Dear American people:

  I feel so sorry to know that Americans still have some fury inside. Market mechanism is the only remedy for dispute, including wealth sharing, medicare, education and other important things. American people may have some envy that other countries have the national healthcare system. The truth is that every country with national healthcare system has their own unresolved problems. The common one is the waste of medicare resource which increases the medicare cost higher and higher without limit. We do not know how much the Taiwan NHS will cost us. We don't even know how to make premium and cost meet. It seems to be impossible today and forever. In taiwan, in 2018, the NHS premium collection is around 290 billion New Taiwan dollars but the payment is around 690 billion New Taiwan dollars. There is a big discrepancy around 400 billion NTD this year. Based on the affordable principle we set, the government could not ask people to pay more premium under certain rules, but you could find the cost is three times than the premium collected today.

  We should not have the NHS in the first place. Now it becomes a pain for the government. From the beginning of Taiwan NHS, the government's payment is around 250 billion NTD per year. Unfortunately, the cost increases each year. After around 20 years, the payment goes to 700 billion per year which is around 2.5 times compared with the starting year. And the number is incrasing even we already make doctors and nurses in the clinic or primary hospital get less salaries for a long time. The salary of doctors and nurses in the clinic or primary hospitals are reduced at least around 30%-40% within 20 years. The payroll may get even less if the governement continues to cut the NHS cost.

  I know Americans have estimated the medicare-for-all system will cost you around 2.5 trillion USD in total. It is a nonsensse number. From our experience, the number is not countable. I guess it is the number of the three years' total. The cost will go up without limit if you use our rules to have your medicare-for-all system. If in first 3-4 years, the cost of medicare-for-all costs 2.5 trillion USD at least, then, after 16 years, the cost of 3 to 4 years will increase to 7.5 trillion USD. I have to remind you the number will keep increasing without bound. The cost will be hard to reconcile from the NHS premium because the mechanism design is so hard to make the number breakeven. No one knows how to make the numbers meet in a long term.

  The reason that American people could not afford to have medicare-for-all have following reasons

   1. Those people who still not have medicare, even after the Obamacare, is a big problem for the US government. The government doesn't know how much it will cost to let all those people, who don't have medicare coverage now, to have some form of basic medicare.

   2. Our system lives with the fact that a lot of bankrupt hospitals and clinics with lower-paid doctors and nurses. I have no idea if your doctors or nurses could tolerate the fact when the government may face the cost cutting issue and have no other way to cut. The hospital may be asked to absorb the medicare cost with the government. Then we may see a lot of medical schools have no students to enroll when doctors get no paid from the medicare-for-all system. the cost will be so large and unexpectable for the society.



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