[This article was first published in October of 2013 on a site that has since closed.]

A friend of mine posted on Facebook some of her experiences with socialized medicine while she was abroad. She spoke of the free health services that she and her husband received in glowing terms. And then she asked why anyone would not want to have free healthcare.

Americans who support the Affordable Care Act, and socialized medicine in general, sometimes assume that if you are against it you must be prejudiced. You are probably uneducated or under-educated, have never been outside the country and have not experienced how things are elsewhere in the world, where socialized medicine is the norm, rather than the exception.

My health card

I am not opposed to socialized medicine because I have never experienced it or because I am under-educated. I have a PhD and a J.D. I was born abroad, have lived and worked abroad, and I oppose socialism in the United States in part because I do know a lot about it. It is not because I want to tell people abroad what to do, and it is not necessarily because all my experiences with socialized medicine were bad. It is because I have perspective on exactly what you are getting and how you are paying for it. As an American citizen, I want the bill of rights enforced here, even though I recognize that it has no application abroad.

In the late nineties, I accepted employment in Taiwan, where I taught as a college professor for three years. I was happy to have the experience, the employment, the salary and the benefits, which it just so happens included socialized medicine. I have no complaints about how I was treated, and I am grateful to this day to have had this opportunity abroad. As a non-citizen of  Taiwan, I was well treated. They were good hosts, and I was a good guest worker.

That being said, I also got to experience the nice side of socialized medicine while being fully aware of how it was affecting other people not so nicely. Let’s face it, when you are a guest in somebody else’s country and you get free healthcare, you can be sure that somebody else had to pay for it, and that it is not really free. Usually it is the citizens who end up paying for the guest workers. And to some extent it is the doctors and dentists whose livelihood is affected by the entire arrangement.

I was given a healthcare card, and every time I went to see a doctor or a dentist, I had to present it, and then my visit, together with all the medicine that they dispensed to me, ended up costing the equivalent of about three dollars. So it was basically three dollars per visit. My hosts explained to me that the Taiwan government had considered making it completely free, but then they realized that some old people (yes, that’s what they said!) tend to be hypochondriacs, going to visit the doctor every time they felt a little lonely, so the government decided to charge something, just enough so that if someone was not really sick they would not go.

My first experience with free healthcare occurred when I broke my front tooth while chewing on chicken legs. Chicken legs are a delicacy that I had not tasted since I left my native Israel, and I was very excited to see it served in Taiwan. Unfotunately, my front tooth, that had been broken before, fell apart as I was nibbling. A colleague took me on the back of her motorcycle to see a local dentist in Tamsui.

Now the thing about most dentist’s offices in Taiwan is that they look a lot like barber shops. You can see everything from the street. There is a line of chairs. The entire office is rectangular, with the shorter side facing the street and made of glass, and the longer side accommodating the line of chairs. There are no partitions, and there is no waiting room, and usually there are not too many other patients, either. The dentist, who was a woman, fixed my tooth right away. She did a good job and was very efficient. She saw what the problem was, went right to work, and did not require X-rays or try to numb the area. All that was actually fine with me. It did not hurt, there was no waiting, the fix worked for years afterwards, and it all only cost three dollars.

“Do you floss?” she asked me.

“Yes,” I answered. I thought I was going to get a lecture on dental hygiene, the way the really expensive dentists in the United States are always indulging in.

“Don’t floss,” she said.

“You don’t think I should floss?”

“Tooth might break.”

“Okay, then.”

The only thing that really bothered me about this inexpensive and obviously impoverished dentist was that the whole time she was treating me, she had a bloody rag draped on her shoulder. That blood was not mine. It was from a different patient, and I was really afraid that it might come into contact with me and my mouth. And so while I appreciated the great work she did, I vowed not to return to that dentist’s clinic.

My concern was not skill, but hygiene. She really was top notch where skill was concerned, but I was afraid.

