If Health Care Reform Fails, Perhaps We Should Go Dutch

This past Saturday evening, at about a quarter past eleven o’clock, our nation took the first step toward rebuilding our struggling health care system.  As the number 218 flashed in the Yea column on C-SPAN, cheers and applause erupted in the House of Representatives after a marathon session of debate that was intense on both sides of the aisle.  They even got 1 Republican to vote for the bill (despite 39 nay’s from the Democrats).

Unfortunately, Nancy Pelosi is not able to smile for too long, as it is clear that the landmark bill just passed by the House is pretty much DOA in the Senate.    And I am not sure if there is any amount of cajoling President Obama can do at this point to change the minds of the few conservative Democrats, along with independent flip-flopper Joe Lieberman, that are seriously threatening to kill the legislation as long as it contains the public option.

Despite the fact that the majority of Americans WANT some form of a public option, a few Democratic senators are willing to go against their constituents and side with the Republicans and the insurance companies.    It is becoming quite apparent that if HCR is going to pass muster in the Senate, liberals may have to give up an immediate public option in exchange for a “trigger”, which certainly doesn’t sit well with many on the left, including myself.

So, in all this hoopla and hysteria over the public option and whether or not it would lead to the end of freedom as we know it, I wanted to take a deeper look at how other civilized nations deal with public healthcare and why their citizens are much more satisfied than we are.

As we all know, our neighbors to the north have completely state run health care, known as Medicare, for which our own Medicare program is modeled after.  Some of the latest surveys show that over 85% of Canadians are happy with their government healthcare, even though they do experience wait lists for non-critical procedures from time to time.  In fact, there was a recent push by individuals within the Canadian government to move to a more American style of insurance through private insurers, and Canadians overwhelmingly rejected it.  Still, despite how many millions of Americans want a single-payer system, it’s not going to happen in our lifetime.

Most other European nations have strong public health care as the leading source of coverage.  The UK, France, Italy – all strong publicly funded.  However, there is one exception, that quite frankly I am surprised nobody in this country seems to be talking about as a good model to build on – the Netherlands.

In the Netherlands, health care is provided as a dual system – a combination of public and private insurance.  People pay a fixed percentage of their income to the government to fund the public portion which only covers major hospitalizations and disability coverage.     For all short-term illnesses and medical treatments, citizens are required to carry insurance from a private company.    The best part, is that the private insurance business in the Netherlands is very tightly regulated.   In fact, providers are required to charge everyone the same premiums regardless of age or health condition.  The government uses a scheme called risk equalization which subsidizes the insurance companies for taking on higher risk patients.  This in turn, leads to a sense of equality and fairness within the industry and would seem to meet the very same goals we are trying to achieve here in the U.S.

  • Coverage for all, regardless of condition
  • Low premiums
  • Access for all citizens

Furthermore, healthcare costs are spread between employers, individuals, and the government, much like in the U.S.  Employers typically pay 50% of the cost, individuals kick in 45%, and the government funds the remaining 5%.And recent surveys show that the Dutch have the highest satisfaction with their healthcare out of all major industrialized nations.  And why not?  Their system actually encourages insurance companies to take on more high risk patients, since they know that they will get a subsidy.  Patients cannot be refused coverage, and doctors remain highly profitable.

The best part, is that it would seem that this type of system could be implemented much easier than  sweeping legislation going through Congress right now.    The key is in the tight regulations.    There would still be the public portion for major expenditures which would take the burden off of the private insurers, and the insurance companies would have to play by strict rules, but would be getting millions of new customers.

So, if health care reform fails this time, perhaps we should not be looking to the North for the solution, but rather across the Atlantic.

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