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.
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.
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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.
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.