Monday Round Up

Along came a spider...

KMT: The internal struggle for the KMT continues apace. This week Wu Den-yi and Hau Long-bin criticized KMT Chairman Hung Hsiu-chu over the One China/Two interpretations of the 1992 Consensus....

Former ROC Vice President Wu Den-yih (吳敦義) and KMT Vice Chairman Hau Lung-bin (郝龍斌) attended the annual meeting of the Taiwan Benevolent Association of America (TBAA) in Boston on September 24. During the meeting, Hau stated that the 1992 Consensus must be connected with “one China/different interpretations.” Hau asked why we would abandon the one China/different interpretations formulation since it worked so well during the Ma Ying-jeou (馬英九) administration.

As the article notes, Wu and Hau have formed an alliance, and Wu will likely challenge Hung for the Chairmanship in the 2017 election. This will be a replay of this year's election when the Taiwanese candidate was backed by the party structure, and the ROC/mainlander ideologue was backed by the Old Soldiers, who form a large voting block that controls who wins. That same occurred a decade ago, when the Old Soldiers voted for Ma Ying-jeou as Chair while the Party elites supported Wang Jin-pyng. Enough of the Old Soldiers should still be around to ensure that Hung wins another term, just in time for the 2018 midterm elections.

NHI: Excellent interview in TT with NTU President Yang on the plight of doctors in the NHI system. The system holds costs down just like any other Taiwanese boss: it overworks its laborers, and underpays them, both doctors and nurses.

ICAO: The ICAO, the aviation safety body, blocked Taiwan's attendance with the usual displays of moral cowardice characteristic of the western democracies. Beijing is punishing Taiwan because Tsai will not say Taiwan is part of China, and took credit for it.

MEDIA: The only good thing about blogging on the media is that the supply of stoopid never dries out. This week J Michael Cole took Simon Tisdall to task for a demonstration of clueless, lazy, incompetent writing...

In reality, the 25 percent drop in support for President Tsai cannot, contrary to what the author argues, be “summed up in one word: China.” In fact, it can be summed up in not one but two words: not China. Like anywhere else, what contributed to President Tsai’s support levels are primarily domestic matters, from a stagnant economy to urban renewal, broken promises on same-sex marriage to lackluster Cabinet appointments, labor issues to the New Southbound Policy that increasingly doesn’t sound so new — in other words, the regular stuff of regular countries.

Tisdall got everything wrong of course, hilariously referring to the China tourist trade as "lucrative" when it is a pernicious money loser that is widely despised in Taiwan.

This problem also showed up last week at FPRI, where Thomas Shattuck, in an article describing the horrible summer of Tsai Ing-wen, completely misread my piece on the Kenya deportations...

In April, Kenya sent 45 Taiwanese nationals to China, and in August, it deported another five individuals. These deportations sparked outrage because the people and government of Taiwan viewed it as a slight to their nation and as another instance for China to assert its power over them. While some have argued that this deportation process is normal operating procedure—Kenya sent them back to the city that they departed from—Taiwan’s government lodged complaints saying that these deportation were nothing more than “extrajudicial abduction.” China argued that these people flew out of China and targeted Chinese citizens with these scams and that as citizens of Taiwan (which China views as a rogue province), they were under the jurisdiction of China. This issue did not just involve Kenya—Armenia recently deported over 70 individuals to China, Cambodia deported another 13, and Malaysia sent 32 suspects. After the latest round of deportations from Armenia, Taiwan’s Mainland Affairs Council said in a statement, “We have repeatedly demanded the Chinese side not to deport our people to mainland China. The Chinese side’s action again disregarded our call … and further hurt the feelings of Taiwanese people.” Making these deportations such a large, international issue between China, Taiwan, and several other countries demonstrates Taiwan’s lack of options when pitted against China—not so strongly worded statements of condemnation. These countries chose to avoid challenging China instead of pleasing Taiwan.

No, I didn't argue it was SOP. Read what I wrote, Mr Shattuck. The key point of what I wrote is that the deportations weren't aimed at Tsai Ing-wen because the policy of deporting (alleged) Taiwanese scammers to China had been decided over a year before Tsai entered office. This policy HAS NOTHING TO DO WITH TSAI ING-WEN. IT BEGAN UNDER MA YING-JEOU. 

How hard can that be to explain? But that's not as sexy as "Look what a tough summer Tsai is having!"

