"Got kids?...why not? Is it because you're fat?"

I'd like to throw a big shout-out to all the Old Ladies of Taiwan (and Taxi Drivers of Taiwan) for daring to ask the tough questions - questions that they really need to know the answers to, and if they don't get them, clearly the Earth will stop spinning and the sky will fall in. Questions that generally seem to fall on foreign women - although men get them too - and require either contortions of information and explanation or just reddening silence and a mumbled "我也不知道噁".

They're really quite adept at getting, ahem, all up in yo' bidness:

"Are you married?" ("Why not?")
"Do you have kids yet?" ("Why not? You should have a boy and a girl. But not more than two.")

Variation: "How many kids do you have?" ("None? Why not?")
"When will you have kids?" ("Why not?")
"Why are you fat? Are all Americans fat?"

"Have you gained/lost weight?"

"How old are you?"

"How much is your rent?"
"What do you make per hour?" ("Oh, my granddaughter makes more/less than that.")

"Did you vote for Obama? Did you know that he's black?"

"What do you think of Ma Ying-jiu?"

"Did you have a boyfriend before you got married?"

"Why are Americans so rich?"

"Do you still work after marriage?" ("Why?")

"Why are your boobs so big?"

"Why do you have hair on your arm?"

"Why do Americans let their parents die in institutions instead of taking care of them?"
"Why did Americans elect someone stupid like Xiao Buxi?" (George W. Bush)

"Why doesn't America like Taiwan?"

"It's cold/warm out you shouldn't wear that." (for all values of "that")

"Where did you buy that? How much did it cost?" ("That's too expensive.")

"How much money do you save?"

"Why don't Americans save money?"

"Why do you have an iPhone" (note: I don't have an iPhone, I have an iPod Touch) "you should save your money."

"Why do you travel so much? You should save your money."
"You should cook at home, not eat here" (while the beef noodle joint owner glares) "...you can save more money and beef noodles will make you fatter."

"Why are you eating that?" ("It's not good for you.")

"Do you believe in Christianity? How about Buddhism?"

And both "Why didn't you stay in the good American economy" and "Why is the American economy so bad?"

"Did you live with your [now-] husband before marriage?"

"Did your father allow you to move abroad/live with a man before marriage?"

I mean, come on ladies, the world needs to know. How will we ever carry on without knowing how old you are, why you don't have babies yet, why you weigh what you do and who you voted for!

And yes, I did say "ladies", because we female expats do get more of this than the men, although they get it too. It's like being female opens you up to being asked so many more probing questions, or maybe it's that the Old Ladies and Taxi Drivers of Taiwan don't think it matters what the men weigh, how old they are, whether or not they're married (and why - they have to know why or it simply does not count), what their rent is and how much they save. Maybe it's a woman-to-woman thing that transcends culture and generation, like when I showed my wedding pictures to my friend's Grandma and we bonded despite age, culture and language barriers. (Note: the same Grandma who talked at length about how she'd run her son's house differently from how her daughter-in-law does it, and who admonished me to have two kids, not three, because she "had three and you can't carry them if you have so many, so don't make my mistake").

You also open yourself up to it more if you clearly speak Chinese; more so if you speak enough Taiwanese to get attention, despite not being nearly fluent (not that I'd know anything about that, ahem).

So. Let's take stock of me.

Young? Check.

Female? Check.

Married? Check.

Speaks Chinese? Check.

No kids yet? Check.

Living in a neighborhood with few foreigners? Check.

I'm like the poster girl for the kind of foreigner Old Taiwanese Ladies and Taxi Drivers like to hurl questions at like streams of betel nut juice at a sewer grate.

Fortunately for them, I'm fairly open. I won't tell them what I weigh and I won't dignify the "No kids? Is that because you're fat?" questions with a response, but I'm happy to talk to them about why I don't want kids right now - I leave the "do you want them someday" debates firmly off the table - what I think of Ma Ying-jiu, how much my rent is, how old I am etc.. I'm not sure if I'm just naturally a sharer or I've been in Taiwan so long that I've become desensitized and I just don't care if they know what I make and the fact that I lean green.

That said, at my non-answer I got the best rejoinder ever from an Old Taiwanese Lady: "if you want to lose weight, you should eat less and exercise more". Thanks, Old Wu. Because I totally didn't know that.

