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September 23
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SEPTEMBER 22, 2009 12:48AM

Uninsured Alien Seeks Health Care: One Anecdote

Rate: 26 Flag

In the context of the furor over U.S. health care and the danger of extending coverage to illegal aliens, I thought I'd share my recent experience with the health care sytem in Taiwan.

I came down with a case of the flu--not awful, but unpleasant: sore throat, sneezing, minor ear infection, overall fatigue and even-more-than-usual crankiness. (My wife pointed out the last item.)

The next day, I went to a small, private ENT clinic that has a good reputation. Appointments aren't necessary, but, since I didn't bother to make one, I had to wait a while--maybe 20 minutes. When I got in to see the doctor, he gave me a thorough examination--asked about my medical history, schedule, sleep and eating habits, peered into the relevant orifices, checked my temperature, listened to my heart and lungs, the usual. I had a couple of questions, which he answered in detail.

As most clinics in Taiwan have an in-house pharmacy, after the consultation I waited about five minutes for my medication. Now, here's the best part of health care in Taiwan: for routine medical care, the flat fee for an examination plus medication is $4.50. Yes, that's U.S. dollars. Great, huh? (In case you're wondering, it's great for the Taiwanese, too; the cost of living in Taipei is about the same as in a mid-American city.)But there was just one problem: when I checked my wallet, I discovered that my national health insurance card was missing.


Sure, all citizens and residents here have excellent, almost-free health care. But what if a casual interloper, as I now appeared to be, wanted try to sponge off the system? The receptionist apologized, explaining that she understood my predicament, but, as an undocumented foreigner,  I'd have to pay a very high fee. Nearly cringing in emarrassment (and I nearly cringing in fear), she laid the bill on the counter.

 $15. Fifteen U.S. dollars. Thta's the flat fee for the ininsured. (But, she explained, if I find or replace my insurance card and bring it by the clinic within a week, I can get the excess $11.50 refunded.)

Fifteen dollar medical care for an alien, legal or illegal. For anyone. How is that possible? As my Taiwanese wife, a bit impatient with the silly question, explained: You're a human being, aren't you? They're doctors, aren't they? How could they turn you away just because you don't have a card?

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Wow! I would rate this a dozen times if I could. I mean, it blows my mind; a system where, if you're a human being, doctors will treat you for sickness without first demanding the rights to your first born child. Of course, that would never fly in the U S of A; we don't play that Maoist nonsense over here.
Nanatehay--Careful who you call a Maoist-- the Chairman isn't exactly popular here in Taiwan!
I bow in humility to Taiwan. xox
great story, neatly told. this should have been on the cover. it is topical, provides an interesting contrast/perspective to the ongoing health care debate here, plus it has exotic interest coming from a non resident American (are you?) married to a foreigner in a so-called third world country. rtd.
This just leaves me in awe. We've spent thousands on doctors and prescriptions this summer and we're insured. Seen by a doctor and leaving with your scrip in under an hour for $15? This seems like a miracle.
Robin--Taiwan has its own problems, but they manage health care immeasurably better than the U.S. does. But then, so does the rest of the developed world.

Rolling--Yes, I'm an American, but I've lived in several other countries, which gives a bit of perspective. Taiwan has actually been considered a "developed" country for the last 20 years or so, so they do have some resources. But if they can do things like affordable, universal health care, what's stopping the richest nation on the planet?

