Universal Health Care With Private Insurers: Can the Dutch Model Fit the American Health Consumer?

[McCamy Taylor]

I. What Do the Dutch Have that We Don’t Have? Besides Legal Marijuana

Answer: Universal health care. And they do it with private insurance companies.

U.S. business groups are understandably excited. The European health care model rated best in 2008 was that of the Netherlands---a system based upon competition between several private insurance companies. However, as I will discuss later in this journal, we have to be careful to give credit where it is due. How much of the success of the Dutch health care system is due to the design of the system (which we can copy) and how much is a result of the character of the Dutch people and decades of dedication to public health education aimed at disease prevention?

The EHCI praised the Dutch effort, describing the winning margin as "the biggest since this 31-country ranking started in 2005". The Netherlands was also paraded as "the truly stable top performer" in the EU, primarily due to its successful patient empowerment track record.

http://www.euractiv.com/en/health/dutch-healthcare-system-best-europe-2008/article-177165

Another poll found that the Dutch rate their health plan higher than citizens in the 10 countries surveyed, while people in the United States rate theirs the lowest.

http://www.alertnet.org/thenews/newsdesk/N07438178.htm

What has the people in the Netherlands so happy? Here is the WSJ on the old (pre 2006) Dutch health care system:

“The country had four different coverage schemes. The wealthiest third of the population was required to get health insurance without government assistance. Some in this group received help from employers in paying premiums, while others paid the whole bill themselves. The bulk of the Dutch population was covered under a compulsory state-run health-insurance scheme financed by deductions from wages. Civil servants and older people were insured under two separate plans within this state-run scheme. The government closely regulated hospital budgets and doctors’ fees, but provided few incentives to cut costs. When hospitals lost money on a particular kind of care, they rationed it. Many patients ended up on waiting lists. People in line for heart transplants were particularly affected. In the mid-1990s, fewer than three Dutch people per million received such transplants. By comparison, a study of 12 European countries showed that only Greece had a lower rate of such operations. In the U.S., there were about nine heart transplants per million people.”

http://healthcare-economist.com/2007/09/07/wsj-on-the-dutch-health-care-system/

Here is what took its place in 2006:

The government has put together a basic package that covers about the same as the previous system. Health insurance companies are legally obliged to offer at least this basic package and can not reject anybody who is applying for it. With the basic package you are covered for the following:
• 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
You can decide to purchase additional insurance for circumstances not included in the basic package. However, in this case insurance companies can reject your application and they have the right to determine the price.

http://www.justlanded.com/english/Netherlands/Netherlands-Guide/Health/Healthcare

Note that the above is free if you are under 18, that the government will help you pay for this insurance if you are low income and that you may pay additional payroll taxes depending upon your income. Also note that everyone is required to have insurance. .

I can almost hear people complaining: But making people buy insurance is so mean. It is something that Hillary would try to make us do.

Eat your veggies. They are good for you.


II. It Is All In the Risk

In the Netherlands, basic insurance costs about 95 euros a month. And you get to shop around. Plus, the insurance companies are not allowed to cherry pick. This is not California. There is no Blue Cross Blue Shield, retroactively canceling your policy after you have just had cancer surgery, because you did not tell your doctor that you had acne years ago. No one will deny you coverage, because you are over forty or because your father died of a heart attack or because you have a uterus.

In the U.S., insurance is all about risk . People that write policies play a betting game. They bet that they can look at you and guess whether or not you will cost them any money on health care expenses. Knowing your age, gender, race, past medical history, zip code, surname, marital status, employer and various other bits and pieces of information that they probably are not supposed to know (but which your previous insurance companies, pharmacies, book sellers and credit card companies have been selling to each other), they can predict to the third decimal place exactly how much cash they will have to shell out for you versus how much you will give them in premiums. If your projected expenses exceed your premiums, you do not qualify for individual insurance coverage.

