Showing posts with label national_health_insurance. Show all posts
Showing posts with label national_health_insurance. Show all posts

Tuesday, January 5, 2021

Neither and Both: proposing an end to the "Taiwan: liberal or conservative?" debates


Piggybacking on my last post about abortion, I began to think about the old dichotomy that seems to keep popping up. Given Taiwan’s democratic success and free press, recent legalization of same-sex marriage (note: not marriage equality), the more-or-less progressive-ish track record of the Tsai administration can we call this country a “liberal” one? 

Or is the ongoing human rights crisis regarding foreign blue-collar labor, often conservative attitudes of the general public, the ridiculous treatment of female public figures, the continued existence of the death penalty and the criminalization of adultery (now decriminalized!) and the continued lack of options for unilateral no-fault divorce enough to swing it the other way — is Taiwan still a “conservative” country?

Of course, as with most of these “is it A or B?” debates, it mostly seems to be people looking for something to debate. In the end, Taiwan is neither liberal nor conservative, or both liberal and conservative. Honestly, it depends on how you define it. 

I do take the liberal viewpoint as the sometimes imperfect but overall superior one; a core tenet of liberalism is to let other people live their lives non-judgmentally and not discriminate against them in any sort of transactional or legal sense. 

Early on, I realized the different ways of looking at this needed to be investigated separately.  So let's investigate! Why is it reductive to declare Taiwan "liberal" or "conservative" like it's a true-or-false question with one clear answer?

It depends on what you’re comparing it to

If your frame of reference is, say, Europe, it’s fairly easy to proclaim Taiwan “still very conservative”, dust off your hands and be done with it. In Europe, adultery isn’t criminalized, marriage equality is broadly (though not universally) recognized, there is no death penalty, in most places abortion can be obtained on request or very easily, gender equality is generally quite good, and —speaking anecdotally — I often find that moderate to center-liberal Europeans tend to equate to so-called “left-wing” Americans (who are not actually left-wing at all: most are pretty moderate.) Most of Europe also allows unilateral no-fault divorce, although the UK and a few Catholic-majority countries don’t.

I don't know as much about the internal social workings of various European nations, so I'll leave it at that.

If, however, you compare Taiwan to its neighbor states in Asia, you will likely come to a very different conclusion. 

In most of Asia, divorce is similarly restricted. No-fault mutual divorce is generally obtainable in other industrialized Asian nations, but mostly banned in the Philippines and very difficult to obtain in some other developing parts of Asia. However, rather like Taiwan, unilateral divorce generally requires proving some sort of fault. Most Asian nations retain the death penalty, even if they don’t exercise it. I can’t find information on some countries, but in Japan and South Korea, spousal consent is still required to obtain an abortion. Along with this, gender equality metrics in most other Asian countries show Taiwan in a favorable light, comparable to Hong Kong and Singapore and ahead of just about everywhere else in Asia

With changes to adultery laws, the legalization of same-sex marriage and hoped-for changes to abortion access, who can reasonably look at Taiwan compared to the rest of Asia and say it’s “not that liberal”? 

Why, if one is inclined to insist that Taiwan remains a conservative nation, does one have to look to the West to validate that view? 

But - does it even depend on what you compare it to? 

Hold up, though. Let’s look at a few examples from the West. Is it really that much more liberal? 

Divorce laws in the UK are broadly similar to Taiwan’s. They don’t have unilateral no-fault divorce either. Spousal consent for abortion is not required, but giving a ‘reason’ is — acceptable reasons are very broadly defined, as in Taiwan. Ending the criminalization of adultery and (probably) making abortion more accessible to married women will still render Taiwanese laws a bit more conservative than their British counterparts, but not by much. The UK will still be ahead due to abolishing the death penalty, which remains popular for some reason in Taiwan. But in what other ways can the UK be said to be “more liberal”? 

In some ways, one could say the tie-breaker here are social mores. Public opinion, you might say, is more liberal in the UK. Certainly you would not find a public opinion poll that showed popular support for the criminalization of adultery, legalizing capital punishment and disallowing same-sex marriage. You might point to British society and say that it’s so much more diverse, and that diversity begets a sort of liberal strength. 

Sure. I’ll buy that. (Taiwan is also multicultural and multilingual but that diversity is less immediately apparent.) 

But I’ll also point out that while it’s nearly impossible to get dual nationality in Taiwan if you don't have the right ancestry, it’s fairly easy to immigrate here, at least for foreign professionals. Even the salary and qualification requirements to do something other than teach English (2 years’ relevant experience or a Master’s degree in anything) are fairly permissive. If you come to Taiwan to study and can get a job offer upon graduation, it’s fairly easy to stay. 

Once in the UK, there is a path for most to citizenship. However, it’s extremely hard to actually immigrate to the UK to get that process started. Once there, you might still be kicked out, possibly for deeply unfair reasons. For all that diversity, it seems as though the United Kingdom doesn’t actually want non-British people to settle there. 

I would call that a distinctly illiberal view. (In fact, in general, I find my fellow liberals tend to have oddly regressive, even reactionary views on immigration. In non-pandemic times, I consider being pro-immigration to be a fundamentally liberal value.)

Of course, it’s not fair as an American to sit here wagging my finger at the UK. 

The US seems to be unable to reconcile the fact that most Americans support abortion rights with the legions of conservative clownwaffles who keep trying to take those rights away. Abolishing the death penalty in the US feels like a faraway dream. Supposedly one of those “more liberal” countries, we (sort of) elected Donald Trump in the same year that Taiwan chose the comparatively liberal and pragmatic Tsai Ing-wen. We only legalized marriage equality a few years ago — look how fast Taiwan moved in comparison. As with the UK, it’s very hard to immigrate to the US. In fact, it’s difficult to immigrate to most Western countries.

You might look at the US and again point to the nation’s visible diversity. Well, I grew up in the US and in most of the country, diversity doesn’t mean mixing. I don’t want to speak for people of color when I haven’t experienced the same things, so all I can say is that many White people I know in the US live in almost exclusively White areas, and for many, there doesn’t appear to be a single non-White person in their circles. I have heard the same sort of conservative or right-wing rhetoric — the same old racist, sexist, anti-LGBT rhetorical trash — in the US as I have in Taiwan. In fact, as I’ve noted before, it seems to be one of the US’s major cultural exports here

So although adultery is not an offense and unilateral no-fault divorce is possible. But in what other ways can I say the country of my citizenship is more liberal than Taiwan? It’s hard to think of much. 

