A Lesson for America? Taiwan’s Single-Payer National Health Insurance

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      Administrative Savings

      The simplicity and IT-enabled efficiency of Taiwan’s NHI make its overhead cost extremely low. NHI’s administrative cost accounted for 0.87 percent of the total NHI expenditure in 2018.

      This is far, far lower than the average of 3 percent of total health spending in OECD economies (in 2014), and strikingly lower than U.S. insurers, whose administrative cost is 7 percent for traditional government-run Medicare and Medicare’s private plans (Medicare Advantage) combined, and 13 percent (no misprint) for private health insurance plans. It long has been known that excessive administrative costs are a significant part of the waste in U.S. health spending.


      The latest NHI satisfaction poll, conducted in November 2019, showed a satisfaction rate of 90 percent, a new high for the NHI. Reasons given for patient happiness: easy access to health services, reduced financial burden of medical care and the “reasonable” premiums. Many Taiwanese-Americans continue to pay their NHI premiums and go back to Taiwan for their medical care. (Our Taiwanese-American daughter-in-law returned to Taiwan to obtain her highly technical, life-saving surgical care – DMc)

      Comment by Don McCanne of PNHP: Tsung-Mei Cheng has provided us with another excellent article on the features of single-payer national health insurance in Taiwan. This time she also provides us with insights for the United States. The full article is well worth downloading and saving as a reference on Taiwan’s very successful single payer system.

      She cites her late husband, Uwe Reinhardt, in cautioning that we have a problem with distributive ethics, limiting our reform discussions to economic terms and letting social ethics fall where they may. She points out that single-payer Medicare for All may be a bridge too far for the United States since our health care system has effectively been captured by financial interests. In contrast, the Taiwanese regard their national health insurance as “a national treasure and the guardian of social peace.”

      As noted in the parenthetical comment above under “Satisfaction,” we have the utmost reason to be thankful for the services of Taiwan’s national treasure. May our health care system be transformed from a system captured by financial interests to a system that is the guardian of social peace

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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