies. Ask Zion how he knows an English word he's just surprised you with and he'll tell you the film he learned it from. Then he'll tell the driver to "hang a right."

In addition to the “usuals,” the Great Wall, the Forbidden City, et al, Zion led us to "Longevity Hill," and through the Lama Temple and "The Hall of Longevity"—the hall of you should live so long, as I like to think of it.


Tuesday in the Park with Teresa

As Shanghai-modish as Beijing is quaint, our guide Teresa graced and grinned us through the gardens, canals, tunnels and towers of Shanghai. Teresa eschews a business card for a rubber stamper, a delicate pink one, which she uses to imprint her name and cell phone number on the document you’re least likely to lose. (That she presented the stamp after she lost me once is a Chinese puzzle.) Not exactly traipsing over hill and dale, we followed Teresa through the Humble Administrator’s Garden, the Master of the Fishing Nets Garden, Blood Alley and Tiger Hill. I remain seduced by the poetry of the names.

They say the national bird of China is the crane. The Chinese wear face masks to prevent contagion from foreigners bearing flu, but it is the edifice complexes that are catching. Park Hyatt Shanghai boasts of having the highest restaurant in the world. A presidential suite at Shanghai’s Hyatt on the Bund becomes “The Emperor’s Suite.” It followed that I was dubbed—by the incongruous professor of architecture and comedy—the Son of the Cucumber Emperor.


‘Tis the Season to Be Airy

“September Song” declares, “It’s a long, long time from May to December.” In an inscrutable reversal, Air China gave us December in May by piping “Oh Come All Ye Faithful” into its cabin of seven sole Caucasians amid an untold horde of Asian passengers airborne between two predominantly Buddhist countries, China and Taiwan. “Oh cuh-uh-ome all ye-ye fai-yay-aithful.” A gospel-soul rendition, in English. Ha-al-lelu-oo-oo-yah and amen. The evergreen Christmas Carol, the lone musical offering, was so felicitous for take-off they repeated it on landing.


Four Days on the Road with Lily

Bitten by the mine’s-bigger-than-yours bug, Taiwan’s capital, Taipei, boasts of the tallest building in the world (for now). Be that as it may, the poetry of Taiwan is the roll call of the cities. By bus, plane and bullet train the Caucasians go rolling along. Taipei to Taichung to Lugang to Tainan to Kaohsiung to Hualien to Taroka. A street festival, a lantern shop, a night market, a foot massage. A serene trek through the sublime Taroka Gorge, for which there are no adequate words or camera lenses. And everywhere, our Taiwanese guide Lily charging forward to rein in the pace-setter of the pack and scampering back to bring up the laggards. Pen to pad, camera in hand or short on breath, I am laggardly.