You might be able to get into an HMO, since they are not allowed to discriminate on the basis of pre-existing medical conditions. However, in managed care, you will find a new kind of bias against those with disease or the potential for illness. This will include capitation----doctors who are paid a flat sum per patient rather than fee for service. This encourages doctors to cherry pick healthy patients and drive sicker people to other providers. There are also insufficient medical resources, not enough specialists or facilities to treat members, so that people end up having to travel long distances or wait for care. And many necessary medications are hard or impossible to come by—if they are the drugs that the chronically ill need. All of these “rationing” strategies are used for the ostensible purpose of limiting health costs. However, they are really intended to drive sick people off the HMO and onto some other form of insurance (if possible) such as a spouse’s health plan, Medicare or another HMO.

In the Netherlands, they have tackled this problem with something called Risk Adjustment . Here is a document that tells all about it.

http://www.minvws.nl/en/reports/z/2008/risk-adjustment-under-the-health-insurance-act-in-the-netherlands.asp

Briefly, in the Netherlands, every time a private insurer enrolls a member, the health plan collect certain demographic information such as age, gender, chronic diseases. This is used to calculate an illness severity index, which is used in turn to figure out how much more expensive this individual will be to insure than some average person. The government then provides the private insurance company with an additional payment on top of the flat fee that everyone pays, so that the insurance company will not go broke from having sick members. There are both prospective and retrospective payments, in case the initial calculations are not correct.

There are several effects of this system. One, since the insurer is reimbursed at a higher rate for higher risk members, cherry picking is no longer a money making strategy. Nor do insurers have an incentive to make sick members dissatisfied in order to drive them off their plan, as they try to do so often in the United States. Instead, they try to keep them happy, since this means that they will sign up with them again at their annual renewal, instead of switching to one of their competitors. People who actually use their insurance who get satisfactory results will provide good word of mouth advertising to friends and family members, improving the reputation and client base of their health plan.

This all works, because the federal government has removed the risk for the insurers and has turned them into care managers, whose primary purpose is to collective bargain for reduced drug rates, physician fees, hospital rates etc. The clients come first, the way they would in most capitalist ventures, with those that use more services being more important, since these are the ones on whom the greatest savings can be made through collective medical fee bargaining. In the United States, just the opposite is true. To private insurers, the most despised individuals are the clients who use the most health care and these become the targets of almost Javertesque (from Les Miserables ) attempts to drive them from the insurance plan.

III. What Do We Have That the Dutch Don’t?

Answer: The American Medical Industrial Complex, a cabal of specialists, drug companies and hospitals directing our medical policy in place of our (deliberately) lacking public health infrastructure.

Unfortunately, any effort to create a universal health insurance plan in the United States is going to encounter a problem unique to our country----the American Medical Industrial Complex, a behemoth of medical specialists, Big Pharm, hospitals, medical equipment companies and others which control how 15% of our GNP is spent. Right now, that money is spent on 1) futile care at the end of life that keeps ICU beds full and ventilators busy, 2) many, many surgical procedures of dubious benefit, 3) many more drugs of even less proven medical benefit and 4) lots of lobbying to keep this cash cow chewing our cud.

As this article about health care in Massachusetts points out, one of the problems with that state’s current health care budget is the ridiculous concentration of medical specialists and hospital beds. If you supply everyone with insurance in a place that is saturated with that level of specialty care, the specialists will create work for themselves.

http://takingnote.tcf.org/2008/08/lessons-from-ma.html

And yes, specialists do create work. Not every painful knee requires arthroscopy. Lumbar surgery is seldom beneficial, except in the rare case of spinal stenosis. Once upon a time, every classic migraine headache did not warrant an MRI and babies were born without every being seen by an ultrasound---if they were growing normally.

Now consider this NPR report which says that most Dutch women have home births and that only 9% have epidurals.

http://www.npr.org/templates/story/story.php?storyId=92641635

Clearly, in the Netherlands you can supply the citizens with carte blanche health insurance, and people will not act as if they are at an all you can eat buffet. In the United States, on the other hand, you will get people who expect to see a dermatologist for a pimple on their chin, an orthopedist to arrange their carpal tunnel surgery because occasionally they have a twinge in their index finger, an allergist to start on shots because for two weeks of every year they sniff when they walk by the bushes behind their house, a gynecologist for a hysterectomy because they are tired of having periods and a plastic surgeon because they heard that insurance will cover a tummy reduction if you say that you have a chronic rash under the stomach fold. All on the day they get their new insurance card, because they arranged to take two weeks off work to get all these surgeries done right away.