The next time I needed a dentist, it was because I had a wisdom tooth that needed to be pulled. I could have gone back to that very efficient and skilled dentist and gotten it done right away, but I was scared of catching hepatitis from an unclean instrument or washrag. So I asked my colleagues for a recommendation for a really good dentist. They wanted to know what I meant by really good, and I had to admit what I meant was that I wanted everything to be clean and sterile.

One of my colleagues gave me the address of a specialist in Taipei. She said he was a very good dentist, she used him herself, and his office and waiting area were very clean.

I took the MRT and then a bus to get to the rich dentist’s clinic. You could tell right away that he was making a lot of money, because he had a beautiful waiting room, with wooden floors and nice plants and paintings and decor and a beautiful receptionist and his rooms where he worked on patients were also lavishly appointed and very private.

The only problem was: he had never pulled a tooth before. He did not know the first thing about pulling a tooth. My wisdom tooth had many strong roots, and he did not know what to do, so he sawed the tooth in half, and tried to pull out small parts of it at a time, and I started bleeding profusely and he did not know how to stop the bleeding, and to make a long story short, I had to be rushed from the rich dentist’s office to an oral surgeon who laughed at him, while he cleaned up the mess he had made.

So why was that incompetent dentist so rich? Because he did cosmetic dentistry which was not covered by the national health insurance. Since it was not covered, he could charge privately whatever fee he wanted, and people who desired straighter teeth or tooth whitening services or whatever else would make them look nicer could go to him. But he never dealt with anything difficult or unpleasant, like pulling a tooth.

When my daughter arrived in Taiwan, she was issued with a baby healthcare booklet by the national health insurance service. In it were places for all the required vaccines and well-baby checkups.

My daughter’s health booklet

We were living in Taichung at the time, and I went to a pediatrician recommended by local colleagues. Because he was recommended, his clinic was far away from where I lived, and I had to take a taxi to get there every time we had a checkup. The vaccines were all free, but I remember that one time he took me aside to let me know that there were two versions of a particular vaccine: one was inert and unlikely to transmit the disease and the other was more risky. The more risky vaccine was free. If I wanted the one that would ensure my daughters safety, I would have to pay for it privately. So what do you think I chose: the free vaccine that would hurt my child or the one that cost money that would not? Of course, I paid. Anyone would!

Every doctor had his own pharmacy in the little kiosk like entrance to the clinic. After you finished your office visit, if you needed any medicine dispensed, you would get it in a little plastic packet from the pharmacist at the entryway. It was very efficient and it all cost only three dollars per visit, medicine included. However, the medicine for babies came in a powder that you had to mix yourself, following the instructions in Chinese. It was not coated and there was no sugar included and it was your problem to somehow get it down your child’s throat, even if she didn’t like it and was too small to understand why it was necessary.

My daughter developed an aversion to strangers around six months of age, and she would scream every time the pediatrician tried to examine her. The pediatrican who was recommended to me did not understand my explanation as to why she did this, and he implied there was something wrong with her.

However, I found an ear, nose and throat specialist within walking distance to our apartment that we went and saw when we had the flu. He had an unusual but effective way to treat our symptoms by sticking giant medicated Q-tips up our nose. When my daughter objected to the procedure, he did not censure her or me, and when she screamed as he was inserting the Q-tip in my nose, he laughed and said I had a brave daughter who was trying to protect me.

I liked the ear, nose and throat specialist, who was less well-off better than the pediatrician who was better off, but something about the system seemed to always make the healers who knew how to heal do badly financially, while the ones who were bad healers prospered.

I did not have any serious health issues and neither did my daughter, so we were really not badly served by this socialized healthcare system, but I always felt sad for the doctors and dentists who had to work and live under it.

My teeth have always given me trouble, so while in Taichung, an old filling came apart and I needed a root canal. I went to the closest clinic, which was run by a very nice and skillful dentist. He only charged three dollars for each visit, but I did have to pay out of my own pocket for the gold crown I eventually got. Over the dentist’s work station, I saw three English words posted on a note: Vampire, Umpire, Empire. When I asked him what the words were there for, he told me that he was studying English in his spare time, and these three words were hard for him to learn, since they all sounded exactly the same. His dream was to master English well enough so that he could open a cram school where he could teach English to school children and make a lot of money. His income as a dentist just wasn’t enough.

