Scotties Toy Box

January 14, 2020

Taiwan’s single-payer success story — and its lessons for America

Filed under: Economics, Education, Health, News, Political, Questions, Reason, Science, Things I like — Scottie @ 11:36

There is much more information at the link, it is a long read but worth it.   Some good things, and it explains some of the harder choices.  It is do able and it has really improved the health of the people.   But there are strains and it will need price increases, which from a US view point are inconceivably low.    The say a co-pay is about 12 dollars.   Remember though our country is much wealthier.   Anyway I found the article fascinating.   Hugs

https://www.vox.com/health-care/2020/1/13/21028702/medicare-for-all-taiwan-health-insurance

Diabetes, alcoholism, and heart disease are common problems among the Taroko. The indigenous people have endured displacement, forced assimilation, and discrimination over the centuries. They are also poorer than the ethnically Han Chinese who make up most of Taiwan’s population.

But they never have to worry about one thing: their health care. In Taiwan, everybody is covered. The Taiwanese health care system is built on the belief that everyone deserves health care, in Xiulin just as much as anywhere else. The costs to patients are minimal. And the government has set up special programs to deliver care to the people in Xiulin and their neighbors in Hualien County.

In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders’s vision of Medicare-for-all as anything in the world.

There’s clearly a need for lessons. Compared to the rest of the developed world, America spends more money on health care and produces worse outcomes. By one advanced metric — mortality for causes that should be avoidable with accessible, high-quality health care — the United States ranked last among the G7 countries in 2016. America’s infant mortality rate is almost double that of some of its peers. Nearly one in 10 Americans lack insurance. People go bankrupt over medical bills. Yet Americans still spend about twice as much money on health care per capita as the average comparable country.

No health care system is perfect. But most of America’s economic peers have figured out a way to deliver truly universal coverage and quality care. The United States has not.

“Canada and virtually all European and Asian developed nations have reached, decades ago, a political consensus to treat health care as a social good,” health care economist Uwe Reinhardt wrote in his book Priced Out shortly before his death in 2017. “By contrast, we in the United States have never reached a politically dominant consensus on the issue.”

Taiwan made its choice in the 1990s and embraced single-payer. It has required sacrifice: by doctors who believe they’re forced to see too many patients every day; by patients with complex and costly conditions who can’t always access the latest treatments; by citizens who have been asked from time to time, and will be asked again, to pay more for their health care than they did before.

The national government would eventually fast-track the implementation of the new system to 1995, hoping to get the chaotic transition period over before the first popular elections in 1996. There was plenty of skepticism leading up to it. Industry, experts, and the public alike doubted the program would succeed. Labor protesters threw paper money traditionally used in a funerary rite when the legislature passed the single-payer bill in 1994. A majority of people in Taiwan disapproved of the single-payer plan when it took effect.

But the program’s reputation quickly improved once people started to enjoy its benefits. Approval has dipped (when premiums were hiked in the 2000s) and risen (when the rural health care program that employs Tien in Xiulin was implemented) over the years, but there has always been a solid baseline of support. Today, approval of the national health insurance program hovers near its all-time high, over 80 percent. The system endures 25 years after it was established.

Part of its appeal is its simplicity. Everybody in Taiwan is insured through the National Health Insurance Administration (NHIA). They receive an ID card as proof of coverage, which also stores their medical records. The Taiwanese program runs with extraordinary efficiency: About 1 percent of its funding is spent on administration, according to a 2015 review by Cheng. (Compare that to the US, where researchers have estimated that private insurers spend around 12 percent of overhead, and hospitals spend around 25 percent on administrative work.) Experts say Taiwan’s advanced IT infrastructure deserves a good share of the credit.

The benefits are quite comprehensive: hospital care, primary care, prescription drugs, traditional Chinese medicine. Patients must make copays when they visit the doctor or fill a prescription or go to the ER, but they are generally low, 360 NTD (about $12) or less. Lower-income patients are given an additional break on their cost-sharing obligations. Higher-income patients can take out private insurance for certain things not covered by the single-payer program.

The system is mostly funded by payroll-based premiums, with contributions from workers and their employers, supplemented by more progressive income taxes and tobacco and lottery levies. Premiums have been raised twice in the past 18 years to cover the growing cost of the program. The most recent rate increase in 2010 moved the payroll income tax rate from 4.55 percent to 5.17, a 14 percent increase.

In the early 2000s, again at Reinhardt’s recommendation, Taiwan converted to global budgets to pay for health care as another cost-control measure. This means that every year, government officials and private providers sit across a table and negotiate rates for services, with an annual cap set on the total payments to hospitals and doctors that the government will make. Health spending has stayed flat in recent years as a percentage of GDP, and it is growing at a slower rate in Taiwan than in the United States.

“That’s the essence of universal health coverage,” he says. “The principle of health [as a] human right is that everybody regardless of geography, religion, gender, age should have the right to access.”

5 Comments »

  1. Thanks for this Scottie! They keep telling us it can’t be done here. I don’t believe it. The problem is we have too many hands in the cookie jar. It’s going to take leadership and the people themselves to make it happen. I hope I see it in our country before I depart this earth!

    Liked by 1 person

    Comment by Brookingslib — January 14, 2020 @ 17:07

    • Hello Brookingslib. I agree. I hope you do not depart any time soon as I enjoy your posts. The people in this country have been indoctrinated, been sold a fake sack of goods. Those wanting to bleed the people dry have convinced those people that it is in their own good. There has been a centuries long attempt to dumb down the US, to sabotage education as the wealthy have realized that allows the workers to cut into their profits. Slaves do not need to have an education. Nothing in the US must interfere with the suction of money from the lower levels to the upper wealthy. Hugs

      Like

      Comment by Scottie — January 14, 2020 @ 18:07

  2. Thanks for that Scottie. Yes, the corporations and the wealthy have this thing rigged pretty good, don’t they? What makes it even worse is that the media is in conflict as well. Many times, some of the issues that need to be discussed, are either whitewashed or ignored altogether, because they’re owned and operated by some of the largest conglomerates on earth. That’s just wrong!

    Liked by 1 person

    Comment by Brookingslib — January 15, 2020 @ 14:34

    • Hello Brookingslib. Yes, oh yes, thank you Jeff. I keep trying to get the word out that the idea of the media being liberal is wrong. Every study shows the mainstream corporate media is very conservative. It is understandable if your motive is profit you have to play to the highest bidder.

      But the real point of the story is it is not too late to change the system. People like to think that because it has always been this way in their life time that it must remain this way. But the truth is if a country wants to , it can be changed. They did it, we can also. Hugs

      Liked by 1 person

      Comment by Scottie — January 15, 2020 @ 14:54


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