A personal story that leads to bigger questions about fairness, sustainability, and what we take for granted

Have you ever had surgery? What for?

My First Surgery Wasn’t Even Mine

Technically, my first “surgical experience” wasn’t something I went through myself —

it was my mother’s C-section, bringing me into the world. It may not have been my body on the table,

but from that moment, I became part of the story.

Later came the more literal surgeries: a childhood fracture from being too playful,

and more recently, the inevitable wisdom tooth removal — listening to the sound of bone being broken under local anesthesia.

Grateful for a System That Never Let Me Worry About Costs

Looking back, I’m genuinely thankful for Taiwan’s healthcare system.

I’ve had injuries, surgeries, emergencies — and not once did I have to hesitate because of money.

With our National Health Insurance (NHI), you can see a doctor for pocket change,

get subsidized hospitalization, and undergo major procedures without financial ruin.

It’s easy to forget how rare and precious that is —

how much of a miracle it is that so many of us can take quality healthcare for granted.

But That Miracle Might Be Cracking

Lately, cracks have started to show.

The NHI is under financial pressure. Medical workers are underpaid, overworked, and many are leaving.

We hear about it often — and yet, we keep using the system the same way.

One of the less discussed problems? Waste.

People going to big hospitals for minor colds Duplicated tests and prescriptions Medicine picked up but never taken Patients (and sometimes doctors) playing it safe by over-using services

Each of these might seem small, but together, they’re pushing the system toward collapse.

The Grey Zone of Overseas Citizens

Then there are people who live abroad long-term but still return to Taiwan to receive healthcare — even major surgeries —

because they still hold Taiwanese citizenship and a valid NHI card.

Legally, it’s allowed. But is it fair?

This isn’t about blaming individuals or suggesting bans.

It’s about asking: Should there be a more balanced contribution model?

Maybe it’s time we consider differentiated premiums, minimum residency requirements, or a tiered access system —

something that reflects both usage and contribution.

Are NHI Premiums Truly Fair?

NHI premiums are income-based in theory.

But in practice, the gap between high-income and low-income contributors is narrow.

Capital gains, overseas income, and asset-based wealth barely factor in.

As with Taiwan’s broader tax system, the burden falls heavily on wage earners —

even though they may not be the heaviest users of the system.

When entitlement and responsibility drift apart, even the best-designed system can start to erode.

So What Can We Do?

Use healthcare responsibly — don’t treat it like a free buffet Respect medical professionals — they’re holding this system together Demand a fairer funding model — one that matches usage with contribution Support thoughtful reforms — before we reach a breaking point

Taiwan’s National Health Insurance used to be something we were proud of.

But without action, it may become something we look back on with regret.

I’ve been lucky. My surgeries — from broken bones to wisdom teeth — have all gone smoothly,

thanks to a system that protected me from fear and financial worry.

But gratitude isn’t enough. We have to protect what protects us.

Because what we take for granted today could disappear tomorrow.