Insuring the uninsured: Lessons from Taiwan and the Netherlands
As of 2024, approximately 28 million Americans did not have health insurance coverage in the United States.1 According to the Congressional Budget Office, that number could reach 34 million people by 2034 due to cuts in Medicaid and lower subsidies for Obamacare plans. This raises the question, can we afford to insure the uninsured?
Under our current fragmented care system, the costs of insuring the uninsured pile up quickly. Purchasing an average silver plan policy with a $5,304 deductible would cost the government $7,500 a year. Multiply that number by 34 million people and health care spending would rise by $255 billion. By comparison, the federal government appropriates $100 billion a year for SNAP benefits.
Taiwan Care
In 1995 Taiwan was in a similar situation to where we might find ourselves one day. The government wanted to establish a national health insurance program for its population, in part, because 43 percent of all Taiwanese people had no medical coverage. Altogether, it took Taiwan two months to enroll everybody into its new plan.
Within the first year, uninsured Taiwanese were two times more likely to visit a doctor or seek out care at a hospital than those who previously had health insurance. Lower out-of-pocket costs led to increased utilization. As a result, health care expenditures jumped 13.4 percent in one year’s time. By comparison, health care costs in the United States only went up 7.2 percent in 2024.2
Assume then that the same thing would happen in the United States if we set up a universal care program. Do we throw up our hands and say a 13.4 percent increase in first year health care expenditures is too much money, the country cannot afford it, and give up?
Based on academic studies and Taiwan’s experience, it is probably best to continue onward.
In a 2020 meta-analysis, the most recent I could find, the authors stated that higher utilization rates do indeed matter toward overall expenditures when starting out with a single payer plan, but not as much as lowering administrative costs or reducing drug prices. As an example, the authors noted that Medicare Advantage pays about 30 percent more for its prescription costs than the Veterans Administration.
The authors reported that studies from both right leaning and left leaning organizations all estimated savings for a single-payer plan.
Fast forward 31 years, and take a look at Taiwan’s health care finances today. They look pretty good. Compared to the United States, Taiwan pays less for medical insurance while its people live longer. The table below sums up those differences.
| Taiwan | United State | |
| Universal Care | Fragmented Car | |
| Percent of GDP (1994) | 4.99% | ~12.4%3 |
| Percent of GDP (2024) | 7.3% | 18%4 |
| Life expectancy (1994) | 74.58 years | 75.7 years |
| Life Expectancy (2024) | 81.21 years | 79 years |
Customer Service
Suppose now that we wanted to move forward with our universal health care plan. We need to first get everybody on board. In this regard, we could learn from the Netherlands, who established their universal health care plan in 2006.
If you go to their website, at the bottom of their webpage they write, “The Netherlands has good social services and good care for everyone.” To the right of that statement is contact information for anyone who has a question or concern. A person could call, email, write a letter, or visit a nearby office.
Now imagine if we had a similar support system in the United States when we first set up our universal care plan. A person with questions, for example, could call up a toll-free number, and if all representatives are busy, hear a voice recording saying, “your expected wait time is less than three minutes.” Real live representatives would then come on and answer any questions Americans might have.
No doubt, having a human touch would cost the country dearly. But the stakes are high. We are currently paying $5.2 trillion a year in health care expenditures while millions of people go without medical coverage. We can do better.
Outstanding customer service, whether during enrollment time or at the doctor’s office later on, is a must if we want to change minds and win over hearts for the greater good.
Note: This is an ongoing series of blogs to develop an affordable, universal health care plan before the 2028 presidential election.
1Centers for Medicare & Medicaid Services (CMS), National Health Expenditure Accounts, Table 22: Health Insurance Enrollment and Uninsured; Number of Enrollees and Annual Percent Change, Calendar Years 1987–2024, https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data
2,3,4Centers for Medicare & Medicaid Services (CMS), National Health Expenditure Accounts, Table 1: Health Insurance Enrollment and Uninsured; Number of Enrollees and Annual Percent Change, Calendar Years 1987–2024, https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data