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All the rabid talk about demanding a public option and/or demanding single payer seems to ignore one of the finest health care systems in the world that has neither.  Let's take a breather.. count to 10.. and take a look at arguably the most successful health care system in the world.

Dutch healthcare system 'best in Europe' in 2008

The Netherlands' healthcare system was this week rated the best in Europe by the annual Euro Health Consumer Index (EHCI). Experts believe it could serve as a model for US healthcare reform.

Follow me below the fold for more..

The EHCI, the 2008 version external  of which was published on 13 November, is compiled annually. It is based on publicly-available statistics and data from a private Swedish company, Health Consumer Powerhouse (HCP). From 34 indicators of quality, the overall ranking was divided into six categories: e-Health, patient rights, patient information, waiting time for treatment, waiting time for pharmaceuticals, and the speed at which new drugs are deployed.

The EHCI praised the Dutch effort, describing the winning margin as "the biggest since this 31-country ranking started in 2005". The Netherlands was also paraded as "the truly stable top performer" in the EU, primarily due to its successful patient empowerment track record.

Every adult in the Netherlands is required to purchase basic health insurance.  Children under 18 are insured for free for the basic health care package and also receive free dental care.

Insurance companies, on the other hand, also have a mandate to provide a specific basic insurance benefit package.

The basic insurance covers general medical care with a family doctor, hospital stays, dental care for up to age 22, prescription medicine, and various appliances. Costs start at approximately EUR 100 a month.  The government keep tweaking this package.

From the Netherlands Ministry of Health web site:

Under the new Health Insurance Act (Zorgverzekeringswet), all residents of the Netherlands are obliged to take out a health insurance.

The system is a private health insurance with social conditions. The system is operated by private health insurance companies; the insurers are obliged to accept every resident in their area of activity. A system of risk equalization enables the acceptance obligation and prevents direct or indirect risk selection.

Risk equalization.  This is a very important point and one that has, in my humble opinion, been left out of most discussions of a future US health care system.  It is so important because it helps eliminate cherry picking patients.  Those insurers who have a higher percentage of sick people (and people with chronic ailments) are paid an equalization payment by the government to cover those extra costs.

Costs
The insured pay a nominal premium to the health insurer, everyone paying the same price for the same policy.  Lower income people have their premium paid for by the government on a sliding scale.

Average costs are about $1600 per year per adult.  Your employer may choose to pay these premiums but is not required to do so.

Optional packages that cover things like dental procedures and physiotherapy are available through most insurers and about 90% of Dutch take advantage of some of these.

An income-related contribution is deducted from your paycheck, but may be paid by the employer. This is a maximum of of about 2250 Euros, or about $3000 per year.  Individuals that self-pay have a maximum of about $2200.

Once again, fixed or low income individuals are subsidized by the government.

-----------

My opinion?  If single payer is off the table, I like this option.  No matter what income level you are at, you get to purchase (or have the government purchase for you) the exact same health plan as other people.  There is no stigma of Medicaid and the poorer coverage and reimbursement options that go with it.

The Dutch system also heavily regulates insurers with an eye on cost reduction.  Costs have gone around 4% per year on average..

Health care costs in the Netherlands (and Germany with a similar private insurance only system) are half what they are in the US.

Note: I had to cobble these figures together from several source, so I apologize up front if I got anything wrong.. I'm sure I will hear about it in the comments, if that is the case!

I think it is worth a look, at the very least.

Originally posted to Skeptical Bastard on Mon May 11, 2009 at 08:44 AM PDT.

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Comment Preferences

  •  Are we the Netherlands? (20+ / 0-)

    Do we have the same average income?

    Do we regulate insurers the same way?

    Do we tax corporate profits and executive pay the same way?

    Do we regulate the provision of medical care the same way?

    Merely saying "the Dutch can do it without a public option" is essentially meaningless. The context in which it operates is what matters.

    Massachusetts has mandated private insurance too, with no public option. It is not a success.

    I'm not part of a redneck agenda - Green Day

    by eugene on Mon May 11, 2009 at 08:48:01 AM PDT

    •  Thank you, Mr Negativity.. (5+ / 0-)

      for your insightful comments.

      You must belong to the "Party of No"...

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 08:49:48 AM PDT

      [ Parent ]

      •  Well, Color Me Skeptical, Too: (11+ / 0-)

        Children under 18 are insured for free for the basic health care package and also receive free dental care.

         Isn't that a Public Plan?

        Currently, the 50,000,000 Uninsured, here in American are probably asking, how much does it cost:

        Every adult in the Netherlands is required to purchase basic health insurance.  

         Any answers?

        •  No. (4+ / 0-)

          Isn't that a Public Plan?

          Those are premiums payed by the Government to private insurers.  Regulated, yes.  A "public option" (in the sense of Government-run)?   No.

          Good snark is hard to come by.

          by LarryInNYC on Mon May 11, 2009 at 09:11:32 AM PDT

          [ Parent ]

          •  Yes. The govt. is the single payer. (6+ / 0-)

            The U.S. govt. contracts insurance companies to manage Medicare and Medicaid on a regional level. The overhead costs are much lower for Medicare because there's one payer, one set of rules and no cherry picking or incentives to shift costs.

            "It's the planet, stupid."

            by FishOutofWater on Mon May 11, 2009 at 09:34:20 AM PDT

            [ Parent ]

            •  That's a. . . (7+ / 0-)

              single payer private plan — which is actual a possibility.  Care is provided privately but paid for by a single entity.

              The fact is that this is largely a meaningless semantic argument.  The Dutch are quite clear that they consider their system a private one — but when everyone is mandated to purchase insurance with set benefits at a set cost, how does that differ from a government run system funded by taxes?  It hardly differs at all.  It's hard to imagine that any single payer system that might be implemented in the US would only consist of clinics owned by the government and doctors paid directly from the government payroll.

              Personally, I'm less concerned about what things are called and more about the effects they have.  If we could achieve the same effect that Dutch have you can call it uber-private corporate depravity for all I care.

              Good snark is hard to come by.

              by LarryInNYC on Mon May 11, 2009 at 09:40:48 AM PDT

              [ Parent ]

              •  Privately provided care is the favored option (4+ / 0-)

                by most Americans who favor single payer AFAIK. I am aware of very few American single payer advocates who want us to have government run clinics like Cuba.

                We aren't proposing a communist health care system.