That is the problem with health care in America. It is often less about health and more about the luxury of finally being able to minister to the temple of one’s body. The American God Doctor presents himself (or herself) as the keeper of the mysteries that offer eternal youth and beauty----at a price. Lay people are never supposed to ask how or why just how much?

This attitude will have to change, and change quickly, otherwise the Medical Industrial Complex will seize upon universal health insurance to speed up the express train that is taking us all to economic ruin----stomach banded, tummy tucked, botoxed and sick to the core.

IV. What Do We Need to Borrow From the Netherlands?

Answer: Besides a mandate that everyone have health insurance, and a risk adjustment, and government assistance for low income people and free insurance for children. Americans need a public health system based upon education and empowerment through fostering a sense of self efficacy.

http://www.ncbi.nlm.nih.gov/pubmed/7971545

For those who like statistics, check out these numbers. The abortion rate in the Netherlands is the lowest in the world at 5-7%. That is because people there---women, but also doctors and society as a whole—take contraception seriously. Women in that country use birth control. They use birth control, because they are taught about using birth control in school, where they see the positive health behavior modeled . They also see their mothers, sisters and other female acquaintances using birth control and not having unwanted pregnancies. More modeling . People, especially young people tend to base their behaviors on those they have seen in other people with whom they identify. Society tells them that using birth control to prevent unwanted pregnancy is a good thing, and this social persuasion also increases the chances that they will use contraception. And they have easy access to birth control, which gives them a high expectation of self efficacy , i.e. they know that they will have no problem acquiring and using it themselves when it is needed. Once they have used birth control once, successfully, they are likely to continue using it regularly. This is proven self efficacy.

Once you get an individual or group of people to practice a desired health behavior once, you are on the road to a healthier society. Or, so goes Bandura’s Social Cognitive Theory. The terms in italics above are key to this theory. They explain how people learn positive behaviors, including health behaviors. You can read more about it here.

http://www.des.emory.edu/mfp/eff.html

Simply having a doctor tell you “Exercise more” is not as effective as being a member of a group of people your own age and gender all of whom are able to exercise (you can identify with them) and being given a chance to exercise with them (you prove that you can actually do it without collapsing) and having someone tell you all the great benefits that will accrue plus having the group cheer you on and record your progress.

Now, consider what we do in the United States to ensure that as many young people as possible end up pregnant. We ignore the studies that show that abstinence only sex ed is completely worthless, and we mandate that this is all that kids will be taught. The poor kids attempt to follow the ideal model----“good” kids never intend to have sex, so of course they never ever think about birth control. That means when they actually do have sex, it is better to just do it spontaneously (“I got swept away by my emotions”) than to rush off and buy some condoms, which would imply a conscience decision to be a “bad” kid. The social modeling they have seen involves a lot of females in the arts, films, books, soap operas with glamorized unwanted pregnancies that always turn out for the best. Their own mothers are likely to have had unwanted pregnancies. Is it any wonder that in the United States, half of all pregnancies are unplanned? Half of these are electively terminated. That means that one in four pregnancies in this country ends in an elective abortion.

http://www.infoplease.com/ipa/A0904509.html

The same thing applies to other unhealthy behaviors. Despite the known risks of smoking and the fact that it is the number one preventable cause of disease and death, the entertainment industry continues to glamorize tobacco. Children see it modeled as something cool or rebellious icons do. New addicted smokers are almost invariably underage. The government makes only a token effort to keep these young people from becoming addicted, even though it will pick up the tab years later for the treatment of heart and lung disease. That is because the tobacco lobby invests heavily to keep the government from restricting the smoking advertising that kids see, while the medical establishment gets rich treating the effects of smoking, and no non-governmental body has any real financial incentive to decrease smoking rates. As long as government action is controlled by profit making corporations, this country will continue to peddle tobacco to children in secret while pretending to launch anti-smoking campaigns, all of which are designed to fail.

