Will the U.S. Go Dutch?
Even in modern politics, $40 million is enough to get elected officials' attention. So today's announcement of a labor/Democratic/disease-group coalition pledging at least $40 million, and the voice of Elizabeth Edwards, to "quality, affordable" U.S. health care will influence November election campaigns. Coincidentally, there's some current buzz among health wonks over the Netherlands' switch to a sort-of-private "choice" system, providing universal care through mandatory private insurance. No one should confuse the Dutch system with any of the U.S. proposals for mandatory insurance.
With the admirable Edwards as its chief spokesperson, the "Health Care for America" campaign will presumably push some version of Sen. Hillary Clinton's plan for universal mandatory private health insurance. Even Sen. Barack Obama now unfortunately says he's open to some form of mandatory plan. The U.S. versions of mandatory insurance leave the insurance companies in charge, without direct government oversight to keep the system fair and affordable. The state of Massachusetts, which instituted a mandatory plan last year, is already struggling with high premiums and costs to the state.
U.S. insurance companies and their backers may be pointing now at the Dutch system as some kind of model, but remember this: There is not a snowball's chance in hell that U.S. insurers would accept the tight regulation and consumer protections of a Dutch-type system. If it's being discussed in the halls of power, the discussion is about how to use it as a Trojan Horse to lull Americans into a system controlled by the insurance companies.
The Dutch system comes to free-market insurance from a different direction. The Netherlands is moving cautiously from a nearly top-down government-supported and controlled system to a tightly regulated system of "managed competition." Individuals pay, on average, half of the premium cost, with the other half paid by employers or government.
The individual adult premium for 2008 averages $1,600 a year, and there is no premium for children under 18. About half of families get an extra subsidy, up to their entire cost of care, and the yearly deductible in most cases is a few hundred dollars. Compare that to a family policy in the U.S. that averages more than $12,000 a year.
While 14 insurance companies participate in the Dutch market, all of them must offer specified and comprehensive care. What the Dutch call "basic" would look generous and comprehensive to Americans. Even long-term care is part of the system. About all that's excluded are adult dental care, eyeglasses and cosmetic surgery, for which the Dutch can buy supplemental private insurance.
Most doctors still work for a salary a syustem established in 1982, though they may now receive incentives from insurers for cost-savings such as prescribing generic rather than name-brand drugs. Every patient receives dietary and healthy-lifestyle advice and encouragement.
The space for competition includes plan structure--the cheaper ones are more like American managed care companies--and specialized management of specific diseases, such as diabetes. Insurers whose policyholders are sicker than average receive extra compensation from government, which encourages them to welcome patients with manageable chronic illnesses.
The system is constantly observed and tinkered with to make it fair and keep it affordable. After 2 years, it is still considered an experiment, with the expectation that the Dutch will revolt at the ballot box if they do not get both universal and comprehensive health care from their insurers, at an affordable price.
Accustomed to near-universal health care and a watchful government eye, the Dutch are accepting innovation, competition and choices, incuding the choice of American-style managed care. But they assume that the government will rein in insurers who try to game the system for extra profit. They see government as their watchdog and insurers as the servant, not the master. They have access to a wealth of information about individual hospitals, doctor groups and the insurers themselves.
It's a far cry from the abusive insurance system we have now, and the political might of the insurance industry will be set against any diminishment of its power. If a candidate tries to sell something "like the Dutch system," you might want to call Amsterdam for a price check before buying it.