                "It's the planet, stupid."

                by FishOutofWater on Mon May 11, 2009 at 09:44:35 AM PDT

                [ Parent ]

                •  UK NHS (3+ / 0-)

                  I would not describe that as COMMUNIST, but equally starting from where you are there is no need for a massive takeover of private run hospitals and clinics by the government, but there already is a large government run service the Veterans Administration, in future those facilities could be used more efficiently for the people in the area and veterans could use other facilities were they live.

              •  Semantics are quite meaningful (4+ / 0-)
                Recommended by:
                Fro, jxg, Catte Nappe, WattleBreakfast

                in selling this to the American people, however.  I agree with you.. but being able to call something this large run by the federal government "private" helps to sell it to the public.

                And, as I stated above, with the private optional packages and the ability of employers to optionally pay for it, it is more in keeping with the way Americans view a desirable health care system.

                In essence, this is single payer health care for a minimum basic package with all the advantages of private health care for those who want (or think they want) more.

                "Those are my principles, and if you don't like them... well, I have others." - G. Marx

                by Skeptical Bastard on Mon May 11, 2009 at 09:57:47 AM PDT

                [ Parent ]

                •  This (4+ / 0-)

                  In essence, this is single payer health care for a minimum basic package with all the advantages of private health care for those who want (or think they want) more.

                  Is essentially what the Australian system looks like.

                  They have, solely as a function of living in their society, a "Medicare" type guarantee.  Then, if you so choose, you can purchase private insurance, in addition to your provided "national health coverage".

                  Take a look, and thank you for this diary.  The "public option" on the table at the moment is nothing more than a whitewash and a mockery of what we have been working for.

                  Thank you.

      •  eugene's questions are valid (9+ / 0-)

        Particularly the one about income inequality.

        Incidentally, the "quality" indicators cited do include a single bona fide health outcome. Only service outcomes. As far as I know, the Dutch system fares well on health outcomes. Just sayin' ... why would such a basic indicator of quality be omitted?

      •  Actually, his comment (9+ / 0-)

        contains real questions IMO about this particular comparison: does the US have the same regulatory infrastructure as is in the Netherlands; an infrastructure package which shapes the manner in which for-profit businesses there are allowed to interact with consumers; are viewed by consumers; shape the philosophies with which those businesses themselves view consumers and thus are run?

        IMO that's not only a valid question, but it's a crucial one as well.

        With hope and virtue, let us brave once more the icy currents, and endure what storms may come. - President Obama

        by GN1927 on Mon May 11, 2009 at 09:03:36 AM PDT

        [ Parent ]

      •  excuse me... (5+ / 0-)
        Recommended by:
        SarahLee, slinkerwink, jxg, corvo, miamiboats

        you wrote a diary championing mandatory insurance - essentially, supporting healthcare corporatism.  what exactly did you expect?

        I can break Sean Hannity by giving him a middle seat in coach. -Wanda Sykes

        by jj24 on Mon May 11, 2009 at 09:31:52 AM PDT

        [ Parent ]

        •  Agree... (4+ / 0-)
          Recommended by:
          SarahLee, slinkerwink, jxg, jj24

          This sounds like Massachusetts and it would likely have corporate health at the table to write the plan.
          No way this happens in the US without a minimum annual of something in the neighborhood of $4K.
          Can't afford it? Fine. The Feds are now required to pick up the tab.
          But about that really costly condition you've developed there? We got an exclusion written in that unfortunately precludes us covering that. Sorry.

          All this would end up doing is requiring folks who right now are going uninsured to fork over money to insurance "providers" and you can only imagine who gets a seat at the table to decide the ground rules.
          Ask Max Baucus to comment on this... he'd LOVE it..

          The two most important things in life are good friends and a good bullpen. ---- Bob Lemon

          by miamiboats on Mon May 11, 2009 at 09:39:28 AM PDT

          [ Parent ]

      •  He brought everything he had n/t (0+ / 0-)

        If spittle & tooth=vigor & youth Bill-O & Savage won't grow any older If wishes & dreams=bitches & beams We'll all live in skyscrapers bu

        by TooFolkGR on Mon May 11, 2009 at 10:38:36 AM PDT

        [ Parent ]

    •  "Are we Japan?" - I can remember (16+ / 0-)

      a time where that phrase was uttered with respect to "Total Quality Control" and similar apt questions were asked.

      See where it got you.

      When something works elsewhere it's worth a look and an analysis what needed to be done to implement it - not an off-the-cuff dismissal.

      Reality is that which, when you stop believing in it, doesn't go away. -- Philip K. Dick

      by RandomGuyFromGermany on Mon May 11, 2009 at 08:55:21 AM PDT

      [ Parent ]

    •  Answers (7+ / 0-)

      We have higher average income.

      The Netherlands are one of the most private-biased economies in Europe, and I suspect it isn't too big a bridge to cross for us to emulate them.

      We do not tax corporate profits and executive pay as highly as they do, but at the rate things are going it's probably only a matter of time.  Dutch taxes are slightly less progressive than ours, but the quid-pro-quo is better public assistance.  Total Dutch income taxes including all payroll taxes add up to 32, 42 and 52 percent (versus the US system which is slightly more progressive at anywhere from 17 to 50 percent depending on the state and income band).  I would assume that as with the rest of Europe their property taxes are lower, and of course I know their sales taxes are higher.  Corporate taxes are lower than ours, at 20 percent on the first 200,000 Euro and then 25.5, but with fewer deductions and exemptions.

      With regard to regulation, the reason Massahusetts is failing is because of the lack of it.  This is where we need to adapt.

      •  Do they have a VAT? (0+ / 0-)

        You mentioned sales tax..

        I don't really understand the VAT completely that many European countries have, but it seems it it usually left out of the equation when comparing taxes.

        "Those are my principles, and if you don't like them... well, I have others." - G. Marx

        by Skeptical Bastard on Mon May 11, 2009 at 09:07:04 AM PDT

        [ Parent ]

        •  The main difference is that VAT (4+ / 0-)
          Recommended by:
          ademption, Sychotic1, dansmith17, MKSinSA

          doesn't accumulate while sales tax does.

          For example, if the sales tax is 8% a logging company which sells wood to a carpenter will have to charge the tax to him while the carpenter will charge another 8% in tax to his customers.

          With VAT the carpenter - the one who sells the end product - deducts VAT which was paid to suppliers.

