<p>"Taiwan offers an opportunity to study how an advanced economy can structure its health care system to advance societal goals. Taiwan learned from worldwide experience that while the free market can often produce products and goods efficiently, it is incapable of distributing the goods equitably because the income and wealth of households are not distributed equitably. Moreover, the health insurance market suffers major market failures from adverse selection and risk selection. When a society is seriously concerned about its people having equitable access to care and about pooling health risks efficiently, the free market is not a good choice. Evidence from the United States amply supports this conclusion also.</p>
<p>Taiwan established a compulsory national health insurance program that provided universal coverage and a comprehensive benefit package to all of its residents. Besides providing more equal access to health care and financial risk protection, the single-payer NHI also provides tools to manage health spending increases. Our data show that Taiwan was able to adopt the NHI without using measurably more resources than what it would have spent without the program. It seems that the additional resources that had to be spent to cover the uninsured were largely offset by the savings resulting from reduced overcharges, duplication and overuse of health services and tests, transaction costs, and other costs. The total increase in national health spending between 1995 and 2000 was not more than the amount that Taiwan would have spent, based on historical trends.</p>
<p>Additionally, Taiwan did not experience any reported increase in queues or waiting time under the NHI. Meanwhile, the government has taken regular public opinion polls every three months to gauge the publics satisfaction with the NHI. It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs.</p>
<p>One notable result that should interest Americans is that Taiwans universal insurance single-payer system greatly reduced transaction costs and also offered the information and tools to manage health care costs. Alex Preker, a leading health economist at the World Bank, came to a similar conclusion from his research of OECD countries. He concluded that universal health care led to cost containment, not cost explosion.26 Equally important, a single-payer system can gather comprehensive information on patients and providers, which can be used to monitor and improve clinical quality and health outcomes.</p>
<p>The Taiwanese experience and practices have limited value for less developed nations. Taiwans economy has advanced to a stage where most workers were employed in the formal sector, so a compulsory NHI can effectively collect premiums through employers. The government also has the revenue to subsidize the coverage of the poor, veterans, and farmers. Taiwan also has the organizational ability and human resources to manage a national health insurance scheme. Most developing nations do not; these nations cannot adopt the models of advanced nations."</p>
<p>Mini, members of Congress get the option of going to a military doctor at Bethesda (a) only when they are in DC and (b) only if they pay an annual fee, like an HMO. Their family members must use private insurance, as must the Senator or Congressman when not in DC. If they don’t want to use a military doctor or military hospital, they must use private insurance. Congressmen also have the option to enroll themselves and their families in the Federal Employees Health Benefits Program, which is a cafeteria plan of insurance policies by private insurers. (apologies in advance, this is a fox news article):</p>
<p>So what I have is officially a “Preferred Provider Organization” administered by the Washington Health Care Authority, and governed by a group of consumers and practitioners through the Public Employees Benefits Board. (The reality is that it is so large, it encompasses virtually all providers.) There is no insurance company - premiums are simply paid into a single managed pool; premiums are recalculated annually. The menu of covered services is pretty much set by the Health Care Authority for both its insurance providers and for the self-insurance plan, so they compete on the basis of price and quality. That one has been easy: the self-insured plan is usually around 30% less than the insurance products, and the difference has been growing. The other providers drop in and out of the market every three years or so, as they can no longer prevent individuals from getting the care they need (i.e. managing to care less). On quality, the surveys show that the self-insured single-payor plan is #1 in:</p>
<pre><code>* Getting Needed Care
Getting Care Quickly
How Well Doctors Communicate
Getting Help from Customer Service
Health Promotion and Education
Rating of Health Care
Rating of Personal Doctor
</code></pre>
<p>The result is that, without any marketing or advertising, now more than 50% of those covered have gravitated to the single-payor option.</p>
<p>As one who sells health insurance for a living, one may think I’m opposed to national health insurance. Few things can be further from the truth. We already have “national health insurance” to a degree: it’s called Medicaid/Medicare. I don’t hear of too many senior citizens and indigent people complain about those programs.</p>
<p>When enough American voters act like Peter Finch in the movie “Network” and say “I’m mad as hell and I’m not taking anymore”–and refuse to vote into office anyone who opposes it-- then and only then will the 40 million people in the country who do not have health insurance have it.</p>
<p>As a sidenote: Take it from me, people are very strange when it comes to insurance. If the government passed a law saying that everyone in the country will get free health care from now on <strong>if you just sign up</strong> you can take it to the bank that you’ll be surprised at how many people never get around to signing up, much less signing up <em>and paying for it.</em> Also, if I had a dollar for every time someone basically wants a lot of coverage for a minimum of premium I wouldn’t have to be overly concerned about the high cost of gas right now. </p>
<p>People are strange when it comes to insurance: too many people are too lazy and/or intentionally ignorant to make a difference in voting for national health care, yet many of the same people won’t even bother to buy <em>some form</em> of health insurance (not all health insurance is high.) Some is better than none.
