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Now that the astronomically expensive corporate election of 2012 is behind us and we are grappling with the devastating reality of a post-Hurricane Sandy United States, maybe it’s time to focus on Medicare for All. That is, maybe it’s time for renewed action on a national health insurance program that aims to cover every American living in the US. I currently live under such a system in the Republic of China (better known as Taiwan) and it has no less than saved my life and allowed my partner and I the chance to bring our daughter into this world without fear of absurdly expensive medical costs and repercussions.
The shocking truth about the wealthiest country in the world is that there will inevitably be many US families and children left hungry and cold this winter, with little hope of getting their lives back on track anytime soon. Maybe they are the victims of Sandy or some other environmental or economic disaster, yet their tales will likely never be told. More than likely, these are the people who need a medical safety net most, but tragically they are also those most likely to not have timely access to health care and will suffer as a result. It shouldn’t be hard to empathize with these families after we’ve all recently seen the countless images of destruction in New York and New Jersey and with more untold disasters bound to appear on the horizon, ripe for more media exploitation. Many will have connections to any new ground zero that appears and we will literally feel sick and tired from this endless stream of bad news. The healthcare connection is not one that the corporate media will look for, so it is time for activists to be as loud as ever on this issue and strike while the empathy is palpable.
It is the endless hunt for success or salvation in the material world that dooms our collective spirit and leads to the nuclear meltdowns, oil spills and burst pipelines occurring alongside the bursting bubbles of the modern economy. The optimist in me wants to argue that perhaps such disasters could help lead to a positive transformation, as they certainly can enhance the effects of empathy and engender a genuine desire to help, to be a part of real change, maybe even neutralizing the “What’s the matter with Kansas?” problem in US politics.
Many of us know people whose lives were destroyed by illnesses untreated, treated too late to be effective, or treated effectively but resulting in financial devastation as a new burden to bear. Unfortunately, much of this anger, frustration and sadness that we bear witness to in the wake of Sandy will be misplaced and may be difficult to tap into for political movements, but if we can get at least 10 percent of the US population demanding that Medicare for All has to happen now and it must be an especially innovative program (Medicare Plus for All), forcing Obama to respond to this renewed resistance to the Affordable Care Act that he handed over early in his first term to a clearly corrupted Congress.
In 2011, the Social Cognitive Networks Academic Research Center (SCNARC) identified ten percent of the population as the tipping point for the spread of ideas. These scientists looked at the uprisings in Egypt and Tunisia as a reference to this process of minority opinion becoming a popularly held belief. 1 The most beautiful thing about watching those two national movements unfold in real time was how cohesive they were against all odds and expectations. I can clearly remember the sense of exhilaration in the air in February 2011 when Alexander Cockburn wrote, “Rulers and tyrants everywhere know…bad news when they see it, same way we know good news when we hear its welcome knock on the door of history.”2 Is this too much to ask for the issue of health care in the United States today? Between the politically brave teachers (fresh off some important victories) and progressive social media alone, I suspect this is doable. The alternative, i.e. the Affordable Care Act or Obamacare, is simply cruel and anti-democratic with its mandate to force individuals to buy private insurance. This would be obvious to many in the US, had the single-payer option been allowed sufficient airtime and political access to make its case.
Dismissing the ‘government as single payer solution’ to remedy the effects of a health care crisis, Max Baucus (D-Montana) made this absurd claim in 2009: “There’s more of an entrepreneurial sense [in the U.S.]. So we’ve got to come up with a uniquely American result. And a uniquely American result will be a combination of public and private insurance.”3 Having spent the last four and a half years in Taiwan, I can tell you that the Taiwanese people have a strong entrepreneurial sense, at least as strong as one would find in the US. It is evident in nearly every aspect of life here and this can sometimes be a bit of a headache. One example of this is the clutter on the sidewalks lining the streets of big cities and small towns. You see, these sidewalks would be lovely for walking, yet any visitor will quickly come to realize that they are actually for businesses to set up shop, while pedestrians must take to the gritty and often dangerous streets. If you ask a local why this is, the common response is that small businesses need the space to succeed.
Taiwan has been hailed as having made the transition to a developed country practically overnight at the end of the 20th century and it is obvious that most Taiwanese take pride in their work ethic and ability to hustle to make due. I expatriated to the island right before the 2008 bailout and election of Barack Obama because I had had enough of the heartache, fear and paranoia that characterizes much of modern life in the US. My partner and I, recently married, felt we had few better choices if we wanted to adapt to the rapidly changing world and find our way by making and saving some money for future plans to live self-sufficient lives. Had we not come but instead remained in our native New York, our lives would be tragically different right now.