Placing a high importance on making sure all of its citizens have what they need is a core tenet of liberalism for me. In that way the US again fails, with not just high rates of inequality but a total breakdown in the accessibility of quality health care to all but the upper classes. Few in Taiwan would disagree that everyone deserves access to affordable basic health care. In wealth equality generally, Taiwan is comparable to many Western nations. 

And of course, the people

Now that I’ve made the country of my birth sound like a terrifying hellscape — which these days, from a distance, it seems to be — remember that there are plenty of liberals, lefties, progressives, radicals, socialists, whatever you want to call them and all of them are slightly different. On both sides, I've met people who challenge assumptions. They could be anyone, from carceral feminists to liberal/leftist activists with misogynist views to people who are pro-healthcare but anti-immigration, to conservatives in every other sense who are finally embracing marriage equality or no longer trying to dictate whether mothers should stay home or return to paid work.

The youth tend liberal, but Young Republicans are a thing. For every BLM activist, there’s surely a Brocktaniel Craigstopher Broseph Dorpington III who is certain he’ll be a senator someday and can't wait to turn his opinions on women's bodies into legislation. My grandparents, when they were alive, always seemed surprised to hear that liberals were a real thing and it wasn’t just me.

My liberal friends always knew that the other side existed — they didn’t live in quite as much of a bubble — but often underestimated exactly how many people really felt that way. That is, after all, part of how we got Trump.

Taiwan is similar. How can you say a whole country is conservative when the youth tend to overwhelmingly support liberal causes (except, for some reason the death penalty, which seems odd...though perhaps not that odd) and then are surprised when those causes meet strong resistance. But how can you say it is liberal when their aunties and grandpas are more likely to vote, though perhaps less overwhelmingly than in the past?

Of course, the aunties and grandpas assume the youth to be a minority of loud kids, perhaps not even realizing that their younger relatives agree with those “other kids”, but have decided it’s easier not to bring it up. Many are traditionally conservative, but some of their views -- such as understanding the fundamental need for universal health care -- would look liberal to your average American. 

In other words, for every young urbanite who was shocked to see marriage equality referenda slapped down in 2018, there is someone like the Bread of Life lady in my building who keeps putting up anti-gay brochures and seems surprised when they are taken down. 

Both groups are loud, and both can mobilize. One is older and on their way out, but will be engaged voters for several years more. The other has shown they can defeat an attempted pro-China “populist” wave. 

It’s very hard for me to say the US is ‘liberal’ or ‘conservative’ when different Americans are, well, so different

So it is with Taiwan. 

What does it mean to be ‘liberal’? 

The notion that Western-style liberal/conservative dichotomies have dominated these conversations is not new. When looking at non-Western societies, it’s quite common for someone to point out that notions of ‘freedom’, ‘choice’ and ‘equality’ can look very different through different cultural lenses. 

I don’t mean this in the old ‘individualist vs. collectivist’ debate, another binary that I find a bit overstated. People who proclaim some societies ‘individualist’ and others ‘collectivist’ forget that nothing is that polar, gloss over the interplay of personal and collective choices at the individual, small-group and larger social levels. They further tend to blur the very different definitions of ‘individualism’ with ‘individuality’. Just as an ‘individualistic’ European or Brit (sorry, Brits, you’re separate now) can insist that national health care and affordable education are common goods, so can a ‘collectivist’ Taiwanese find their own path and express their individual spirit while caring about society and family.

Instead, let me illustrate this through a series of anecdotes. Although this is now considered a somewhat traditional or even out-dated practice, some men still hand their salary over to their wives, who run the entire household budget and give their husbands ‘allowances’. (This also happens in Japan and the practice might originate there; I’m not sure.) This has led to society as a whole believing that women are good with money. As a result, accounting tends to be a more female-dominated profession, and ask any family business who keeps the books. I bet you a beer it’s likely a woman. 

And to think, I grew up in the “more liberal” United States hearing dumb jokes about how women just spend money shopping and a husband might have to cut up his wife’s credit cards because she bought too many purses! 

And yet, a 老闆 (laoban) is assumed to be a man, whereas 老闆娘 (laobanniang) can be translated as "female boss" (as though it needs to be a gendered term) or...the boss's wife, even if she's really the boss.

Here’s another one: the Taiwanese government, despite all of its recent progressive leaps, still seems to think that more babies and bigger families are always a good thing, despite the country being already fairly densely populated. And yet, they now seem willing to look at the country’s current abortion laws and realize that they need to be liberalized, without compromising their view that families should have more babies. 

I believe (and hope) they see that abortion isn’t what’s stopping people from procreating; that a person who wants to have a child will try to have one, and abortion being more accessible won’t make them change their mind. That encouraging people to have more kids means ensuring a better standard of living, that families have enough time, money and housing to raise children. Do that, and most people will choose to have children. Abortion is a separate issue entirely. 

Oh, how I wish I could get anti-abortion politicians and reactionary voters in the US to realize the same thing! 

In fact, here's a quick aside: let's jump back to my assertion in the last post that making abortion accessible to unmarried women had nothing to do with giving women choice while valuing the partnership of marriage. We know it's more about which babies are "desirable" to society than about rights, because single people and same-sex married couples who do want children aren't allowed to access fertility treatments

The government is finally starting to act on improving abortion access, but nobody seems interested in fixing this problem despite it being a protested issue since at least 2016, and probably earlier. So is it acting in a liberal manner, or not? It's hard to say.

I could add more cultural anecdotes from other parts of the world — for example, the fairly liberal stance of Islam on family planning compared to much of the West through history — but they would be cultures I haven’t spent as much time with, and thus would be less informed. However, such examples exist. 

The short of it? I don’t think it’s fair to measure Taiwan by a liberal/conservative spectrum informed by Western assumptions, when the way people make sense of the world through a Taiwanese cultural lens is just...different. Sometimes, I think better. In some ways, perhaps not. 

This was apparent watching so many otherwise liberal Taiwanese go pro-Trump, who is about as right-wing as it gets (though it's hard to tell how much of this was straight-up malicious trolling, as people seemed more reasonable in real life). I don't agree at all with their reasons -- nobody who thinks Trump's pandemic response is an acceptable price to pay for anything is welcome in my life -- but the reasons did exist. They mostly don't care about our political binaries, so it's not fair to measure Taiwan based on those same binaries.