And really, you just have to laugh. The questions are clearly not going away - Taiwan will always have taxi drivers who ask you all sorts of crazy stuff, and those Old Taiwanese Ladies are already pushing 150 and will probably outlive you.

Which reminds me - best conversation ever:

Old lady in night market, grabbing my butt: 妳為甚這麼胖呵？

Me: 妳為甚麼這麼老呵？

Old lady in night market: 因為我小的時候我不是那麼胖啊！

(Old Lady: 1 - Jenna: 0).

Anyway, I figure, they're just trying to be friendly. They don't mean it to be rude, and don't even realize that there are people out there who think it is rude - or they realize it's a bit rude but when it's 2011 and one is old enough to tell stories about one's childhood friend the Dowager Empress Cixi, one simply stops caring.

I can see how this might bother some foreign women enough that they'll choose not to stay, and I've certainly heard my share of Western women mentioning this phenomenon. I do think that most of us take it with a grain of salt ("Don't eat that salt! It's not good for you! How will you have babies?") and adjust to it enough that we can laugh about it rather than be offended.

I have found that if you actually answer their questions, they tend to like you more and sort of adopt you as a surrogate granddaughter. One woman in my neighborhood, who's 75 if she's a day, has taken to calling me 妹妹 ("Little Sister"). Another told me her life story, which was a fascinating insight into life 60+ years ago for a Taiwanese woman, from the perspective of that woman and not a museum exhibit or history book written by a bunch of men, and was totally worth divulging my age and rental fees.

In the end, this isn't a post complaining about the personal questions or asking "What's up with that?" because deep down, I think we all know what's up with that.

It's more of a chuckling recognition, and maybe a bit of a warning for any potential expat women who find this blog before coming, or who are just settling in and dealing with culture shock. Be prepared.

Reason #17 to Love Taiwan

Photo from here: 5 Days in Taipei

Note the 7-11 down the road from the main 7-11. There is probably a Hi Life next to the photographer and a Family Mart behind him/her.

Convenience Stores. Everywhere. So convenient that they're actually a little too convenient, too the point where a big facet of culture shock here might well be that there are just too damn many 7-11s in Taiwan, and do they really need to put a 7-11 around the corner from another 7-11, across the street from a third 7-11 and next to a Family Mart?

As you know, 7-11 not-so-recently started offering espresso drinks - lattes, cappuccinos (which are basically lattes), Americanos etc.. The coffee is about as good as Starbucks but no better - perfectly acceptable, inoffensive, but with a one-note flavor ("espresso roast coffee") that has nothing close to a bouquet.

That's fine with me, because if I buy a 7-11 latte - and I do, because I'm both a coffee snob and a coffee slob - I'm not looking for a flavor profile or a complex bean with a fruity nose, woody bouquet and chocolatey finish. I'm looking for a basic latte because I need to be caffeinated at hours of the morning when I don't feel like brewing coffee at home.

Well, the coffee machine at the 7-11 near me - correction, at one of the 7-11s near me - broke a few weeks ago and is still not fixed. I have a tendency to leave home with just barely enough time to get to class, so for the first few days I just bought a Red Bull instead ('cause I'm healthy like that).

Now I walk a few steps in the other direction to get coffee at the Hi Life before my 8am class, which is maybe a half-minute walk from 7-11, and pick up a sandwich at the breakfast shop on the way.

This is both wonderful and terrible.

Wonderful because if the coffee machine at the place nearest me breaks, I can walk less than a minute to another convenience store for coffee.

Terrible, because that extra twenty meters (at most) is just so inconvenient!

Never mind that I come from a country where, if you don't live in an urban area you have to drive a mile or more to get anything (from my parents' home, you literally cannot walk to anything at all - you have to drive. It's that rural). If you live in a city, you still may have to walk ten minutes or more to get what you need. It's not considered a big deal that you have to plan shopping trips and remember everything - "must get pens! Don't forget or you'll have to drive back!" - and not a big deal that even something simple may require navigating an entire Wal-Mart five miles from home.

Here, I take it for granted. Forgot paper clips? Who cares! I can just get them the next time I leave home and take ten steps. In the middle of cooking dinner and out of soy sauce? So what! Send Brendan out and he'll be back before I've even got the contents of the pot heated up. Back home you'd have to turn the oven off, cover the pot, get in the car and drive to the nearest store, wasting at least a half hour if not more.