          Iuris praecepta sunt haec: Honeste vivere, alterum non laedere, suum cuique tribuere. - Ulpian, Digestae 1, 3

          by Dauphin on Mon May 11, 2009 at 09:15:10 AM PDT

          [ Parent ]

      •  Is the Massachusetts program really failing? (1+ / 0-)
        Recommended by:
        Skeptical Bastard

        I've heard this asserted many times in comments, but haven't seen much documentation.  I know the budgetary cost to the state was higher than expected because more people than expected signed up for subsidized CommonwealthCare coverage and Medicaid.  But that's a good thing in some respects -- more people covered.  I've also heard premiums in CommonwealthCare are going to be flat (zero growth or even slightly reduced) for the upcoming year.  In my opinion, any major new program to cover the uninsured that survives the worst recession since the 1930s even partly intact deserves some credit.  And I was under the impression that the coverage was decent, though certainly not lavish.

        •  Here's a fact sheet (2+ / 0-)
          Recommended by:
          SarahLee, this is only a test

          from Kaiser Family Foundation

          http://www.kff.org/...

          Costs of insurance have risen as have costs for the state.

          A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. FDR

          by Betty Pinson on Mon May 11, 2009 at 10:00:22 AM PDT

          [ Parent ]

          •  Thank you -- I think they conclude... (0+ / 0-)

            ...it has been a success in getting people covered,  but controlling health care costs will be a problem looking forward:

            Two years following passage of comprehensive health care reform, Massachusetts has been largely successful in expanding coverage to the uninsured. Over time, from Massachusetts we will learn the extent to which an individual mandate for health insurance coverage is enforceable and leads to broader coverage and whether statewide purchasing pools, such as the Commonwealth Connector, can provide affordable health insurance options for those without coverage. Continued success will depend on controlling health care cost growth and holding together the coalition of stakeholders that came together around the broad tenets of health reform. All eyes will remain on Massachusetts as it continues to carve a path toward comprehensive health care reform and as the nation debates national health care reform.

            I also found this page from the Mass Connector Authority, which has links to what looks like a fairly comprehensive fact sheet.  

            Beginning July 1, 2008, premiums for the unsubsidized Commonwealth Choice program rose by an average of 5% over July 1, 2007. This is in sharp contrast to the typical double-digit percent annual increases experienced by employer-sponsored and non-group plans in Massachusetts prior to healthcare reform.

            Again, higher than expected costs for the state, but good improvements in coverage.  

            I haven't found a source for my own assertion that premiums in Mass are expected to be zero or negative next year, but I believe it's accurate.

            •  Less than overall inflation (0+ / 0-)

              I think during that period US inflation was approaching 6%, if you can swallow the government numbers.  Real inflation might have been several points higher.

              So I'd say it's too soon to tell.  The current deflation will make it very hard to compare the prices of anything from Q3 2008 forward; some things are going up and others going down.

    •  Funny (4+ / 0-)

      This is the same argument used by the right against the statistics that prove we need national health care.  

      The argument is generally like this:  "Those stats about how we die earlier and everything, they don't take into account that we have a different population..." And so on.

      The lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging and kicking them into obedience.

      by otto on Mon May 11, 2009 at 09:03:22 AM PDT

      [ Parent ]

    •  Ok.. good questions then.. (7+ / 0-)

      My diary was not meant to be a comparative treatise on the entire economies of the Netherlands and the US.

      I'm throwing this out there as one possibility in response to all of the diaries and comments stating categorically that any plan without a public option in completely unacceptable.

      Further research needs to be done for eliminating anything, it seems to me.

      If you have some enlightening info comparing the two countries, please donate them to the discussion.

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 09:10:40 AM PDT

      [ Parent ]

    •  Of all the economies in Europe. . . (3+ / 0-)
      Recommended by:
      Sychotic1, MKSinSA, Grumpy Young Man

      we are arguably closest to Holland.  Therefore, if looking for models abroad, we could do worse than taking a good look at Holland.

      Good snark is hard to come by.

      by LarryInNYC on Mon May 11, 2009 at 09:13:43 AM PDT

      [ Parent ]

    •  eugene, you're way too polite . . . (2+ / 0-)
      Recommended by:
      eugene, jj24

      I hear Massachusetts is basically a disaster.

    •  That is due to costs, though. (0+ / 0-)

      And frankly, I wouldn't mind Mass.'s system down here in Georgia because at least you can get insurance if you have the money.  Pre-existing condition often means you can't get insurance, period in most states.

      There are problems with the Mass. system.  But it is not a total failure.

      •  "If you have the money" (0+ / 0-)

        Kind of a big qualifier there, don't you think?

        I'm not part of a redneck agenda - Green Day

        by eugene on Mon May 11, 2009 at 10:18:20 AM PDT

        [ Parent ]

        •  Actually, that is something. (2+ / 0-)
          Recommended by:
          Aexia, Skeptical Bastard

          Because if you have a family with asthma or some other kind of pre-existing condition you don't get insurance at any price.   Say, you earn a decent living consulting, but you don't have health ins. and must buy it on the individual market.  If you have a pre-existing condition, no matter how well you are doing you can't get it!!  I heard it is $1400 a month in MA.  Crazy expensive.  But if you are where I am, you can't get that insurance AT ALL.

          Oh, and if you are unemployed, you get insurance in MA.  Again, not so here in GA.  

          My take is lessons learned about MA.  Controlling cost is a component that must be considered.  But don't act like it is a big nothing.  

  •  I'm all for alternative solutions (11+ / 0-)

    The problem with the Dutch case, or with any European (or elsewhere) example of universal coverage without a public option, is that their distribution of income is far less skewed.  The only reason that a public option is on the table here is that we have so many people who are unable to pay for any private option, and we don't have a culture that permits the government to pay for a reputable private option on their behalf.

    Al que no le guste el caldo, le dan dos tazas.

    by Rich in PA on Mon May 11, 2009 at 08:49:04 AM PDT

    •  We pay for it one way or another (4+ / 0-)

      paying premiums for low income individuals for a basic insurance package just like everyone else seems to me to carry with it a level of dignity that Medicaid does not.

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 08:52:11 AM PDT

      [ Parent ]

      •  huh? (2+ / 0-)
        Recommended by:
        Big Tex, neroden

        In NL, you get an assigned GP in your neighborhood.  If you don't fit in, you can get another, but it's something to deal with.  It is still a really interwingled public/private partnership, to spite the fact that insurance companies are private.

        ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

        by jessical on Mon May 11, 2009 at 08:54:29 AM PDT

        [ Parent ]

      •  What A Crock! (2+ / 0-)
        Recommended by:
        Big Tex, corvo

        Your so called, "basic insurance package," is like $600 - $800 per month, or more, for an individual!  If you qualify.  

        And of course Millions don't!  Cause, there's just about as many rules in all the different states that conspire to keep People who really need insurance, without it.  

        Ever heard of Pre-esixting Conditions?  There's hundreds of them, too.

        And finally, which insurance company is subsidizing low income People.  Which one?