I’m also not a total cultural relativist; I too have my lines and I too make personal and individual judgement calls. But I am open to conceiving of liberalism in different lights and will criticize or praise individual ideas, not entire belief systems, including my own.

There are people who insist that any and all conservative ideas they don’t like which exist in non-Western societies were put there by colonialism, and decolonization will therefore liberate those societies from such beliefs. I don’t fully believe that; although I occasionally come across examples of this (say, certain aspects of Taiwanese society that seem to have been shaped more by the outside influence of Christianity on ROC politics than on any local cultural norm), it’s far too ‘noble savage’ or Orientalist. In other words, I’m not impressed by ‘every Western idea is bad, every non-Western one is good’. The West has had some pretty good ideas and some atrocious ones. Every society is capable of both, and a whole lot in between. Every society is going to have some ideas we might see as ‘conservative’, and others that could be called ‘liberal’. Taiwan is no different.

What matters is that we recognize that there is no objective yardstick by which to measure any of this, and perhaps it’s wise not to make any sort of proclamations about it. 

Sunday, March 15, 2020

Data and Lore (a COVID-19 story)

Does this mean...I'm Wesley?

I had always imagined that, living on an island, I'd feel trapped if disaster struck. There are no borders to cross, only open sea. I know it's not a reasonable worry: land borders can also be treacherous, but knowing your only options are a plane or a boat (and probably not even a boat) rather than a truck, car or your own two feet can honestly induce claustrophobia.

So, while the world around us seems like it's collapsing, I'm surprised by how wrong I was in predicting my own feelings about island life in a global catastrophe. Thanks to Taiwan's pre-emptive, centrally-planned and intelligent response to the COVID-19 pandemic, I feel like I'm living in an island of safety, calm and normalcy in a world gone mad.

I am not terribly concerned that Taiwan will be felled by COVID itself. Even if there is a spike in cases, the time the country bought itself through a strong, early and professional response will be priceless: it is time Taiwan has had to prepare for that potentiality, and considering how they've treated the issue so far, we can be fairly sure they've been using it wisely. 

People are doing their part too - for every anecdote I hear about someone not practicing good pandemic hygiene, I see 20 people who do.

Of course, my confidence extends only to health. I worry quite a bit about the economic backlash. We have enough savings to weather a brief storm, or even a somewhat-prolonged quarantine, but what about an interminable economic crisis? A lot of my clients are businesses, and when the economic crash really hits, the first thing they're going to cut is English training. My teacher training work might see an uptick, but it's honestly hard to say.

Let's not think too much about that, though. There is literally nothing I can do about it except spend less on non-essentials. Once it was clear that climate change was real, I never expected the second half of my life to be easy anyway.

So, what has Taiwan been doing right? I won't write out a whole list because there are lots of places where you can read about that: see here, here, here and here. Suffice it to say, a large component of Taiwan's response has been data collection and public regulation. Most notably, for certain people quarantines are mandatory, and everyone that person had been in contact with might also be asked (or required) to quarantine. Quarantined individuals have their phones tracked and are notified if the government can see there is a violation. The CDC calls them every day (though this is a lot friendlier than it sounds). Isolated people report their temperature online once a day. All face mask production lines were bought up (in essence, expropriated) by the government, and masks are now rationed. Huge amounts of personal health data - including masks purchased - is tracked on National Health Insurance cards. Some public transportation, including all Kuo-kuang buses and all airport MRT trains - require face masks.

This gives the government a massive amount of data to work with, which has some fantastic benefits. There is an app (which is a bit difficult for foreigners to use) that can track which pharmacies will have masks, how many, and when. Apparently one can now pre-order masks. Potential disease vectors are swiftly located and locked down to prevent transmission.

Watching the news from the US right now, where the response seems to be to run out in the street screaming and flailing one's arms, it sure feels like they could learn a lot from the way Taiwan has handled this, starting with universal health coverage.

On the other hand, I have to wonder how much of this Americans would realistically put up with. The scale of data collection really is astounding. If you are identified as a risk, you lose a lot of personal freedom - both in terms of data privacy and freedom of movement. It is, to be honest, a lot to ask.

This is the point at which a different writer might start waxing rhapsodic about Confucian societies and collectivism and the people are more willing to submit to authority because 5,000 years or...something like that.

I won't.

This is a country where people set their sights on overthrowing a dictatorship and succeeded. Where protests are practically a hobby and producing protest gear a side hustle for many. Where your average person would be pretty upset if they couldn't day drink under their favorite temple awning (or in front of their favorite convenience store). Where an entire generation of people under 40 defied their elders by voting for same-sex marriage. There's no Confucian about it and I'm sick of the trope.

Instead, I'll say this: as an American, I'm fine with the level of intrusion into my personal life and willing to give up the data. I suspect - though don't know - that most Taiwanese are too. Not because of some 'different, exotic Asian values' fake East-West divide (a divide that online trolls really seem to push, which is how you know it's fake).

Rather, most Taiwanese are okay with Big Government  right now because this particular circumstance is a true emergency, because they know that this particular data is useful and important for a centrally-coordinated response to work, and because they trust this particular government. 

While we can heave a sigh of relief that this government was re-elected (for a peek into how a Han administration would have handled it, you need only look at Trump's non-response), unfortunately, this perspective doesn't offer many solutions for what to do when you don't trust the government. I don't often agree with libertarians but they're right about this: you only want the government to have as much power as you'd be comfortable with them having if you didn't trust the people in charge, because eventually, someone you don't trust will get elected.

In other words, I'll give this information (and power) to Tsai Ing-wen. I would never be happy to give it to Donald Trump. Or Han Kuo-yu. Would you want either of them at the helm of a government that has just taken sole control of key medical supplies? Would you want either of their administrations insisting they had the right to track your location?

All that data, though, has kept Taiwan feeling more like a cozy ark on a rising flood, rather than a prison from which there is no escape. And perhaps, considering that dictatorship existed in Taiwan in living memory so they know the difference between authoritarianism and a centrally-planned response, maybe we should take their word for it that government data collection for this purpose is acceptable?