Back home, there were two options for coffee before work (if I didn't make it at home, which I never did because I always wake up at the last possible moment) - office break room or overpriced Starbucks in the hotel next door. If there was a line at Starbucks and the coffeemaker at work was broken, it was really, truly irritating. I might not get coffee for an hour or more - I had the sort of job where I had to at least put in my face by 9am: five minutes late and there'd be a "discussion" with the manager. Fer serious. I hated that job.

Now, a few steps out of my way and maybe one extra minute of my time is an inconvenience and my old work situation would be unbearable.

Back home, for lunch I could either bring my own or buy something in the office park food court, or eat in the hotel restaurant. That was it. In Taiwan, I can eat here or here or there or that Tainan noodle place or dumplings or a sandwich or a crepe place or lu wei or I could just grab a 7-11 sushi roll or Sushi Express or that shwarma stand or won ton soup or fried rice or pasta or...

That, my friends, is what I call perspective.

Which makes me wonder: like the two aisles of cereal and twenty-six kinds of soft drinks that nobody really needs in American supermarkets, is all this convenience good for us? Is it turning us into spoiled brats who can't be bothered to walk a few meters out of our way?

It also makes me wonder - do I mind? Nah. It's made me spoiled but I kind of love it.

Women and Children, and Human Rights in Taiwan

Taiwan's apparently doing really well on human rights issues (not surprising to me) - among the best in Asia, in fact.

I'd say that the amount of time Taiwanese office staff are expected to stay at work is a human rights violation (OK, I'm using hyperbole, but come on), but otherwise...great.

Except.

As usual, women and children are the ones still suffering. Domestic abuse (including child abuse), rape and spousal rape, including discrimination against women, are all still significant problems in Taiwan. This I also believe: random acts of violence against women are not common - women can walk outside, alone and safely, at literally any time of day or night and not have to fear being attacked. I am sure it does happen, but it's so rare that I feel quite safe in Taipei, even in the darkest hours of the early morning.

It's violence against women by people they know and are possibly married to that remains a problem - for several reasons. It's still a social anathema to report spousal rape, there are still people who believe - even if they wouldn't admit it openly - that spousal abuse is acceptable/explainable (ie "she deserved it, if she kept him happier..."), that rape within marriage is not really rape, and that it's OK to hit your child. In many cases, saving the face and protecting the family status of the relative is considered more important than getting help for the wife or child, and so cases go unreported. Many foreign brides have nowhere to turn when they suffer abuse, and that goes unreported too.

And, as usual, despite a generally clean human rights record (human trafficking is still an issue, but at nowhere near the levels of other Asian countries), those still suffering are women and children. We can clean up most of the problems in a place, and yet there will still be people who think it's OK to treat those two groups as subhuman.

One is half the population, adult females who are still grouped in with people who are not yet adults - in many ways, around the world, women are treated more or less as children, workhorses or both - and the other is most defenseless segment of the population.

Comparative Politics 101

So the US government won't be shut down after all - which is a good thing, I guess, when it comes to museums, parks, federal workers, federally-backed mortgage approvals and government services for the poor and elderly. Allowing it to be shut down would have also had some upsides, and I'm not entirely sure it wasn't a good idea to just let it happen (for once, I agree with Eliot Spitzer!) and what we've got is a country where liberal social principles are triumphing, but Republican (I can't say conservative - it's not, really) financial ideas are sharing that winner's circle.

This brings about an interesting little eddy in the writhing tides of comparative politics.

Before we found out that there would be no shutdown, I mentioned it to a student. She was taken aback - positively horrified - by the idea that a government would go so far as to not reauthorize spending to maintain itself.

"I thought that American politics was more mature than Taiwanese politics, and these things don't happen in America," she said.

"Yeah, well, that's not true. We're just as immature politically as the DPP and KMT. The arguments and divisions are different but the rhetoric is the same. The only thing that separates the Legislative Yuan from the Senate is that American Senators don't beat each other up..." (Which, actually, I'm not sure is historically true). "...although sometimes I think they should."

And it is absolutely true. For all the complaining that you hear about politics in Taiwan and how it's too rough, immature, pointless, boastful and full of empty rhetoric and political game-playing over serious investments in improving the country - honestly, you'd think that that was only a problem in Taiwan. It's not. We're just as bad, if not worse. I mean, is there a Taiwanese Sarah Palin? Although, for all his wishy-washiness, Obama is a better and more centrist leader than Ma.