Note that the Netherlands also has the highest rate of use of Health Information Technology at 98%. The study found that physicians with higher rates of IT usage also reported feeling more confident in dealing with patients with multiple chronic diseases and adverse reactions.

http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Jan/Health-Information-Technology-and-Physician-Perceptions-of-Quality-of-Care-and-Satisfaction.aspx

I mention this, because recent legislation leads me to believe that our own health care system may mimic that of the Netherlands. So, study the Dutch. Maybe take a road trip to Amsterdam. I will be happy to come along for a family physician/public health perspective if someone wants to pay my way.

Postscript. Since We Are Talking About Corporate America, If We Let the Corporations In Be Prepared for Lots of Fraud and Waste at Taxpayers' Expense

Oh, and one more thing. There is strong evidence that members of the Medical Industrial Complex engage in collusion to fix prices. For instance, the prices of the top name brand drugs drugs that seniors take rose at 2.5 times the inflation rate when the Medicare prescription drug benefit started.

http://www.pharmalot.com/2008/03/drug-prices-rose-74-percent-on-widely-used-meds/

Normally, you would expect competition for increased sales opportunities to drive down prices or for prices to stay the same, right? Someone was talking to someone else saying We will raise ours if you raise yours. . Health insurance companies also engage in this kind of coordinated behavior, both when raising rates and reducing fees. Therefore, the Dutch model will fail in the United States if the Department of Justice is not watching these companies like a hawk for any sign of price fixing. Because the first instinct of Blue Cross, United Health and the others will be to cook their books, claim massive losses and demand huge increases in their premiums. And at the same time they are doing this, they will be paying their CEOs multimillion dollar bonuses and lobbying like there is no tomorrow. And Big Pharm will do the same. And so will everybody else involved in medicine. None of them really wants universal health care to work, and any one of them would be happy to make a few hundred million undeserved dollars bringing about its fall.

I am betting that this kind of corporate climate of greed and corruption is not tolerated in the Netherlands the way that it is tolerated here. People with a high sense of self determination probably expect to run their own country and not have politicians sell their votes to the highest bidder.

[FiveGoodMen]

1. Private insurers will want to make private money.

We need non-profit health care.

[L. Coyote]

9. Indeed. Remove profit from health care to make it function for the People, not for business.

[me b zola]

52. Bingo

I am angry as hell that my life/health is a commodity to be used as trade.

Seriously. :grr:

[MercutioATC]

2. Expand FEHBP (private insurers) to cover all Americans.

The Federal Employees Health Benefits Program gives employees a selection of private PPO, HMO, and PPV plans to chose from. Insurers wishing to be part of the plan agree to certain criteria (such as the inability to disapprove coverage for pre-existing conditions).

It's an existing system, so it doesn't have to be built from the ground up. It works.

[Cleita]

7. Wiser heads than me have posited that it works for the middle class, relatively

healthy demographic of public employees. It won't work so well when the insurers have to insure the general public. Watch premiums go way up and the usual accountant gate keepers decide what your health care will be.

[MercutioATC]

16. If it's the only game in town, insurers will get on board.

They agree to the rules because they want to be able to offer insurance to the huge pool of federal employees.

What do you think will happen if the decision becomes "comply or offer insurance to nobody"?

[Donnachaidh]

19. if everyone has the SAME payment. I might consider this okay

But having a child with a genetic disorder that requires medication that costs $1,000 a DOSE, I'm skeptical of ANY insurance plan being offered. We've been screwed over so many times, after being told we'd be treated *just like everyone else* it isn't funny anymore.

[MercutioATC]

21. You'd be able to choose between a range of plans from different insurers.

HMOs, PPOs, PPV plans. All would have to meet the minimum criteria and each plan would have its own premium, set by the insurer (but that premium would apply to anybody who chose that plan).