So what's happening beyond the rough seas? Between many Western countries' totally botched responses - including a massive failure to test leading to rapid, undetected community transmission - and China's repeated cover-ups and lack of reliable data, there is fertile soil for misinformation and fake narratives to take root.

I had opined, when this all began, that such an obvious and self-evidential failure and clear, documentable cover-up on the part of the CCP might just offer up a silver lining: that the CCP itself would fall. That the systemic failure would be so inescapable that they would not be able to control the narrative. I figured it would be so undeniably true to anyone with working brain that China did not "buy time" for the world, but rather that the CCP's initial cover-up is what caused the disease to go pandemic in the first place, that something would possibly - maybe - give to loosen the grip of that brutal dictatorship on a country that absolutely deserves better.

For a brief period, it seemed that the world might just hold the Chinese government to account for this, or at least report clearly on who was to blame  - not China or the Chinese people, but the CCP.

But even before the US botched its response by completely failing to prepare, one could watch the narrative change almost in real time.

First, the media started saying that China "bought time" for the rest of the world, how its "decisive" and "bold"  response - note the adjectives used instead of the more appropriate draconian and inhumane - saved lives, how it "acted quickly"  (see here, here, here, here and here).

I thought when I hate-read these pieces that, yes, dragging screaming people into their homes and boarding the doors is, I supposebold in a sense. But are we really all pretending that the initial cover-up which is directly responsible for the pandemic going global in the first place just...never happened? Are we truly allowing COVID-19's origin story to be re-written so easily?

I'm not the only one who's noticed, fortunately.

Of course, it's difficult to argue now that the US or Europe could have done better, as they have now both failed so spectacularly. The difference, of course, is that in a liberal democracy you can say so without getting shot, and theoretically can put better people in office next time.

I can empathize, however, with people whose governments did too little thinking that maybe the government that did too much - and now claims that cases are in decline - had the right of it. Even if that sentiment ignores the facts. Even if you are in essence saying "it would be acceptable to drag my screaming neighbor into their house, padlock the door and walk away with the key. It would be acceptable to do that to me, too."

These are the same people who think it's un-American to even ask them not to gather in crowds. Do they think China couldn't possibly be as bad as it actually is, or that it's OK to do that to others but "it would never happen to me" they just use the cognitive dissonance like a white noise machine to help them sleep at night? I truly don't know.

Neither of these are good! 

It doesn't help that the facts are hard to come by. It's honestly surprising to me how many people understand that the US has no idea how many COVID-19 cases currently exist within its borders, but actually believe the numbers from China, despite China's clear history of lying about them. Now people are saying cases in China are on the decline, but can we really trust that, when nothing the CCP has said since the initial cover-up can be trusted? I don't, and you shouldn't either.

The CCP understands this better than anything: in the absence of trustworthy data, you can make up your own lore.

While all of this has been going on, there's been an ongoing discussion of whether calling COVID-19 "Wuhan Pneumonia" or anything relating to its place of origin is racist, as these viruses can originate anywhere. I don't know that changing a disease's name can really combat racism, but it almost doesn't matter. I'm not qualified to say whether referring to Wuhan in the disease's name is, indeed, racist - totally not my lane. I don't use it - it's too long and seems unnecessary. Holding the CCP to account and not treating people in racist ways both seem like more important things to worry about than exercising my 'right' to call a disease by a common name.

 But I will note that in Taiwan it's called 武漢肺炎 (that is, Wuhan Pneumonia) in Mandarin. It's slightly amusing to me that the CCP insists that Taiwan is a part of China, but also that calling COVID-19 "Wuhan Pneumonia" is racist...against Chinese. By that logic, Chinese people are racist against themselves.

Anyway, I've noticed a particularly bit of nasty ret-conning on the English front too.

I support a general push not to stigmatize people by using place names in disease names going forward, but there seem to be a lot of gullible people who now think we've never called diseases that in the past, so "Wuhan Pneumonia" is a unique example of racism on this front. Of course, those same people will still use disease names like Ebola, Nipah, Zika, Marburg and MERS.

Don't laugh - I saw someone arguing that "we've never named diseases after places!" under a chart that included all of the above. So I suppose I consider users of the term "Wuhan Pneumonia" exactly as racist as I would consider users of the terms "Ebola" and "MERS".

It's been disconcerting to watch how the CCP propaganda machine has taken advantage of this confusion.

First, insisting that its response was appropriate and effective. Then, trying to tell the world (and their own people) that we should be grateful. Then, getting behind a call to label everyone saying "Wuhan Pneumonia" racist moving to a general call not to "blame China" (which, of course, runs in tandem with labeling all blaming of the CCP "blaming China" and therefore "racist"). And now, we've got CCP officials spreading rumors that the virus did not originate in China at all.

I still don't intend to call COVID-19 "Wuhan Pneumonia", but I do note that it's a lot easier to convince idiots outside the Chinese-speaking world that COVID-19 did not come from China if everyone's afraid of being called racist for discussing how it absolutely did.

And so from an undifferentiated mess of information - most of which is unreliable as China's numbers can't be trusted - we have a myth of CCP "decisiveness" saving the world. Lore spun from literally nothing into a narrative that credible people actually believe.

I had hoped that cold, hard data would carry the day. That it would be clear what works (a response like Taiwan's) and what doesn't (running around screaming like a hemorrhaging goat like the US). How draconian, inhumane methods like China's are not necessary if there is initial transparency and swift action. I had hoped that this clarity would lead to much-needed changes in how governments operate around the world, from an end to CCP tyranny to drastic changes in the US's broken system.

Instead, it seems that between data and lore, the latter can pose as the former because most people can't tell the difference.

We will all pay the price for it.

Wednesday, March 11, 2020

Paper Ninja Stars (or: Fear, Foreboding and the Taiwanese Left)

Screen Shot 2020-03-11 at 11.11.45 AM
The graphic that appeared by the names of some Taiwan Statebuilding Party candidates in the 2020 election on official ballots

First, an announcement: you’ll be seeing fewer (and shorter) posts from me between now and June. I am now officially shoulder-deep in dissertation writing and really must concentrate on that. I’ll update occasionally, but in the meantime I’ll be posting relevant content by others on the Lao Ren Cha Facebook page (yes, that is a thing which I never formally announced). 

Anyway, let me tell you a story. 

