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Why Is This So Hard? 

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The year was 1993, and something rare was happening — both political parties were finally agreeing that something had to change about the health care system. They didn't agree on what exactly to do about it, but they knew something had to be done. We know the rest of the story: Sweeping reforms were passed the following year, implemented in 1995 and two decades later, all citizens are now covered, people are living longer and costs are well under control.

Wait, did you think I was talking about the United States? Sorry, I'm talking about Taiwan — you know, that Asian country with about the same population as Texas.

It is a striking juxtaposition: At the very time the Democrats here dabbled with a single-payer system and Republicans threw their support behind the individual mandate, Taiwan's competing political parties went ahead and just got 'er done.

The results of doing something instead of punting the political football are stunning. As of 2009, Taiwan was spending about 2 percent of its GDP on health care; the U.S., as of 2011, was topping 17 percent — a ridiculous amount by international standards. Taiwan also has had zero personal bankruptcies due to lack of insurance; data from the CDC, the U.S. Census and the Commonwealth Fund show that 1.7 million households will go bankrupt over health bills in 2013. And nobody dies from lack of health insurance in Taiwan; the American Journal of Public Health counted 45,000 American deaths as being related to a lack of health insurance in 2009.

Multiply those figures by 20 years, and you have a medical mystery: How did America ever vaccinate itself against what should have been a nasty case of moral outrage?

What Taiwan did in a couple years with the help of one Harvard professor, as detailed in T.R. Reid's The Healing of America, we still can't get right. The president's website has just barely come back from the dead, and his political opponents — the same ones who championed the central premise of Obamacare in 1993 — keep heckling and throwing stuff.

Why am I bringing all this up again? Haven't I written this column, like, a dozen times? For 20 years at least, we've been doing nothing but talk — meanwhile, the likes of Taiwan (seriously, Taiwan?) are passing us by. So as we embark on the messy business of implementation, and as many still want us to 46th-guess our decision, it's worth remembering the moral and financial reasons for reform. Getting there has been way too painful, but we are doing the right thing. ♦

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