Taiwan’s single-payer system is popular — but it might be in trouble

Doctor Tien Hui-Wen sees a patient at Xiulin Health Center. | Ashley Pon for Vox

The US can learn a lot from Taiwan’s 25 years with a single-payer health insurance system.

On the east coast of Taiwan, where a small valley meets sharp, green mountains, lies the township of Xiulin. It has a few narrow streets. Many houses have corrugated roofs and siding.

In this township is a clinic, a building a couple of stories tall with physicians’ offices, X-ray facilities, and a small office for dental care.

Dr. Huei-wen Tien works there. She’s a short woman in her late 50s. Her hair has gone white so she’s dyed it bright pink, and she wears an all-black outfit with black ankle boots. Her motorcycle helmet has the word “PUNK” written on the side, and she rides her moped to visit her patients.

Today, her trips take her just a few minutes into the township, but some days, she drives hours up into the mountains to treat patients living in very remote areas.

In one house, she visits a stroke patient. She checks his blood sugar levels and talks him through some medications.

For the patient, all of this care is free.

Taiwan has a program that looks a lot like the Medicare-for-all proposal being floated by presidential candidates like Sens. Elizabeth Warren and Bernie Sanders. It’s called National Health Insurance, and it covers every single person in the country.

The Impact is Vox’s podcast about how policy shapes peoples lives. On this episode, Vox policy reporter Dylan Scott walks us through how Taiwan built their single-payer system and what the US can learn from the program. Dylan Scott went to Taiwan with The Impact’s Byrd Pinkerton. They interviewed patients, doctors, government officials, and a researcher with a charming love story.

Listen to this episode to hear what they discovered:

Dylan learned that the people of Taiwan love their universal health care program that has significantly improved Taiwan’s health outcomes.

But he also learned that the entire system could go bankrupt — and soon — if the country doesn’t make dramatic changes.

Further listening and reading:

• Ask Dylan anything about universal health care in r/politics today at 2 pm ET today
• Dylan’s piece on Taiwan’s single-payer success story
• Uwe Reinhardt’s latest book, Priced Out: The Economic and Ethical Costs of American Healthcare
• Tsung-Mei Cheng wrote a Wall Street Journal opinion piece making the case for a public option
• Dylan’s piece on the three different kinds of health care plan floated by the Democratic candidates
• Vox’s guide to where 2020 candidates stand on policy

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