Both countries are deeply divided over social and economic issues, and both of those divides follow cultural lines (in the USA it's generally regional and is in some way related to religion; in Taiwan it's mostly about who immigrated when). The words are different and the issues are different, but the BS is the same.

So.

A lot of people like to boast that they are "socially liberal and fiscally conservative". This is apparently something that many people are proud of, and they think it makes them somehow more sensible than either party. I am not fiscally conservative - while I'm not in favor of debt, cutting government programs that many needy people rely on is not the way to go about reducing it. Lowering tax rates for the wealthy and corporations is definitely not OK - I'm sorry but supply side, Libertarian and trickle-down economics do not work. We've been through this. We talked about this in the late '80s and '90s. We agreed. Doesn't work. Money spent on social programs for the poor, elderly and unemployed put more money back into the economy than money spent giving breaks to wealthy people. So, America, WTF?).

I do believe that a time of recession and high unemployment is not the time to slash spending. I do believe that the spending the government has agreed to cut isn't the spending that really matters, and isn't the right thing to be cutting. I do believe that Obama should have called the Republicans' bluff.

I am happy that liberal values are winning out in the USA (because they're right, natch) and that for the first time in awhile, the Democrats actually stood up for women's rights and refused to allow the de-funding of Planned Parenthood.

I am not happy, though, that conservative fiscal values, at this time, are winning - and that they're cutting the wrong things and lowering taxes for the wrong people.

So yes, we might be basically just like Taiwan except we don't slap each other, but really, someone should just take Boehner and rough him up a bit, Taiwanese-legislature style.

The Taiwan Shop

I'm not sure of the Chinese: 台灣(something)店

#6 Lane 76 Xinsheng S. Road Section 3

(02)23625799

That third character looks like 下 with a little roof like the one on 仝, and I can't find it even with the awesome handwriting feature on my iPod's Chinese dictionary.

But anyway - tucked in a lane off Xinsheng S. Road near Tai-da, this store sells everything to meet your pro-Taiwan, anti-China needs. Want a Taiwan passport cover to cover up your ROC passport (or any passport)? They've got that (above). Want the complete songs of the imprisoned A-bian on CD? They've got that too (below).

They've also got those old-school postcards that I love so much, decorated with old prints of Taiwanese cartoons, vintage product labels and ads, antique maps and posters.

Not from the store - this postcard is from my own collection from many sources, but this store sells similar ones.

You can also get your fill of pro-Taiwan and/or anti-China t-shirts:

You have to read the top ones in Taiwanese for them to make sense

It's also a great source of maps, toys and books - there's a very small English book section with titles such as Lee Tung-hui and the Democratization of Taiwan, A Chronology of 19th Century Writings on Formosa, Taiwan Is Not Chinese!, Taiwan's International Status, Travelers in Taiwan and Taiwan Agenda in the 21st Century. If you can read Chinese you can also pick up some great titles, such as Fault Lines on the Face of China: 50 Reasons Why China May Never Be Great and Edible Wild Plants of Taiwan.

There are also aboriginal-style glass bead knickknacks, posters, a selection of Taiwanese movies (including Monga) on DVD and plush green pillows shaped like Taiwan that feature cartoon depictions of well-known DPP politicians.

Basically, it's your one-stop shop for all things obscure and patriotic!

Thrills! Chills! Taiwanese dentistry!

So, right on the heels of this post (yeah, I know, I'm linking it but it's right below, whatevs) I started to feel a vague ache in my jaw. I figured, as usual, it was a wisdom tooth coming in and so it'd hurt a bit for a few days and then go away, just like with the other ones, which came in normally.

By the end of Brendan's birthday party it was a bit more serious, but I'd had three cocktails and could still eat, though it was hard to open my mouth fully, so I figured I'd sleep on it (not that I had much choice; by that time there were no realistic medical options beyond an emergency room run for prescription pain medication). Deep down I knew that this was more serious, but didn't really want to admit it. I'm the author of this old Lonely Planet classic from 2003 and as a result of that experience I'm a bit wary of dentistry generally, at least when it involves more than a filling.