      •  but that fails to address Rich's point (2+ / 0-)
        Recommended by:
        Big Tex, pamelabrown

        show me how Netherlands poverty, unemployment, under-employment is similary to the problem faced in the US.

        show me the broad cost-of-living and standard-of-living variant there that exists when comparing the northeast (or west coast) with much of "fly-over" America.

        not to say that something might not be workable without single-payer or a public option ... but projecting the Dutch solution becomes problematic when considering the lack of analogism

        R.I.P. Chicago Eddie Schwartz (May 5, 1946 - February 4, 2009)

        by wystler on Mon May 11, 2009 at 09:04:58 AM PDT

        [ Parent ]

  •  this is a very important point... (15+ / 0-)

    ...though it is also perhaps worth keeping in mind that NL has a much more robust overall social safety net than the US, and is infinitely more common-sense than the US in many aspects.

    ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

    by jessical on Mon May 11, 2009 at 08:49:44 AM PDT

    •  And as eugene pointed out above (3+ / 0-)
      Recommended by:
      ferg, jj24, jessical

      if the Netherlands has a different regulatory and corporate philosophy than what's gone on here these past years, how would that affect the implementation of a for-profit mandated health care coverage program?

      If the corporate philosophy here views its relationship with government and consumers in a much different manner than in the Netherlands, what affect would that have on the success of a plan implemented here?

      With hope and virtue, let us brave once more the icy currents, and endure what storms may come. - President Obama

      by GN1927 on Mon May 11, 2009 at 09:08:29 AM PDT

      [ Parent ]

      •  heh... (5+ / 0-)

        ...it's the attitude of the doctors, the hospitals, everything...

        I thought eugene was dismissive (there may be more comments by now that I've missed).  It is less true now than when I was growing up, but in the 70s at least America had strongly regulated industries that could only pull x percent out of the stream.  I don't quite understand why we can't make insurance one of those industries (except of course for the Washington being owned by greedheads thing).  

        ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

        by jessical on Mon May 11, 2009 at 09:13:48 AM PDT

        [ Parent ]

        •  Seems like that would require the reversal (3+ / 0-)
          Recommended by:
          corvo, jessical, dansmith17

          of an entire philosophy by which corporatists have effectively convinced a not-insubstantial portion of the population that "freedom" somehow means abusive market practices, and any attempt to curb that abuse somehow compromises the individual liberties of the average wage earner.  I think people are coming around, but we have got a ton of work to do in terms of reinstalling any sensible approach to market regulation here; that's why I think this diary is really interesting, but I have doubts about whether we could really make the Netherlands' approach work here.

          With hope and virtue, let us brave once more the icy currents, and endure what storms may come. - President Obama

          by GN1927 on Mon May 11, 2009 at 09:19:40 AM PDT

          [ Parent ]

          •  yeah... (6+ / 0-)

            ...not as such.  If you wanted your spaceship to reach the next star, you'd staff it entirely with Nederlanders...they'd frickin make it work and all arrive 100 years later mostly sane and with a working society.  If you staffed it with Americans you'd just end up with Easter Island, a few starving descendants of the people who ate everyone else dressed in the threadbare remnants of pinstripe suits.

            It does seem to me that we should be practical in considering how to get from a society all about greed and Ayn Rand to one which is about quality of life.  I don't think there is a magic lever...so I'm glad this at least came up...

            ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

            by jessical on Mon May 11, 2009 at 09:32:13 AM PDT

            [ Parent ]

            •  LOL (1+ / 0-)
              Recommended by:
              jessical

              I know this is not a funny subject but:

              a few starving descendants of the people who ate everyone else dressed in the threadbare remnants of pinstripe suits.

              I laughed out loud at that.  Decades of regressive philosophy with the anti-intellectual and wedge issue/lowest common denominator brand of politics...your joking hypothetical is scarily possible.

              With hope and virtue, let us brave once more the icy currents, and endure what storms may come. - President Obama

              by GN1927 on Mon May 11, 2009 at 09:45:55 AM PDT

              [ Parent ]

  •  We are Americans. We are not the Dutch. (1+ / 0-)
    Recommended by:
    Big Tex

    They tortured people to get false confessions to fraudulently justify our invading Iraq.

    by slinkerwink on Mon May 11, 2009 at 08:51:29 AM PDT

  •  Interesting... (8+ / 0-)

    I'd like to hear from any open-minded supporters of single payer what they think of this.  Less interested in hearing from those who reflectively twitch when they hear the words "single-payer is off the table."

    From what I can tell, single-payer seems to be the best option, and I am suspicious when I hear Baucus or others refuse to consider it.  But if there really is another system that would cover everyone and minimize costs, I'd like to hear about it.

    •  dutch system is 'managed competition' (6+ / 0-)
      Recommended by:
      zeke L, jxg, Embee, vacantlook, phonegery, jessical

      Hillarycare, basically.  It works -- unlike the US disaster -- but it's a lot more expensive than the French single-payer system, and not much better.  Worse, it's much much harder to sell politically, as we discovered back when Hillary tried....

      Calling the Dutch system "private" is a bit bogus, but calling the German system "private is bogus in the extreme.  The German system is essentially a collection of single-payer government-run systems; which one you're in is determined by various historical accidents (are you a unionized worker?  A management worker?  A business owner? Which state do you live in?).  A small number of people are allowed to get truly private insurance or self-insure, but only if they can prove that they're rich enough.  The overhead of multiple systems means they waste a lot more money than the French, who have single-payer.

      -5.63, -8.10. Learn about Duverger's Law.

      by neroden on Mon May 11, 2009 at 09:00:18 AM PDT

      [ Parent ]

      •  Yes. neither is really "private" when coordinated (5+ / 0-)

        and heavily regulated by the government. Especially when there is a payroll tax component.

        The lack of a government run health provider/insurer was the main point.  

        Benefits are administered by private contractors.

        "Those are my principles, and if you don't like them... well, I have others." - G. Marx

        by Skeptical Bastard on Mon May 11, 2009 at 09:03:56 AM PDT

        [ Parent ]

        •  How is managed competition going to make (0+ / 0-)

          a person who needs to take five or six drugs to stay alive - costing over $1000 a month, profitable at $200/month?

          How?

