An American got sick in Taiwan. He came back with a tale of the ‘horrors of socialized medicine.’

#1

Great story about Taiwan medicine.


An American got sick in Taiwan. He came back with a tale of the ‘horrors of socialized medicine.’

February 28, 2019 at 10:50 PM

The Facebook post was illustrated with an image of an IV. “Went to the ER in Taiwan,” it began.

Kevin Bozeat, a 25-year-old student, wrote about coming down with severe gastrointestinal symptoms while studying in Taiwan: stomach cramps, bouts of vomiting that would not abate and perhaps worst of all, he couldn’t keep any fluids down.

Around 3 a.m., he decided it was time to go to the hospital for treatment, not knowing what to expect having never been to a hospital in Taiwan — a country that has a national health care system, or as Bozeat wrote, “socialized medicine.”

He was checked-in and given IV fluids within 20 minutes of his arrival. Phlebotomists drew blood which the lab ran tests on. Hospital techs performed an ultrasound to make sure he didn’t have gall stones or appendicitis. And eventually they diagnosed him with a stomach flu, gave him two prescriptions and discharged him.

“Each day since I’ve gotten progressively better and am now pretty much back to normal,” Bozeat wrote. “The bill for the ER visit? . . . U.S. $80.00.”

He sarcastically titled his tale “The Horrors of Socialized Medicine,” noting he didn’t even have health insurance — in Taiwan or the United States. If he had Taiwan’s national health insurance, his costs would have been a fraction of that, he wrote.

The post struck a nerve, as debates about health care and whether to move toward “Medicare-for-all” loom over the 2020 presidential race. More than 200,000 people shared it.

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Taiwan has a so-called single payer health system — meaning the government controls health-care payments, though most of the service providers and hospitals are privatized. Liberal groups and officials are increasingly looking to single-payer systems to address both the United States’ woefully high health-care expenses, and the millions of people who are uninsured.

Some 17 percent of the United States GDP in 2017 went to health care — nearly twice the average 8.8 percent for other developed countries, according to data cited by Health Affairs. And that number is projected to increase as health care spending rises to nearly 20 percent of the GDP by 2020, according to the Centers for Medicare and Medicaid Services.

Bozeat estimated his treatment in the United States, without insurance, would have likely cost thousands of dollars.

“But here in Taiwan I was able to receive speedy, quality care comparable to what I would have gotten in a U.S. hospital for relatively small amount of money,” he said.

According Health Affairs, by Tsung-Mei Cheng, a health policy research analyst at Princeton, Taiwan instituted a single-payer health care system in 1995. (Cheng’s late husband, Uwe Reinhardt, a Princeton economist and health care expert, had been the one to recommend a single-payer system to the country in the 1980s.)

The country is home to about 24 million people and is the world’s 19th-largest economy; 99.9 percent of its residents are enrolled in the national health care program, regardless of preexisting conditions.

“Comprehensive benefits include inpatient and outpatient care, mental health care, prescription drugs, dental care, Chinese medicine, dialysis, and day care for the elderly,” Cheng notes.

She continues:

“Patients in Taiwan can choose their doctors and hospitals freely, in sharp contrast to the US where patients often have limited choice of both insurers and providers. There is no such thing as in- or out-of-network providers, a distinction which in the US not only restricts patients’ access but also subjects them to vastly different charges. Patients in Taiwan do not receive the “surprise medical bills” that many Americans do after their inpatient- or outpatient treatment. The NHI’s copayments and coinsurance are low, and generous ceilings and exemptions safeguard access to needed care.”

Only around 6.1 percent of the GDP in Taiwan is spent on health care; in the United States, one of the highest levels of a developed country, it’s around 17 percent.

In an interview, Cheng gave some examples of price disparities between the United States and Taiwan, based off statistics from insurance companies and government agencies.

Harvoni, a drug to treat hepatitis C, costs $2,132 for a course of treatment in Taiwan; in the United States the same amount costs an average of $32,114, she said.

An MRI costs $288 in Taiwan; in the United States, it’s $1,119.

A C-section procedure costs $1,404 in Taiwan; in the U.S. it’s $15,106.