I'm covered under FEHBP and right now I have Aetna. The plan and premiums are exactly the same for me as they would be for a 70-year-old diabetic cancer patient.

[Donnachaidh]

23. I'll believe it when I see it, no offense

meant to you.

We've been burned far too many times. We now have our kid under an s-chip program, and just the beginning of seeing how this program *works*, I can see the political wheeling and dealing being done by the medical groups to wring out the most of the dollar for profit, and delivering the LEAST amount of actual care for that dollar. It's obscene, it's WRONG - and the machinations are infuriating.

we'll see. We have enough scars to warrant a heavy dose of skepticism.

[MercutioATC]

25. If you were a federal employee, you'd be having a different experience.

That's what I'm advocating...expanding the system used to provide health insurance to federal employees to everybody.

It's a system I've been part of for 18 years and I've never had a problem.

[Cleita]

33. You are wrong. Aetna will not cover the 70 year old because he

qualifies for Medicare. All they will cover is the 20% that Medicare doesn't cover for 2 1/2 times the cost of the Medicare premium. I have the same plan. $96 for Medicare part B, $256.00 for private insurance medigap. I could also get Medicare part D for prescription drugs for an extra $30 a month if I could afford it but I can't.

[eridani]

38. FUCK choosing insurers

I want to choose my PROVIDERS, which private insurance will not let me do. Single payer will.

[MercutioATC]

55. I want to choose a plan that best fits my needs.

...and my plan DOES allow me to choose providers.

[sansatman]

32. Expanded & Improved Medicare for ALL. A system that already exists!

More info:

Tell me a little bit about H.R. 676...

The opponents of national health care, mostly those who are badly misinformed or paid agents of big corporations that are now making huge profits off of the current system by denying needed care to millions, will try to scare you by calling it “socialized medicine”. You’re going to hear that a lot in the coming months but don't be fooled; nothing could be farther from the truth. In fact, the goal of this program is simply to create a fair and equitable single payer health care plan that all Americans can afford and benefit from while leaving most of the existing structure of practicing health care professionals and facilities completely alone. You choose your doctors, your hospitals and need no permission from anyone to go see them whenever necessary. No exclusions, no pre-existing conditions, no denied claims, just top rate, affordable, professional care for you and your family including prescription drugs, mental health AND dental services in addition to long term care, whenever you need it.


Why should I support HR676.org?

There are a lot of organizations out there today that are in favor of national health insurance. You probably haven't heard about too many of them even though some do have really great web sites with a lot of information on them. The problem is that few of them have any real plan of action designed to actually make national health insurance a reality. Talking about the problem is a very good thing, but we simply feel that talking just isn't enough. Ours is a totally unique approach in that regard because our intention is to actively work towards changing the landscape in America by fundamentally altering the current health insurance scene from one dominated by large for-profit corporations whose primary goal is to serve the needs of their investors and are content to leave millions behind to one controlled by a much more fair and equitable system whose primary responsibility will be to promote and protect the health of every American leaving none behind. Simply put we believe that our approach will make it possible to actually achieve this goal; a goal that has eluded us for so long. The basic premise is that if left to the existing political system, achieving the goal of creating a national health insurance system will never be possible. Why do we feel this way? The reasons are clear...


http://www.hr676.org/index.html



http://www.calnurses.org/media-center/press-releases/2009/january/first-of-its-kind-study-medicare-for-all-single-payer-reform-would-be-major-stimulus-for-economy-with-2-6-million-new-jobs-317-billion-in-business-revenue-100-billion-in-wages.html

http://www.pnhp.org/publications/united_states_national_health_care_act_hr_676.php

[LWolf]

3. Why go with private insurers when we don't have to?

"Private" means "for profit." The purpose being to produce profit, rather than make sure everyone gets high quality health care.

We already have HR 676 on the table. Why settle for something less effective, and more problematic in the long run?

[Jackpine Radical]

8. I am very pessimistic that 676 will go anywhere.

The Dutch system may be the best alternative, if we can get something like it.

[LWolf]

11. So am I.

I'm also pessimistic that compromising with insurance companies will get us actual universal health care.