Annette--It is impressive. I could have been a tourist, or an illegal alien--they didn't even ask for any ID. Of course, it seems a little less miraculous when you consider the billions in inflated costs the U.S. is paying to companies like Halliburton and Blackwater in Iraq. It's just a matter of priorities.
Well, crud. It appears my employer has recently blocked access to Digg and Reddit, so somebody else had better do it for me!
I wish this had made the cover. The Tawainese have far excelled this "greatest nation on earth" in terms of their humanity. They treat foreigners and "aliens" better than we treat our own citizens - not that residency should matter when it comes to illness. Thank you for writing this. Rated, promoted, etc.
As an "illegal" alien, I would like to say that when a country have a health care system that works, like France for example, everybody is required to pay a annual (or monthly) fee for health care. If you are a citizen, or if you are not, you need to pay the Health Care System. Because Health (and Education) are NOT products for companies to make profit from. And the more people you have contributing to the system, the lower the prices are. And if the person using the system is to poor to pay, that's where the government get into. Paying for the ones that cannot afford it. Being they citizens or not. It's not like if people are coming from other countries, just to use the health care system here in US for free and them going back home. Those "illegal" people, they are here to stay, they have families, work here, some pay federal taxes (through special IRS numbers designed to collect the money from them), all pay sales taxes that finance schools and city services (many small cities in US would be in trouble today if there were not "illegal" people buying locally and renting). If they work here, if they live here, and they get sick here, they should be treated here too. As fairly billed and treated as anyone else! When the Germans and the Polish Jews, and Irish and Italians came to US, there was prejudice too, and no one denied them health services as long as they could pay like anyone else. Actually, they were more easily assimilated because they were white. The new wave of immigrants is getting so many resistance because they are not white. They are in the big majority Mexicans with a nice brownish indian tan. Face it people. It's racism.
Holy crap.

That is all.
Donkey, your wife is wise. We should all be so impatient. This is an important post.
do you have a spare room? I'm house-broken.
BBE--Yes, I'm constantly amazed by the vast gulf between Americans' view of themselves and the reality.


Ren--But this wouldn't be so shocking to a German or a Swede. Of all the "developed world," only the U.S. doesn't take care of its own people, much less others.

Ms. Tai--Thank you.

austin--That's how it works here, of course. I and every other working person pay a little every month, and the government makes up the rest. I think the racism factor you metioned is part of the historical problem, but not the whole story.


C.K.--She may be wise, but it's just common sense to people here. As it should be in the U.S..

Trudge1964--You may be housebroken, but my 2 sons aren't. I'll put you in with them. Hope you don't mind crying and baby poo.

Sao Kay--Thanks!
Compassion, what a concept. Timely, affordable, and accessible health care, how brilliant. But as I just read on Ardee's blog, companies here are taking out life insurance policies on their workers for profit, so they have no incentive to help you stay healthy.
Nice story Ben, but not quite free of spin is it. Were you an illegal visitor? I assume not. In fact you don't say what you status is. You say you have a card you could not locate, so that says to me you actually are insured. So I assume you must be at least some legal status. The debate in this country is illegal aliens. It is about
12 MILLION who already are here and millions more that will come will cross the border for free heath care. Does Taiwan have this problem? Doubt it. For that matter does Canada have that problem. No.
And guess what, we don't turn away people either do we. And further more they wont pay $15 dollars, they will pay nothing if they have nothing.
Ah and did it cross your mind why the person told you it would be "expensive"? Maybe in her mind it IS expensive Maybe because 15 US bucks may be nothing to you, but that comes to over 450 TWD. So there are two points there. One, how much is 450 TWD mean to the average local and 2nd, however much it means, they are charging triple for not being insured.

So can you elaborate on the average income of a local, how you came to get a card. What does that cost and what your exact status is there. Lets just please have the full explanation. Also I would not expert you to be turned away, but what if it was $100 or even $200.
Why should it not be. IS $100 an excessive burden on you. So why would it be inhumane for them to make you pay a $100 assuming you are an alien not paying in to their tax system? Why should you get it cheap or free if you can afford it. S0 what if you have one less steak dinner out on the town in trade for treatment?
Is that evil?
But then I still don't know what 4.50 or 15 or 100 US means there.
Maybe the 450TWD is a lot relative to local income.

And your grandiose statement about being a human being is so heartwarming. You say it as if 99% of Americans don't feel the same way. They is no large amount of people in the country saying all humans shouldn't get health care. We are debating HOW it will be administered. Maybe what you should be taking away from Taiwan
Also, I once had to go to a dentist in New Zealand. It was not free.
I cant remember as it was many years ago. It wa abotu what I would expect a dentist here to charge to put some temp. cement stuff over a tooth that a crown came off. Maybe it would have been free for a local. I have no idea. It never crossed my mind if they have national health care or not. What crossed my mind is that I going to have t pay for it and I did. Big deal.
Joseph--Not free from spin? Well, in as much as I'm strongly in favor of national health care in the U.S., it isn't. But I reported the events as they happened. I'll try to address your other points one by one.

