Switzerland and the Netherlands have universal coverage - via mandate & regulated insurance polices

[ehrnst]

It's not simply about giving US health care insurers whatever they wanted - it has precedent in Switzerland and the Netherlands and has worked for them. For the record, I am an advocate for single payer - but there are other ways to get to universal health care, and should not be discounted simply as Insurance Industry boondoggles:


http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Jan/The-Swiss-and-Dutch-Health-Insurance-Systems--Universal-Coverage-and-Regulated-Competitive-Insurance.aspx

The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets

<snip>As the United States resumes debate over options for achieving universal health coverage, policymakers are once again examining insurance systems in other industrialized countries. More recent attention has focused on countries that combine universal coverage with private insurance and regulated market competition. Switzerland and the Netherlands, in particular, have drawn attention for their use of individual mandates combined with public oversight of insurance markets. This paper provides an overview of the Swiss and Dutch insurance systems, which embody some of the same concepts that have guided health reforms adopted in Massachusetts and considered by other states and by federal policymakers. The two systems have many features in common: an individual mandate, standardized basic benefits, a tightly regulated insurance market, and funding schemes that make coverage affordable for low- and middle-income families. Differences include degree of centralization, basis of competition among insurers, availability of managed care, and reliance on patient cost-sharing to influence care-seeking behavior.</snip>

[EFerrari]

1. And both of those countries have real regulation, isn't that right? n/t

[Warpy]

2. That's right, real regulation with real teeth

that limits executive greed and threw the claims deniers out of work.

Remember, private insurance worked pretty well here while it was non profit.

When the MBAs took over, though, it became a cash cow. They got rich feeding on the suffering of the sick.

[WeekendWarrior]

30. And I'm sure that regulation

evolved over time. Just like everything else.

People here act as if this bill is the end of everything. It's just the beginning.

[EFerrari]

31. Right. Medicare was supposed to include younger people in increments

of ten years over time. That was just the beginning, too.

[Fumesucker]

3. But we aren't getting universal coverage..

And for about the ten millionth time, insurance does not equal care..

What are the copays and deductibles in the Swiss and Dutch systems?

The devil is in the details..

[quiller4]

23. The Dutch system provides a cost sharing varying from 70-30

for some procudures to full coverage for others. That is for the average working person. There is separate indigent care coverage that is very similar to our Medicaid/SCHIP.

I have a friend in Holland with MS. She is still working and her health has been relatively good for the last few years. She spends about $3600 per year on her care including her medications and physical therapy. She says the covered portion of her care runs close to $8500. (I've used her conversions into US currency and these are approximations). She has quarterly clinic appointments and most of the time sees a PA who monitors her care. The physician is called in only when something out of the ordinary is going on. She pays about $20 at the time of each clinic visit.

My friend is an editorial assistant for a publishing firm. Her salary is close to $55,000/year. She is a 60 year old widow with grown children.

[Fumesucker]

24. Thanks for the info..

For someone making $55K a year $3600 out of pocket doesn't sound that bad..

I'd be willing to bet the treatment (total cost) would be substantially more expensive here for the same condition though.

Insurance is only part of the problem with high medical costs in the US and not even a major part at that.

[mdmc]

4. Yes WELL REGULATED..

I would love either system here in the USA..

[kenny blankenship]

5. SWISS *NON PROFIT* INSURANCE. THEIR BASIC INSURANCE IS NON PROFIT *BY LAW*

the Dutch system was totally govt. controlled up until 4 years ago. It is absolutely misleading and disingenuous to compare what we're passing to the Swiss system, implying that we're getting the same thing.

Your brand of disinformation has been debunked and refuted continuously here at this site for going on a year now.

[ehrnst]

6. Not comparing it - but simply saying that mandates + private insurance are not as evil as

has been presented here on DU.

[kenny blankenship]

7. Your brand of disinformation has been debunked and refuted

NEXT!

[ehrnst]

8. Whatever. Complain to the Commonwealth Fund - they wrote the paper.

[CTyankee]

13. Maybe you didn't read the paper all the way thru.

Kenny Blankenship is right. Here is the money quote: "In Switzerland, only nonprofit insurers may participate." It's right there. Go back and see for yourself...

[ehrnst]

14. Again, I recommend you send your gripes to the Commonwealth Fund.

They wrote it, I simply posted it.

