“Taiwan.”
“Thailand?”
“No, Taiwan.”
Taipei 101 at sunset
Admittedly, I was in the same position when I applied for a teaching position in Taipei, the capital of Taiwan. Since then, I’ve spent two years living here, and I talk Taiwan to anyone who will listen.
The people? Delightful. The food? Phenomenal. The culture and history? Fascinating. I could easily run out of positive adjectives to describe this small island nation, which in the past two years has become my home. A sometimes stinky (tofu), smartphone-addicted, frighteningly small dog-obsessed home, but a home I love nonetheless.
Health insurance? Unlike the location of Taiwan, that’s something most Americans have had on their minds lately.
Without digging into the specifics of the health care proposals from the current administration, I’d like to share my experiences with Taiwanese and American health insurance systems. Of course, I’m an English teacher and not a doctor, politician, or insurance broker. Therefore, my information is based purely on my own experiences. However, those experiences have been, perhaps not many, but definitely several and varied in nature.
While attending college in Massachusetts, I was covered by my school’s Student Health Insurance Plan. It was an excellent insurance plan. Or so I was told. I mean come on, I was 18 and headed to college, what did I know of health insurance?
Despite that great insurance, after a brief emergency room visit, I was presented with a hospital bill in excess of $500. And however astronomical that amount seemed to me at the time, in the scheme of American hospital bills, $500 is practically cheap.
Fast forward four years and I’m a foreign teacher in Taiwan, currently enrolled in their National Health Insurance program, personalized insurance card in my wallet and all. I pay about $30/month (all costs are quoted in USD) on a salary of just under $2,000/month after taxes (yeah, cost of living is different here). With that card, I can stroll into any doctor’s office or hospital (and stroll in I usually do, as booking an appointment by phone far outstrips my Chinese language abilities) and be seen for no more than $10, and usually closer to $5.
That’s the fee you pay upfront to see a doctor, and any tests run or pills prescribed during the visit will set you back even further, in my experience about $15.
Unfortunately, NHI doesn’t cover birth control. I have to pay a whole $8 a pack for those pills. However, it’s also available over the counter (without a prescription), so I’ll willingly cough up $8 for the convenience of being able to buy as many packs as I want at one time.
Whenever I go to the pharmacy, I find myself remembering similar experiences in the U.S. While the Affordable Care Act does (currently, and keep those fingers crossed) cover the cost of birth control in America, the uninsured may pay up to $50 for a one-month supply of birth control pills. I used to pay $20 per month before Obamacare took effect, and I still remember my disbelief when the pharmacist announced it was now free.
While $8 is more than I’d currently pay in America, I still count myself lucky whenever I walk out of the pharmacy in Taiwan, especially if I’ve just purchased multiple packs at once without having to seek permission from (and possibly be denied by) an insurance provider.
Despite the ease and relative low cost of over the counter birth control in Taiwan, it’s not the only thing NHI does not cover. For example, I was recently advised by my doctor that insurance does not cover pap smears for women under 30. She then reluctantly informed me that, because of this, it would cost me $13 out of pocket.
In addition to these expenses, I’ve also paid about $14 for a hospital visit and EKG, $20 for a three-day course of medication, $5 for a dental cleaning and cavity filling, and—my best bargain shopping—a mere $2 for a prescription cream.
Now, Taiwanese health care is not perfect. Because it is so affordable, people run to the clinic at the slightest sniffle. Thus, doctors have less time to see patients, resulting in a health care system that is more reactive than proactive (I’ve gotten confused looks when I tried to get a standard physical) and a culture that expects less personalized and attentive care than patients in America typically receive.
However, the point is that Taiwanese citizens grow up knowing that they can run to the doctor at the slightest sniffle and certainly for anything more serious. They don’t have to make the choice between a doctor’s visit and paying their rent or, often the best-case scenario, spending years on a payment schedule (assuming the hospital or clinic allows it). And of course, there is no fuss with plans, deductibles, or pre-existing conditions.
And there shouldn’t be.
I currently live, as a foreigner, in a country where I know my health will be taken care of at a very low cost to me. Despite the cultural differences and expectations, the quality of care is high (in fact, most doctors I have seen studied in America). Nothing prevents me from seeking care if I even suspect that I need it.
In a few months, I will return to a country—my country—that is mired in a system that turns health care into a tangled mess of catchphrases and for-profit companies, with a government that is currently designing and voting on a new plan that will likely put insurance beyond the reach of millions of citizens, resulting in innumerable untreated conditions and even deaths.
It seems absurd to have to point out that that is the antithesis of health care.
Get a grip, America. Let’s put our competitive spirit to work, acknowledge that we’re far behind much of the world, and play some serious catch up. So far, Taiwan is beating us, even if many of us can’t find it on a map or insist it must be Thailand.