1) I DO have insurance. I work and am a resident here. But the people at the clinic had no way of knowing that. Now do you get it?

2) Taiwan DOES have a major problem with illegal immigration. In fact, a HIGHER percentage of the population in Taiwan is illegal than in the U.S. Hundreds of thousand of Filipinos, Indonesians and Vietnamese work illegally here for the same reason that Mexicans and Central Americans want to work in the U.S.--much higher pay than at home, even for menial labor. They get health care at the price I mentioned.

3) People DO cross the border into Canada to get health care. They're called U.S. citizens.

4) 450 Taiwan dollars (US$15) is only "expensive" relative to how much people usually pay for health care here. It's still a very low price. Think of how much $15 would be to a person working in a small town in, say, North Dakota or Louisiana; it's about the same to people here. Not a lot.

4) You ask, why shouldn't they ask me to pay $100 or $200 if I'm not contributing to their system? They COULD, of course, but the point is, they DON'T.

5) The "heartwarming" words were my wife's, not mine.

6) If, as you say, 99% of Americans feel the same way, then they should make it happen.

7. I've never been to New Zealand.
actually, quite a few yanks work in taiwan nowadays, and glad to get the job.
A must-read for the Baucus Caucus (gang of six - finance committee - now in mark-up).
I'm not sure what people are impressed by here ... is it simply the difference in cost of living? Because that seems to be all that is being evaluated. What you have shown is that the difference in cost between the nationalized health plan and the a la carte option, is a 3x price increase.

A doctor's visit in the US is roughly $125 without insurance (though there are subsidized clinics where anyone can go for less) - if you have insurance, your co-pay is about $35. So the difference between insured and uninsured is roughly equal to that offered in Taiwan. I know you said you got a prescription, too. But since we don't know what it was, the comparison would be irrelevant.

If you had simply posted an article stating that food was inexpensive in Taiwan, do you think people would have jumped on it as evidence of the USs inability to manage food costs?
It's so important to hear about this. I hope the collective American government ear is listening.
Wow, again! "You're a human being, aren't you? They're doctors, aren't they? How could they turn you away just because you don't have a card?" Do our Senators ever consider this possibility?
Cameron--Do YOU know the cost of living in Taipei? If not, then think twice before making yourself look like a fool. US$15 to a Taiwanese person IS cheap for medical care. It may be a 3X increase for the ininsured, but most of the cost is subsidized by the government! And, as my post states, what I paid is a FLAT FEE, so the exact medications are irrelevant.Why is that so difficult to understand? Look at the comments above and you'll find this point already addressed.

In general the cost of living in Taipei is similar to that in a smaller town in the U.S.; I'm going to make a minor edit to the post to make sure this is clear.
Stacey, Caroline & berrycomposer--I wish Americans would come to their senses. But it hasn't happened to far.

Al-- Yes, & quite a few Canadians, Brits, Aussies, Germans and others, as well.
I don't know whether to laugh, cry, fly into a rage or all three. Taiwan implemented its system after studying ten other single payer systems.

The result of the study? Our Medicare system is what they found worked the best--and just took our model and expanded it to the entire country. (See excerpt and site below.)

Thanks for your post--I always love a good irony, even though I'm the butt of the joke.

"JC: How did you decide on that model - the single payer? Why did you go in that direction?

MC: Well, we sent our people around the world to learn their programs, including the United States. Actually, the program is modeled after Medicare. And there are so many similarities - other than that our program covers all of the population, and Medicare covers only the elderly. It seems the way to go to have social insurance…"
gazoo73--Thanks for the link and information! I've lived in Taiwan, on and off, for years, but I had no idea that the system here was based on Medicare. Truly a cruel irony....