When I was in junior high, I was the target of a not-very-successful bully (everyone else hated him too; his bullying did not win him any popularity). He’d randomly trip me in the hall, push or whack me for no reason. Once, he ran into a classroom I was in, put some tape he’d pulled from a cassette around my neck and ran out holding both ends. One day, he made a paper ninja star and flung it at me just as a class we had together was about to start. It nearly hit me in the eye.

I lost it. I got up, slapped him hard across the face, picked him up by the neck - lots of adrenaline going - threw him into a row of desks, and then kicked him so he slammed further into those desks. I may have done more; I was a whirling dervish of rage and I truly don’t remember. 

My response was way out of proportion to his throwing a paper star at me. But honestly, considering everything else he’d done over the past two years, it had been a long time coming. I don’t condone violence and would not do this as an adult, but I’m also not sorry for beating the crap out of him as a teenager. 

So what? 

I’m not talking about those who pointed out the logistical issues or the question of priority. Those opinions are reasonable. I’m talking about those who expressed that the lives of those people were not Taiwan’s concern - despite their being family members of Taiwanese nationals.

I had been trying to start from kindness - that is, recognize that it’s important to treat even people you don’t like as human beings whose lives matter. I’ll be the first to admit I don’t care for the attitudes of Taishang generally. And, just as importantly, that it’s not right to dismiss children as ‘not our concern’ because you don’t like the decisions of their parents - decisions the children had no say in. 

After acknowledging that, talk of logistics becomes possible, and the same decision may have been made in the end because China has left Taiwan with so few options - but the process of the discourse matters. 

I stand by that view, but here’s what’s changed: I should have also started from kindness when considering Taiwanese public opinion. 

With a few exceptions of some extreme comments online that do not represent the norm, I highly doubt most people actually want to punish those children by refusing them evacuation because they dislike their parents. Most people are quite capable of realizing that those children did not choose to be Chinese nationals.

Rather, it was a howl of rage from Taiwanese who’ve chosen to stay and engage with their country, who are sick and tired of both China’s bullshit and Taishang opportunism and sellout behavior that actively harms Taiwan. Howls of rage are not always politically correct, but that does not render them unjustified. This one was a long time in coming, and I should have seen that immediately. 

In other ways, I’ve tried to be empathetic to these expressions of anger. While I appreciate the discussion of Sinophobia in Taiwanese discourse, generally I feel we should always - always - view statements that may seem aggressively nationalist or anti-China on their face in the context in which they are made. 

Taiwan has been treated like garbage by the Chinese government for so long - and individual Taiwanese have been insulted by a large number of Chinese citizens so regularly - that honestly, can you blame them for lashing out? Maybe give the victims in this game a break instead of (yet again) putting the burden of assuming a conciliatory tone on them. 

Especially when they already know that it’s logistically impossible to do much for those children and accompanying spouses, it becomes easy to vent one’s justified rage at Taishang who expect special treatment and whine and writhe with entitlement when they don’t get it. 

That said, my actual conclusions remain the same: a different active response is not logistically possible, but I still cannot condone a “those children aren’t Taiwanese so they are not our concern” attitude. Even when their parents often have an opportunistic, have-your-Chinese-money-but-get-Taiwanese-benefits-too attitude to Taiwan (to put it gently).

The difference is this: I’ve come to realize the public anger mostly did not stem from the question of the Taishang children specifically, just as my throwing that kid into a desk in junior high wasn’t really about a paper ninja star. 

And that’s just it: while remaining true to ethical convictions that do matter to me, I could have started from kindness when evaluating a facet of public opinion that bothered me deeply. Both were possible. 

So where did my original reaction come from? 

Fear, honestly.

I don’t think the ethical divide on this issue is really that great, if it’s there at all. But where I saw “people lashing out at foreigners...and I’m a foreigner!”, I suspect most people saw “we’ve been bullied for so long by China and people who sell out to China, and we’re sick of it!”

“Foreigners” as a general class was never really the point.

This fear also includes worries over the unstable life situations all immigrants face. I do wonder, for some people (though not all), at what point in a crisis I might be deemed “not Taiwanese enough” to receive the same assistance as everyone else, as a taxpayer and part of the system. 

I’ve had a few experiences in the past where expressing a political opinion that a Taiwanese local did not personally agree with caused that person to default to “well, you’re not Taiwanese” (implied: so you don’t matter). That a lot - if not most - locals might actually agree with my opinion didn’t seem to register. I’ve had people just assume that if Taiwan faced a true emergency I’d just leave, because theoretically I "can" (I wouldn’t - and there are real questions over whether I actually "can"). 

At what point does a reaction like that spill over into views on who should get access to what services?

But, overall, I doubt most people would think I should be denied, say, medical care in Taiwan during a pandemic. I pay for NHI just like everyone else, after all, and don’t try to game the system the way a lot of Taishang do. In any case, there’s an element of white privilege which would blunt such an effect. 

Remember, however, that the vast majority of foreigners in Taiwan are not white, they are Southeast Asian, and they have neither the privilege nor often the resources to weather a public opinion backlash against their access to health services in Taiwan.

Is it any wonder, then, that when I hear “Taiwanese citizens first!” that it puts me on edge, even though I know that’s not meant to include me?

But, there’s an even more complex fear: fear that the Taiwanese political left I generally support does not actually support people like me. 

As much as I hate them, I can’t deny that the immigration reforms the KMT passed under Ma Ying-jeou were genuinely helpful for foreigners and conveyed a more welcoming attitude (though, again, that was very much contingent on white and Han privilege - rules were relaxed for Chinese accompanying family, and foreign professionals like me, but nothing really improved for the blue-collar workers who make up the backbone of Taiwan’s foreign labor and community). 

I also don’t doubt that the Tsai administration is more or less on our side: they passed some pretty striking immigration reform themselves, though again they seemed to encode privilege into law, demarcating in even more detail which immigrants were ‘worthy’ and which were not (spoiler alert: I’m not). 