          Public Option is Unproven Experimental Procedure
          We KNOW that single payer WORKS!

          by Andiamo on Mon May 11, 2009 at 09:15:19 AM PDT

          [ Parent ]

          •  Because in a cooperative society... (4+ / 0-)
            Recommended by:
            Embee, corvo, dansmith17, max227

            ...you decide that this over here is a business and this over here is government and you regulate the hell out of both of them in a way which keeps some set profit flowing, while keeping the whole ball of wax under control.  And never forget the basic goal that nobody falls through the cracks, because it makes things suck for everyone.  You have to live in one, as an American, to believe it :}

            ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

            by jessical on Mon May 11, 2009 at 09:24:01 AM PDT

            [ Parent ]

          •  Risk equalization (0+ / 0-)

            Insurance companies get compensated by the Dutch government for risky clients.

          •  They need to be taking money from 5 other people (2+ / 0-)
            Recommended by:
            Catte Nappe, Skeptical Bastard

            who at that point in their lives are paying in $200 a month and not taking anything out, basically everyone who is not pregnant from 10-40.

            The European systems work because EVERYONE pays.

            The US system does not work because if you are young and well you do not pay, and if you are sick and expensive the Insurance companies exclude you, to stop one you have to stop both.

            •  Exactly.. (1+ / 0-)
              Recommended by:
              denise b

              Everyone needs to pay or it all fails.

              We will never have a working health care system if we allow the healthiest individuals who do not use it much to opt out of the system.

              That is akin to opting out of Social Security until you retire!  It's insane.

              "Those are my principles, and if you don't like them... well, I have others." - G. Marx

              by Skeptical Bastard on Mon May 11, 2009 at 10:04:49 AM PDT

              [ Parent ]

      •  Only about $200 more per person than France (1+ / 0-)
        Recommended by:
        pamelabrown

        And they only spend 9.2% of their GDP v.s. France's 11%.

        http://www.npr.org/...

        You can compare what different countries spend here.

        •  Excellent resource (1+ / 0-)
          Recommended by:
          Eloise

          I remember NPR doing a series on various models, with interviews of people who had experienced both US and another country's systems. I didn't get to hear all of the segments, but of those I did hear there wasn't anybody who said they would prefer the US system.

          "People who have what they want are fond of telling people who haven't what they want that they really don't want it." Ogden Nash (on universal health care?)

          by Catte Nappe on Mon May 11, 2009 at 11:01:05 AM PDT

          [ Parent ]

    •  Personally (2+ / 0-)
      Recommended by:
      corvo, SweetLittleOkie

      I am for governement run or single payer, with a shitton of restrictions.  What we don't need is to have the insurance (useless fuckers) industry to have a stranglehold over us.

      There are bagels in the fridge

      by Sychotic1 on Mon May 11, 2009 at 09:23:25 AM PDT

      [ Parent ]

  •  Dutch pay under $200/month (12+ / 0-)

    look what New Yorkers pay for their "public option" (because it takes all)

    http://www.pnhp.org/...

    April 2009

    New York County

    Monthly family premium rates for Point of Service Plans (POS)

    $4450 - Aetna Health. Inc.
    $3776 - Atlantis Health Plan, Inc.
    $4066 - Empire BlueCross BlueShield HMO
    $6824 - GHI HMO Select, Inc.
    $4187 - Health Insurance Plan of Greater New York, Inc.
    $3816 - Health Net of New York, Inc.
    $3500 - Managed Health, Inc.
    $4208 - Oxford Health Plans (NY), Inc.

    HMO family rates for these same insurers range from $2266 to $5686

    http://www.ins.state.ny.us/...

    Public Option is Unproven Experimental Procedure
    We KNOW that single payer WORKS!

    by Andiamo on Mon May 11, 2009 at 08:52:35 AM PDT

    •  OMG (0+ / 0-)

      That's fucking ridiculous.

      No matter what happens or how healthcare ends up looking, I think that unless the "profit" is taken out of the equation, it will fail.  Period.

      Healthcare should in no way be a for-profit business.

      Check the stats for success rates at non-profit hospitals vs. for-profit across the U.S.

      Remove the insurance company's shareholders and maybe they'll act human.

      The difference between genius and stupidity is that genius has its limits -- Albert Einstein

      by SweetLittleOkie on Mon May 11, 2009 at 10:54:37 AM PDT

      [ Parent ]

  •  If we can't get a good public option on the (16+ / 0-)

    table, thanks to the influence of the for-profit health insurance industry, what makes anyone think we can heavily regulate that same health insurance industry?

    And what happens if an anti-regulatory Republican ever takes over?

    Healthy Minds, Healthy Bodies, discussing outdoor adventures Tuesdays at 5 PM PDT

    by indigoblueskies on Mon May 11, 2009 at 08:54:16 AM PDT

  •  Dutch and German systems *are* public. (10+ / 0-)

    For some reason the Netherlands decided to involve private companies.

    However, the extreme level of governmental control over absolutely everything they do makes them more regulated than the power company.  Effectively, your insurance policy is government-designed, whether your claim is approved or rejected has constant government oversight, et cetera et cetera.  This system would be next to impossible to implement in the US where we can't even get food safety right.

    The German system is essentially public insurance only.  The "private insurance" consists of a number of giant pools administered and micromanaged by the government.  The funding mechanism is officially "private", but in fact it's entirely government-run.

    To put it another way, these "private" systems are about as "private" as the Federal Reserve and the FDIC (which are nominally private corporations).  Or Amtrak (ditto).

    -5.63, -8.10. Learn about Duverger's Law.

    by neroden on Mon May 11, 2009 at 08:55:01 AM PDT

    •  exactly... (6+ / 0-)

      ...NL has a culture which recognizes quality of life, and a completely different attitude toward public service and government, in many ways.  

      But, eh...the reason I rec'd the diary was because at least this was brought up, instead of just barkin'.  I don't know if it is possible, but if insurance was regulated like power companies and Ma Bell used to be, in a very American form, the overhead would -- as a matter of law -- go down, and if the insurance company gets to make 5 percent, sobeit.  What's killing us I think is naked profiteering.  We can call it whatever we want, so long as we stop paying 20 plus percent to companies that are evaluated on insane growth of profits.

      ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

      by jessical on Mon May 11, 2009 at 09:08:45 AM PDT

      [ Parent ]

  •  An interesting possibility. (12+ / 0-)

    Personally, I hate the idea of any health insurance industry.  I think there is something deeply unethical about an industry that profits from denying health care to people who need it.

    I guess my biggest question is what their insurance actually covers.  Do they have co-pays and deductibles and restrictions on how many visits a year and all that kind of extra stuff that makes our health care a lot more expensive than just the insurance payments?

    If I could pay $200 a month, but that would literally cover all the health care I could ever want or need, I'd gladly do it.