This morning it was worse, and by 2pm I was seeking out a dentist, with a growing fear in my heart that this would not end well. And it didn't: I did have an impacted tooth, I did need it removed, and the pain wouldn't go away until it was removed. So I had it taken out. Once again, I didn't have much choice: it was so bad I could barely eat, and if I wanted the full general anesthetic I'd have to make an appointment and go to the hospital, which would have to wait until Monday at the earliest.

This brought me in touch with yet another aspect of Taiwan's health care, so I figured I'd write about it here.

The bad parts were (mostly) not the fault of the Taiwanese system or the dentist:

- I had it done with just Novocaine (or whatever they use now), not general anesthesia. Apparently that's normal for fully erupted wisdom teeth. I'd assumed that one got put under because, hey, it's a pretty medieval procedure when you think about it. It's basically the same thing as Ye Olde Tooth-Puller, except more sterile and with local anesthetic instead of local moonshine. This surprises me - if I ever have to get this done again, goshdarnit, I'm going under! Waking up from general anesthesia is not as horrible as being fully conscious when they do...that...that...twisting forcep thing to you.

- My tooth was more firmly embedded than most, so it took longer and was more painful than it normally would be.

- The ginormous forceps. The pressure. The blood. That crunching sound as they widened the socket and maneuvered the tooth out - I admit that I started sobbing. I'm not even embarrassed about that. It was thoroughly horrifying. (I have kind of a fear of crunching bone and have never had to face it, as I've never had a broken bone, so there's that too). Why don't people go under for this?

- I had to do it all in Chinese. My regular English-speaking dentist closes at noon on Saturdays so I went to the first dentist I could find, and he didn't really speak English. Considering the circumstances I think I did pretty well. With a wad of bloody gauze in my mouth, I managed to say "給我你們最強的藥。鴉片，大媽 － 都可以！"

- The horror of the procedure was kind of low-balled, in my opinion. I was told "It's OK to get it without general anesthesia. It's a little uncomfortable but I promise it doesn't hurt". Yeah, uh, it's true that it's not "painful" but they clearly have a different threshhold of what constitutes acceptable discomfort! I thought "OK, maybe that means the tooth just comes out" but no, it means "we get to squish your skull and move the tooth around in the socket, which causes bone trauma, before extracting it with the biggest forceps you've ever seen, and you'll feel it in your EYEBALLS".

- I do feel that partly because of the language barrier, I wasn't given enough prep on what to do afterwards. For example, they didn't tell me not to drink from a straw, so I started out doing that (then found out I wasn't supposed to, and stopped). They told me not to spit, but they didn't tell me how to properly brush my teeth and rinse. They didn't tell me about the importance of not dislodging the blood clot. They didn't tell me to avoid solid foods for two days (although I kind of assumed that). They did say "only eat food you feel you can comfortably eat. If you feel wary, don't eat it", but that's it.

- The painkillers they gave me? Yeah, so not strong enough. I've been supplementing with Panadol.

...but there were some good parts, too - somewhat attributable to the Taiwanese healthcare system.

- The entire thing cost three US dollars. Yes, $3. US. No missing zeroes. Fo' shizzle, to steal an outdated '90s slang term. A friend of mine broke her ankle in January and it's not healing, and has to have surgery. She is currently waiting for insurance approval to have the procedure and is living a very limited existence while that approval goes through. She'll still be in the bag for several hundred, if not thousand, after it's approved (which it had better be). I walk into the dentist, no appointment, pay THREE DOLLARS, and get a wisdom tooth out. It really throws the two systems into stark relief, when you put it that way, and it's clear which system comes out on top.

- General anesthesia is a covered option: I'd have to go and stay in a hospital and it would be delayed and take longer generally, as well as cost me a bit more, but it is a possibility. I'm hoping there's no next time, but if there is, I'll take this option. No way will I be conscious if those terrifying tongs of terror come near me ever again. Not every American insurance plan offers that for an erupted tooth.

- I was able to make a follow-up appointment for Monday. Not all American dentists do that - if you think you're healing fine they don't worry about checking on you a few days later. You only go back if there's a problem. In Taiwan, I'll go back on Monday, pay another $3 and get checked to make sure it's healing smoothly, which is a good way to help prevent possible dry socket, something I'm at elevated risk for.

