Report by PNHP Illinois Intern Chihwen Chen, MD

I am a Taiwanese citizen who is covered by the national health insurance, which is a single-payer system that was implemented 16 years ago. For the past 16 years I’ve been living in the United States. Since high school through college, graduate schools and now just graduated from medical school, I was always covered by my student insurance until recently I’m now officially uninsured. I went from having the protection of single-payer to somewhat lousy student insurance to now not being covered at all.
That’s why I felt the need to voice my opinion and contribute my time to single-payer.

Sometimes I wonder why, why don’t we have single-payer here? It is such a wonder, convenient system, and yet in expensive. I was a beneficiary of single-payer in Taiwan and I am uninsured in the U. S. I understand what it was like to have single-payer and I understand what it is like to be uninsured. I believe I need to be involved in changing the health care system and become a single-payer activist. I always knew I wanted to get involved, but I didn’t know where to turn to until Dr. Claudia Fegan from Physicians for a National Health Program (PNHP) came to Mt. Sinai Hospital in Chicago to talk about single-Payer during our grand rounds. I dropped off my resume at PNHP and the next thing I knew, I was working with my mentor, Dr. Anne Scheetz.

During the internship, Dr. Scheetz came up with an idea of interviewing physicians in Taiwan. With my family ties back home, I was able to conduct a phone interview with a cardiovascular surgeon at Veteran General Hospital in Taipei, Professor Chun-Che Shih. MD, PhD, FACS., one of the top surgeons whom I had the opportunity to work with on a research project two years ago and later published a paper in the Journal of Vascular Surgery. I was also able to have a fun conversation with Dr. Chung, MD., an energetic pulmonologist at Taiwan Anti-Tuberculosis Association. They both agreed that implementation of single-payer in Taiwan definitely put more burden on health care professionals. Whereas, under the old system, they could make profit from each service (office visits, tests, procedures, prescription drugs etc.). Dr. Chung’s daughter lives in the U.S. and he said jokingly, “The money I make now wouldn’t even cover the vet bill for my daughter’s cat” But both he and Dr. Shih felt it is well worth it for the well-being of their patients and for the satisfaction of being able to treat people as they know they should. They mentioned that whatever diagnostic tests or procedures that are needed now can be done without patients having to worry about financial burden. The system in Taiwan before the implementation was just like what we have in the U.S. right now, trying to patch holes with different plans and left many people uninsured. I asked the physicians when they first heard about a single-payer system. They answered that they first heard about it two years before it was implemented. During that two year period, there wasn’t much opposition to single-payer from the physicians. They told me that they followed the direction of the government and it was good for all the citizens, so they went along with it without too many complaints.

Part of it has to do with Taiwanese culture as a whole, we are taught to obey the hierarchy, to look up to the elderly who have wisdom and experience, and to respect authority. I believe this is an important factor in why it was easier to execute the system in Taiwan than it would be here. As the doctors described it, they didn’t think too much about the new system at that time nor were they afraid of it, because the government said it was going to be good.

One of the most interesting things I have done during my internship would not have been possible if I were in Taiwan. Physicians aren’t allowed to form organizations that can rally or demonstrate protests in Taiwan, so I would have missed my participation in various rallies and demonstrations with Dr. Anne Scheetz. Having never done such things in my entire life, I found it to be a valuable experience to have.

Anne guided me through this internship tirelessly and made sure I was on the right track. She gave me numerous opportunities to make sure I truly learned something from this experience. Dr. Scheetz was always on top of the game and had a clear vision and direction about what needs to be done. I also enjoyed traveling down to southern Illinois to Edwardsville to spend time at the farmer’s market with Dr. Pam Gronemeyer where I was able to chat with many single-payer supporters. Dr. Gronemeyer was very friendly and easy to chat with. She was always enthusiastic and has endless ideas. Also, meeting with U.S. Congressional candidate Dr. David Gill was one of many highlights of this internship which gave me a taste of American politics. Having dinner, chatting about health care system over piano pieces with Drs David Moore and David Deblatt was one fun event that I won’t forget. Their friendliness and their hospitality was beyond I expected. Dr. Moore’s piano skill and his interpretation of classical piano pieces was truly advance. We finished the get-together with a duet and hopefully we will share our love of piano again soon.

Dr. Scheetz also sent me to meet with Sue Saltmarsh who is an amazing writer for TPAN’s (Test Positive Aware Network) Positively Aware magazine, a national HIV/AIDS treatment journal, to learn interview skills. During the course of our meeting, I learned a lot from her regarding what to expect during interviews or when giving a presentation.

Being a foreign student, English is my second language and I always struggle with it, even though I have lived in the States for a long period of time. This internship trained me and helped me to improve my communication skills. Because of this internship, I was given many opportunities to improve my conversational and social skills.

Being a PNHP intern, and a single-payer activist makes me start preaching single-payer health care system to all the people I am encountering. Because of PNHP, I’ve found a new purpose in life. Together with my knowledge in medicine and in accounting, I believe I can make a difference in the future and hopefully I will see single-payer here in the U.S. one day soon.