In March of 2009, I underwent an eight-hour surgery in southern Taiwan that ended with the removal of three feet of my small intestine. The doctors originally thought it was acute appendicitis but had to make some quick determinations and they were competent enough to come up with a proper diagnosis and approach. The feeling of being at death’s door was surreal as I awoke 24 hours later to find myself in a bed being tugged at by my doctor on one side and my wife on the other. I can clearly remember the fear in both of their eyes as they struggled to assert themselves despite an unfolding emergency and a frustrating language barrier. The doctor was afraid that if they didn’t cut me open again, I would die, since he believed there were further complications and internal bleeding. My wife was afraid that if I was cut open again, then that would surely be my end. It was a frightening intense personal moment that changed everything for me. There were surreal and indescribably emotional moments in those weeks between the numbness of the morphine, when I realized I was merely a shell of the man that I was only days earlier. I feared getting back on my feet and I couldn’t help but feel that tragic sense of victimization and loneliness. A friend visited with a book of DVDs and Michael Moore’s Sicko was amongst the selection. Though I had seen the film twice before, watching it in the hospital alone one night I felt overwhelmed with anger at how cruel the United States could be, yet I was also energized by the power of empathy, and hearing all those stories gave me a connection to the country unlike any I had felt before.
Like too many other US citizens, I spent most of my twenties living without medical insurance. I saw it as a luxury that I could not afford and figured I would not need it if I took care of myself. Unfortunately, no matter how cautious we are, there are accidents and sicknesses that could afflict us at any time and without emergency protection, the results could be devastating. In my particular case, I required emergency hospital care and was driven there in the back of a stranger’s car, on the floor moaning in pain. Yet, I let it get to this point because of a conditioned understanding that seeing a professional doctor was an option I didn’t really have, even when I actually did. This was something for wealthy folks who could afford an ambulance, the co-pays, medicine and all the other ridiculously ruinous costs that are too common for people with or without insurance in the United States.
However, Mitt Romney disagrees. If “Mr. Corporations Are People My Friend” is adept at anything aside from hiding his money or shipping jobs overseas, he knows how to brutalize the use of words to ‘prove’ a point that offends a great number of people. In October, the original patron of what we now call Obamacare made an outrageous claim about the nearly 50 million Americans who are uninsured: “[Y]ou go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.” 4 This claim is as outrageous as the 47 percent comment because of the countless true stories of lives that have been ruined by the lack of insurance, not to mention of those covered inadequately. The numbers of deaths from lack of access to appropriate or timely care are estimated to be around 48,000 in 2011 alone, according to Physicians for a National Health Program (PNHP).5 That is approximately sixteen September 11ths per year and growing, and yet we are expected to believe Mitt or even Barack’s outrage at the deaths of four Americans in Benghazi!
Romney continued in his assault on the cold tragic truth confronting millions in the US: “But then once people have all had that opportunity to become insured, if someone chooses not to become insured, and waits for 10 or 20 years and then gets ill and then says ‘Now I want insurance,’ you could hardly say to an insurance company, ‘Oh, you must take this person now that they’re sick,’ or there’d literally be no reason to have insurance.”6
This is exactly the kind of sentiment that made millions across the country and the world hold Romney in such contempt. It is a sociopathic dogma that places corporate profits and the health insurance ‘industry’(?!) above the rights of human beings who only want to live without the fear of losing everything they have as a result of some illness. It is impossible to have a genuine debate about this without considering the impact that corporations have on our lives. It is not only big tobacco, the food and beverage companies and big oil that are polluting our bodies and our environment. Nearly every major industry has deleterious effects, or the euphemism “externalities”, that spill over to our health as individuals and our collective societal health. Some of these industries are especially perverse in that they prey upon our sickness and vulnerabilities.
Think for a minute about all the insidious adverts that try to convince people that they need to be medicated for one illness or another. The pharmaceutical industry happens to also be a major environmental polluter,7 wreaking material devastation on top of this spiritual sickness that they exploit. Yet, even worse is the insurance industry. It would be difficult to find an industry and its major companies as reviled as that of the health insurance industry. Could it really be impossible to galvanize 10 percent of the population into action? Polls have consistently shown that people favor single-payer, and this issue needs to be front and center now that Obama has been reelected and people, naively I fear, expect some real change.
