Medicine
My parents were both born in Taiwan, and about every four years (most recently, last November), I travel there to visit relatives. Since I was a child, Taiwan always struck me as in the same league as the U.S. with respect to advanced technology - in fact, they had the newest handheld video games (and later, the Nintendo Wii) months before these games arrived in stores in the States. But it wasn't until recently that I learned from a New York Times blog that Taiwan made the transition to unversal health care insurance in 1995, not long after the Clinton health care plan failed in the U.S. In a single year, Taiwan went from insuring only 55% of its population to 95%, and today the figure is close to 99%. (By comparison, U.S. Census data suggest that about 85% of the U.S. population has health insurance at any point in time, a figure that fluctuates as people lose their jobs and become poor enough to become eligible for state Medicaid coverage.)
How did Taiwan arrive at their health reform plan? After appointing several prominent domestic experts to a special task force that went nowhere due to differing views on how the new system should work, the government invited an American economic professor from the Harvard School of Public Health to break the impasse. As Dr. William Hsiao stated in an interview for the Times blog, "It turned out to be a big advantage that I'm not Taiwanese and had no aspirations of getting a job in Taiwan. At the end of the day, our recommendations and findings were perceived as more objective and free of self-interest."
The task force recommended that Taiwan adopt a single-payer model, analogous to the Canadian national health system. Highlights of the plan that was implemented include coverage for traditional Chinese medicine ("We tried to design a benefit package that would give people what they value," explained Hsiao), prevention and primary care, home health care, and a single, uniform electronic medical record system. With low co-payments and low administrative costs, the share of Taiwan's gross domestic product devoted to health care is about 6 percent, compared to 17.3 percent of GDP in the U.S. in 2009.
While it's hard to escape the irony of Taiwan inviting an expert from the U.S. - a country that has, after all, failed several times since the 1930s to enact comprehensive health reforms - to tell them what to do, the Taiwanese example is instructive as President Obama's bipartisan "health care summit" approaches. Perhaps our Congress should invite a foreign health policy expert without a stake in the outcome to make reform recommendations that are "objective and free of self-interest." Preferably from a country with more insurance coverage, better quality of care, lower infant mortality rates, and longer life expectancies than our own ... which, alas, leaves plenty of countries to choose from.
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Medicine
Getting health reform done: the Taiwanese experience
My parents were both born in Taiwan, and about every four years (most recently, last November), I travel there to visit relatives. Since I was a child, Taiwan always struck me as in the same league as the U.S. with respect to advanced technology - in fact, they had the newest handheld video games (and later, the Nintendo Wii) months before these games arrived in stores in the States. But it wasn't until recently that I learned from a New York Times blog that Taiwan made the transition to unversal health care insurance in 1995, not long after the Clinton health care plan failed in the U.S. In a single year, Taiwan went from insuring only 55% of its population to 95%, and today the figure is close to 99%. (By comparison, U.S. Census data suggest that about 85% of the U.S. population has health insurance at any point in time, a figure that fluctuates as people lose their jobs and become poor enough to become eligible for state Medicaid coverage.)
How did Taiwan arrive at their health reform plan? After appointing several prominent domestic experts to a special task force that went nowhere due to differing views on how the new system should work, the government invited an American economic professor from the Harvard School of Public Health to break the impasse. As Dr. William Hsiao stated in an interview for the Times blog, "It turned out to be a big advantage that I'm not Taiwanese and had no aspirations of getting a job in Taiwan. At the end of the day, our recommendations and findings were perceived as more objective and free of self-interest."
The task force recommended that Taiwan adopt a single-payer model, analogous to the Canadian national health system. Highlights of the plan that was implemented include coverage for traditional Chinese medicine ("We tried to design a benefit package that would give people what they value," explained Hsiao), prevention and primary care, home health care, and a single, uniform electronic medical record system. With low co-payments and low administrative costs, the share of Taiwan's gross domestic product devoted to health care is about 6 percent, compared to 17.3 percent of GDP in the U.S. in 2009.
While it's hard to escape the irony of Taiwan inviting an expert from the U.S. - a country that has, after all, failed several times since the 1930s to enact comprehensive health reforms - to tell them what to do, the Taiwanese example is instructive as President Obama's bipartisan "health care summit" approaches. Perhaps our Congress should invite a foreign health policy expert without a stake in the outcome to make reform recommendations that are "objective and free of self-interest." Preferably from a country with more insurance coverage, better quality of care, lower infant mortality rates, and longer life expectancies than our own ... which, alas, leaves plenty of countries to choose from.
- Medicaid Expansion Will Leave Out Many Of The Poorest: What Is Wrong With This Picture?
In States’ Policies on Health Care Exclude Some of the Poorest, in the New York Times on May 25, 2013, Robert Pear describes how this bizarre situation has come to pass. Basically, it is because the programs established by the Affordable Care...
- Government Sponsored Health Coverage: The Good, The Cautionary, And The Ugly
The good news: The recent New York Times/CBS News poll (June 21, 2009, http://www.nytimes.com/2009/06/21/health/policy/21poll.html?em) demonstrates conclusively that, as the headline reads, there is “Wide Support for Government-Run Health”. “The...
- The Social Ethic And Covering Everyone: Reinhardt And Himmelstein
Don McCanne, MD, provides a widely-read information service and commentary called “Quote of the Day”. It is distributed by listserve, but is also available through the PNHP website (http://www.pnhp.org/), a link to which is on the left side of this...
- "sick Around America": A Little Bit Sickening
Last week I watched “Sick Around America”[1], the PBS show Frontline. I was greatly looking forward to it as the follow-up to the outstanding show “Sick Around the World” that T.R. Reid, a former international correspondent for the Washington...
- Cutting Prevention Fund To Pay For 10 Month "doc Fix" Is Medical #linsanity
Like millions of basketball fans around the world, I've been transfixed by the story of Jeremy Lin, the undrafted Taiwanese American point guard from Harvard who has taken the NBA by storm this month as the new superstar of the New York Knicks. It...