Interest in Taiwan’s health care system has been surging in recent years. Chen said she briefed Sen. Bernie Sanders (D-Vermont) on the system, and will speak to state lawmakers in California Friday amid a broader push for universalized health care in the state.

“People envy [Taiwan’s] system because they’re spending a third of we’re spending,” she said. “It’s very high-performing in terms of cost coverage and benefits. Many, many countries that are looking to cover everyone — they are looking to Taiwan’s model as a guide.”

Doug Holtz-Eakin President of the American Action Forum, conservative think tank and a former director of the CBO, said inflated U.S. health care costs were due in part to a “pattern of overutilization of some things like excessive testing and under utilization of preventive care.”

"You add it all up it costs a lot,” he said.

Holtz-Eakin said a recent study of prices looked at 23 drugs and found they cost 80 percent more in the United States than other places. Still only 11 of those drugs were available in every other country in the study, Holtz-Eakin said.

“So one of the prices you pay in another country is you don’t get access to some diagnoses and therapies,” he said. “It’s hard to put a price tag on that.”

While a few countries with socialized medicine systems, like Canada and the U.K., are known for long wait times for some procedures, Taiwan does not experience this problem, Cheng wrote. She highlighted another significant disparity between the Taiwanese and American health care systems: administrative costs were much lower in Taiwan than in the U.S. (“A staff of fewer than 3,000 administer the NHI for Taiwan’s population of 23.8 million,” she noted.)

Bozeat said in a brief direct message exchange that he thought his post had gone viral because it was likely “shocking to most Americans who saw it, particularly the price.”

“I received a ton of direct messages and comments from people sharing their higher bills, WITH insurance,” he wrote. “Some people also attacked me and called me a liar. Even though they know nothing about Taiwan or its health care system. Interestingly I received a lot of support from Taiwanese people who thanked me for praising their health care system.”

He had followed up the viral post with another with a plea for universal health care.

“Taiwan is less wealthy than the U.S., yet it spends less and gets more out of its health care system. We see the same story repeat itself,” he said. “This debate is all so tiresome, because there is no debate. Universal health care works, it can be done here, it can be done in any country with sufficient resources. All we need is political will and an implementation plan.”

Eli Rosenberg is a reporter on The Washington Post’s General Assignment team. He has worked at the New York Times and the New York Daily News.

6 Likes
#2

I saw the guy’s original post on the Taiwan news in English FB page and a commenter there suggested getting it to the media in the States.

#3

time to repeal obomocare, then!

#4

Uh huh.

Believe me, if it were that easy it would have been done long, long ago in the US.

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#5

For the record an mri here can be way cheaper than quoted, as is a c section. C section, lots of care, 4 days stay in double room, mprphine and ICU for baby for 2 weeks cost us about 300usd…

Obama care haters et al. Think about evolving your system, its gotta start at ground zero…i thought americans were proud of their building from the ground up storyline.

Taiwan nhi is riddled with problems, but i thank whatever god you believe in im not in the states with that system!

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#6

Do you actually know anything about what’s been going on in the US with regard to the healthcare system? Do you know how Obamacare came into being?

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#7

Let’s not forget a doctor’s salary in Taiwan is way way lower than in the US. I would guess it’s the same for nurses. I like the health care system in Taiwan, but bear in mind the salary differences.

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#8

Salary has little to do with the disparities in cost of care.

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#9

You might be right , however I know doctor’s here on about 90K NTD per month only. So a well paid factory worker on overtime could make more in the US. I would think if you took salaries disparities into amount it wouldn’t be small.

#10

A doctor’s salary is way lower anywhere than in the US. Doctor’s salary in the US is not normal since the healthcare is 100% commercialised. Doctor’s salary in Taiwan is very much in line with other countries.

That is absolutely not true. 90k NTD is what interns would make (PGY starts from 1 million), or maybe your friend/acquaintance told you their base pay, which is what they would get if they don’t work at all. Residents make 1.2-1.5 million and the salary for an attending starts from 2 million. Standard pay for senior physicians at a public hospital is 3 - 5 million (Ko Wen-Je’s salary was around 5-6 million when he decided to ran for the election and he was head of the neuro department at NTU hospital if I recall correctly), and if you have your own successful clinic (usually dermotologist or plastic surgery) it’s 10s or even 100s of millions.