But those left of Tsai - think the NPP, back when they mattered? They were key voices in scrapping the proposed relaxation of rules on hiring foreign workers, such as the required salary floor and required previous work experience for professionals. (Their arguments did not make a lot of economic sense, either - they just ensured that people who wanted to move to Taiwan either could not do so, or got stuck teaching English when they really didn’t want to, which isn’t good for the profession.) I hear noises from them that immigration should be controlled to ‘protect Taiwanese jobs’ and no specific support from them on the ever-present dual nationality issue, despite their putting forward an ‘internationalized’ face more broadly. At the end of the day, a few (though not all) of them are still localists who may be friendly to ‘foreigners’, but will always consider immigrants in Taiwan to be just that - only foreigners, never ‘new’ members of a common community. That is, if they consider us at all. 

So, when newly-elected legislator Chen Bo-wei made the news saying that “foreigners” (外籍人士) should pay more for health insurance in Taiwan, surely it is understandable that it sounded as though he were referring to all foreigners. After all, the term he used is fairly broad: I might be considered 外籍人士

Several people asked his office for clarification, at which point it was explained that he specifically meant Chinese accompanying family, who are covered under a different category of National Health Insurance (foreign residents like me are covered like ordinary taxpayers as we work here), and whose 'residency requirements' were relaxed under Ma Ying-jeou. Simply put, Chen - a known localist - should have made himself clear from the beginning and not spoken so carelessly. 

In a world that made sense, I’d still disagree with Chen: Chinese are foreigners, just like me. Therefore, eligible Chinese nationals shouldn’t obtain NHI coverage under a special category, any more so than any other foreigner. Acknowledging that they’re not like other foreigners, if anything, implies that there is a special quasi-intranational relationship between Taiwan and China when I’d argue that there shouldn’t be. 

However, the world doesn’t make sense, and I don’t know that we’re at a point in international relations where adjusting the law in that direction would be feasible. 

In any case, surely one can see how a statement like Chen’s would raise concerns. The KMT is out of power and they’re awful (and Han supremacist) anyway - they might’ve passed some strong immigration reform, but to them Taiwan’s fate is ultimately Chinese, period. The DPP under Tsai is more internationally oriented than in the Hoklo chauvinist Chen years, when there was essentially no forward momentum on immigration policy. 

But, the Tsai administration is also slow and cautious. The Taiwanese left - those whom I’d otherwise tend to agree with - are not necessarily strong allies of the foreign community. This makes it hard to know quite who to support.

With all this in mind, is it any wonder that criticism of “non-Taiwanese” getting access to “Taiwanese” resources would cause worry in Taiwan’s foreign community? We’re not exactly sure who our allies are, though we know we have them.

And we're the most privileged foreigners (after perhaps overseas Chinese who have obtained ROC nationality). What about the most vulnerable?

But, there are times when something that looks on its face like an anti-foreigner backlash isn’t really that at all: it’s a reaction to years of being bullied (by China) and really has nothing to do with “foreigners”, or “children”. I can’t ever agree with the more extreme comments I saw (e.g. “bastard children of traitors and their mistresses”) and I still think that the child of a citizen deserves to be treated as more than just a foreigner regardless of their nationality. Context matters, however, and the anger I witnessed certainly has a a fraught one. 

Sunday, June 4, 2017

An untitled mess

Editor's note:

Although I'm on vacation, for some reason this seems to be the week for long, difficult reads on Lao Ren Cha. This isn't as long as my last post, but it was far harder to write and will probably be far more difficult to read. I don't even have a title for it. 

One week before Brendan and I left for a trip that would have me out of Taiwan for over two months, a friend and I sat in the basement-level clinic of the psychiatric ward of National Taiwan University Hospital. Yvonne (not her real name) had been struggling with mental health issues for years, but they had recently gotten worse: she'd been in and out of the ward as a resident several times over the past six months. She hadn't shown up for a planned coffee date, canceled on a small group dinner, was calling or chatting online with a small group of friends, including me but failing consistently to show up in person. I wasn't angry, I was worried about her.

Yvonne was a good friend - health issues aside, she was intelligent (she completed her undergraduate degree at prestigious American liberal arts college and gone on to do a Master’s in Linguistics in Taiwan), loyal and caring. I considered her a good friend - I listened to her, and she to me. When she had an English teaching job and struggled with classroom management, I sat down and gave her a crash course in it, with the idea that as she picked up the basics, more would follow. She pushed me to look seriously into doing a Master’s degree, pointing out that I was full of excuses when the only things really holding me back were nervousness (I'm terrified of people I respect thinking I'm stupid) and money. She was right. We’d met as coworkers at an absolutely horrid “management consulting” company, and spent many an hour excising our bad memories together, stopping when we felt it was starting to get unhealthy. We supported each other and had fun together.

When a mutual friend tipped me off that she had also been skipping her doctor's appointments, I was worried. I feared she'd also been skipping her medication because it interfered with drinking, and I knew she wasn't getting the support she needed. What was scarier was that I wasn't sure what kind of support could reach her.

She was happy to accept my offer to accompany her to her next appointment, which was on a rainy Tuesday morning. I got there first, shook out my umbrella and waited in the old NTU hospital building, the beautiful Japanese-era one. I'd taught a few seminars here once. I'd figured she was less likely to skip an appointment if she knew I'd be there too, and the first step towards some sort of normal that could hold was ensuring she was in regular contact with professionals and taking her medication.

The psychiatry department at NTU is labyrinthine, as are many departments in many hospitals across Taiwan. You go to one window and register, take your registration to the doctor, take something from the doctor's assistant back upstairs, get a number and then wait. There are more papers, trips up-and-down, numbers and queues for payment and medication. I'm not sure how a very ill person - mentally or physically - would be able to manage it alone: most would have to have family, friends or a domestic worker/health aide accompany them. The system is simply not built well for people who are on their own.

I recalled the time when my mother, after having seemingly recovered from the cancer in her lungs, found out that it had spread to her lymphatic system and now she had "months". I was gutted, made plans to return to the US, and thought it would be smart to talk to a grief counselor, or any counselor. I couldn't go to the Community Services Center in Tianmu, because they're only open during weekday business hours and I am simply not able to go to Tianmu during those hours on a regular basis. I found another center closer to home that offered services in English, but they wouldn't let me make an appointment until I chose someone from the list of counselors on their website. Even that was too much of a hurdle, I wasn't in a good state to attempt it. I read through the biographies several times, but kept getting flustered, tired and more depressed. I never called back, and worked through the grief on my own.

If that small stone in the tracks could derail my search for fairly-straightforward counseling when I wasn't even battling a mental illness, just deep grief, imagine the sort of obstacle the back-and-forth of visiting a doctor in a psychiatry ward at a hospital could present to someone in a much more unstable condition.

