Around 3 a.m., he decided it was time to go to the hospital for treatment, not knowing what to expect having never been to a hospital in Taiwan — a country that has a national health-care system, or as Bozeat wrote, “socialized medicine."
He was checked in and given IV fluids within 20 minutes of his arrival. Phlebotomists drew blood and the lab ran tests on it. Hospital techs performed an ultrasound to make sure he didn’t have gallstones or appendicitis. And eventually they diagnosed stomach flu, gave him two prescriptions and discharged him.
“Each day since I’ve gotten progressively better and am now pretty much back to normal,” Bozeat wrote. “The bill for the ER visit? . . . US $80.00.”
He sarcastically titled his tale “The Horrors of Socialized Medicine,” noting he didn’t even have health insurance — in Taiwan or the United States. If he had Taiwan’s national health insurance, his costs would have been a fraction of $80, he wrote.
The post struck a nerve, as debates about health care and whether to move toward “Medicare-for-all” loom over the 2020 presidential race. More than 200,000 people shared it.
Taiwan has a single-payer system — meaning the government controls health-care payments, though most of the service providers and hospitals are privatized. Liberal groups and officials are increasingly looking to single-payer systems to address both the United States’ high health-care expenses, and the millions of people who are uninsured.
About 17 percent of the United States gross domestic product in 2017 went to health care — nearly twice the average 8.8 percent for other developed countries, according to data cited by Health Affairs. And that number is projected to increase as health-care spending rises to nearly 20 percent of the GDP by 2020, according to the Centers for Medicare and Medicaid Services.
Bozeat estimated his treatment in the United States, without insurance, would have likely cost thousands of dollars.
“But here in Taiwan I was able to receive speedy, quality care comparable to what I would have gotten in a US hospital for relatively small amount of money,” he said.
According to a Health Affairs report by Tsung-Mei Cheng, a health policy research analyst at Princeton, Taiwan instituted a single-payer health-care system in 1995. (Cheng’s late husband, Uwe Reinhardt, a Princeton economist and health-care expert, had been the one to recommend a single-payer system to the country in the 1980s.)
The country is home to about 24 million people and is the world’s 19th-largest economy; 99.9 percent of its residents are enrolled in the national health-care program, regardless of preexisting conditions.
“Comprehensive benefits include inpatient and outpatient care, mental health care, prescription drugs, dental care, Chinese medicine, dialysis, and day care for the elderly,” Cheng notes.
“Patients in Taiwan can choose their doctors and hospitals freely, in sharp contrast to the US where patients often have limited choice of both insurers and providers. There is no such thing as in- or out-of-network providers, a distinction which in the US not only restricts patients’ access but also subjects them to vastly different charges. Patients in Taiwan do not receive the “surprise medical bills” that many Americans do after their inpatient- or outpatient treatment. The NHI’s copayments and coinsurance are low, and generous ceilings and exemptions safeguard access to needed care.”
About 6.1 percent of the GDP in Taiwan is spent on health care; in the United States, one of the highest levels of a developed country, it’s about 17 percent.
In an interview, Cheng gave examples of price disparities between the United States and Taiwan, based on statistics from insurance companies and government agencies.
Harvoni, a drug to treat hepatitis C, costs $2,132 for a course of treatment in Taiwan; in the United States, the same amount costs an average of $32,114, she said.
An MRI costs $288 in Taiwan; in the United States, it’s $1,119.
A C-section costs $1,404 in Taiwan; in the United States, it’s $15,106.
Interest in Taiwan’s health-care system has been surging in recent years. Chen said she briefed Sen. Bernie Sanders (I-Vt.) on the system and will speak to state lawmakers in California on Friday amid a broader push for universal health care in the state.
“People envy [Taiwan’s] system because they’re spending a third of [what] we’re spending,” she said. “It’s very high-performing in terms of cost coverage and benefits. Many, many countries that are looking to cover everyone — they are looking to Taiwan’s model as a guide.”
Doug Holtz-Eakin, president of the conservative think tank American Action Forum and a former director of the Congressional Budget Office, said inflated U.S. health-care costs were in part the result of a “pattern of overutilization of some things like excessive testing and underutilization of preventive care.”
"You add it all up, it costs a lot,” he said.
Holtz-Eakin said a recent study of prices looked at 23 drugs and found they cost 80 percent more in the United States than other places. Still, 11 of those drugs were available in every other country in the study, Holtz-Eakin said.
“So one of the prices you pay in another country is you don’t get access to some diagnoses and therapies,” he said. “It’s hard to put a price tag on that.”
While a few countries with socialized medicine systems, like Canada and Britain, are known for long wait times for some procedures, Taiwan does not experience this problem, Cheng wrote. She highlighted another significant disparity between the Taiwanese and American health-care systems: administrative costs were much lower in Taiwan than in the United States. (“A staff of fewer than 3,000 administer the NHI for Taiwan’s population of 23.8 million,” she noted.)
Bozeat said in a brief direct message exchange that he thought his post had gone viral because it was likely “shocking to most Americans who saw it, particularly the price.”
“I received a ton of direct messages and comments from people sharing their higher bills, WITH insurance,” he wrote. “Some people also attacked me and called me a liar. Even though they know nothing about Taiwan or its health care system. Interestingly I received a lot of support from Taiwanese people who thanked me for praising their health care system.”
He had followed up the viral post with another with a plea for universal health care.
“Taiwan is less wealthy than the US, yet it spends less and gets more out of its healthcare system. We see the same story repeat itself,” he wrote. “This debate is all so tiresome, because there is no debate. Universal healthcare works, it can be done here, it can be done in any country with sufficient resources. All we need is political will and an implementation plan.”