The situation on Single Payer HealthCare

This is a summary of an article in The Washington Spectator, June 15, 2008 (v34, no12) by Ian Williams.

Taiwan offers single-payer universal health care with dental and prescription drug coverage, with a choice between modern and traditional Chinese medicine, all for about 1/3 of the proportion of their GDP than the US system costs. Taiwan searched the world's countries for the best system, and they chose Medicare.

The problem with the US system is that health care is tied to employment, which in the modern economy is sometimes precarious. Further, many jobs do not pay enough to manage a place to live, food, and health care. If someone is too ill to work, they lose both job and health coverage. In Taiwan, the government started by including everyone; in the US, bills designed to cover the uninsured (e.g. SCHIP) are vetoed or voted down because some people might be able to afford coverage on their own.

The economic gap between the haves and have-nots in the US is roughly equivalent to the gap between the insured and uninsured. The main reason, as CEO of Wellpoint Angela Braly stated, "We will not sacrifice profitability for membership."

In Taiwan, people pay their premiums through a payroll tax similar to Social Security or Medicare: based on what they earn. The maximum per/month premium is $20, the maximum covered dependents is three. Employers pay an average sum for dependents. There are exemptions for those who cannot pay, loans for emergencies, and referrals to charities if the loans fail. Further, there is catastrophic illness coverage cards for those with chronic illnesses, reducing or eliminating premiums for them. This is the same class of people who American insurers do not want to cover.

This is not socialized medicine; Taiwanese can visit the public or private clinic or hospital of their choice. Each citizen has a smart card carrying their medical information (this is something mentioned in at least two of the above articles). The smart cards allow doctors to skip unneeded tests that happen so often in the US. It also helps prevent the human errors resulting in mis-prescribing drugs, allergic reactions, and so on.

The big problem in the US is that almost nobody in the government is willing to stand up to the big health care lobby or pharmaceutical industry. Until that happens, little or no progress will occur.

Taiwan's costs are about 6.2% of their GDP, versus the US's cost of 16.2% of our GDP. Taiwan spends about $1,000 per person on medical care, while the US spends over seven times that much. The stark reality is, the pharmaceutical and health care companies will not change; in their opinion, higher premiums, reduced coverage, and paying doctors less per patient will allow everyone to get health care. In fact, they admit they do not want to cover everyone. They are also inefficient, callous, and have high overheads.

US health insurance companies spend about 20% of their premium income on administrative overhead, compared to 2% for Taiwan's universal plan. Governments really are efficient in handling very large numbers of people. Further, the infrastructure is basically in place through Medicare, Medicaid, the VA, and a network of public and not-for-profit hospitals. Again, the only thing lacking is the political will because of the enormous amount of lobby money the health insurance and pharmaceutical companies funnel to our elected representatives.

There is little I can add to this; Mr. Williams pretty much covers the topic. My brother-in-law was in Taiwan for many years, and received generally good-to-excellent care. He had only two complaints: getting a specialist could be difficult (that was the same as in Canada's system), and follow-up care could be a problem if you had a complaint about your local doctors. The plan covered all health care, so it was free, except for transportation to and from the doctor's office, hospital etc.