I've spent many years thinking about, researching and otherwise grappling with how to reform the U.S. healthcare system. Ever since Hillary tried to reform healthcare, as a matter of fact. I think that the Dutch may have hit on a solution, that with some small tweaks, may work here and also satisfy the free marketers and doesn't require a separate public option.
It doesn't require a public option because the private, free market solution is integrated with public funding. In the 4/29/09 issue of the New York Times there is a great article you should read called Going Dutch. It's written by an American living in Holland. The writer discusses many aspects of "socialism" Dutch-style, but the part I want to concentrate on here is the description of the Dutch health care system.
From the article:
The Dutch health care system was drastically revamped in 2006, and its new incarnation has come in for a lot of international scrutiny. "The previous system was actually introduced in 1944 by the Germans, while they were paying our country a visit," said Hans Hoogervorst, the former minister of public health who developed and implemented the new system three years ago. The old system involved a vast patchwork of insurers and depended on heavy government regulation to keep costs down. Hoogervorst — a conservative economist and devout believer in the powers of the free market — wanted to streamline and privatize the system, to offer consumers their choice of insurers and plans but also to ensure that certain conditions were maintained via regulation and oversight. It is illegal in the current system for an insurance company to refuse to accept a client, or to charge more for a client based on age or health. Where in the United States insurance companies try to wriggle out of covering chronically ill patients, in the Dutch system the government oversees a fund from which insurers that take on more high-cost clients can be compensated. It seems to work. A study by the Commonwealth Fund found that 54 percent of chronically ill patients in the United States avoided some form of medical attention in 2008 because of costs, while only 7 percent of chronically ill people in the Netherlands did so for financial reasons.
The public option is rendered unnecessary by the rules of universal coverage by insurers as well as the high risk fund the government provides. People get a choice of insurers, who are required to cover anyone who applies, but are not penalized (but in fact are rewarded) for high medical expenditures. It seems like the best of both worlds to me.
The Dutch are free-marketers, but they also have a keen sense of fairness. As Hoogervorst noted, "The average Dutch person finds it completely unacceptable that people with more money would get better health care." The solution to balancing these opposing tendencies was to have one guaranteed base level of coverage in the new health scheme, to which people can add supplemental coverage that they pay extra for. Each insurance company offers its own packages of supplements.
So how does this all work? From wikipedia (Link):
For those who would otherwise have insufficient income, an extra government allowance is paid to make sure everyone can pay for their health care insurance. (snip)
A key feature of the Dutch system is that premiums are set at a flat rate for all purchasers regardless of health status or age. Risk variances between funds due to the different risks presented by individual policy holders are compensated through risk equalization and a common risk pool which makes it more attractive for insurers to attract risky clients. Funding for all short term health care is 50% from employers, and 45 percent from the insured person and 5% by the government. Children until age 18 are covered for free. Those on low incomes receive compensation to help them pay their insurance. Premiums paid by the insured are about 100 € per month (about US$145 in Jan 2008) with variation of about 5% between the various competing insurers.
So what could possibly be the objection to a plan similar to this one? I can think of a few off the top of my head.
- The insurers would probably not make a profit off of basic health care, but could make a profit from supplemental policies.
- The high risk fund and the government premium subsidy may have to be funded by a tax of some kind (anathema to Repubs).
Actually, I can only think of these two objections.
I also think money could be saved (and used for funding the high risk fund and low income premiums) by getting rid of Medicare and Medicaid and having the one health care system. It seems redundant to me to have multiple systems all providing for the same basic human right to health care.
Just my two cents in the discussion.
UPDATE: Here is a list of what basic coverage entails:
* Medical care, including services by GP’s, hospitals, medical specialists and obstetricians
* Hospital stay
* Dental care (up until the age of 18 years, when 18 years or older you are only covered for specialist dental care and false teeth)
* Various medical appliances
* Various medicines
* Prenatal care
* Patient transport (e.g. ambulance)
* Paramedical care
Also, Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation.
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