The Taiwan system is really rather amazing for the patients. I’m an American who works in Taiwan, and I’ve used the public NHI and private care over a decade.
Ironically, I had a terrible stomachache in September 2024, ended up in a ball in the shower, then the ER at the “top” hospital in the country around midnight. Towards the end of this story, I had my gallbladder removed at a different hospital.
Key points:
- the trip to the ER included a CT scan and x-rays and ultrasound, done within two hours of when I walked in. Awesome speed, compared to what I’ve experienced in the US.
- I was admitted to the ER overnight, given a bed in a hallway lined up lined up with people in beds, and given morphine when it was really necessary.
- I left “ against medical advice” three days later, because during day two and day three, the highly trained doctors with several dozen research articles published weren’t able to communicate with me in English at adequate level to be able to answer my due diligence questions about the surgery that they said was necessary. Not great.
- My total out-of-pocket expense at that was a little over $100, and I have no private insurance - this was a typical NHI Coverage situation. There is never a follow-up bill that comes weeks or months later in this situation. The total amount that me + my employer paid in NHI taxes during that same month was $600 for my own coverage.
- Tricky laparoscopic cholecystectomy at my preferred hospital 5 days later. I paid $1200 out of pocket, most of which was for the private (1 person) room
- both points above are just fucking awesome. This is where the Taiwan system really shines, immediate access yourself through the web to make an appointment directly with any type of doctor you want with no referral required. And some highly skilled doctors that are using modern everything. And low low out-of-pocket costs.
The Meh parts
- Zero follow up care to hunt me down. There was a follow up appointment made during my discharge, but the day of my follow up happened to be a day when there was a cat 4 typhoon hitting the island and everything was closed. No hospital in Taiwan is going to follow up to chase you down to make sure that you come back for follow up care.
- the NHI system has been operating at a loss most years during the last decade. Not sustainable. No surprises what happens, no politician has the balls to enforce any cap on total operating losses, because NHI is the thing that Taiwanese people are most proud of and most expect as a “right” now that they’ve been accustomed to it for 20+ years.
- Being a doctor in Taiwan sucks. My friends in Taiwan who are doctors tell me: this sucks. The media here says that doctors say: the working conditions absolutely suck. On average a doctor in a hospital here will sit at his/her desk and see 80-150 patients during one working day.
- the surgeon who operated on me had become wealthy, through the private wing of the hospital that I went to (I’ve used that private wing sometimes for conditions that are not covered well by NHI, or when there is no availability with any good doctors within a reasonable timeframe when my family has had an urgent situation). The deal the surgeon has is that he works like a dog to fulfill the NHI mandates, to earn the privilege of spending part of his time practicing on the private side. I did not go into surgery with him until 1:15 AM, and he closed me up around 3 AM. I saw him next around 10 AM, in the same clothes. Dude is about 60.
I'm an American living in New Zealand. I'm responding because I had a similar condition that was dealt with through the NZ health system. I collapsed late one evening with a pain I told the ambulance drivers who arrived to take me to the local hospital as nine on a scale that went up to ten. As painful as the feeling in my stomach area was, I thought that, maybe, there might be a worse pain out there somewhere, but I'd never experienced it like the one I was feeling at the moment. I was treated immediately with an opiate (I think fentanyl?), which managed the pain, given the appropriate pre-operational care right after admission, and had my gallbladder removed via laparoscopic surgery. The operating surgeon told me after the operation that my removed gallbladder was "terrifying" to look at. I spent a few days recovering with assistance from English speaking health professionals (no private room, though), and the total cost to me was about $40.00 US dollars for the ambulance service that included a team of three medical professionals.
I also have other health issues that require an operation to remove some parathyroid glands, and am waiting to have them taken out. I've been waiting for almost a year, as I live in what are called "The Provinces", where surgeons are in high demand, and things like cancer take priority, but have been reassured that my needs will be met soon. So, the long delay is a downside to nationalized health care, but I'm waiting patiently because I know I'm being looked after by people who have my health as their primary concern, and am happy that I won't have to pay a nickle to any insurance company that places their investors higher than they place their customers. It would be nice if Americans living in their country could feel the same way. Thanks for listening.
I just can’t tolerate your take on healthcare. All you’re doing seeing both sides of the issue, understanding there are trade-offs, and then speaking reasonably and eloquently about it. You didn’t even take into consideration that I’M CORRECT and People Who Disagree With Me are IDIOTS, or use my own personal experience of health care as the ONLY necessary data point. Healthcare is an Extremely Simple Issue, and I won’t put up with these “words” trying to confuse me into believing anything else.
I still think Jeff is missing the point of baby it's cold outside, and all of the comments disagreeing with him when he published the piece. It's definitely a time capsule of a different era, a worse era, but an era in which a woman can't decide she wants to stay and spending the evening with a man without her controlling family and other members of society judging her. It's not my original interpretation, but the man is providing excuses she could give to all the people who will be waiting up for her and angry if she doesn't come home. Only reluctantly admitting "she's into it" seems almost a deliberate misreading. It can be seen as an edgy song that's challenging the mores of the time, and celebrated for that. Everyone focuses on what the man says in the song, but imagine a grown woman today saying the same things that this woman is. Her whole family waiting up and angry. You'd think that she's part of some sort of oppressive ultra-religious group. I live pretty close to the Amish, I imagine that's what they're dating lives are like. So I agree that it's still a worthwhile song, but I think even with the amendment, this analysis misses the mark.
The Taiwan system is really rather amazing for the patients. I’m an American who works in Taiwan, and I’ve used the public NHI and private care over a decade.
