Sunday, May 03, 2009

"Going Dutch" for ideas on healthcare reform

There's a real lovely article in the NY Times Sunday magazine about the Netherlands. The ostensible focus is on the social welfare network of the state, and contrasting an American expat's experience there. One of the issues discussed is health care, a very timely topic as it relates to the United States.

Since I started writing Plastic Surgery 101 in December 2004, I've periodically touched on medical economics as it's something that's fascinating both personally and professionally. It's been clear for several decades that we're creeping towards some type of state funded system ("Universal healthcare"), and the time table has sped up due to a couple of factors

  • the coming retirement of the bulk of the baby boomers. A demographic who has always been described as somewhat self-entitled. Their clout and collective zeitgeist are proving a potent voice in this.
  • the economic incentives of employers and unions coming into alignment on this. Someone wrote a few years ago that when Wal Mart decided it was time for universal health care, then discussions would happen in earnest.
  • a liberal president has a aggressively liberal congress and slight liberal majority senate
  • the real estate and stock market crisis have made not having both a job and health insurance a reality for a lot of middle, upper-middle, and white-collar classes.

  • I've been convinced that we're going to end up with a public-private system where basic care is covered and people with more money will be able to purchase higher levels of care or convenience to care. It's what actually exists in most of the world. There will still be moaning and gnashing of teeth about unequal access, quality, etc... but we'll be better off then we are on the whole.

    Anyway, there's a great descriptor of this in the article I was referring to, "Going Dutch"

    "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 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.

    Nobody thinks the Dutch health care system is perfect. Many people complain that the new insurance costs more than the old. “That’s true, but that’s because the old system just didn’t charge enough, so society ended up paying for it in other ways,” said Anais Rubingh, who works as a general practitioner in Amsterdam. The complaint I hear from some expat Americans is that while the Dutch system covers everyone, and does a good job with broken bones and ruptured appendixes, it falls behind American care when it comes to conditions that involve complicated procedures. Hoogervorst acknowledged this — to a point. “There is no doubt the U.S. has the best medical care in the world — for those who can pay the top prices,” he said. “I’m sure the top 5 percent of hospitals there are better than the top 5 percent here. But with that exception, I would say overall quality is the same in the two countries.”

    While free associating on things Dutch, Sasha Cohen's Borat paid Amsterdam a visit a few years back. Good stuff!



    Anonymous said...

    Sweden can be Sweden, Germany can be Germany, Holland can be Holland, England can be England, France can be France ONLY if America is America. If we weren't providing the defense for the world, all of those countries would have to provide for their own defense and could kiss their socialist brotherly love BS goodbye.

    A. Sexton said...

    Having lived in Germany for almost 4 years, working for a German company and paying my share into the health care system here (while also being a "heavy user" of the system in the past year), I would have NEVER guessed I would actually think a socialized system was GOOD for the majority of people. Despite paying a much larger percentage of my salary to pay for medical coverage (for the "standard" insurance everyone receives), the medical care and services I have received have been excellent. My spouse has "private" insurance coverage, which basically means he pays for all services out-of-pocket then gets reimbursed 100%, but I have seen no real difference in my level of care. Perhaps the "Dr." title preceding my name helps my situation or maybe I receive a higher standard of care since many of our medical appointments are together, but so far, I have been pleasantly impressed with the socialized system here. Such a system could be a real advantage in the US enabling a larger percentage of the population medical insurance. However, as a health-care provider myself, I would expect such a system to negatively impact my financial bottom line.