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Tsung-Mei Cheng brings us lessons from Taiwan

August 17, 2020

Topics: Quote of the Day

By Tsung-Mei Cheng
New York Daily News, August 14, 2020

U.S. Health and Human Services Secretary Alex Azar was in Taiwan this week for what was the highest-level meeting between the U.S. and Taiwan in decades. A focus of his trip was to highlight Taiwan’s success in combating COVID-19 and “cooperate with the U.S. to prevent, detect, and respond to health threats.” Azar’s praise for Taiwan’s success in health is significant, especially given that he’s a member of a Republican administration.

Much of Taiwan’s success is due to its government-run, single-payer health system, established 25 years ago on the recommendation of the late Princeton economist Uwe Reinhardt, then a high-level adviser to Taiwan’s government. Reinhardt believed that a single-payer system can best achieve equity and cost savings. It’s also cheap to run, and the public can easily understand it. He was right.

Today, Taiwan’s health system covers everyone with generous benefits for about a third of the cost of American health care. This is a sharp contrast to America, where “nearly 1 in 10 adults say cost would keep them from seeking help if they thought they were infected.” Because everyone is insured and access to care is easy and cheap, there are no barriers, financial or otherwise, to receive care in Taiwan.

Second, Taiwan owes its impressive success in combatting COVID-19 to having a national plan, which is science and evidence-based and IT-driven. They implemented this plan almost immediately upon learning of the first cases of the novel coronavirus in Wuhan in December 2019.

Having learned from the 2003 SARS crisis, Taiwan’s government classified the new coronavirus as a statutory infectious disease before the World Health Organization confirmed the human-to-human transmission of the new coronavirus. This enabled the government to activate a whole series of infectious disease prevention measures put in place since 2003.

Equally important, Taiwan’s government established a central command, or CentCom, in early January to oversee and implement the national plan, with Health Minister Shih-Chung Chen serving as commander-in-chief. The performance of Taiwan’s COVID-19 CentCom is a study of the power of a timely national response by leadership from the top in a national crisis.

Taiwan’s approach to COVID-19 was two-pronged: prevent and contain. Effective Jan. 1, 2020, travel restrictions, initially applied to travels to and from Wuhan and other parts of China and later expanded to include other high-risk nations, went into effect to prevent the new coronavirus from entering Taiwan.

To contain the spread, the government began quarantine and contact tracing, strictly enforced through a powerful IT system that links a person’s recent travel history, visits to clinics and hospitals and persons contacted. Violators are fined.

Taiwan’s public, to its credit, also played a crucial role.

Universal health coverage, timely actions by government, and public trust and cooperation allowed Taiwan to escape large scale testing or lockdown. People do wear masks. Life has been otherwise mostly normal. Schools and businesses are open. Travels (domestic) are extremely popular. Taiwan’s economy enjoys near full employment and is projected to grow by 1.77% in 2020.

Has Azar brought back these lessons from his visit to Taiwan? Or is it simply too late as we are a full six months into the COVID-19 crisis? I believe it’s not too late — if America acts now.

We need interventions that are specific to the American situation. To start, we must step up testing. As coronavirus has spread into communities nationwide, it is impossible to do quarantine and contact tracing. We must use tests that give results in minutes rather than days. This will quickly identify infected individuals regardless of symptoms, even if they are asymptomatic.

A timely private sector initiative to scale up testing is the Rockefeller Foundation’s initiative involving six state governments. The initiative aims to increase testing from the current 5 million to 30 million per week over the next six months. It will use tests that give results in minutes. This is the largest public health testing program in American history, and indeed a fine example of public-private partnership.

There are things individual Americans can do starting immediately, if they are not already doing them: wear a mask, keep social distancing, wash hands often and avoid crowded places. Equally important, respect and follow science and evidence.

COVID-19 can be controlled and contained, as we have seen in Taiwan and many European and Asian nations. It is said that Americans will always do the right thing after exhausting all alternatives. Now is time that we, as a nation, come together and start doing the right things to help save lives.

Cheng is a health policy research analyst at the Princeton School of Public and International Affairs.


HHS Secretary Azar’s Remarks at National Taiwan University

By Alex M. Azar II
HHS.gov, August 11, 2020

I am so pleased to be here today, to thank Taiwan for setting a positive example and for choosing, enthusiastically, to be a part of the global health community.

Your contributions have never been more appreciated than they are today.

In these trying times, the United States knows that we will always have a friend in Taiwan, and we will not shy away from telling the rest of the world that they can rely on Taiwan too.



By Don McCanne, M.D.

There is some irony in our HHS Secretary, Alex Azar, praising Taiwan for setting a positive example as part of the global health community when the United States has failed so miserably in its response to the COVID-19 pandemic. Taiwan’s response to the pandemic has been spectacularly successful whereas the United States remains the leader in deaths and other disastrous consequences of the pandemic. What explains the difference?

Tsung-Mei Cheng describes the efforts that Taiwan has made in establishing public health policies and infrastructure so that it is ready for expected and unanticipated demands on its health system, plus they are responsive when the need arises.

One of the differences is that Taiwan has a single payer financing system that ensures that their people have access to the health care system when needed. In contrast, our government leaders, including Alex Azar, have been outspoken against our proposed single payer Medicare for All program, leaving tens of millions of our citizens without affordable access to our health care system and thus prime for spreading this highly contagious disorder. Also the Taiwanese government provided leadership in implementing basic public health policies that would help stem the spread of the coronavirus. In the United States, our government failed in providing this leadership and further often compounded the problems by ridiculing citizen and local government efforts to reduce the spread of this disease.

Taiwan’s efforts should be emulated, and, as Cheng states, we can still reduce the severity of the consequences of our inept national response. Sadly, although we are seeing some modest efforts finally being made, they remain grossly inadequate. It is difficult to see how we can achieve a more dramatic shift towards the necessary interventions we need without a change in leadership. The election is still months away and the time required for a new government to implement the essential changes needed will still require more months – delays during a pandemic that will certainly compound the tragic results that we are experiencing. What is even worse is that the likely replacement government has already promised us that we will not have the single payer Medicare for All system that we desperately need. What kind of leadership is that?

Now that we know the lessons from Taiwan, can’t we do a better job in applying them here? Not only would it help repair our economy, but, much more importantly, it would improve our health and likely prevent the premature loss of hundreds of thousands of lives. Do we really value life that much less than the Taiwanese?

Tsung-Mei Cheng, aka May Reinhardt, has been a special friend of PNHP, and we really appreciate her continuing efforts to make the United States and other parts of the world a healthier place for all of us.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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