So what is missing here? I agree with those such as Russell Mokhiber and Margaret Flowers and other activists8 who argue that the branding has been all wrong; single-payer doesn’t really move people as much as Medicare for All because we all tend to have positive feelings about Medicare. We tend to regard the program with a brave attempt at social justice in the lieu of letting the elderly have to fend for themselves. Personally, I associate Medicare with my grandparents and their generation, slowly dissolving in form before our very eyes, along with the empathy that they believed made their country the best place to live in the world. This should certainly be a major focus of our approach. Politicians like Mitt Romney deserve to be defeated. We need the flexing of muscles such as we saw in New York last week when the billionaire Mayor Bloomberg was forced to retreat on his absurd attempt to host the marathon, despite the fact that people were out in the streets of Staten Island and Queens, hungry, cold and more or less abandoned by their government. Empathy and shame could be the keys that reach the Obama center (right) and beyond.
For my part, I am offering my own tale of tragedy averted and vibrant health reclaimed. It is replete with the kindness of complete strangers, alternative treatments (acupuncture, cupping and massages) sponsored by the government of Taiwan, and most of all, an exacting and professional staff of conventional doctors and nurses in a private hospital, freed from the constraints of working with private health insurance companies and able to focus on assessing the needs of people and regularly saving lives.
Taiwan’s National Health Insurance Program is an innovative combination of public and private, yet it is on the delivery of services side, not seeing any need for a middleman. You are free to purchase private insurance here but you are also mandated to buy into the system. I recently had a health scare and was able to see five different doctors for their opinions, public and private alike. I realized that the public doctors and hospitals are most in demand here, pretty much the opposite of how it is in the US. This is important because it allows people real freedom of choice when it comes to their health. The Taiwanese government made sure to include alternative treatments because people believe in them, according to William Hsiao, a professor of economics at the Harvard School of Public Health, drafted by the Taipei to research health care systems around the world and come up with a plan based on the findings.9
Furthermore, the government-run program offers a system designed to encourage a lot of competition among medical providers and has succeeded by most accounts. This is clearly something that we can sell in today’s United States if we can only get the message out to people. I have heard several remarks by single-payer advocates that there should have been Canadian and British experts invited to the U.S. to testify and discuss their system. This would have made sense and I know the Taiwanese government would have been eager to send representatives to explain their system and the reasons for its design. In fact, the architects of Taiwan’s NHIP argue that it works a lot like Canada’s system, or like Medicare in the States, but with more benefits such as dental, vision, and alternative treatments.10
To give the reader an example of costs, consider the following: I regularly pay $100NTD (@$3USD) for acupuncture and the same for a recent visit to the dentist when he replaced a filling and did a cleaning. Additionally, the cost for my 2009 health crisis fell shy of the costs my sister was quoted for to do an allergy test for her 1.5 year old daughter earlier this week, when I received the following: two major surgeries; round the clock nurse supervision for nearly two and a half weeks; an enormous amount of antibiotics, morphine, and other medicines; and a private room (an expensive option that ended up being nearly 50% of the total bill). That is to say, my incredibly exhausting ordeal cost me around $31,000NTD or roughly under $1,100USD, meanwhile my niece’s allergy test would cost a prohibitive $1,200USD. How could that be? Some critics of Taiwan’s system point out that isn’t generating enough revenue with over 6% of the GDP going to healthcare and private banks having to make up the shortfall, but if the politically unpopular decision (for fear of voter backlash) to raise the premiums to where the system is generating around 8% of GDP, the problem is solved.
In an interview on NPR in 2008, one Taiwanese official who was involved in the planning for the system cited a well-known Chinese proverb that roughly translates “’The track of the previous cart is the teacher of the following cart’, meaning that it is often better to follow than lead to avoid the mistakes made by those leaders.”11 This is a common notion in Asia and the Japanese economy certainly is exemplary of this belief. Taiwan’s health care system was guided by this philosophy. While many people in the US may feel compelled to argue against being a follower in this sense, we should recall President Obama’s praise for the South Korean educational system and his straight-faced proposal to emulate it.12 Furthermore, East Asia offers a variety of arguments against neoliberalism because of how destructive it tends to be in such advanced economies where regulations are sorely lacking. I half-jokingly consider setting up a tourist service for Tea Party folks to come out and see what a developed economy with minimal regulations looks (and smells) like.