- No appointment necessary! Try THAT in the USA without a severe emergency (mine was an emergency in that I couldn't eat, but not so severe that an American dentist wouldn't have minded if I'd shown up without calling first).

- My sweet and wonderful husband, who came immediately out to the dentist's when I texted him with the news, was there when I started sobbing (which I did - that crunching bone sound really freaks me out and I think I'm going to have nightmares about those massive glinting forceps), went out to buy me more gauze, soft food and Panadol, made me a smoothie and has generally taken great care of me.

- Millions of people suffer from far worse pain than this and have chronic conditions, or can't afford treatment (ahem USA....ahem), or have no access to treatment (much of the Third World). I have led a relatively pain-free life with the one exception of my severe slipped disc, and really, I'm quite lucky. So please don't take this post as pure complaining.

Anyway, my advice: no matter whether the tooth has erupted or not, go ahead and get general anesthesia. This is one heck of a traumatic procedure when you're conscious.

Improving Taiwanese Health Care: Some Suggestions

As most Taiwanese and expats in Taiwan are aware, our fair country boasts one of the best healthcare and health insurance systems in the world. We have care that is comparable to that in a Western country - I've never felt as though the care I received in Taiwan was substandard or not as good as what I'd get back home. We also have a government-sponsored insurance program that, while expensive for the government, is not nearly as expensive as for the Canadian and British governments, who control care as well as payment - or for the USA, where we bear the cost of a broken insurance system and astronomically priced care later on, in the wasted money of inefficient and unproductive workers who can't perform better because they can't afford treatment for what ails them. It may cost Taiwan a lot of money to run its program, but it's still a step ahead of the USA where even greater costs are invisible (or at least we'd like to pretend they are).

It was wise for Taiwan to have a public insurance plan but allow for private care clinics that do accept insurance, alternative plans and non-insured clinics to exist. It takes the burden of paying to build the infrastructure off the government and allows basic supply and demand to determine the availability of care. As such it's less expensive and there are more care options without long waiting periods.

I'd like to see the USA adopt a system similar to Taiwan's, which does mean that everyone would be obligated to have insurance, just as everyone pays taxes to fund education and then has access to that educational system. Generally, we have a great system in Taiwan that deserves accolades, study and emulation globally.

There is definitely room for improvement, though. There are a few aspects of the system that I would like to see changed...now. Here are my thoughts:

- Women's health: cover more reproductive health options and preventive osteoporosis testing.

In terms of women's health in Taiwan, there is a striking dichotomy. On one hand, pelvic exams for women over 30 are covered at a rate of one per year. OB/GYN services are covered, birth in a hospital costs a bit more but does receive coverage, prenatal care (I believe) is covered, mammograms and other women's health issues are covered and there is excellent coverage for treatment of illnesses that affect women.

On the other, birth control is not covered. This is ridiculous, seeing as it's a $450-$600/month proposition, or more - that's more than you'd pay for a weeklong hospital stay if you have a shared room! Granted it's still only US$20 a month, but it should still be covered. I've heard two reasons as to why it's not: the first is that contraception is "elective" (excuse me?!) - you don't "need" birth control, apparently (yeah, you don't "need" it according to people who are deeply out of touch with modern society). The second is more sadly pragmatic: the government wants to increase the birth rate - something I personally don't think they should be encouraging, in fact, I think it's short-sighted and idiotic - so they are happy to push women to become mothers in any way they can.

This second reason is downright sexist: if a woman is sexually active, as most adult women are, she has to bear the full price of contraception. For me, NT$600 is not a lot of money but for a college student who doesn't feel she can talk to her parents about the issue? A new graduate in her first job earning NT $25,000/month? A working-class woman, whether foreign (such as a domestic care worker) or Taiwanese who may earn far less? A foreign bride who can't or doesn't want to communicate with her husband on the issue? NT$600 is a bigger burden for them, and yet the government doesn't seem to care. Considering the general attitude towards condoms in Taiwan, that's hardly a solution.

It also pushes women who can't afford the pills to risk pregnancy when they are not necessarily in a position to become mothers.

Abortions are only covered in certain circumstances (in the case of rape, incest, a health threat or "seduction" - whatever that means - I believe it does receive coverage, but if you claim "psychological duress" it's not, as far as my research showed). They should receive coverage regardless.