2 Likes
#11

You said it is not true?
http://m.focustaiwan.tw/news/aeco/201502090018.aspx

#12

No, it is not true. I know people who have just started their medical career and the standard pay for PGY (post-graduate year) is 100k.

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#13

I just gave you the link. Do you read?

#14

There is no need to be condescending.

Yes, I read your link, but I would never buy any survey from the human resource banks in Taiwan. No doctor would ever get on 1111 or 104 and look for a job there.

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#15

That is an average , taking into account trainees , I suspect . of course the salary is lower than the US, but then again the drugs are probably 75% cheaper here too. Still sustains the NHI at a reasonable level for 6% GDP or so . I think they have done a pretty good job with what they have.
Pharma and Insurance play a part in USA costs , I think , as well as higher pay / Some things here , like no Nursing care /Food etc ( beyond medication etc) helps too.
Not sure how accurate this is?

https://www.salaryexpert.com/salary/job/doctor/taiwan

#16

I wasnt being condescending I was interpreting that you were accusing me of lying and I wasn’t as that is what I was told. I didn’t say heads of departments etc. I was told this about 5 years ago by one new doctor and one “family” GP. Not a heart surgeon etc.:ok_hand:

#17

I know that my sister loves Obamacare because her premiums are considerably lower than before it was implemented, and that two of her friends would have died without Obamacare.

All three of them would still prefer a socialized system like the UK’s NHS, Taiwan’s NHI, or Canada’s Medicare.

If Taiwan can do it, the US can certainly do it.

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#18

Here’s the biggest problem, by way of a irl example.

When my mother turned 60 she began falling, once or twice a year. By that time she had T2 diabetes, the kind that could be controlled by changing her diet (she refused). She also had heart disease, which was congenital on her mother’s side.

About the time she became eligible for Medicare I began to notice that she was always bruised. Turned out that she was falling regularly but refused to admit or even talk about it. My mother’s people have the bone density of grizzly bears, so she never fractured even a wrist. She was eligible for two physicals a year, but because she’s stubborn she never shared her falls with her doctor.

One day she managed to drizzle some superglue on the floor and accidentally step in it. She didn’t feel the skin rip off the bottom of one foot, and because her diabetes retarded sensation in her feet she didn’t realize she had developed a massive foot infection until she went in for a biannual physical and the doctor found it (she had been ignoring the smell). He amputated two toes and eventually managed to end the infection.

I visited her not long after. I asked about her foot and how her new diet was going.

Her answer is the biggest problem. “Not my job to make me healthy,” she said. “That’s Dr. xxx’s job. That’s what he’s paid for.” As far as I know she never changed her diet a whit. Instead she insisted on a pill.

Unfortunately we Americans refuse to accept the consequences of poor choices. What’s more, by not accepting any responsibility for our own health we expect our healthcare system to deliver miracles from Day 1. We strongly prefer cures in the aggregate and in the aggregate we eschew wellness. The biggest problem is my mother’s attitude, multiplied by about 330 million. There is no way Medicare for all will cure that.

Until attitudes change, Medicare for all is akin to burning US$100 bills in your fireplace for heat - imho.

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#19

“Do you read” strikes me as extremely condescending.

Residents only make $50-60k in the US as well, and that’s extremely tough since >80% of them are under mountains of medschool debt, whereas most young doctors in Taiwan (or basically everywhere) are debt free. What’s worse is that most residencies are in larger and expensive cities so a lot of the residents in the US have to take even more loans to get through those 5 years. It’s not an ideal situation at all.

2 Likes
#20

Without insurance? I have trouble believing that. I needed a CT scan which is normally cheaper and not only did I have to wait like 3 weeks for it and cost about 260$ USD. In Canada I got a CT scan (free under coverage, not sure how much without) within 2 days but an uninsured MRI cost about 750$ USD. My guess is it costs closer to 400$ in Taiwan but this is just a single semi-related data point.