By Edith Kenna, ACSW, LCSW
The (Fort Wayne, Ind.) Journal Gazette, June 5, 2017
Imagine my delight in meeting Dr. William Hsiao, the rock star of health care reform and the man who developed Taiwan’s system in 1995.
In preparation for his work, Dr. Hsiao studied the systems of several high-income countries and settled on the Canadian system as his model. Taiwan’s system is a single-payer, universal system of care. It offers choice of doctors and hospitals, and there is competition between public and private hospitals. Taiwan’s system covers prevention, primary care, hospitalization, mental health, vision, dental, home health and long-term care. There are small copays for service; $4 for outpatient care, 10 percent for hospitalizations of fewer than 30 days, and 20 percent thereafter. There are caps on copays to prevent bankruptcy if someone is seriously ill. Ninety-nine percent of Taiwanese are enrolled, and it took one year to operationalize. Each enrollee has a smart card that he/she provides for care. This card is used for billing and carries with it the patient’s medical history. Reimbursement to providers takes about two weeks.
Our private, for-profit system is expensive. There are no cost controls other than eliminating people or denying care. This is the cost control when making money is the goal. Taiwan’s system operates at about 2.3 percent overhead, while overhead for us is about 15 percent. Warren Buffett favors a Medicare for all system and calls health care costs “the tapeworm running through our economy.” The costs and efficiencies of a private, for-profit system of care are holding back the economy and its citizens, according to Buffett. If you can’t believe this social worker, one might assume Buffett understands how the economy works.
It is possible to have universal coverage and good quality health care for all, but only under a single-payer system, says Dr. Hsiao, a Harvard economist. Medicare for all is way overdue in this country. Medicare covers the sickest and oldest of us with low overhead. Medicare consistently ranks highest in consumer ratings. The AHCA/Trump/Ryancare is an abomination that discourages care, leaves 23 million without access to health care, and puts elimination of coverage for pre-existing conditions back into our system. It does nothing to control your costs for care or medication.
Do not let Congress and the president get away with the charade that Obamacare is the root of the problems in U.S. health care. Prior to the passage of Obamacare, 45 million people were uninsured, and pre-existing conditions were never covered until eligible for Medicare or Medicaid. The intent of Obamacare was to keep private, for-profit insurers in the mix. Big health care and big pharma still made billions under Obamacare, but not enough for them, President Donald Trump and Congress. If the marketplace and free enterprise were going to work, it would have done so by now. It doesn’t work, and it can’t work because health care is not a commodity. There is no market when the consumer has no idea what he/she is buying; there is no way to compare value vs. cost. It’s plain dumb to assume health care can be sold and compared like a car, cell phone or toilet paper.
Medicare for all is way overdue in this country. The Expanded and Improved Medicare for All Act, again introduced in Congress, now has 112 co-sponsors, the most ever in its history since first introduced in 2003. Sen. Bernie Sanders, I-Vermont, is expected to introduce similar legislation in the Senate. We can no longer be the only western democracy without some form of national health insurance.
We the people deserve better, no matter what politicians think. Call your senators and your representative today at the free congressional switchboard. Voice prompts will direct you. Call now, call often and say no to the AHCA. Say yes to Medicare for all, and your own health care.