Osteoporosis preventive testing is only covered after a fracture, and you are only covered at a rate of 2 or 3 for life. It's not an expensive exam, and should be covered for women over a certain age.

Also, cover iron supplements (NT$800 per bottle, generally) for menstruating women and calcium supplements for women at risk of osteoporosis. This is an important component of good female health. Many women suffer from anemia during certain points of their cycle and this is a simple way to boost overall health and as a result, productivity (a woman who is not anemic is going to be more attentive, alert and efficient at work than a woman who can't think straight and feels dizzy, as I used to before I realized that it was caused by cyclic anemia).

- Have a payment plan offering so that those who need an emergency procedure but don't have the money can pay it off gradually.

Right now, if you need a procedure you're expected to pay for it more or less immediately. If you can't pay, in theory you can't get the procedure. For those who need immediate care and have no money, there are charities that can help pay or defray the cost. Generally if you have family they will also step in to help if you don't have the money. This is insufficient, however, and not always available to foreigners. A system in which, if you require expensive treatment (or inexpensive treatment but you happen to be below the poverty line), you can get it and pay it off in regular monthly installments would be a great improvement in terms of health care availability for the poor, working class and struggling.

- Pay for the most effective procedure or medication, not the cheapest

Also not necessarily the newest, most expensive or most advanced: do more objective research into the most effective procedures and cover those, even if they are not the cheapest option. This will save money down the road, as people who receive more effective care generally need less care later. This includes procedures or medications with the least side effects or recovery time.

Here's a real life example: when I first came to Taiwan, I ended up with a severe herniated disc in my lower back - so severe that it required surgery. There are two surgical options: a multi-hour ordeal with a full opening of the back and two-month recovery period, and microsurgery, which takes an hour, has a one-week recovery and is easier on everyone from doctor to patient to employer. NHI only covers the first option, which seems downright medieval when better technology exists. The second option is out-of-pocket and costs NT$80,000. Still cheap by American standards (that's what it would cost in the USA with many insurance plans) but still a few thousand US dollars.

I had the microsurgery. Rather than keep someone out of work for over a month and have the doctor do an operation that takes up half a day when he or she could be seeing other patients, I truly do not understand why they don't just cover microsurgery. In terms of economic productivity, someone who can be back to work in a week and a doctor who can see more patients is better in the long run, even if microsurgery is more immediately expensive.

The same is true for medication: for septic shock, the most effective medication costs NT$300,000 a dose (I believe it works in one to three doses) - NHI doesn't cover it unless the patient has suffered two organ failures. If they covered it before the organ failure(s) though still as a second-string option, sure it'd cost a lot up-front but in the long run, you'd have two less organ failure treatments to deal with - and those can get expensive.

Along these lines, cover procedures that greatly increase patient comfort, even if they cost more. Obviously some are more effective than others, but occasionally a slightly more expensive procedure can drastically improve patient comfort, especially for the elderly. A more comfortable citizen is a more productive citizen.

- Cover preventive care.

A popular new benefit offered by Taiwanese companies is an annual check-up. As a foreigner, I have to get a check-up on my own dime every year to renew my work permit. I don't mind this, as physical exams are good to have regardless, and by American standards it's not that expensive (NT$800-$1600 depending on the hospital). Preventive care for Taiwanese should be covered - one inexpensive check-up per year could save thousands, if not millions, of NT dollars per patient down the road. I'm happy that many people have this option through work, but many don't, and most don't want to pay out of pocket so they simply forgo preventive care. This really ought to be addressed.

- Cover better dental care.

Cleanings and fillings are covered, but root canals and crowns are not. Why? How is that "elective" in any way? If your tooth is abscessed or infected and you need a root canal and crown, how can you not get it? As someone with three crowns (I blame the water in China), I can say that you really can't eat or do much of anything without one, if you've undergone a root canal.

Why on earth is this not covered?

At least vision care receives pretty good coverage.

- Consider not covering certain elective Chinese medical practices.

I don't mean "stop covering Chinese medicine" because, while I do believe it's a good holistic method of preventive care and yet not good for acute treatment, it is a part of local culture and as such deserves respect and coverage for people more comfortable with that option. Chinese herbal medicine should definitely be covered (especially for preventive care). Things like suction, acupuncture etc. have not been proven to work, however, and don't deserve coverage while other important things, such as more effective procedures, women's reproductive health and preventive care are neglected.