While we got this upstairs-downstairs workout, we chatted. Yvonne mentioned that she was only able to see a doctor perhaps once a month or for prescription refills, and that today was actually her physician's day to meet new patients. He'd agreed to see her because she'd skipped her last appointment and didn't seem well. She mentioned that she'd tried therapy, but it didn't seem to be yielding fast enough results, and she couldn't afford to keep it up: it's several thousand NT dollars per session, and she was unable to work.

She agreed when I asked her if I could write about her situation, without using her real name, in a post about why mental health services in Taiwan are so deeply lacking. Something needed to be said, but I didn't want to write it while excising the story that caused me to see the problem, and I didn't want to include the story without her consent.

Due to the events that have transpired since then, there is so much more to say. 

On one of our trips back down the stairs, I mentioned that her doctor seemed to be a good professional to have in her corner, as he'd agreed to see her on a day when he did not normally see existing patients. She agreed, but pointed out that during one of her stays in the ward, they'd assigned her a junior doctor who only wanted to talk about her alcoholism. She'd requested a change and the ward had refused - so she drank detergent.

I gasped.

"Well I wanted to make a point. Anyway, I knew it wouldn't kill me," she replied.

A bell should have gone off in my mind then, but didn't. I gathered my composure enough to point out gently that, in fact, drinking detergent could well kill a person.

Back downstairs, waiting for her number to be called, we talked again about therapy. It seemed to be simple common sense that regular contact with professionals - both doctors and counselors, at more frequent intervals than hospital visits could provide - would be a good idea. I didn't have the professional credentials to support Yvonne in the way she needed it, but I hoped I could be supportive in getting her in regular contact with people who did.

She revealed that her boyfriend, who chiefly supported them, was on a leave of absence from work and had his own issues. Although she could not work and was legally classified as 'disabled' and as a result received a small monthly sum from the government, this was just about enough to cover the cost of food and doctor's visits under National Health Insurance. It would not cover therapy, nor a place for her to live when things were not going well with her boyfriend, with whom she'd broken up and gotten back together with several times.

In short, more regular contact with professionals was not something she could afford. National Health Insurance didn't cover it and she had no other means to pay for it. That she desperately needed it - that it might have saved her life - didn't change the cold hard reality of her empty wallet.

The next day, I would speak with a friend who is a psychiatrist, but in an entirely different sub-specialty. She pointed out that, in fact, National Health Insurance does cover therapy in cases like Yvonne's, but the government rate paid to therapists who accept the insurance is something like NT500/hour. This for a professional with graduate-level training. So, clearly, few if any therapists wanted to go through the insurance system. Offering private, non-insured care only, they could charge exponentially more. Unfortunately, this sort of rationalization means that important mental health support is only available to those with means.

As a result, people who need help but can’t afford it like Yvonne have no access. In that way, it’s not that different from the USA, where people do die from lack of access to health care. Praise for Taiwan’s healthcare system is common, especially when compared to the near-total lack of a consistent system in the US, but in this particular way, Taiwan has failed. Family and friends can, in most cases, help someone connect to the right professionals, but consistent access to those professionals is key. If it is not affordable, it is not accessible.

My friend went on to say that, as a result, a lot of psychiatrists whose job would ordinarily be to see a patient in order to determine what sort of medication to prescribe and nothing more - certainly they weren’t paid for more - kept tabs on their patients the way Yvonne’s doctor seemed to be keeping tabs on her. That’s noble, and is one bright light in an otherwise dark landscape, but it really shouldn’t have to come down to that. The care Yvonne and those like her needed shouldn’t have been sparingly provided, at the discretion of a doctor who decides whether or not they’re willing to devote the extra time. That Yvonne had a doctor who did step up is an individual compliment but not praise of Taiwanese healthcare: it speaks to a breakdown of the system that he felt he had to do so in the absence of any other option.

I considered what sort of financial outlay would have been required to band together as friends and just pay for it, but it quickly became clear that it would be too much to ask of mutual friends, with costs approaching what many of them pay for rent each month, for something Yvonne wasn’t very motivated to do. I could give her money (I don’t loan money to friends: I give it, and if I get it back that’s fine. If not, that’s fine too) but not enough to supplant a needed income. 

While waiting for Yvonne’s appointment, I tried to say as gently as I could that the junior doctor who’d wanted to talk about her alcoholism seemed to certainly have had a bad ‘bedside manner’, and I could understand that anyone would be put off by that and by the idea of stopping drinking, but he wasn’t wrong. She did struggle with alcoholism, and it was affecting her medication. Without the medication, however, her mental health would not improve.

Although I’m not a doctor, it did seem clear that, while figuring out her relationship, living and financial situation were important, none of it would hold if she didn’t consistently manage her health.

Yvonne took this well, to my relief. I wondered why the doctor who brought up the subject with her to begin with could not have also broached the topic in a way that she’d have been more likely to be receptive to.

This is not unique to Taiwan: around the world you will find doctors who are empathetic, caring and understanding and can reach patients, and those who don’t make those connections as easily. In Taiwan, that means for every doctor like the one who’d agreed to see Yvonne on an atypical day, and who took care to keep tabs on her situation knowing she had no other professional support, there is likely one whose manner does not meet a patients’ needs.

Yvonne was living with her boyfriend, but it was clear from the instability of that relationship that she would at least need an alternative open to her if it ever did end. Again, Taiwan failed her. She could have stayed with me - and I offered, with Brendan’s support, and gave her a key that she could use anytime - but we both knew it wouldn’t be a good idea to make that permanent. Her disability payments were not enough to cover housing, and her family, who lived in central Taiwan, had long since rejected her (I will not go into their relationship here - I had Yvonne’s consent to write about her situation, but I never asked if I could include her family history, so I won’t).

The disability payments seem designed for people who cannot work but have a place to stay - generally, it is assumed, with family. Although homeless shelters exist, and there are welfare organizations such as Harmony Home for people with specific illnesses (in Harmony Home’s case, HIV/AIDS), a long-term sponsored or subsidized living option does not appear to be available (or widely available - while options may exist, even after several searches I was unable to locate any) to people in Yvonne’s situation. A mutual friend and I discussed whether group living options were available, perhaps with flexible work opportunities for those who might not be able to be reliable as traditional employees, but neither of us could find such a place.

