From the experience of reform in Taiwan and Switzerland what can the US learn?
For many years, but especially since the early 1990s and the election of William J. Clinton to the presidency, the issue of health care for the American public has been hotly debated. At the core of this debate is the question of whether the existing health care system in the United States – one dominated by private-sector medical practitioners and ‘governed’ by an enormous, and enormously powerful, insurance industry – should be replaced by the kind of single-payer, government-controlled universal health care system practiced in many other technologically-advanced countries. The Taiwanese and Swiss models, in addition to those of Canada, Britain, and elsewhere, do lend themselves to a somewhat favorable comparison, but for the scale of the systems operated in those much smaller countries with histories of socialized health care and the fact that medical care in the United States does remain a model for most of the world.
The Taiwanese model, adopted in 1995 following the consolidation of a democratic form of government that replaced the dictatorship of Chiang Kai-Shek and his Kuomintang Party, was a testament to the liberalization that tiny country of 23 million experienced. A system of universal health care was installed to replace the previous highly inequitable system that saw the country’s indigenous population at a distinct disadvantage relative to the ethnic Chinese who fled there from mainland China after the 1949 revolution that brought the communists to power. That newly-installed system proved highly popular and has been successful. Again, however, the question remains as to whether the Taiwanese model, or that of the Swiss, a country of eight million, can, or should be replicated in a country of over 300 million, or whether reforms targeted at specific components of the health care industry should be reformed, such as the insurance industry. Clearly, the controversy surrounding the Obama Administration’s “Affordable Care Act” (derisively referred to as “Obamacare” by its critics) illuminates the sensitivities among millions of Americans fearful of the scale of change that legislation entails and which has forced many people to drop their existing coverage in favor of different health insurance plans specified in so-called exchanges – plans often considerably more expensive than those these individuals and families were forced to abandon.
Controversy surrounding the “Affordable Care Act” aside, there is no question to many Americans that room exists for improvement in the manner in which medical care is provided. The nexus between physicians, health insurance companies, and patients has proven excessively costly in many areas, including costs of routine medical procedures and of prescription medications. Physicians charge patients, through their insurance companies, exorbitant fees, in part to compensate for the losses incurred providing care to the uninsured, and in part due to the administrative costs associated with a heavily bureaucratic system. Insurance companies arguably wield too much power in determining courses of medical care, and patients frequently abuse high-cost components of the health care industry, for example, by visiting emergency rooms when no emergency is evident rather than make appointments with their regular physician. Among this triangle there is room for improvement. Whether the Taiwan, Swiss, British, or other systems can be models for American health care reform is uncertain; what is less uncertain, however, is that the flaws in the existing system need attention – the kind of attention that alienates politically-powerful constituencies.