Taiwan’s health care scheme certainly has its flaws. Some of the doctors I know complain about the failure to innovate and stay on top of the latest technologies. There are constant debates about funding and tax increases that could raise health care spending to 8 percent of the GDP13, but this would still be only half of what the US spends, while gross inadequacies in the American system lead to a stadium full of victims each year and nearly 50 million people (equal to the population of 25 US states14) uninsured. Here in Taiwan, the government has gone to significant lengths to cover as much of the population as possible and achieved remarkable success. Life expectancy has increased by several years for both men and women since wide implementation of the program was underway, and there have been significant reductions in infant and maternal mortality.15 It’s also important to note that Taiwan’s administration costs are the lowest in the world—less than 900 USD per person—with an innovative smart card that holds each member’s data.16
I understand that the implementation of such a system in the US is highly unlikely but we cannot consider it an impossible dream and be satisfied with a plan whose central features were originally written in a plan by the Heritage Foundation in 1992 (called the Heritage Consumer Choice Health Plan),17 implemented by Governor Romney in Massachusets, and drafted in its modern form by a beholden Congressional committee led by the likes of Max Baucus. Don’t worry about Obama spending his capital on this because enough significant and unrelenting pressure might just force both the Executive and the Congress to consider the real and obvious fix. They may yet realize they should fear the 10 percent and their influence, rather than appease their golfing buddies in one of the most vile and vulture-like industries. The mean and even sociopathic neoliberal agenda must be pushed back against worldwide, so why not join in the fight today by revisiting this freshly conceded battle and force the re-elected Obama Administration to finally ‘do it’. Allow me to close with the words of Martin Luther King Jr. in a speech to the Medical Committee for Human Rights, 1966: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”18
Adam Chimienti can be reached at firstname.lastname@example.org
1 ScienceDaily. “Minority Rules: Scientists Discover Tipping Point for the Spread of Ideas,” July 26, 2011 at http://www.sciencedaily.com/releases/2011/07/110725190044.htm
2 See Alexander Cockburn. “Ain’t that good news,” CounterPunch Weekend edition February 11th-13th 2011 at http://www.counterpunch.org/2011/02/11/ain-t-that-good-news/
3 See Kaiser Daily Health Policy Report February 4, 2009 at http://www.kaisernetwork.org/Daily_reports/print_report.cfm?DR_ID=56795&dr_cat=3
4 See Sy Mukherjee. “Romney Says Insurers Should Be Able To Deny Coverage To Some People,” Oct 11, 2012 at http://thinkprogress.org/election/2012/10/11/990281/romney-uninsured-hospital/?mobile=nc
5 See Physicians for a National Health Program for a summary of Steffie Woolhandler’s report: “Despite slight drop in uninsured, last year’s figure points to 48,000 preventable deaths: health expert,” at http://www.pnhp.org/news/2012/september/despite-slight-drop-in-uninsured-last-year%E2%80%99s-figure-points-to-48000-preventable-
7 Hepeng Jia. “Pharma pollution is out of control in China,” June 24, 2011 at http://www.rsc.org/chemistryworld/News/2011/June/24061103.asp
8 June 28, 2012 Democracy Now! Special: Supreme Court Upholds Healthcare Overhaul Individual Mandate at http://www.democracynow.org/blog/2012/6/28/watch_democracy_now_special_supreme_court_upholds_healthcare_overhaul_individual_mandate
9 Anne Underwood. “Health Care Abroad: Taiwan,” The New York Times Health Section, November 3, 2009 at http://prescriptions.blogs.nytimes.com/author/anne-underwood/
10 T.R. Reid. “Taiwan Takes Fast Track to Universal Health Care,” April 15, 2008 at http://www.npr.org/templates/story/story.php?storyId=89651916
12 Leonie Haimson, Executive Director, Class Size Matters. “Obama and Duncan on South Korea: What Can They Be Thinking?” at http://www.huffingtonpost.com/leonie-haimson/obama-and-duncan-on-south-korea_b_845916.html
14 Tara Parker-Pope. “How Big Is 50.7 Million Uninsured?” July 13, 2012 at http://well.blogs.nytimes.com/2012/07/13/how-big-is-50-7-million-uninsured/
16 Ian Williams “Taiwan gets healthy”. The Guardian October 7, 2007 at http://www.guardian.co.uk/commentisfree/2007/oct/07/taiwangetshealthy
18 Rob Cullen. “Martin Luther King and Health Care,” January 20, 2010 at http://whatifpost.com/martin-luther-king-and-health-care.htm