    They tortured people to get false confessions to fraudulently justify our invading Iraq.

    by Kaili Joy Gray on Mon May 11, 2009 at 08:55:03 AM PDT

    •  Most systems (7+ / 0-)

      involve copays and deductibles in one form or another. For example, essential medicine will be free or available at a token cost.

      For example, in my country, antiretroviral medicine tends to be available very cheaply or for free, since your life depends on it. A month's supply of antibiotics can cost you around €10. But that newfangled afterexposure therapy for HIV (which has an 85% success rate) is not covered and the cost totals around €800. If it were covered, the cost would likely be negligible.

      Iuris praecepta sunt haec: Honeste vivere, alterum non laedere, suum cuique tribuere. - Ulpian, Digestae 1, 3

      by Dauphin on Mon May 11, 2009 at 08:58:16 AM PDT

      [ Parent ]

      •  Ah, but the devil's in the details. (5+ / 0-)

        My husband and I pay about $7000 a year for our insurance.  Except that it's actually $8000 a year, because of deductibles.  And we're only permitted visits to certain doctors once a month.  Like physical therapy, for example.  Which, when you need physical therapy, is absurd, because you generally go at least once a week.  

        Again, I don't mind paying for my health care.  But I want to know what the actual costs are and what is, and isn't, covered by my "insurance."

        They tortured people to get false confessions to fraudulently justify our invading Iraq.

        by Kaili Joy Gray on Mon May 11, 2009 at 09:02:01 AM PDT

        [ Parent ]

    •  They do have modest co-pays.. (6+ / 0-)

      Not on family doctor visits, but on other things.. but it is a maximum, I believe, of about $150 per year.

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 08:58:41 AM PDT

      [ Parent ]

    •  In Germany: one co-pay a quarter (3+ / 0-)
      Recommended by:
      jxg, Catte Nappe, Angry Mouse

      My in laws are German.  They pay premiums but for the longest time they paid absolutely zero copays or any kind of payment except the premiums.  However, like everywhere else, healthcare costs have gone up in Germany, so now they must pay 20 Euros a quarter in a co-pay if they go to the doctor.  But, if they go a bunch of times that quarter the maximum paid is still only 20 Euros.  Germans were really pissed off about that change.

      I want to emphasize that nobody should get utopian about various universal health care systems in Europe.  They have their problems, too.  Michael Moore did a great disservice lying about how great it is there.  That was misleading.  There ARE problems, and they are different (medical lawsuits don't yield big settlements there like they do here).  I just think that over all they still have a better system despite their flaws.

      •  Very good points re utopia. (2+ / 0-)
        Recommended by:
        beachmom, SweetLittleOkie

        I have a lot of family in Canada, and they certainly gripe about their health care system too.

        However, they never say they'd rather have our system.  Never.  They think we're pretty much barbaric when it comes to health care.

        They tortured people to get false confessions to fraudulently justify our invading Iraq.

        by Kaili Joy Gray on Mon May 11, 2009 at 10:37:09 AM PDT

        [ Parent ]

        •  when it comes to delivery of health care (0+ / 0-)

          and access to health care.  We still have the best health care in the world if you can afford it.

          "Those are my principles, and if you don't like them... well, I have others." - G. Marx

          by Skeptical Bastard on Mon May 11, 2009 at 11:49:16 AM PDT

          [ Parent ]

          •  No, we really don't. (0+ / 0-)

            They tortured people to get false confessions to fraudulently justify our invading Iraq.

            by Kaili Joy Gray on Mon May 11, 2009 at 12:57:13 PM PDT

            [ Parent ]

            •  I don't buy the WHO criteria (0+ / 0-)

              Have you ever read this report?  First off, it is from 2000.

              Secondly, its criteria is based more on distribution and "fairness in contribution" than anything else.

              That said, those are the things I mentioned where we fall short.  We do need to improve those areas.

              However, I would still argue that when you have access to all health care in the US, you have the best outcomes.

              I sure as hell would rather have cancer in the US than in the UK.  You have nearly a 20% greater chance of survival here in the US, despite their universal health care.  The WHO report rates the US #1 in "responsiveness", yet weights that category one eighth while "financial fairness" carries a weight of one fourth of the total score.

              "Those are my principles, and if you don't like them... well, I have others." - G. Marx

              by Skeptical Bastard on Mon May 11, 2009 at 01:37:33 PM PDT

              [ Parent ]

  •  Artificial doctor shortage.. They keep it low (7+ / 0-)

    And the prices of drugs here are orders of magnitude higher than the very same drugs sold in other countries.. often they come from the very same plant.

    Public Option is Unproven Experimental Procedure
    We KNOW that single payer WORKS!

    by Andiamo on Mon May 11, 2009 at 08:55:45 AM PDT

  •  interesting diary (4+ / 0-)
    Recommended by:
    Sychotic1, jessical, pamelabrown, MKSinSA

    i'd like to learn a lot more about the Dutch system.

    (0.12, -3.33) disagreement does not automatically render one a shill. duh.

    by terrypinder on Mon May 11, 2009 at 09:03:30 AM PDT

  •  Huh? (8+ / 0-)

    How is that not public?  The government defines the basic package, requires everyone to get it, and requires that anyone who sells insurance offer it.

    That is public.  The fact that they utilize the private sector to provide the actual insurance is irrelevant.  Everything I've heard points to the government going the route of the Federal workforce for all.  In that system, there are no exclusions for pre-existing conditions.  Moreover, the government pays for some portion which by and large is fixed.  So, you can get a basic package for next to nothing, while those who want/need more, pay a larger share.

    And if children being automatically covered isn't public, I don't know what else is.  Now, if owing to our higher mobility/lower bar in terminating employees gets mixed in with a full basic coverage for people who get laid off for some period of time, we are essentially done.

    To answer your question, yes, that looks like a good first step.

    "What the cynics fail to understand is that the ground has shifted beneath them..." Amen.

    by nsfbr on Mon May 11, 2009 at 09:07:42 AM PDT

  •  I tipped because (6+ / 0-)
    Recommended by:
    ferg, jxg, Big Tex, jessical, Giodude, pamelabrown

    I see no downside from at least talking about every avenue to reform.

    But several commenters raised several extremely important differences in context between the US and the Netherlands re: regulation schemes, corporate philosophies, government running of the health care coverage plans.  I personally have doubts that the Netherlands model could be replicated here at this point in time.  I don't think we have the regulatory and philosophical tools in place to make such a plan effective rather than inevitably abusive of consumers.

    With hope and virtue, let us brave once more the icy currents, and endure what storms may come. - President Obama

    by GN1927 on Mon May 11, 2009 at 09:12:59 AM PDT

    •  I find them disingenuous for the following reason (8+ / 0-)

      Whenever opponents of single-payer raise the same exact questions, they are quickly pounced upon as naysayers.