The deportations do not demonstrate Taiwan's "lack of options" against China. Instead they demonstrate that China was complying with international practice in having criminals who had committed crimes against its people deported back there, as Ma Ying-jeou's own officials admitted. The noises that the Taiwan gov't made about the unfairness of it all were just noises designed to placate its own voters, made by both the Ma and Tsai Administrations. They don't signify anything. No nation could have stopped China from deporting the alleged Taiwanese gangsters back to China, because China had every right to.

But why bother to explain anything like that? It's waaay more fun to write about how bad things are. Actually, they are pretty normal for the first 100 days of a presidency on The Beautiful Island.

Deportations back to Taiwan, as happened with Indonesia don't count for Tsai, aren't even mentioned, in fact. No selective use of facts here folks, move along now.

Shattuck also nattered about the tourists...

China’s self-assertion also involves pinching local Taiwanese citizens’ pocketbooks by preventing Mainlanders from travelling to the island. The normal deluge of Mainland tourists to Taiwan has slowed to a trickle over the summer in response to Tsai’s election and her refusal to meet Beijing’s demand of accepting the 1992 Consensus. Though Tsai has moved towards the center recently in this regard, Beijing’s “red line” is its acceptance for the continuation of cross-strait relations. In 2015, between May and July, over 1 million Mainlanders came to Taiwan; this year, during that same time period, under 900,000 made the trip—the lowest since 2013—for a difference of nearly 150,000 tourists.[2] While that number does not seem too significant at face value, there are now that many fewer people renting rooms, using tour buses, taking taxis, frequenting museums and restaurants, and buying souvenirs. Places once full of tourists are now empty thanks to this 30% decrease in Mainland visitors. Workers rallied in Taipei to protest their current situation, and the government has set up a NT$ 960 million fund to help ease the burden. It has gotten so bad that counties not run by the DPP have sent delegations to China in order to encourage tourism to specific cities and counties that have a more friendly view of China. These leaders hope to increase tourism again and create new markets to increase economic interactions.

The key issue is this: tourists are a tiny part of the Taiwan economy, and the missing group tours, the stingiest, lowest spending, crappiest tourists, are less than a third of Chinese tourists, and an even smaller fraction of all tourists. In other words, the missing fraction is a fraction of a fraction in Taiwan's ~$530 billion economy. The only people complaining are those idiots who invested in an obvious political bubble.

There are way more important sectors, so why are we talking about tourism from China? Quick -- what's the largest sector of Taiwan's economy? What happened to our manufacturing orders last month? What's the inflation rate? Those things are far more important than 150,000 sheep for the slaughter from China. The automatic reach for the Chinese tourists, along with the deportations, neither of which is important, is just another example of how the outside world continues to view Taiwan in terms of China, and how Beijing controls the narrative, dominating the minds of those who write about Taiwan. Sad.
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Daily Links:

• 7 part history of Taiwan on Youtube
• Yet another pro-independence politician refused a visa to Hong Kong.
• Another article on craft brewing in Taiwan
• Increasing taxes on the wealthy widely supported. The Ma Administration's anti-labor, pro-big business policies profoundly harmed the wealth distribution in Taiwan. 
• New Bloom on the handling of a rape case at Fujen U.

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!

CNN iReport on Taiwan's Nurses

A Taiwan nurse speaks out on CNN:

When all of the medical workers in an unhealthy working environment, the patient must to facing a high risk care quality, because in Taiwan, every nurse should take care of at least eight patients in morning shift, even more. Over twelve patients in afternoon shift and almost take care of nearly twenty patients in night shift! That’s pretty incredible.

Nurses in Taiwan are not only superwomen or supermen, but are also patients. Staff shortages happened in past ten years, the trickiest thing is that Nurses do not have right to sick anymore, only because of nurses shortages. Taiwan's hospitals manager will not let their nurse get a sick leave if the nurse still able to walk even in public hospital system.

The Nurse’s working hour in Taiwan often over ten hours every shift, even more. However, the hospital did not give overtime fee; they only give nurses unreasonable pay to buy their break off. The medical environment of the culprit was created by the National Health Insurance System.

The emoting here is offputting, but the information is correct, as I noted in the post a few posts below this one. It would have been great if she had found a native speaker to edit it properly. But it would have been even better if she had identified the real culprit: the fact that many hospitals are essentially for-profit concerns that run by farming the government subsidy, and thus, nurses represent costly labor rather than profit centers. Taiwan institutions, whether public or private, health or manufacturing, all treat labor the same way. The real issue is not the NHI but that in Taiwan a nurse is like most laborers, without a real union.
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Daily Links:

• Taiwan LED maker moves factory back to Taiwan. Some interesting quotes in here....
• Growth forecast slips again.
• Gov't once again loses sanity on the Senkakus. Taiwan's crazy claims on the South China Sea and on Japanese territory hurt its ability to cooperate with neighbors.
• Stores to lock up charcoal to prevent suicides? It won't work. I wrote on the charcoal/suicide issue five years ago, still relevant. 

