Well, the Healthcare Summit is over. Not much happened that wasn’t expected: the whole country got to witness Republican obstructionism first-hand, and Democrats stuck to their agenda. But there was one very important participant missing from the invite list, someone who could have made the meeting less of a rehash and more of a critical visioning session.

William Hsiao is a professor of health care economics at Harvard School of Public Health. He’s not just an academic number-cruncher though. As TR Reid describes in The Healing of America, this 70-something year-old has helped create or optimize universal healthcare systems in Denmark, Dubai, Djibouti, Taiwan, and Columbia. In other words, he knows what it takes to create a meaningful healthcare system, backed by a common vision, which covers everyone. Do you think he could have added something to the messy, circular US healthcare reform debate?

To help Taiwan develop its universal healthcare system, he commissioned white papers from England, Canada, Japan, the US, Germany, and France. He asked representatives of these nations to answer four not-so-simple questions:

1) What is your country’s system?

2) What part is successful?

3) What part is not working well?

4) Why isn’t it working well?

Initially Taiwan wanted to do whatever we Americans are doing, as the Taiwanese idolize our country. But they soon realized that we didn’t have a system; it’s a market and it isn’t working well AT ALL. Any healthcare economist around the world could have told them that – American healthcare is a global laughingstock. It is the lowest quartile solution that every country strives to avoid. Merely bringing up the US healthcare situation is enough to quell any complaint about a universal healthcare country’s system.

So Taiwan left the US on the scrap heap and did the Asian thing by choosing items off a multi-columned menu. It selected Canada’s single payer system, but assessed premiums instead of taxes, similar to Germany’s Bismarck approach. Then it added France’s carte vitale, which is a Smart Card patients carry containing their medical record and insurance information. It allows providers access to their patient’s medical histories and enables them to bill at the time of service (literally with the patient still in the exam room) so they receive payment within days.

Next Taiwan established government rate-setting powers over healthcare services and drugs, just like France and Japan have been doing successfully for years. Finally, Taiwan set an aggressive timeline for implementing the plan; on March 1995, within one year of plan publication, Taiwan’s new universal healthcare system became available to all citizens.

How did this Asian country accomplish such a huge, controversial undertaking in such a short time? They started with Dr. Hsaio’s “First Question”:

Do we believe that everyone should have access to healthcare, that it is a moral right?

It doesn’t just work for new healthcare systems though. Switzerland asked the same question when revamping its healthcare mess in 1993. Instead of getting side-tracked by arguments about “socialized medicine”, the federal deficit and personal responsibility, Swiss leaders asked, “What are our basic ethical values? Do we believe that every Swiss has a right to healthcare when she needs it?” The answer was yes.

Dr. Hsaio could lead the US through the same process if we allowed him to. Instead of talking in circles, taking dead end and circuitous backcountry roads, let’s start with the key question. Do we believe that every American should have equal access to healthcare, regardless of financial means? That’s the Hsaio method of defining a country’s healthcare vision. From there, all roads lead to the vision. Pick from a menu of successful international healthcare strategies, and avoid the problem-laden ones.

We could have the best of everything, instead of a uniquely American failure. It just takes inviting the right people to the party.

Photo Credit: Pete Souza

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