2012 / 9月
Teng Sue-feng /tr. by Scott Williams
My father was constantly in and out of emergency rooms and critical care units in the few years before he passed away.
After one of his heart attacks, he was blue by the time the ambulance got him to the ER. Then a lung infection kept him in the hospital for nearly a month, first in the critical care unit, then an ordinary room. Bedbound and hooked up to oxygen tubes, his throat became raw and the muscles of his legs atrophied. Unable to speak and limited to a fluid diet while in the CCU, he occasionally became so distraught that he would pull out all his tubes and IVs. Afraid that he would seriously injure himself, we had to secure his hands for a time. He continued to need respiratory treatment and rehabilitation even after his transfer to the general ward. Though his condition turned critical several times, the conscientious care of his doctors and nurses enabled him to leave the hospital on his feet.
I got the bill after he was discharged. It was an unbelievably low NT$10,000 or so. Taking into account my father’s advanced years, the hospital had “wasted” enormous amounts of medical resources on his care, and I couldn’t help but feel grateful for our National Health Insurance (NHI) system.
My father had a colleague who lived in Keelung who used to have to spend three to four hours traveling to Taipei Veterans General Hospital for care. When you add the time actually spent on the appointment, getting his monthly blood-pressure medication took all day. All told, the registration, examination, copayment, and medication cost him something over NT$300. But given that his monthly pension was only NT$8–9,000, the figure was more than just pocket change to him.
The greatest attribute of Taiwan’s NHI system is that it benefits everyone. This is especially apparent when it is compared to the free-market system of the US, which lacks universal coverage. The US’s government-administered health insurance programs consist of only Medicare for the elderly and Medicaid for the poor, and together cover just 22% of the population. Most salaried workers (about 61%) receive health insurance via their employers.
Some have described the US health insurance system as being an “every man for himself” kind of system. That is, the rich can purchase high-quality medical insurance, while poor people who become sick are likely to find themselves further impoverished by exorbitant medical expenses. At present, roughly 15% of the US population (more than 40 million people) have no medical insurance.
In 2010, the US spent an astronomical US$2.6 trillion (nearly NT$78 trillion) on medical care (about 17.9% of US GDP), the highest level of such spending in the world. By comparison, Taiwan spent roughly NT$800 billion, or 6% of its GDP.
During the 2008 US presidential campaign, then-candidate Obama made health insurance reform a core policy position. Obama’s determination to change the system was informed by memories of his seriously ill mother worrying about being unable to pay for treatment. The experience made him painfully aware of the hardships confronting low-income individuals unable to afford health insurance or healthcare. He concluded that a hybrid public-private health insurance system would provide broader coverage at lower cost.
Following the 2010 passage of his reform program, 20-some US states sued to block its implementation. The state governments argued that the law’s requirement for individuals to purchase health insurance was unconstitutional. In June, the US Supreme Court ruled that the mandate was constitutional, and that the reforms could move forward.
Among Obama’s reforms are measures to extend coverage to a larger percentage of the population and introduce the use of electronic medical records. Taiwan is far ahead of the US in both these areas. While our system has some problems with its finances, it is built atop a solid foundation and is moving in the right direction. We should be proud. We have created an NHI system that is the envy of the world, and all agree that we should work to ensure it remains sustainable over the long haul.