I'd like to fight harder, for longer, before I step down and let them own health care for another several decades.

But then, I'm the idealist, not the pragmatist, and have never made a secret of that. ;)

[Jackpine Radical]

18. Oh, hell yeah, fight by all means. Me too.

[byeya]

40. Agree. There's no need for profit to be mixed with

health care. Remove the leeches and save money and hassle.

[LWolf]

54. It's the simple, obvious solution. nt

[pinto]

4. In re: modeling and self-efficacy, the Dutch gov't response to AIDS was

swift, *public* and clear. The public followed suit and they were much better at stemming new infections than we were in the US.

[leftstreet]

5. Take the profit out of healthcare n/t

[Cleita]

6. I'm under impressed and it seems it's a club of European pharmacists

who have crowned the Dutch system as the best. It makes me wonder exactly what their expertise is in evaluating health care.

[Donnachaidh]

10. private insurers will ALWAYS find ways to demonize pre-existing conditions

And they will ALWAYS find ways to refuse care to people *who don't need treatment* (their words).

American insurance companies work in tandem with the rest of the Medical Industrial Complex to marginalize the ones who cannot fight back. It's second nature to them.

They are a CANCER on the public. Cut them OUT of the program altogether, otherwise we'll still have people DYING for lack of care. Do YOU want some pencil-pushing asshole deciding the fate of your mother, or your child?

Do YOU want YOUR fate to be decided by an actuarial table?

[MercutioATC]

17. Nope. They don't under FEHBP.

Hell, I've had them pay for things that they weren't even contractually bound to pay for by threatening them.

The "pre-existing condition" exclusion will be a thing of the past.

[eridani]

39. That's only because employed adults are a far healthier on average--

--than members of the general population. Require those inusurers to cover actual sick people, and you will see a turn for the worse.

[ColbertWatcher]

12. Kick, red and bookmark (can't read the whole thing during the Olbermann-Maddow hour) n/t

[BlooInBloo]

13. Scalability is the #1 issue never addressed by Why Can't We Be Like Country X people....

Just because it works well for itty bitty countries is no guarantee that it can scale up to work well for large countries.

[leftstreet]

14. How many Americans are on Medicare?

:shrug:

[Juche]

22. 42 million

Add in medicaid, SCHIP, FEHBP, VA etc and about half of the country that has health insurance is on gov. healthcare.

[tucsonlib]

20. Explain, Please.

Of all the arguments I've heard opposing universal health care, this is the first time I've encountered the concept of "scalability". I fail to see how the size of a country factors in at all. (Or maybe that's why the issue is never addressed - because it's irrelevant?)


:shrug:

[GreenPartyVoter]

15. Unless it costs no more than $10 a month, I will stick with my medicaid

[roamer65]

24. Put everyone under Medicare.

It is the most efficient health care insurance in America.

[byeya]

42. Medicare: Less than 3% over head.

It would be more efficient if republiKKKans didn't prohibit bargaining for drug prices and setting national cost standards for routine procedures.
Like the poster said: Medicare for everyone!
{I can't help but remember that the former republiKKKan leader, Robert Dole, said the vote he regretted most, was his vote in favor of Medicare}

[bread_and_roses]

26. I can't see any reason to like this complicated hybred

why not just have universal, national single-payer? The idea that people can make sensible choices about health care coverage is nonsense, for one thing. You can't make a sensible choice when you have no idea what tomorrow will bring. Will you be the statistically unusual person in 20's who gets a cancer? Will your child be born with or develop some condition requiring expensive and rare treatment? Will you get hit by a bus?

And...why tolerate health care for profit? It distorts what should be the very foundation of health care for all.

[SammyWinstonJack]

27. I guess their private insurance companies aren't are greedy as our are?

:shrug:

[McCamy Taylor]

30. Or, did their citizens have stronger objections to a tiered health care system without choice?

Maybe there is a stronger sense of social justice in the Netherlands and also a greater sense of self determination, which caused the citizens to reject a model in which the federal government "took care of" the citizens in favor of one in which people were more actively engaged in the process of making their own health decisions.