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums! Delenda est, baby.

Nursing a Grievance

This is a video of 500 nurses holding a meeting to complain about conditions at Taipei's Rungzung Hospital, a situation replicated all over Taiwan. The hospital was successful in keeping the media out of the meeting so this video comes from the cellphone of a participant.

According to the video, the hospital is short 171 nurses, and thus each of its nurses care for too many patients. Rungzung is famous; it has a 95% occupancy rate. The nursing shortage is paradoxical -- there are more nursing students then places for them, but then they leave the profession at greater rates than they enter when they realize how awful it is. At some hospitals the nurses clock out at the end of the shift as required by law but then work unpaid and unrecorded overtime, exploitative, illegal, and dangerous.

This is not a health industry problem but is par for the course in all sorts of production situations in Taiwan, especially where there is a moral or public service element involved (the police also have brutal schedules) but in general workers in offices and factories who work overtime without pay don't kill people when they make inevitable errors. These problems are only the tip of the iceberg, I hope to do some interviews of nurses before the summer and expand the list of issues. What I've already heard will make your hair turn white.

The first nurse to rise complains that they make $30,000 month as a nurse; on her recent trip to a Taichung night market she encountered a student worker making $33,000 a month selling fried octopus meatballs in the night market. "Shouldn't I go sell octopus balls in the night market?" she says, to everyone's laughter and resounding "yes!" Then she goes on: "those of you who have been here three years, four years, have you been promoted?" "No!" The next woman who stands up complains that the money the hospital has been spending on purchasing flowers to beautify the place should be going to paying the nurses.

Because it is doctors who generate income for the hospital by taking on patients, hospitals seek to maximize doctors and minimize nurses, who represent a cost to the institution, which are often privately owned and like so many large corporations in Taiwan, farming Taiwan's subsidy regime. At the bottom of the institutional pecking order, often from working class families, nurses are the target of the System's attempt to reduce costs by exploiting labor. The job is so awful that even nursing positions that pay as much as college professor positions go unfilled.....

Clearly reforming the NHI is going to involve much more than simply adjusting the billing and payment regimes. The whole approach to the use of labor is going to have to be rethought.
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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums! Delenda est, baby.

Persistent Vegetative State (PVS) in Taiwan

A few posts down from this one I posted part of a conversation I had with a young nurses in the health system here. She had spoken of the lawsuit from the family of an accident victim against a team of neurosurgeons. Sure enough, today the Taipei Times hosted a piece  on the Increasing Cost of Saving Lives:

Seven years ago, surgeons at Tung’s Taichung MetroHarbor Hospital operated on a man who had suffered a head injury in a traffic accident, but the outcome was that the man ended up totally paralyzed and blind. At the end of last month, the -Taichung branch of the Taiwan High Court ruled that the hospital and the three doctors who performed the operation must pay the man’s family more than NT$33 million (US$1.1 million) in compensation.

One of the doctors is neurosurgeon Lee Ming-chung (李明鍾), who is famous for his valiant, though ultimately unsuccessfu, efforts to save the life of another brain trauma patient, a little girl surnamed named Chiu (邱), who had been turned away by several other hospitals.

The Chiu case was quite sad. Readers probably recall it. The girl had been beaten unconscious by her father and then refused at hospitals all over Taiwan claiming they had their quota of neurosurgical cases. She finally wound up at a hospital in Taichung, where she died.

Tung's is the big building with the rotating restaurant easily visible from almost anywhere between the slopes of Tatu Mountain and Taichung Harbor west of Taichung city. Despite its unusual name it is a first-rate and extremely well run hospital, where foreigners from ships in the harbor are taken for medical help. The sons of the founder ran for legislator posts in the recent election, some Blue, some Green.

The Taipei Times piece observes that one reason health care is cheap in Taiwan is because doctors are often not insured. Because litigation is so common -- it is not even more common because of the undersupply of lawyers -- doctors are becoming shy about entering professional specialties where the likelihood of lawsuits increases. The writer goes on:

Taiwan has the highest rate of PVS [persistent vegetative state] in the world. The number of PVS patients in the US is estimated to be somewhere between 15,000 and 40,000. According to available information, Taiwan had a total of 4,792 PVS patients as of 2008, and 6,000 PVS patients are now registered for care with the Genesis Social Welfare Foundation, a charity that specializes in this field. These figures suggest that not only does Taiwan have a very high rate of PVS, but the number of cases is increasing very fast. As to why people end up in this condition, the most common cause is scooter accidents, followed by overmedication.