      Ask proponents of single-payer who crow about the UK or Canadian systems about the same differences.. ask them about the socialization of the medical profession as opposed to the US.

      Go ahead.. I dare ya. ;)

      That said.. I merely think it should be looked at.. as an option.  I think most Americans are probably not even aware that a system like the one in the Netherlands even existed.

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 09:20:56 AM PDT

      [ Parent ]

  •  so, umm, let me guess . . . (4+ / 0-)
    Recommended by:
    mattman, Big Tex, jessical, MKSinSA

    Those in NL who are more or less penniless can afford basic health insurance because (a) the cost is really -- one might say artificially -- low and (b) they get welfare in quantities more than sufficient to pay those premiums.

    Those are two nasty big hurdles if such a system were to be adopted here.

  •  Garbage (4+ / 0-)
    Recommended by:
    badger, GN1927, Big Tex, corvo

    Sorry, but although your diary is quite good, the information on which it is based is garbage:

    From 34 indicators of quality, the overall ranking was divided into six categories: e-Health, patient rights, patient information, waiting time for treatment, waiting time for pharmaceuticals, and the speed at which new drugs are deployed.

    None of the above have any direct effect on improving Dutch health (or anyone else's) and at best, have only indirect effects such as error prevention (presumably) via e-charting.

    What would have an effect would be preventive health care:

    1. Vaccinations
    1. Mammograms
    1. Blood Pressure checks
    1. Colon cancer screening
    1. Cholesterol control
    1. Smoking cessation (and alcohol and drug cessation/treatment).
    1. Diabetic management

    etc, etc.

    The difference is between health care and health service; the latter, while pleasing, does nothing to improve the quality of your health.  After all, given the choice, would you rather wait an hour to see the doctor that prevents the heart attack that causes congestive heart failure 10 years down the line or get the quick in and out clinic visit where your pimples are treated?

  •  If I thought for one moment (4+ / 0-)

    that we'd get a private-only system exactly like the Dutch (subsidies for those who don't have the money to pay their premiums that would cover the full cost of their insurance, and regulations to ensure that insurance companies are required to pay for legitimate medical procedures and required to give coverage to everyone at the same price), I might be willing to consider a private-only option - even though it would still be less efficient and generally inferior to single-payer.  But since we know that the health care industry, and their puppets in Congress, aren't going to allow that to happen, I'm not sure that we should waste too much time considering the Dutch model.

  •  Dutch healthcare saved me two C sections. (8+ / 0-)

    My family practice doctor had done a stay in the Netherlands to learn low intervention obstetrics. A large fraction of Dutch babies are delivered by midwives and they have all kinds of canny tricks to facilitate deliveries. Without going into (literally) bloody detail, she safely delivered both my kids when my physician husband thought for sure I needed a ceasarean section.

    •  I read about that.. interesting.. (1+ / 0-)
      Recommended by:
      Wee Mama

      that most Dutch women choose to not even have an epidural or drugs during delivery.

      That the infant mortality is so much lower in the Netherlands than in the US and many women choosing to home birth with midwives says something as well!  I'm not sure what, exactly..

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 09:32:05 AM PDT

      [ Parent ]

      •  They use a lot more patience. Both my deliveries (2+ / 0-)
        Recommended by:
        Catte Nappe, pamelabrown

        took longer than if I had had the c section that my husband thought was going to happen. Of course, my recovery was a whole lot faster!

        You also need trust in the clinical judgment of your physician. If you are afraid of being sued you'll tend to do the "safe" option rather than trying something a little non-standard. For my first, for example, I delivered lying on my side to avoid pressure on my daughter's umbilical cord. Odd but functional, but if the whole situation were one of adversarial feelings I can imagine a doctor might not want to risk it.

  •  You cite a lobbyist (2+ / 0-)
    Recommended by:
    slinkerwink, corvo

    (HCP) as proof of anything? These are people that loathe public healthcare and want everything privatized.

    Dissolve Israel; stop distinguishing between jew and non-jew in Palestine.

    by high5 on Mon May 11, 2009 at 09:29:34 AM PDT

  •  without (1+ / 0-)
    Recommended by:
    corvo

    without a public option, all this healthcare talk is nothing but a GIANT give away to the healthcare insurance industry.

    Gee the private healthcare industry has BROKEN healthcare in this country, so why reward them?  why trust  them?  THEY ARE THE PROBLEM! NOT THE SOLUTION!

    (regarding the bank mess) They want to cure the patient but not deal with the disease.

    by dark daze on Mon May 11, 2009 at 09:34:39 AM PDT

  •  I used Dutch healthcare once (6+ / 0-)

    I was in Eindhoven and I had a pizza store owner hit me in the ear- longer story.  Apparently, he ruptured my ear drum.  My friend called his doctor and she came to his apartment to see me.  She made a housecall.  

    If it is possible to provide a system which gives doctors the ability to have that kind of personal service- even if it requires that some of the system is private, I'm in support of it.

    I am ultimately a supporter of single payer.   It leads to both flexibility and cost containment, but I don't want to be an ideologue, so I am willing to listen to more than my own personal opinion.

    The lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging and kicking them into obedience.

    by otto on Mon May 11, 2009 at 09:42:49 AM PDT

    •  the downside of a political site... (0+ / 0-)

      ...is the sad truth that I'm honestly more interested in the story of how you got an Eindhoven pizza store owner to whack you than the dynamics of a huisarts call :))

      But, I guess, some things must remain mysteries...

      ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

      by jessical on Mon May 11, 2009 at 10:20:06 AM PDT

      [ Parent ]

      •  Only because I like to tell it (2+ / 0-)
        Recommended by:
        jessical, Skeptical Bastard

        I was visiting a friend who was in college in Eindhoven.  This was about 14 years ago.  I called up and ordered a pizza over the phone.  The pizza was about 8 kronen.  I went to pick it up, but was rebuffed by the Italian Expatriate who told me, in English, Dutch or German- I can't remember which- that I couldn't pay for it with a card, because it was under 10 kronen.  I, being the sassy 25 year old I was, argued with him on that point.  I didn't have any cash, I hadn't actually seen a menu that told me the rules... The entire argument was taking place with a little bit of bastardized Dutch (that's where I was just taking German words and making them sound Dutch, whether they were correct or not), English, and German.  

