With droves of Taiwanese Americans reportedly bolting stateside on “vaccine tours,” the issue of transnational healthcare opportunism is back in the public eye. If you’re wondering if that’s a real thing, well, while I believe I may have just coined the phrase, the phenomenon it describes has been controversial since Taiwan’s superb National Health Insurance (NHI) system was launched in 1995.
“Editorials of major Taiwanese newspapers — such as Apple Daily, United Daily News, United Evening News and the Liberty Times (the sister paper of the Taipei Times) — have criticized overseas Taiwanese for manipulating public health insurance by paying minimal fees and shifting their medical cost to other local taxpayers,” writes Ken Chih-Yan Sun (孫志硯) in Time and Migration, a new work on aging Taiwanese migrants to the US.
In 2006, the law was changed so that dual nationals had to have been in country for at least four months of the year to avail themselves of NHI; a 2010 amendment pushed the threshold to six months. Still, the perception remains that many Taiwanese Americans are taking advantage of both systems in an unscrupulous manner. As Sun observes, those who return to live out their dotage full-time in their homeland are not spared criticism: “Given that they had spent most of their working years contributing to the United States … many returnees faced negative critiques in Taiwan …”
Although this is just one element of the book’s penultimate chapter, which focuses on migrant thinking on access to social rights, long-term Taiwan residents are likely to find it among the most engrossing. As with other sections of the book, the opinions offered on this issue are mixed.
“For Mr Guo, immigrants using public benefits in Taiwan, whether visiting or settling there, were transgressing moral boundaries … ‘How can we dedicate the prime of our lives to the US and utilize Taiwan’s resources in our twilight years?’ he argued.”
This kind of reaction, Sun found, was much more common among migrants who had “aged in place” (ie remained in the US). Returnees, in contrast, justified access to benefits in a variety of ways. Some highlighted their political lobbying for Taiwan in the US or activism during the Martial Law era; others, the skills and know-how they (or, nonsensically, prominent Taiwanese) had shared with peers in their homeland.
A fair few deflected by railing against “undeserving others,” including undocumented Latinos, immigrants from China and even lower-income Taiwanese. In a couple of cases, where they had transferred savings to relatives or underreported earnings in order to access US welfare, the respondents matter-of-factly admitted what they had done was morally suspect but reasoned that their situations meant they couldn’t have done otherwise.
Healthcare is far from the only arena where recriminations over the advantages of dual nationality arise. In Chapter 5, which is titled Navigating Networks of Support, a woman surnamed Guo relates the difficulty of engaging in politics with family back home.
“One remark, she told me,” Sun writes, “could leave her speechless. ‘If you love Taiwan so much, why do you live abroad?’”
She is also asked by relatives if she will flee to America should China invade. Although the implications rankle, Mrs Guo feels they are not completely unfair.
If their non-migrant friends and family in Taiwan challenge the right of the transnationals to engage on domestic issues, back in the US, politics continue to play a key role in their sense of identity. In an appendix outlining his methodology, Sun himself admits to masking or playing up his waishengren (外省人, those from China who came to Taiwan after World War II) and Hakka heritage depending on who he was speaking to.
“I believe my strategy encouraged my respondents to be more forthcoming, especially when they had strong views of an ethnic group in Taiwan,” he comments.
Among the US-based interviewees, clannishness based on ethnicity and politics seemed even more pronounced than what one would expect in Taiwan.
“In Boston, there are two different chambers of commerce from Taiwan,” says a woman surnamed Liao. “One is pro-China and supports the [Chinese Nationalist Party, KMT], and the other is pro-Taiwan and supports the Democratic Progressive Party (DPP).”
She explains how pro-KMT Taiwanese will attend a Chinese church rather than one where the congregation is made up of their independence-leaning compatriots.
“There is nothing we can do,” she says. “The Taiwanese American community just mirrors what kind of society Taiwan is.”
Further evidence of a clear-cut schism appears when Sun suggests having lunch at a restaurant he knows, only to receive a surprising rebuff. Their hard-earned cash, the Guos insist, won’t end up in “Chinese” pockets.
“Feeling somewhat confused, I answered, ‘Oh, I think the owner is from Taiwan,’” writes Sun. “But Mr Guo explained, ‘Yes, they are from Taiwan, but they are waishengren.’ For Mr and Mrs Guo, not everyone from Taiwan counted as ‘Taiwanese,’” Sun concludes. “Those they considered inauthentic were excluded from their community.”
Among the waishengren, there are attempts to play down the bitterness of the divide. A man surnamed Tan, for example, claims that politics is not an issue and that he had plenty of “Taiwanese” friends before the DPP began stoking ethnic tensions. This shop-worn claim seems to be the go-to excuse among the aging ex-pat waishengren. A man surnamed Chao, for example, says he “was deeply worried that the independence movement and corresponding nationalism were exacerbating intergroup relations …”
Elsewhere, reflections on changes to traditional conceptions of patriarchy, filial piety and conjugal roles are examined with sensitivity and balance. The overall feeling among interviewees is that “Americanization” has made them more progressive and tolerant as parents, grandparents, husbands and wives. Even if these changes are imagined or based on a misapprehension of American ideals, the processes involved, Sun contends, have led to tangible lifestyle differences within migrant families.
In researching and writing this book, Sun’s aim was to fill a posited gap in the field of migrant studies by documenting “the experiences of long-term aging migrants who relocated to the United States during adulthood.”
The transitions they underwent, he urges, should be considered “in both a national and a transnational context.”
In Time and Migration, Sun has achieved more than goals that were set firmly within the niche of migrant studies: He has produced a work of enduring value to anyone interested in the perennially evolving notion of Taiwanese identity.
By Ken Chih-Yan Sun
Cornell University Press
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With droves of Taiwanese Americans reportedly bolting stateside on “vaccine tours,” the issue of transnational healthcare opportunism is back in the public eye. If you’re wondering if that’s a real thing, well, while I believe I may have just coined the phrase, the phenomenon it describes has been controversial since Taiwan’s superb National Health Insurance (NHI) system was launched in 1995. “Editorials of major Taiwanese newspapers — such as Apple Daily, United Daily News, United Evening News and the Liberty Times (the sister paper of the Taipei Times) — have criticized overseas Taiwanese for manipulating public health insurance