I found this paragraph astonishing, since I'd never heard this distressing claim. The author notes that rates of PVS in Taiwan are 60% higher than in the US. In Taiwan PVS patients cannot be taken off life support at the request of the family; who must also help pay for the upkeep. This probably increases the number of  PVS cases. Another cause is likely the enormous number of scooters in Taiwan. Maintaining such patients is presented by the MOI as a "pro-life" position. Taiwan Panorama had an article on the local hospice system a while back, with some comparisons to similar systems in Japan:

The costs, in terms both of money and manpower, of the Japanese model are huge-monthly care for the average patient costs roughly NT$380,000, a world apart from the NT$50,000 spent by CSWF. As the majority of PVS patients in Japan entered their states through automobile accidents, much of the funding for their care comes from fees levied on vehicles for that very purpose. CSWF, on the other hand, receives only 10% of its funding from the government, with the remaining 90% coming from public donations.

After starting initial work on the hospice in 1980, Cao was finally able to open the hospice six years later, taking on patients from poorer families free of charge. To date, CSWF has cared for nearly 500 such patients.

Patients in vegetative states are cared for by professional caregivers at CSWF, with nurses providing care 24 hours a day over three shifts. Every two hours the patients are rolled over, patted on the back to help clear their airways, and have their linen changed, and they are fed once every four hours. They are washed every two days, to help maintain their cleanliness and hygiene, as well as their dignity.

Over the past 18 years, CSWF has opened branch hospices around the country. The goal is to have 23 locations in cities and counties throughout Taiwan, Cao says. Thus far they have completed 13, with another four in the planning stage, and the organization hopes to meet its goal within the next five years.

The GSWF home page is here.

UPDATE: A nursing professor explained to me that in cases of terminal disease, if the entire immediate family and the succeeding generation signs a DNR and the hospital ethics committee approves, then the tubes can be removed by doctor. This change was made last year. But for a coma patient whose prognosis is uncertain, that is still not possible.
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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums! Delenda est, baby.

A Nurse Speaks

Had a conversation on Facebook with an old student who is now a nurse.... not her real name, of course:

PAULA:

i think NHI is not used properly...

think about it, even drug abusers are sent into the hospital and the government pays for their treatment or people drink and drive and kill people in an car accident and the government pays for all their medical treatment

another thing is that,more and more Taiwanese people took this for granted they pay little when they go to the hospital and they see doctors and nurses with no respect because its cheap

NHI pay too little for medical staffs especially nurses so hospital wouldnt hire more nurses, they would rather pay more to doctors ( cuz NHI pay doctors by how many clients they treat)

too many things, this pyramid is going down

and one thing is that, families dont appreciate what doctors and nurses do they are getting more picky and complain about medical treatment

again, because it is too cheap what they are paying

NHI cover mostly 80-90%

i was upset by the news that a neurosurgeon has been sued by a patient who was paralyzed after brain surgery but he was nearly dead in a car accident

the doctor was sentenced to pay 30 million to the family

but, some other guy drinks and drives and causes people to die in a car accident

how much does he have to pay? like 2 or 3 million ridiculous

i work in the ICU sometimes i can really feel tense communication with the patient's family

its like they all assume that we are gonna harm them or something because they ve been watching bad things like this on TV before

media!

even after the patient is cured and goes home many times we hear doctors talk about "NHI refuse to pay them money (those medication and examination has been given and done on patients)

so the doctors have lots of paper work to do to write down the reason one by one why they chose to give that order because the NHI officer assumes that doctor wanted to make more money so they prescribe expensive medications

you see, this is the problem: there is only one pie for everyone to share

so hospital wouldnt give move money to the staff and it is too cheap

people dont cherish it

and they are not friendly to medical staff

so there are many news stories about doctors rather choosing to become plastic surgeons

no one wants to risk their life to be a heart surgeon or neuro surgeon

cuz they dont wanna ending up getting their ass in the jail or bringing themselves to the court and eventually having to pay lotttsssss of money to the patients

doctor and nurses are not God

well, from my experience, i just dont like some people who come into the ICU and notify me that their family or friends are someone famous or big

i just dont care

i got only two hands

thats stupid

im not saying everyone is like that

there are some family are really nice

but im concerned this is dragging everybody down

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums! Delenda est, baby.

