Jonathan Cohn interviews Taiwan's Dr. Michael Chen
TNRtv: The Case for Single-Payer Health Care
By Jonathan Cohn
The Treatment (TNR’s health care blog)
The New Republic
April 17, 2009
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 Cohn (JC): You have what most people refer to as single payer health insurance - the government is the main insurer for everybody.
Dr. Michael Chen (MC): Yes.
JC: How did you decide on that model - the single payer? Why did you go in that direction?
MC: Well, we sent our people around the world to learn their programs, including the United States. Actually, the program is modeled after Medicare. And there are so many similarities - other than that our program covers all of the population, and Medicare covers only the elderly. It seems the way to go to have social insurance…
JC: Now, one issue that comes up in the United States when people talk about a single payer system, or even any kind of a system where the government is defining the benefits, there’s a big concern that there’s not enough choice. People in America… we want to know that you can choose the kind of insurance you want - how much coverage, what services. Is that an issue you dealt with in Taiwan? Was that a concern?
MC: Not at all, because in Taiwan the benefit package is rather comprehensive… We maintain a very long list for prescription drugs - more than twenty thousand items. And the benefit package includes inpatient, outpatient, and dental service which is usually not covered in this country.
JC: Now the flip side is that if you are offering such a generous package, that’s very expensive, is it not? I mean, how do you pay for it?
MC: Not the case.
JC: Not the case. What percentage of GDP?
MC: Six percent of GDP, so that’s very affordable. The premium on average that the family pays is about two percent of the household income because the premium is shared by your employer.
JC: … In this country we spend far more than that, and even looking at Europe - Switzerland, France - they spend a lot more than that also. Are there waiting times for services in Taiwan? Is there something that people are going without? I mean that’s a lot of services for such a little amount of money. I’m trying to figure out what it is that you’re not getting.
MC: No waiting lines.
JC: No waiting lines? I can see a doctor any day I want…
MC: If you are not too particular.. you can visit even a specialist in a matter of minutes…
JC: … If I were to be sitting here with a doctor in private practice in Taiwan - I know in this country doctors worry a lot that Medicare doesn’t pay enough money and that it’s very bureaucratic - what kind of complaints would I hear from them?
MC: Of course, doctors would complain in public, but appreciate it in private - because, you know, especially in this economic downturn, how can you find an industry with assured growth rate annually? Right now they enjoy somewhere between four percent to five percent increased rate, and this is a sure thing.
By Don McCanne, MD
Our political leaders keep telling us that Americans don’t want single payer, but instead we want a uniquely American solution for all Americans.
So what did Taiwan do? They looked at health care systems throughout the world, and they chose a uniquely American system for Taiwan! - Medicare! - except that they expanded its benefits and included everyone. And it really works well.
So Congress is returning from recess with health care reform at the top of its agenda. They have already decided that single payer is off the table, but they are having difficulty in addressing three issues: 1) the role of government in regulating the private insurance industry and offering a public insurance option, 2) the near impossibility of covering everyone in the fragmented, multi-payer system that they have selected, and 3) the difficulty in finding funds to pay for this model of reform - the most expensive ever devised.
But they’ve taken off the table the one model that would work - the uniquely American program: Medicare for All. Fixing Medicare and providing it for everyone would: 1) define the most effective and efficient role that government could have in health care financing, 2) make coverage completely automatic for absolutely everyone, and 3) reduce inefficiencies and waste that would eliminate the need to search for other funds.
Oh wait… There is that uniquely American industry that helped pay for the elections of our members of Congress: the private insurance industry (no relation to the social insurance private plans of other nations).
What a difficult decision for Congress: taxpayer dollars to support a uniquely American private insurance industry that remains incapable of ensuring affordable health care for all, or efficient financing of a uniquely American Medicare for All that would provide for the health care needs of everyone.
Actually, for Congress that decision is not so difficult. Medicare for All is already off the table.