Ironically, I had a terrible stomachache in September 2024, ended up in a ball in the shower, then the ER at the “top” hospital in the country around midnight. Towards the end of this story, I had my gallbladder removed at a different hospital.
Key points:
- the trip to the ER included a CT scan and x-rays and ultrasound, done within two hours of when I walked in. Awesome speed, compared to what I’ve experienced in the US.
- I was admitted to the ER overnight, given a bed in a hallway lined up lined up with people in beds, and given morphine when it was really necessary.
- I left “ against medical advice” three days later, because during day two and day three, the highly trained doctors with several dozen research articles published weren’t able to communicate with me in English at adequate level to be able to answer my due diligence questions about the surgery that they said was necessary. Not great.
- My total out-of-pocket expense at that was a little over $100, and I have no private insurance - this was a typical NHI Coverage situation. There is never a follow-up bill that comes weeks or months later in this situation. The total amount that me + my employer paid in NHI taxes during that same month was $600 for my own coverage.
- Tricky laparoscopic cholecystectomy at my preferred hospital 5 days later. I paid $1200 out of pocket, most of which was for the private (1 person) room
- No referral required to make an appointment with either the gastroenterologist or the gastroenterology surgeon through the website directly: https://www.tahsda.org.tw/Register_en/add_sub.php?sub=022
- both points above are just fucking awesome. This is where the Taiwan system really shines, immediate access yourself through the web to make an appointment directly with any type of doctor you want with no referral required. And some highly skilled doctors that are using modern everything. And low low out-of-pocket costs.
The Meh parts
- Zero follow up care to hunt me down. There was a follow up appointment made during my discharge, but the day of my follow up happened to be a day when there was a cat 4 typhoon hitting the island and everything was closed. No hospital in Taiwan is going to follow up to chase you down to make sure that you come back for follow up care.
- the NHI system has been operating at a loss most years during the last decade. Not sustainable. No surprises what happens, no politician has the balls to enforce any cap on total operating losses, because NHI is the thing that Taiwanese people are most proud of and most expect as a “right” now that they’ve been accustomed to it for 20+ years.
- Being a doctor in Taiwan sucks. My friends in Taiwan who are doctors tell me: this sucks. The media here says that doctors say: the working conditions absolutely suck. On average a doctor in a hospital here will sit at his/her desk and see 80-150 patients during one working day.
- the surgeon who operated on me had become wealthy, through the private wing of the hospital that I went to (I’ve used that private wing sometimes for conditions that are not covered well by NHI, or when there is no availability with any good doctors within a reasonable timeframe when my family has had an urgent situation). The deal the surgeon has is that he works like a dog to fulfill the NHI mandates, to earn the privilege of spending part of his time practicing on the private side. I did not go into surgery with him until 1:15 AM, and he closed me up around 3 AM. I saw him next around 10 AM, in the same clothes. Dude is about 60.
I'm an American living in New Zealand. I'm responding because I had a similar condition that was dealt with through the NZ health system. I collapsed late one evening with a pain I told the ambulance drivers who arrived to take me to the local hospital as nine on a scale that went up to ten. As painful as the feeling in my stomach area was, I thought that, maybe, there might be a worse pain out there somewhere, but I'd never experienced it like the one I was feeling at the moment. I was treated immediately with an opiate (I think fentanyl?), which managed the pain, given the appropriate pre-operational care right after admission, and had my gallbladder removed via laparoscopic surgery. The operating surgeon told me after the operation that my removed gallbladder was "terrifying" to look at. I spent a few days recovering with assistance from English speaking health professionals (no private room, though), and the total cost to me was about $40.00 US dollars for the ambulance service that included a team of three medical professionals.
I also have other health issues that require an operation to remove some parathyroid glands, and am waiting to have them taken out. I've been waiting for almost a year, as I live in what are called "The Provinces", where surgeons are in high demand, and things like cancer take priority, but have been reassured that my needs will be met soon. So, the long delay is a downside to nationalized health care, but I'm waiting patiently because I know I'm being looked after by people who have my health as their primary concern, and am happy that I won't have to pay a nickle to any insurance company that places their investors higher than they place their customers. It would be nice if Americans living in their country could feel the same way. Thanks for listening.
I just can’t tolerate your take on healthcare. All you’re doing seeing both sides of the issue, understanding there are trade-offs, and then speaking reasonably and eloquently about it. You didn’t even take into consideration that I’M CORRECT and People Who Disagree With Me are IDIOTS, or use my own personal experience of health care as the ONLY necessary data point. Healthcare is an Extremely Simple Issue, and I won’t put up with these “words” trying to confuse me into believing anything else.
I loved everything up to the 11:45 minute mark.
I still think Jeff is missing the point of baby it's cold outside, and all of the comments disagreeing with him when he published the piece. It's definitely a time capsule of a different era, a worse era, but an era in which a woman can't decide she wants to stay and spending the evening with a man without her controlling family and other members of society judging her. It's not my original interpretation, but the man is providing excuses she could give to all the people who will be waiting up for her and angry if she doesn't come home. Only reluctantly admitting "she's into it" seems almost a deliberate misreading. It can be seen as an edgy song that's challenging the mores of the time, and celebrated for that. Everyone focuses on what the man says in the song, but imagine a grown woman today saying the same things that this woman is. Her whole family waiting up and angry. You'd think that she's part of some sort of oppressive ultra-religious group. I live pretty close to the Amish, I imagine that's what they're dating lives are like. So I agree that it's still a worthwhile song, but I think even with the amendment, this analysis misses the mark.
Frank Loesser also wrote “What Are You Doing New Year's Eve?” And if you haven’t heard Diana Krall’s version here it is-
https://youtu.be/Ac-S0dJy_eA?si=mzhqb_RcD0f0hVC-