US president-elect Donald Trump is set to take office on Friday next week. Since his victory at the polls, a Trump craze has swept the world. As well as delivering a strong message about global political and economic transformation, Trump’s election win offers an opportunity to reflect on how to reform health insurance.
During Trump’s election campaign, one of his main platforms was to dismantle the US’ universal health insurance system, known as “Obamacare,” which is one of US President Barack Obama’s major political achievements and one of the policies that the Republican Party most strongly opposes.
The essence of Obamacare is that every citizen must buy health insurance and that those who do not buy it have to pay a fee when they file their taxes.
The Republican Party thinks that citizens should not be forced to buy health insurance, because this kind of compulsion restricts their freedom. Trump favors encouragement instead of force and penalties.
His policy proposals include giving people an incentive to buy health insurance by making all medical insurance premiums deductible from income tax. He also wants to institute health savings accounts similar to Singapore’s Medicare system, which works a bit like the individual account setup in Taiwan’s labor pension scheme.
In the Singaporean healthcare system, each person’s insurance contribution is a kind of saving that is supplemented by government subsidies and employer contributions. People can decide how to use the money in their account, as long as it is used to pay medical expenses.
When all the money in someone’s account has been spent, they have to pay for any further medical expenses themselves. The advantage of this kind of system is that patients keep an eye on how much money they have in their health savings account and are more likely to use it sparingly instead of wasting money by going from hospital to hospital to get treatment.
Trump has announced that he is to appoint Republican Representative Tom Price, a former orthopedic surgeon, as US secretary of health and human services.
Over the past few years, Price has repeatedly proposed a bill to abolish Obamacare. His bill, which is called the empowering patients first act, largely reflects Trump’s political views, namely using encouragement instead of force, and it aims to strengthen patients’ self-control and their sense of responsibility for their medical spending.
Taiwan’s National Health Insurance (NHI) system is a form of government insurance with mandatory participation. As such, it is different in nature from Obamacare, which is also mandatory, but stresses market mechanisms.
Nonetheless, Taiwanese should still take note of Trump’s proposed reforms when thinking about how to fix the NHI, because patients’ sense of responsibility for and control over their medical spending are precisely what is missing in this nation’s system.
The NHI has achieved great successes, but its all-you-can-eat provisions lead to waste and with all the funding coming from a central source there are problems about how it is allocated. Consequently, the second-generation NHI added a lot of scope for collecting self-payments through double billing.
It has also been getting harder to get NHI coverage for new medicines and technologies.
One example is last year’s controversy about whether new drugs for hepatitis C should be paid for by the NHI.
Just after the end of the Lunar New Year holiday, a governance platform formed by Taoyuan and Hsinchu cities and Hsinchu and Miaoli counties announced that it had obtained a change in the formula for allocations from the total NHI budget.
The group pointed out that while the regions have the nation’s fastest-growing populations, over the past four years there has been a shortfall of NT$17.2 billion (US$538 million) in NHI payments to hospitals in those areas — an annual average shortfall of NT$4.3 billion.
This shortfall has now been corrected.
The NHI system has for a long time been running a financial deficit. If the insured are not encouraged to use the system sparingly, in the long run the scheme might reach a situation where petty illnesses are covered, but serious ones are not, with people losing more than they gain.
Amendments to the system should take Trump’s ideas into consideration by adopting the concept of health savings accounts that to some extent allow people to plan how to use their own money.
These measures would help make the NHI sustainable.
Yang Cheming is a professor at Taipei Medical University’s School of Healthcare Administration.
Translated by Julian Clegg
A series of strong earthquakes in Hualien County not only caused severe damage in Taiwan, but also revealed that China’s power has permeated everywhere. A Taiwanese woman posted on the Internet that she found clips of the earthquake — which were recorded by the security camera in her home — on the Chinese social media platform Xiaohongshu. It is spine-chilling that the problem might be because the security camera was manufactured in China. China has widely collected information, infringed upon public privacy and raised information security threats through various social media platforms, as well as telecommunication and security equipment. Several former TikTok employees revealed
For the incoming Administration of President-elect William Lai (賴清德), successfully deterring a Chinese Communist Party (CCP) attack or invasion of democratic Taiwan over his four-year term would be a clear victory. But it could also be a curse, because during those four years the CCP’s People’s Liberation Army (PLA) will grow far stronger. As such, increased vigilance in Washington and Taipei will be needed to ensure that already multiplying CCP threat trends don’t overwhelm Taiwan, the United States, and their democratic allies. One CCP attempt to overwhelm was announced on April 19, 2024, namely that the PLA had erred in combining major missions
The Constitutional Court on Tuesday last week held a debate over the constitutionality of the death penalty. The issue of the retention or abolition of the death penalty often involves the conceptual aspects of social values and even religious philosophies. As it is written in The Federalist Papers by Alexander Hamilton, James Madison and John Jay, the government’s policy is often a choice between the lesser of two evils or the greater of two goods, and it is impossible to be perfect. Today’s controversy over the retention or abolition of the death penalty can be viewed in the same way. UNACCEPTABLE Viewing the
At the same time as more than 30 military aircraft were detected near Taiwan — one of the highest daily incursions this year — with some flying as close as 37 nautical miles (69kms) from the northern city of Keelung, China announced a limited and selected relaxation of restrictions on Taiwanese agricultural exports and tourism, upon receiving a Chinese Nationalist Party (KMT) delegation led by KMT legislative caucus whip Fu Kun-chi (傅崑萁). This demonstrates the two-faced gimmick of China’s “united front” strategy. Despite the strongest earthquake to hit the nation in 25 years striking Hualien on April 3, which caused