If that is the case, then the United States is not ready for the private-national revolution, because we are definitely not at the stage where the majority of people are ready to take responsibility for their own health.

[McCamy Taylor]

28. Re: profit, we tolerate a two tiered education system, one nonprofit/public, another for profit.

And you do not hear anyone say that the for profit academies are necessarily "bad". Parents spend a lot of time and effort making sure that they get quality for their dollar.

Therefore, you can not say that "profit" alone necessarily makes something that is required like education or health care unfit for consumers. Other factors like fraud come into play. Or how much the product is valued. Do we value education for our children more than we value disease prevention? Do we take more responsibility for their futures than we do for our own health?

And "nonprofits" can be just as bad as for profits when it comes to price gouging. For instance, an organization can pay its CEOs and executives excessive bonuses for keeping costs low even if it is not in the business of generating a profit. You will see this in some public hospital or clinic set ups, which will horde their resources, refusing to provide care because they would rather keep the money or spend it on things they value more, like research or new buildings or stuff to attract paying patients.

[Donnachaidh]

34. apples and oranges

Parents have the CHOICE to put their kids in private for-profit schools. They are not restricted to one school (as employees are now restricted to one insurer thru their jobs) and if they decide to move their child to a different school, they aren't penalized because they went to that other school.

Really disingenuous example put forth. :grr:

[McCamy Taylor]

29. In the US we actually have a system of "national health care" much worse than that of England.

Anyone who has ever been to a Veterans Administration Hospital knows that the VA system does things its own way in its own sweet time. That is because the people who depend upon the VA have no other options. It is a 100% public health program, like a nightmare version of national health in England. It hires its own doctors and staff in its own hospitals and clinics. You take what you get and you like it or do without. If they butcher you, too bad. You do not collect malpractice from the VA.

This is the model which scares the daylights out of Americans when they are told that they may get federal government controlled health care. The VA system got worse under Bush, probably in order to scare Americans away from government run health care.

Medicare has provided lots of choice. It is essentially a private program with private providers---it is just managed by the government with low overhead. This is why many health care providers prefer the plan, even though government engages in some pretty strong arm collective bargaining on doctors' fees, hospital rates and will probably do some drug price collective bargaining, too. However, for the last 8 years, the Bush administration has engaged in policies designed to make Americans hate and fear Medicare, at the bidding of private insurers and the drug companies (I have an old journal in which I discuss this). They knew that Medicare formed a convenient template for national health.

So, it will be a hard sell, after what Bush-Cheney did, convincing Americans that the American government can be trusted to look after people's health. They saw Bush ignore NOLA after Katrina. They saw Bush gut the public health infrastructure. They saw the FDA cater to drug companies and put people's lives at risk. Obama will have to appear very committed and his HHS will have to be absolutely dedicated to making national health care work, before people will trust the federal government. That is why I think someone high profile like Dr. Howard Dean would be perfect for the job.

[enlightenment]

31. Interesting, but it won't happen the same way here.

Too many variables and one of the largest is culture. We are not the Dutch - and what makes the system work is that the Dutch people buy into it. They are an astonishingly prosaic and liberal nation, classically homogeneous (though not so much anymore) with a well-developed sense of social altruism. They are also very family oriented; seems to me that even now the majority of Dutch women only work part-time in order to have more time for their families. And they can do that and survive because they also have one of the highest minimum wages in the EU - around $1600.00 a month. Plus, they take home around 55% of that (compared to less than 40% net in the US).


(the article that accompanies this graph is most enlightening: http://www.oecdobserver.org/news/fullstory.php/aid/2217/ )


So the $121.35 (95 Euro) that is the basic rate for insurance is a much more 'do-able' proposition for most Dutch citizens.

[rpannier]

35. While it sounds good

I remember when we went with mandatory drivers insurance.
The rates were supposed to go down and everyone would be able to afford insurance.

Instead, auto insurance went up.
Many couldn't afford it and then it went up more because insurance companies had to safeguard against you being hit by an uninsured motorist.

on edit: I have Government run Universal Health Care. I live in Korea. It's 100x better than what the US has and Korea has one of the weaker National Health Care programs.

