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MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

Universal health care has been a topic of debate this political season. As the presidential candidates lay their policies out, we were curious about how other wealthy countries provide health care and if they hold lessons for the U.S.

The journalist T.R. Reid has been looking into this and his documentary about health systems around the world airs tonight on the PBS show, "Frontline."

Yesterday, Reid took us to Japan; today Taiwan. Reid explains how Taiwan recently created its system of universal coverage.

T.R. REID: At the end of the 20th century, Taiwan became a rich country, almost overnight, but it still had a poor country's health care. About half the population had no coverage at all, so Taiwan set out to design a national health care system from scratch.

Hongjen Chang was one of the officials in charge back then. Walking through Taipei's imposing Chiang Kai-shek Memorial Park, he recalled how they did it.

Dr. HONGJEN CHANG (President and CEO, Bureau of National Health Insurance, Taiwan): Taiwan is a small island. We always look abroad, internationally, for ideas. Chinese saying we say, the track of the previous cart is the teacher of the following cart.

REID: So if the other guy's oxcart has found a good route to universal health coverage, follow those tracks.

Dr. HONGJEN: Follow those tracks. If they were trapped in trouble, avoid that track. Find a new track.

REID: So they consulted experts from all over the world, like the Taiwanese-American health economist Tsung-mei Cheng.

Ms. TSUNG-MEI CHENG: (Senior Health Economist): In the end, the program that they finally set up in 1995 really is like a car that was made of different parts, imported from overseas but manufactured domestically.

REID: They wanted a system that gave everybody equal access to health care, free choice of doctors with no waiting time, and a system that encouraged lots of competition among medical providers. To finance the scheme, they chose a national insurance system - a single government-run fund that forces everybody to join in and pay. The result: A system that works a lot like Canada's, or like the U.S. Medicare system but with more benefits.

Ms. TSUNG-MEI: It has drug benefits, vision care, traditional Chinese medicine, kidney dialysis, inpatient care, outpatient care - just about everything under the sun.

REID: And to satisfy the patients in Taiwan, there's no gatekeeper who controls access to specialists and no waiting lines.

If I woke in Taiwan some morning and my shoulder is really hurting, how long would it take me to see an orthopedic specialist?

Dr. HONGJEN: We go now.

(Soundbite of laughter)

REID: This morning, I could see one?

Dr. HONGJEN: Yeah.

REID: I don't have to go to a G.P. and get a recommendation?

Dr. HONGJEN: No. All people don't like the idea of gatekeepers. They want to just buy by themselves.

REID: By consolidating so much, one government plan that covers everybody, Taiwan achieves remarkable efficiency. Everybody here has to have a smart card to go to the doctor. The doc puts it in a reader and the patient's history, medication, et cetera, all show up on the screen. The bill goes directly to the government insurance office and is paid automatically, so Taiwan has the lowest administrative cost in the world — less than 2 percent. They also use that smart card to track patterns of use.

Ms. TSUNG-MEI: If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the I.T. picks that person out and then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well.

REID: That may be too much like Big Brother for people in the U.S., but surveys show that Taiwanese are highly satisfied with their health care.

How many people in Taiwan every year go bankrupt because of medical bills?

Dr. HONGJEN: None.

REID: So the patients are safe from bankruptcy, but the system itself is under strain.

How much of Taiwan's GDP are you spending on health care now?

Dr. HONGJEN: They spend some 6.23 percent.

REID: And do you know the number in America - what percent?

Dr. HONGJEN: It's about 16 percent.

REID: Sixteen percent. That's right in…

(Soundbite of laughter)

REID: So the U.S. spends too much on health care and doesn't even cover everybody, but the Taiwanese just don't bring in enough money to pay for all the services they offer.

Ms. TSUNG-MEI: So actually, as we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers.

REID: Taiwan's politicians are reluctant to increase premiums. They're afraid the voters will punish them for it. So that's the problem here, and frankly, the solution is fairly obvious — increase the spending a little to maybe eight percent of GDP. And of course, if Taiwan did that, it would still be spending less than half of what we're paying in the USA.

For NPR News, I'm T.R. Reid.

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