I was doing my daily scan of the news both at the Huffington Post, CNN.com, and NYTimes.com and came across a wonderful article that got me thinking. The title of the article is “Taiwan’s Progress on Health Care” by Uwe Reinhardt. It is an excellent read. It caught my eye because Fareed Zakaria wrote an article and did an hour long program on CNN that contrasted different countries’ approaches to healthcare. He included Great Britain, Switzerland (which is similar to Obamacare), and Taiwan. Uwe’s article reinforced my belief in a single payer system (Medicare for all) as the most efficient system.
Many like to make the blanket statement that America has the best healthcare system in the world. After-all the international wealthy and heads of states from around the world come here for their treatment. That is true. The statement is shortsighted however. The United States of America has the best healthcare in the world money can buy. As American wages stagnate and healthcare prices inflate more and more Americans were left out of the system causing untimely deaths for those who went undiagnosed and untreated.
Given that we spend more than all countries in the world by a large margin and given that our medical outcomes are not better than most should tell us we were in fact doing something wrong. We needed a change.
Unfortunately companies who benefit from our healthcare chaos and inefficiency used a false sense of patriotism to prevent Americans from seeking or accepting factual information from countries that are performing better at a lower cost for their population. Based on what the Obama administration had been saying during the crafting of the Affordable Care Act (Obamacare), it is safe to assume that unbeknownst to most, the administration and the major crafters of the legislation looked into what other countries were doing. They also looked at experts that were marginalized but that had data to show why certain policies needed to be in place to make the system more efficient.
Ultimately we got a bill based on the political realities of our corporate power structure. It was not the best bill. Medicare for all would have been significantly less expensive by removing insurance companies from the mix since their sole purpose is to pay a bill while skimming a piece of every premium dollar.
Obamacare is a start. We must ensure that it is maintained and that going forward it is modified into a complete universal healthcare bill. We can start by looking at much of what works in Taiwan and other places and merge it with our excellent research, technologies, and medical professionals.
Taiwan’s Progress on Health Care
July 27, 2012, 6:00 am By UWE E. REINHARDT
Several years ago I wrote “Humbled in Taiwan,” a commentary for The British Medical Journal.
Perspectives from expert contributors.
The piece was prompted by a conversation between a health services researcher and the head of health information technology of Taiwan’s Bureau of National Health Insurance, which administers Taiwan’s single-payer national health insurance system. By that time, virtually all of Taiwan’s claims were billed electronically.
In that conversation, the bureau’s head of health information technology lamented that some hospitals and physicians in Taiwan still failed to submit fully completed claims forms for encounters with patients within 24 hours of the encounter.
In the United States, claims settlement for medical procedures under private health insurance can take up to three months; it takes about three weeks for Medicare. As I noted in my commentary for The British Medical Journal, “private health insurance companies in the United States count themselves lucky if high-priced actuaries can tell them in the middle of the year what the carrier ultimately will have to pay the providers of health care for services rendered in the previous year.”
Since 1995, Taiwan’s 23 million people have enjoyed universal, comprehensive health insurance coverage under its single-payer national health insurance system, which is financed by a mixture of payroll contributions from employers and employees and government subsidies.
The system is administered by the Bureau of National Health Insurance, whose administrative budget absorbs less than 2 percent of the system’s total spending for health care benefits. Over all, Taiwan spends about 6.9 percent of its gross domestic product on health care, compared with close to 18 percent spent in the United States. (More detail on the genesis of the system and its modus operandi can be found in this article in Health Affairs and on the bureau’s Web site.)
About two weeks ago, I attended the Europe-Taiwan Health Dialogue, held in Taipei. That two-day conference was sponsored jointly by Taiwan’s Department of Health and the European Health Forum Gastein, whose European Health Forums are among the leading platforms for discussions on health policy and are attended by participants from around the world. (My travel to the conference, to which I was invited as an academic expert, was underwritten by the Department of Health.)