This article explores the history of the Chinese Nationalist Party (Kuomintang KMT) government’s expansion of health insurance in Taiwan from 1950 to the 2010s through the lens of ethnicity, politics and medicine. I argue that the KMT party-state’s expansion of health insurance privileged government employees who were the core supporters of the ruling party. By comparing the history of the insurance programs for government employees and laborers, the article makes the case that KMT provided better coverage, lower premiums, and less medical gatekeeping for Chinese waisheng government employees who fled to Taiwan with the KMT than for ordinary Taiwanese bensheng laborers. Global actuarial science experts from the United Nations International Labor Organization also buttressed such a discriminatory process. This China-centered approach towards universalizing healthcare on the island became increasingly challenged by provincial legislators, labor activists, and the emerging political opposition that promoted local Taiwanese concerns on healthcare equity and access. This article concludes that this dual process of KMT’s population management and leveraging of United Nations actuarial expertise as the Republic of China became symbolic of the bio-geopolitics that animated the history and development of health insurance in Taiwan.
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In the 2008 documentary Sick Around the World, shown on PBS on the eve of Barack Obama’s victory, filmmaker and journalist T.R. Reid visits and compares the healthcare systems of Taiwan and four other countries (United Kingdom, Germany, Switzerland, and Japan) with that of the United States. Reid argued that Taiwan was a “small Asian nation” that “picked and chose from the best healthcare systems” around the world to develop “a system that gave equal access to healthcare, free choice of doctors with no waiting time, and a system that encouraged lots of competition from medical providers.” Reid interviewed Princeton health economist Taiwanese American Tsung-Mei Cheng, who remarked that “the [national health insurance] program they [the Taiwanese] set up in 1995 is really made up of a car that was made from many parts … imported from overseas but manufactured domestically.” Unlike Germany, which allowed rich people to opt out of public insurance, Taiwan mandated everyone to join the insurance system. Unlike Japan or Switzerland, which had multiple funds, Taiwan had only one national fund, which drove administrative costs down and kept premiums modest. Reid argues that all Taiwan needed to keep their healthcare system going was to raise their insurance premiums modestly, even though they have been reluctant to do so for fear of angering voters in free and fair elections. Too much democracy, in other words, might impede the future success of the Taiwanese enviable healthcare system. To Reid and Cheng, Taiwan’s national health insurance (quanmin jianbao 全民健保, hereafter NHI) program was a thriving global assemblage of knowledge, resources, and ideas in the 1990s, elements that Obama and John McCain should consider in making healthcare cheaper, accessible, and more affordable to more Americans without comprising the quality of care. Since Reid’s production, Taiwan’s NHI system has been widely lauded by transpacific critics, both for its elegant single-payer system, as well as how it has been used to fight against COVID-19 successfully (Cheng Citation2020; Scott Citation2020; Wang et al. Citation2020).