When they need it, though, they sure want it! It’s too late then–to vote or to buy.</p>
<p>“…it’s called Medicaid/Medicare. I don’t hear of too many senior citizens and indigent people complain about those programs.”</p>
<p>That is re-assuring to hear. I seem to only end up hearing the complaints. Again, I speak primarily regarding mental health and pediatrics, but what I always hear is that it’s hard to find providers who accept this coverage. Where I live, Psych hospitals & peds inpatient wards close regularly because of money lost on this primarily Medicaid (MediCal here in Cal; “managed” MediCal in most communities. The only peds word in the city next to mine will close next month.I hear the exceptions are providers who run “mills”, i.e. make money through volume. I’m glad to hear this is not true everywhere, or that people with this coverage do not think it warrants complaining.</p>
<p>We have socialized police, fire protection, libraries, primary and secondary education, roads, health care for the elderly and our armed forces, park systems, the list goes on and on. Why single out health care as an area unworthy of socialization?</p>
<p>This argument is similar to that over religion or abortion; either you believe access to health care should be a right, or you don’t. Beyond that, we argue over details.</p>
<p>You raise interesting issues. Most business (above a certain size) have additional security… Sprinkler systems… Buy our own books…</p>
<p>I’ve always been in favor of a two-tier health CARE system: guarantee care to everyone, and if you want luxuries, pay for them. (Luxuries would be plastic surgery, for example. The definition varies, of course. In some countries, chemo is a luxury if you’re above a certain age.)</p>
<p>France has basically 2 tiered and it is wonderful. The national health covers everyone and if you work for a company which offers extra, then you get, extra! This is important because it has ramifications for every aspect of life. It allows job mobility for example. It also allows for someone who wants to study part time and work part time do so because they don’t have to worry about healthcare. And no you do not get some bureaucrat making decisions about every aspect of your care (as opposed to having an insurance flunkee do so here). I could go on and on but after having been employed, given birth and been operated on several times on both sides of the Atlantic, the only benefit the American system has given me is wood panelling and a computerized piano by the waterfall in the lobby of the hospital. I would much prefer knowing that people like my daughter’s friend ( 20 years old, unemployed, not a full-time student because she can’t afford it, and who needs wisdom teeth pulled but can’t afford that either so is using tylenol to kill the pain until she ends up in a hospital with an infection) get decent quick care than have the damn waterfall in a hospital lobby! The American system has also cost me much not just in terms of money but in the amount of time it takes dealing with a stupid and inefficient billing system. Anyone who thinks that our current system of for-profit, insurance-medical -legal take what they can system is what we should build from is simply wrong. Yes, and I always felt I got more bang for the buck (at the time, francs) in terms of taxes than I do here…oh except we do know how to run a really great war! Which is perhaps the problem, maybe Americans just don’t know how to do most big programs efficiently (our trains don’t run on time either).</p>
<p>Thank you, merepoule, this is what we need, first-hand experience of how other systems work better. I lived in Germany for five years, and could give the same kind of report: it is a far superior system, also two-tiered. </p>
<p>I think a lot of Americans don’t want to admit that someone else’s system could work better.</p>