TNRtv: The Case for Single-Payer Health Care
From the New Republic—
At the 2009 World Health Care Congress, TNR senior editor Jonathan Cohn sat down with Dr. Michael Chen, Vice President and CFO of Taiwan’s National Health Insurance Bureau, to discuss the results of Taiwan’s switch to a universal health care system.
Jonathan asked all the right questions. Dr. Chen would not appear to have some hidden, self-interested agenda with promoting single payer national health care. Perhaps another way to end the media blackout on single payer would be to appeal to the heavy hitters to take on health care reform as one of their issues for political satire. Write to Jon Stewart and Stephen Colbert c/o Comedy Central at: 1775 Broadway, 10th Fl., New York, NY 10019. The hyprocrisy, political self-interest and misuse of political power that prevents meaningful healthcare reform would seem right up their alley.
I was fortunate to hear Dr. Chen speak in Teaneck, N.J., the same evening that this interview was taped, and his presentation was most informative. His slides included many facts and figures regarding coverage, costs, and cost sharing. The Taiwanese system splits premium costs between employer and employee, and has both state-run and private clinics and hospitals. The private institutions are nonprofit, which means that any excess income goes into expanding services.
The Taiwanese are committed to providing health care to all, especially the frail and elderly, as a societal obligation. In response to a question of how they reach less-populated areas, Dr. Chen pointed to the fact that the government has set up a helicopter pad on a small island with fewer than 10 residents to enable quick transfer to a medical center; they also use telemedicine.
The government has reached out to the population to strongly encourage participation, educating since 1995 to get to the current 99% level of coverage. (The uncovered 1% is basically Taiwanese living overseas for extended periods of time.)
Dr. Chen said that doctors, who work very hard and long hours, are better paid in Taiwan than in the United States (6x average income there, as opposed to 5x average income here; the latter number seems small to me). He also pointed out that medical tuition costs are much lower there than in the U.S., and that doctors pay approximately 1% of income into a fund for those few cases that are decided against them.
Regarding electronic records, when a patient visits a clinic or hospital, all three cards—patient’s, doctors, and clinic’s are swiped to provide the doctor with access to the patient’s last six uses of the system. If the doctor wants a more complete history, he or she can request it, but they generally do not need or like to do so. No private citizen can get access to another’s records, even those of a dependent, but the government program can access all information, which Dr. Chen pointed out as being helpful in rapid awareness of/response to epidemics, such as the SARS epidemic.
He is aware that success breeds rising expectations, and could cause costs to rise, but one of his graphs showed that Taiwan, at 6% of the GDP, has a “cushion” under the expected cost, so there is room to pay more. Conversely, the United States’ 16% falls well above that line; we are spending much more than we should to keep from deficit in the system.