The Netherlands has universal health insurance -- and it's all private

[brooklynite]

Vox

Democrats in the United States who support Medicare-for-all want to take a fractured and stratified health care system and make it more unified and equitable through nationalized health insurance.

The Netherlands saw the same problems in the mid-2000s, but they came up with a different fix.

Before then, the country had a two-tiered health care system: About two-thirds of the country was covered by a social health insurance program, and the remaining third was covered by private insurance. Disparities developed between the two tiers; wealthier people got better access to doctors with their private coverage.

By 2006, the two-tiered system teetered on the brink. Health care was becoming very expensive for the middle class, who faced high out-of-pocket costs. Yet private insurance was more attractive to doctors, because it paid better, than the public program that was covering people with lower incomes. And about 2 percent of the population still lacked insurance.

So the Dutch decided to overhaul their health insurance. The ruling center-right government compromised on a program to achieve universal coverage, which both sides agreed was essential, without abandoning the private market.

[OnDoutside]

1. And it's still not cheap !

Ireland looked to go with the Dutch model but after a lot of analysis they backed off it.

[MoonlitKnight]

2. Nobody is advocating nationalized healthcare

Not even Bernie. No point reading further with that huge inaccuracy in the first paragraph.

Single payer keeps the service side private. It cuts costs substantially by reducing administrative overhead. It cuts premiums by spreading risk among the largest pool possible.

Does everyone who hates single payer also want to get rid of flood insurance?

[George II]

3. The first paragraph says "nationalized health INSURANCE", not nationalized health CARE.

Too often people mix up "insurance" with "care", they're two completely different things.

[TwilightZone]

5. "nationalized health insurance"

isn't nationalized health care.

[DanTex]

4. And it's still closer to M4A than our current system, even with the tweaks being proposed.

The level of regulation in Holland and other hybrid or mandate based systems around the world make them entirely different from Obamacare or Obamacare plus public option. There are all sorts of price controls and rules set by the government that we don't have here, so that there really isn't much of the "magic of the free market," nor should there be, because healthcare is one area where free markets don't work well.

Really, if we want to get to something like the Dutch system, the way is to start with M4A as a negotiation point. Basically, if you force the insurers to charge the same amount as M4A, and to cover everything that M4A would cover, and force doctors, hospitals, and drug companies to set their prices at the same level as M4A, and also subsidize premiums for lower income people the way M4A would, then you get the Dutch system.

Taking the current system and making some tweaks is not going to get there.

[ehrnst]

7. "if you force the insurers to charge the same amount as M4A"

Honey, it's medical providers who do the price setting on procedures, not the insurance companies.

Insurance companies then set the rates on premiums...

It's helpful to do some research on a subject before lecturing on it. Give one a bit more credibility.



Also, as I recall, the ACA tried to force states to participate in Medicaid expansion, but SCOTUS knocked that down.

How do you think the current SCOTUS would rule on a challenge to imposing Medicare rates on all medical providers for all procedures?

[DanTex]

8. LOL. It's insurers that set premiums, not hospitals.

[ehrnst]

9. I'm talking about costs...which are set by the medical providers

during negotiations, and then the premium costs are calculated accordingly - be it private insurers or Medicare.

Is that clearer?

BTW, current medicare premiums cover FAR less than the promised smorgasbord of M4A... and even Canada doesn't cover what the MFA promises, because that's how they keep it affordable...

About passing legislation that "forces" states or companies to participate... See also: SCOTUS striking down the mandate for states to expand Medicaid as per the ACA.



Re-read my post.

[DanTex]

10. Good for you. And I was talking about premiums.

[brutus smith]

11. Boom!

[ehrnst]

12. And you still can't address the probability of SCOTUS striking down legislation "forcing"

insurance companies and providers, like they did with the Medicaid expansion requirement in the ACA.

I thought you'd be frantically avoiding that...






You think they're going to uphold a mandate for pricing for insurance companies and providers nationally? Because pricing is set at the state/region level, even with Medicare, there would need to be participation in administering at the state level.

If you knew something about the topic, you would know that Maryland has been regulating all-payer pricing (on a facility by facility basis) for a few years. The only hope for this to go national, is, like Canada did, let all states do this on their own, then once that happens add a federal layer over it. With state level single payer proposals failing to get off the ground in VT, CO and CA, that doesn't look likely. and you think that this will be solved in one fell swoop with one piece of legislation?

With no challenges going to this particular SCOTUS and being successfully upheld?

[DanTex]

13. Interesting change of subject. Didn't see that coming.

[ehrnst]

14. And we have yet another evasion...

It was right here, Hon.

https://www.democraticunderground.com/?com=view_post&forum=1287&pid=516958

Not a change of subject, just a relevant question about your "solution" and a possible wrench in it. Imagine THAT happening on a discussion board...



So, you going to evade again, or do you have a workaround for SCOTUS, and the precedent set with the ruling striking down state participation in ACA's Medicaid expansion mandate?

[ehrnst]

15. How long ago did Holland start work on it's current UHC system? 2 years ago?

MFA is promising this in two years, yes?

By 1930, almost all the Dutch population had access to basic medical care encompassing general and specialized medical services, hospital care and community services. The system by which this had been accomplished was determined by the fact that central government was unwilling to accept responsibility for health care by stimulating public services or regulating health insurance. In general, the poor were cared for out of municipal medical relief funds while the rest of the working classes were able to participate in voluntary sickness fund insurance schemes. The middle and upper classes had to rely on private practice, yet they found it increasingly difficult to pay for expensive hospital admissions. Moreover, the financial limitations of voluntary insurance, as well as the dominant position of the medical profession vis-à-vis sickness funds, meant that most funds did not cover hospital care or community services. The actual delivery of these services was often in the hands of private organizations but the municipal authorities paid most of the costs, either through direct payment or through subsidies.

Before the introduction of compulsory health insurance in 1941, the highly independent Dutch municipalities did not only care for the poor; they also provided hospital care and community services for almost the entire population. This brought about wide geographical variations in the Dutch health services

https://www.ncbi.nlm.nih.gov/pubmed/11613270

Lacking a time machine, replicating that would be somewhat difficult, don't you think?

Not to mention that Holland is pretty homgenous race and religionwise, and is pushing back against immigrants. We are a very different, more diverse society, and the motivation to "take care of our own" including everyone in the nation just doesn't translate to the US.

[IronLionZion]

6. GOP claimed Obamacare was a socialist plot leading to death panels and bread lines

through a regulated marketplace to compare prices and buy private insurance

Their solution: Everybody would have to purchase private health insurance individually, through a strongly regulated market. The public program would disappear. The Dutch system’s rules presaged the rules in the Affordable Care Act on preexisting conditions: guaranteed issue (nobody could be denied health insurance because of their medical history), community rating (nobody could be charged higher premiums for their health status), and an individual mandate (everyone must carry insurance or pay a penalty).

The Netherlands fines people who don’t carry insurance for up to six months and then auto-enrolls them in an insurance plan, with premiums that are about 20 percent higher than they would have paid if they signed up during the regular enrollment period. A small number of people — about 200,000, or around 1 percent of the population — default on their premiums, and their wages are garnished to cover the cost of their insurance.

And then Obama sent us all to the gulags in Siberia