Japan has a much better one.

[clear eye]

36. Japan's Nat'l Insurance Involves Private Companies n/t

[McCamy Taylor]

44. Japanese also take a lot of responsibility for their own health, like the Dutch.

[rpannier]

47. Most Health Care in Japan is still provided through the government

Healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments.

-Local and National Government provide much of the insurance for the country.
-Health Insurance is heavily regulated.
-If you work for Mitsubishi you take the insurance provided by Mitsubishi, you do not shop around -- I use Mitsubishi because I have friends who work there.
-It still does not change the fact that in the US, when auto insurance became mandatory, the costs went up. So, why should I believe that health insurance will become more affordable by including companies that are 'for-profit'?

[rpannier]

46. It involves but much of it is still provided by the government

Healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments.

And while you did respond to my blurb at the end, you did not respond to my concern over the way auto insurance rates increased several fold AFTER mandatory auto insurance was enacted, which we were assured would lower auto insurance rates.

[clear eye]

50. I didn't argue w/ the rise in auto insurance rates because

my reason for posting was not to discredit you, but to clarify that the Japanese system which you said was better than the Dutch private insurance-based system also used private insurers. Apparently if rates are strictly prescribed by law, private insurers can be included and there can still be a good outcome. This is important to know since in the U.S. it is unlikely that private insurance will be eliminated. Of course, it won't hurt for there to be strong pressure for the "Medicare for all" model to influence the private insurers to stop throwing huge amounts of money into blocking strict rate regulation.

[rpannier]

51. Thanks for the clarification

Have a nice day :yourock:

[Vinca]

37. I am 100% opposed to private insurance companies having any part

in the solution to the mess they've created. The carnage left in the wake of greed cannot be measured in dollars and they need to find another occupation for their firms than insuring healthcare.

[Romulox]

41. It's illogical to think that huge new outlays to for-profit corps can result in "savings".

This is just corporatist dreck.

[Faryn Balyncd]

43. With our 31% administrative costs (and health costs at 17% of GDP) - - the only way we can afford...

...universal health care is to cut out the bloodsucking middle-men insurance companies.


These leaching insurance companies are the very ones who created our present perverse medical pricing system in which people DENIED insurance are then subjected to fantasy "normal rates" of 250% to 400% (or perhaps 600%) higher than the still profitable "discounted" rates charged to insurance companies.


We are reaching the point where we can no longer afford such a corrupt, perverse system.


In the beginning, insurance provided a way to spread out the erratic occurance of medical expenses.


Today insurance companies do everything possible to avoid writing policies to anyone other that a cherry-picked population of those least needing insurance. And the prices charges to this select group is approaching unaffordable.


Insurance companies are NO LONGER PROVIDING VALUE.


They are sucking the blood out of both our citizens and our economy.


Universal coverage in the United States can only be affordable if we eliminate these leaches.

[crimsonblue]

45. Overall, very nice, but I have to disagree about one thing

Prescription prices didn't rise rapidly after the Medicare Prescription plan went into effect because of collusion. It was a simple matter of economics. Since more seniors and poor were able to obtain prescription medications, the demand for those medications rose. As demand rises, prices rise. It is simple economics.

[Laelth]

48. Destroy private health insurance.

I want the UK's NHS. The uber-rich can buy supplemental insurance and go to private doctors if they're willing to pay for it.

I do not believe the Dutch model can work here.

The United States is a LIBERAL Country.

:dem:

-Laelth

[demodonkey]

49. Where does long term care for the disabled of all ages fit in?

It should NOT be, "sorry you had a stroke and are paralyzed, but everyone has to stand on their own two feet so you and your family will have to 'spend down' everything you worked for for three generations after that we MIGHT give you some help."

The disabled should pay the same percentage of their income and assets as everyone else, and get the care they need.

No one ASKS to become disabled.

[dysfunctional press]

53. no, thanks...i'll take the single-payer option please.