© Aya Katz – –  Words and Images

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Below are the comments that had accumulated on the post when I decided to archive it.

Katiem2: @ yes, three dollars is pretty darn cheap. And yes, hospitals in the US and most doctors and dentists do charge too much. But it is because they have a government monopoly. Allow free competition between MDs and other kinds of healers and the price of healing will go down, while the quality of care goes up. The socialist way penalizes good healers at the expense of those who are bad.

We are not a socialist government, the healthcare system has been this way for decades, I have worked in upper management – dealing with health insurance companies and plans for 20 years and well I do not understand your position. Please explain more clearly as this makes no sense to someone who’s been in the thick of it working closely with the insurance companies, the employees who use it and come to me for advice as how to best utilize it. After which I dig in and do the research, leg work calling and contacting doctors and nurses first hand to get the facts as to whats best and what’s really going on. This has been the situation long before Obama came into office. I say this as it seems many people say exactly what you just did with the claims it is Obama who created this “S” movement. The monopoly you speak of was brought about by Bush a republic the very party who preaches against socialism. 

I can tell you this, I have worked with multiple companies and those who have really good insurance…those are the ones with many employees with many spouses who run their children to the doctor for anything and everything and needlessly taking advantage of the stellar coverage, abusing it, abusing the Insurance companies good coverage and the companies benefit. This is very annoying and well I know has contributed to the problem in some small way and possible in a larger way. Who knows???

My response: 

&katiem2 , thanks for coming back to ask your questions. I welcome the opportunity to exchange ideas.

First of all, this is not an article about Obamacare. The socialized medicine that I allude to was that practiced in Taiwan in the late 1990s and early 2000. I describe how through its interference in the marketplace, the government of Taiwan was discouraging the good practice of medicine, while encouraging bad doctors and dentists to prosper.

You read my article, but did you pay attention to the incidents with both good and not so good practitioners of medicine and of dentistry? Did you notice how all the skilled dentists were poor and had bad facilities to work in, while the bad practitioners were able to make more money?

I think I explained the mechanism by which that worked. Essential difficult medical and dental services, such as fixing a broken tooth, doing a root canal or pulling a tooth, and also healing people who are very sick with the flu, were paid for by the government. Because the government dictated to the doctors and dentists who performed these services, they were all poor. But doctors who specialized in easy jobs, like pediatricians who just gave wellness checkups and vaccines and offered more expensive non-provided services (such as a vaccine that will not make your child sick) or who straightened and whitened teeth, were able to make a lot more money and were prospering. This was because the price of their services was not set by the government.

By interfering in the marketpace like this, the government of Taiwan was driving out the good doctors and dentists, who began to dream of running their own non-price-regulated businesses, such as running a cram school.

By interfering in the marketplace for healthcare, the government of Taiwan was making things worse not just for the medical professionals but for the Taiwanese patients as well . They were making medicine a non-paying profession that really smart and talented people would not want to work in.

Here in the United States, medical insurance and doctors’ services cost too much. In fact, they cost more than the market will bear and have done so for decades and decades. Why? Because there is already a mandate out to employers of over a certain number of employees to purchase health insurance on behalf of employees and to make health benefits part of the employment package. Since purchasing health insurance is required, health insurance prices have skyrocketed. If people were actually buying their own health insurance and opting out when the plan was not reasonable, then the price of health insurance would be lower.

Also M.Ds have a monopoly on the practice of medicine. I have been treated by the same medic at a clinic here in Missouri for years. The doctors he works under change every couple of years. But he stays. By law he cannot practice medicine alone without a doctor’s supervision, even though he is the one who does the actual work and the doctor is not there when he examines, treats and prescribes for me. Yet the doctor gets most of what he brings in. Think how much less expensive the visit to the clinic would be if we cut out the middleman! To do that, we would need to deregulate medicine.

It is the government and not the greed of medical practitioners or insurance companies that caused the current crisis in medicine and health insurance. All of this happened long before the ACA.