In short, when you have no family to take you in, but no ability to earn enough income to live on your own, there are few if any options available to you in Taiwan. It almost feels as though the healthcare system is designed with the assumption that everyone has family to support them, or with the unconscious belief that if your family has disowned or rejected you, it must somehow be your fault. From simply finding the right care to navigating the hospital system to living day-to-day to paying for services that NHI doesn’t cover, it is assumed you have a support network.

If you don’t…

Yvonne seemed to be in a good mood, or at least a clear mood. We talked about things other than her illness: her cats, her boyfriend, her family, our mutual former employer and how awful they were (they were a part of the reason she was in such a bad financial situation). Music she liked. When we’d meet next, perhaps for dinner or coffee. I pointed out that I was leaving in a week, and it’s likely we wouldn’t be able to meet before then, but if she really needed someone she could always come over, or if she couldn’t manage that, I’d send a taxi to pick her up.

She repeated that she agreed with me that she was going to have to stop drinking and start taking her medication. I knew it wouldn’t be as cut-and-dried as that - wrangling alcoholism and medication rarely are - but as we started to say goodbye, I hoped that at least it was a path she was ready to start down. 

“I really think I’ll be OK, y’know,” she said jus before we parted ways. “Maybe I don’t even need therapy. It’s not like I have suicidal ideation or anything like that.”

At the time I’d been happy to hear a clear indication that she was not considering taking her life. Of course, looking back, that statement was the reddest of flags.

We chatted online a few more times before I left, mostly about nothing terribly important. She said she was feeling up, and other friends agreed she seemed to be doing a bit better. I didn’t reply immediately to her chatty messages, but I did reply. She asked if she was bothering me with ‘chatter’. I said no, I was just working is all, but I’d always respond when I was free. It was true. 

Mutual friends talked about how to support her while I was away, and we thought it’d be okay, at least for the summer. The system was failing her, her family was failing her, her relationship was rocky, but she had us and while we couldn’t replace the full support system she needed, we could do our best to create a basic safety net.

The next week, Brendan and I left for the airport early in the morning. It was May 24th - I would not be back in Taiwan until August 9th. We flew first to Greece, where we enjoyed ourselves as well as seeking out an important piece of my family history.

On our second day there, we were sitting in the cafe near our Airbnb drinking Greek coffee and reading. I was working out how we were going to get to the Athens suburbs the next day. We’d gone to the Acropolis that morning and were sunburned, got lost trying to find a post office, and were planning to go to the Acropolis museum that evening.

Then, I got a message from one of those mutual friends - Yvonne had committed suicide on either May 22nd or 23rd. It would later be determined that she’d taken a number of pills with alcohol.

I sat there, shocked, not knowing how to even begin to process it. For those of you who know me on Facebook, if I sounded unemotional or as though I were unaffected in my upbeat travel posts, it was because my brain went into overtime compartmentalizing, unsure of how to react let alone handle what had happened. 

I’m still not sure how to process it. It feels unreal, as though it didn’t really happen. As I’m not in Taiwan right now, it feels as though I’ll return in August and Yvonne will still be around. I suspect when I return is when the real processing will begin.

I’ve been circling this for a week, unsure of how to write about it, although I knew I wanted to, and know Yvonne had wanted me to write about the system that had so profoundly failed her. I’ve probably painted myself to be an angel in this story, but honestly, I don’t feel I was. I’m neither looking for, nor do I want, sympathy for the pain of losing a friend nor the guilt of feeling like I could have done more. It’s just the truth and ought to be said. I had laid down a boundary that I did not want phone calls after midnight or before 8am (Yvonne had a habit of calling at odd hours and talking for a very long time) - would things have been different if I’d just taken those calls? Or if I’d responded to those final messages more promptly? If I’d searched just a little bit harder for affordable therapy, group living options or anything else that could have helped Yvonne? If I’d been more insistent that I wanted her to stay with us? If I’d given her a bit more money so her financial situation didn’t seem so hopeless? (I’d given her some, not more than I could afford to lose).

Intellectually I know none of these things would have changed much - she needed more help than a few chat messages could have provided - but emotions are slow to follow what the intellect knows.

Or - and this is the key - would it have changed anything if I’d not been so blind to the obvious red flags? Someone seeming like they’re doing a bit better is not a sign that they’re not about to take their life. In fact, it could be a sign that they are. Mentioning twice, unbidden, in one conversation that one is not contemplating suicide is also a clear sign something is wrong. If I’d stopped for half a second to think about it I might have seen that for what it was.

The painful fact remains, however, that the health care system we praise so much - praise which is often, but not always, deserved - failed Yvonne, and it cost her her life. In Taiwan if you don’t have the means to pay for needed treatment that NHI either doesn’t cover or doesn’t cover adequately, and don’t have family to support you, it is a difficult road indeed getting the level of care you need. This is true in terms of physical illnesses - in Taiwan, the hospital staff doesn’t care for you the way they would in other countries (of course, in the US you might not be able to afford a hospital bill). What do you do if you’re in the hospital and have nobody to take care of you, but can’t pay a nurse to care for you either?

It is also true, if not doubly true, for mental illnesses. What do you do if you are so physically or mentally ill that you cannot navigate the maze of windows, queues and numbers at the hospital and have nobody to go with you? What do you do if you need consistent psychological or psychiatric support but cannot afford specific therapies that might be beneficial? What do you do if you can’t work, but have no family to live with? To some extent, these are questions one might face in other countries, especially the USA. The difference is that, unlike the US, Taiwan has a healthcare system that is consistently praised and looked at as a source of national pride.

Looking back, I can see how hopeless Yvonne must have felt. No family, nowhere to live permanently, no way to make money, no way to be independent, insufficient help from the system. Friends who tried to do their best but were ultimately not able to make up for these gaps in the social fabric.

The base assumption really does seem to be that either you are financially independent and can afford what you need on your own, or (more likely) you have family who can do it for you. At the very least, it seems to be assumed that you can live with relatives.

This is not the basis for a modern healthcare system or social welfare system. I’ll always remember Yvonne, but I can’t help but think the system couldn’t have cared less about her. As a result, Taiwan lost one of its smartest, kindest, most loyal citizens, and I lost a good friend.