        Pretty soon, the guy starts getting really angry with me, and he starts approaching closer.  In my 20 something wisdom, I sense I'm going to be hit, and I might just have a play for the pizza if I get hit the right way.  He hits me pretty hard across the left ear, I go down!  I go down hard, because I'm thinking somewhere that I might have a shot at getting the pizza on my card, or at least getting some sympathy from whomever else may become involved in this.  

        The police come.  The policewoman is very nice, but she is not having any of my story.  It was probably the only time I wasn't lying to cop, but she didn't know that.  I told him he could keep his pizza, and I left.  

        At the time, that was a win in my mind.  I figured, he just lost 8 kronen (minus the credit card fees, obviously)  

        The lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging and kicking them into obedience.

        by otto on Mon May 11, 2009 at 11:31:49 AM PDT

        [ Parent ]

  •  and if you want to go looking really deep (1+ / 0-)
    Recommended by:
    Catte Nappe

    into the discussion, there's this

  •  I think Obama, with his reported (3+ / 0-)

    success in getting the health insurance companies to publicly agree to reduce the rate of increase in health insurance costs, has finally gotten the camel's nose into the tent.  Their agreement admits that they can reduce costs.  The next step will be enough regulation to prove that they are indeed succeeding. It's a "you said you could and would, now prove that you are doing it" catch.  Then will come the demands to do standardize forms, to reduce the office costs of practitioners, the requirement to reimburse promptly, the requirement to settle claims within a set period, to report all claims not settled and on and on.

    The politicians who are getting large contributions from health insurers will be called out if they refuse to vote for these regulations, or try to sidetrack the implementation.

    Or, I hope so.  If all else fails, maybe this will be the backup plan.  Single payer would be faster, if it could be achieved.  

    To those who hunger, give bread, to those who have bread, give the hunger for justice.

    by phonegery on Mon May 11, 2009 at 09:57:05 AM PDT

    •  you should also include regulatory savings (1+ / 0-)
      Recommended by:
      phonegery

      right now, insurers are required to run under different regulations for each state the do business in.  That needs to be standardized nationwide.

      In addition, a Dutch style system takes away the need for an insurer to "rate" a client.  They are all rated the same.  Do you have any idea how much they must have to pay actuaries to rate a group of people right now, given their past medical histories, age, etc..??  

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 10:10:40 AM PDT

      [ Parent ]

  •  Okay (4+ / 0-)

    I'm going to jump into this. I'm a big supporter of single player/the public option. However, if we don't get it, managed competition isn't an awful alternative if the proper regulations are put into place. My thought is, if we can't get a public plan, we at least need a heavily regulated private insurance sector with heavy subsidies. And by heavily regulated I mean Hillarycare in the basic sense with a profit cap, banning them from rejecting people and min standards. Like I said, I'm a supporter of the public option but a Dutch-style system if it's politically possible wouldn't be awful.

    •  not "awful" by (0+ / 0-)

      any stretch of the imagination compared to the mess we have now.

      Minimum standards.. of course!
      Taking on all applicants.. yes.. it would fail otherwise.

      One of the things I liked about the Dutch system is that since all basic care is covered, the private insurers can use competition, by lowering costs for the mandated basic package, to draw clients in and (hopefully) sell them optional coverage.

      I'll be the first to admit private insurers are sleazebags on the whole.  It seems to me a system like the Dutch one, however, turns them into participants in keeping their clients healthy.  It is to their advantage to have healthy clients, after all, since they cannot simply dump unhealthy people or raise their premiums until the person drops it.

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 10:17:30 AM PDT

      [ Parent ]

  •  It doesn't appear (1+ / 0-)
    Recommended by:
    Kestrel228

    that the plan you mentioned addresses the right of top executives to millions of dollars in pay, benefits, bonuses, and pension plans.

    The banks have a stranglehold on the political process. Mike Whitney

    by dfarrah on Mon May 11, 2009 at 10:16:13 AM PDT

  •  Hopefully this will make it to the rec list (2+ / 0-)
    Recommended by:
    Kestrel228, pamelabrown

    It's worth discussing.

  •  what about deductibles and co-pays under those 2 (1+ / 0-)
    Recommended by:
    Kestrel228

    systems?

    Are they high?

    •  fairly low.. (0+ / 0-)

      with maximums for each quarter/year.  Maximum out of pocket in the Netherlands is, I believe, about $160 per year.

      Compare that to my $750 deductible and $1000 co-pay per year on an already expensive Blue Cross plan, and it sounds dirt cheap to me!

      "Those are my principles, and if you don't like them... well, I have others." - G. Marx

      by Skeptical Bastard on Mon May 11, 2009 at 11:54:06 AM PDT

      [ Parent ]

  •  McCain (0+ / 0-)

    I don't think McCain's general idea to push people to get their own insurance is inherently a bad idea. It'll keep them from being dependent on their employers for coverage, which is fast becoming an unmanagable situation for both employers and employees.

    The biggest single flaw in McCain's plan is he didn't do anything to protect the consumer, from beind denied coverage for pre-existing conditions. Additionally, when you have individuals purchase their own insurance, whatever group discounts get factored into employer based plans get dropped, so some protection for individuals to not be gouged should've been in the plan.

    Otherwise tax credits to get your own insurance, isn't an inherently stupid idea, though I have mixed feelings about adding healthcare benefits as additional income.

    Also, as much focus as people put on the insurance industry, at some level they are just responding the bills the doctors and hospitals send them.

    You have to get everyone - doctors, insurance providers, pharamceutical companies, patient advocates, etc. - at the table to hash out healthcare reform in the USA.

    Solving our healthcare problem needs to be done in two steps. Step one get to universal coverage. Step two figure out how to control costs.  

    Step two, in my opinion, will be much harder to implement.

  •  Misleading about Dutch and "public" (0+ / 0-)

    Definitions should be made, clearly.

    A must-read is Russell Shorto's recent article in the NY Times on his experience in Holland.

    http://www.nytimes.com/...

    I have personal/family connections with Holland, England, and France and have experienced their healthcare systems.

    #1 difference between Europe and USA?
       They start with a belief that nobody should fall below a minimum standard of living.

    They never had public opinion manipulated by massive PR campaigns by corporate interests.

    In Holland their self-esteem derives from their continued efforts at social justice. Some comes from deep Christian feelings, some from Progressive-Socialist-Labor idealism, and much comes from their open and honest attitudes towards how to handle differences.

    Our American "winner take all" and our unbridled ambition for stardom and wealth doesn't sit well with most Europeans. They already lived through Feudalism and Monarchy. Now they prefer democracy at all levels.

    Media Reform Action Link http://stopbigmedia.com/

    by LNK on Mon May 11, 2009 at 12:45:08 PM PDT

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