Principled Resignation

I always enjoy reading comments from China on Taiwan's democracy, such as this excerpt from a speech from a PRC scholar on rule of law in Taiwan. Such principles were on display this week as two cabinet officials tendered their resignations over issues of principle.

First, justice minister Wang resigned over the death penalty....

Justice Minister Wang Ching-feng published an article on March 9 entitled “Rationality and Forgiveness,” articulating her view that the death penalty should be abolished and stating that she would not sign the execution order for any convict on death row during her term in office. Minister Wang’s article induced an angry backlash among the public. Wang wrote that she would insist on doing the right thing even if her opposition to the death penalty meant that she would have to step down.

However, Presidential Office spokesman Lo Chih-chiang yesterday, in a press conference, stated that ours was a government of law, therefore, everything must be done according to the law. The executions of death row inmates must be carried out unless there was a legally sufficient reason for the execution to be stayed, Lo said, adding that otherwise, the Justice Ministry must carry out its duty in accordance with the law.

The local focus was on how the President simply threw Wang to the wolves, refusing to support her. Focus Taiwan translated a China Times editorial that sketched her career as an activist. The editorial observes that the Chen Administration stalled executions because it feared international repercussions. It also hints at a problem within the Administration: when it vetted its appointees for the justice post, didn't anyone ask about this key issue? D'oh.

The Wang resignation also highlights another problem endemic with Ma: the appointment of individuals to high position who come from academic backgrounds and have little political experience. This pan-Blue papers have roundly condemned Ma for this.

The death penalty is highly popular in Taiwan, with widespread public support. It make a cheap target for moralizing. But when it comes to the hard stuff.... it is a shame that Wang's high morals didn't extend to the numerous problems with the Chen Shui-bian detention and trial. Taiwan News gives another take and observes that under the law -- despite claims to the contrary by KMT officials and KMT papers -- she is not required to sign execution orders:

Unfortunately, Taiwan society remains dominated by the hoary and barbarian precept of vengeance and understandable but dangerously vindictive feelings of survivors of murder victims, which ultra-conservative KMT lawmakers are utilizing to stir a reactionary populist storm in order to turn the clock back on Taiwan's human rights progress.

The fuse was lit by Control Yuan Commissioner Chao Chang-ping and other colleagues who declared "orders for the death penalty should be approved by the justice minister and implemented within three days" and threatened to "investigate" Wang for "illegally" delaying executions.

Indeed, Article 127 of the Criminal Code mandates that public officials who do not implement legal punishments are liable for a sentence of up to five years, but this rule applies mainly to prosecutors or jail wardens and not to the justice minister who is not an "public official tasked with implementing punishment" but the chief of the highest administrative judicial agency.

Indeed, there is no article in the Criminal Code that explicitly requires the justice minister to sign such orders and it is evident that the justice minister is granted the "under the law" the discretionary power to sign or not to sign such orders.

Therefore, neither Wang or any other previous justice ministers who refused to sign death sentence orders have transgressed the law and indeed have honored the Constitution through their respect for all human life.

There were even gloating KMT legislators who said that all 44 of the prisoners currently on death row should be executed. Disgusting. The sad part, as many noted, is that with Wang calling attention to the death penalty, which has 70%+ support on the island, it is likely that executions, which had been stayed for the last five years, will resume.

Also resigning this week was the Health Minister Yaung Chih-liang, who bluntly told the Premier that his requirements to confine health fee increases to the upper income brackets wouldn't work. The Premier had wanted 75% of the population to experience no fee increases, but the math doesn't work. Yuang instead had called for 41% of the population to experience slight increases. His resignation has not been accepted.

Take note of the explosive political issue that underlies this, one that shapes so many issues in Taiwan, but often flies under the radar: local government debt. A number of local governments, including Taipei, have not paid their debts to the NHI. It is not just fees that have to rise, but enforcement of payments on local governments as well.

It is obvious to every sentient mind on the island that health fees must go up if the wonderful NHI system is to survive. It would be great if the legislature would sit down and pass a set of fee increases with bipartisan support. I think the government and both parties would be pleasantly surprised to find how quickly the public would adapt.
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Daily Links:

• Short film on Taiwan's critically endangered dolphins.
• A story about fox spirits in Taiwan from RTI.
• Taiwan rejects ban on tuna fishing but will accept a quota. As if anyone would pay attention to it. Do these people want to have tuna left for their children to eat? Apparently not.
  
• Ma says Chinese students to enter Taiwan universities. Some are already here, I have one in one of my classes, from Macau.
  
• Taiwan approves plans to permit Chinese banks to invest.

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!