Your venom and anger should be directed at them - they are the evil demons that you seek, not me.

[Raineyb]

15. You're the one who posted it as though the systems of the Netherlands and Switzerland were

exactly like ours. The fact that they don't allow their citizens to be raped by for profit companies when it comes to basic health care is a HUGE point that needs to be pointed out. For you to neglect it makes your argument suspect.

[ehrnst]

16. I apologize for the abbreviated title - there are limits to the length

The idea of the mandates is an accepted idea for cost cutting.

That's what I was trying to point out, and got pilloried for it.

[CTyankee]

20. I have no gripe against the Commonwealth Fund paper, I just quoted from it!

Sorry, but I really don't have a gripe at all. Perhaps you just missed it, but it IS there.

I'm not angry with you. I'm not angry with the Fund.

It's a very big distinction, though, I am sure you will agree. As long as the insurance is from a nonprofit and is carefully regulated, the people don't get cheated, gouged and left without decent health care.

[Lars39]

9. Did the insurance companies there drastically raise the rates before the mandates

and regulation? 'Cause that's sure as heck what the companies are doing here before this passes.

[ehrnst]

10. Well, no, you can't regulate prior to passage of legislation that regulates....

That happens after passage.

[kenny blankenship]

18. Swiss insurance was regulated to be non-profit for basic care long before the individual mandate

was imposed. The two things didn't happen together.

This is a very instructive bit of history actually.

The individual mandate was imposed in the mid nineties (passed 1994 going into effect 1996). Because Swiss health insurance had long been required to be non-profit, the rate of coverage was already high - up to 94% of all citizens.

94% coverage without any individual mandate. Massachusetts can't say it has a better rate of coverage WITH a mandate.

Why did this system succeed so well? Because they did THE IMPORTANT THING FIRST : get profit seeking out of the middle of their public health system. You can buy a for-profit policy that goes above and beyond the basics, but every insurance company that wants to play in Switzerland's market has to by law offer basic, essential health coverage at no markup. You cannot get insurance through your employer. People were neither at the mercy of their boss nor the insurance numbers racket. Because profit seeking was tamped down for the overall good of the Swiss people, the Swiss people could almost universally afford insurance coverage, without any help.

Obviously this isn't ANYTHING like our system or what our system is about to become.

Another important issue to bear in mind when thinking about what small Northern European countries like Switzerland and the Netherlands can tell us about healthcare is inequality. Their rates of poverty historically run about ONE THIRD that of the United States. You can take that as a general metric of inequality -or relative lack of same- compared to us and our "society". Swiss society tends to emphasize equality by tradition. Since all Swiss men are by tradition active or reserve forces in their military, it was in the state's interest to ensure that all men were maintained in good health and maintained efficiently. Hence the forbidding of profit taking to the insurance middle man. Dutch society has imposed equality by strong welfare state design - 66% of Dutch households are receiving subsidies for their health insurance.

[tbyg52]

29. They are when there are vast giveaways and no regulation. nt

[Warren Stupidity]

26. dutch for profit insurance. their basic insurance is for profit

see, i can post in all lower case!

I'm not saying that for-profit systems are ideal, or that the dutch system is the best there is, just that it can be made to work and to deliver universal care.

[Romulox]

11. Switzerland is also known as the money laundering capital of the world.

And every adult male owns an automatic assault rifle. :shrug:

[Greyhound]

12. Not sure if this is twisted enough to qualify as an actual lie.

Definitely a weasel.

No other nation of earth is stupid enough to have anything like our system of murder for profit. Swiss, Ditch, even Japanese health insurance companies are nothing like ours, they simply share a name. So it is disingenuous at best to claim that their system works on the same principles we're being screwed with.

[ehrnst]

17. MEA CULPA - I corrected the title line. Removed "private"

Continue with the feeding frenzy.

[TreasonousBastard]

19. Makes no difference around here...

insurance companies are pure evil and only single-payer will do.

BTW, Germany, France, and a whole bunch of others rely on regulated insurance companies, too. I suspect the real difference between the US and these other countries is that the other countries didn't have two groups of assholes, on from the left and one from the right, yanking at it so hard that nothing worthwhile got done.

(BTW, iirc, Germany's pension system was the model Roosevelt used for Social Security, but Roosevelt had to contend with Republicans and some assholish Democrats while Bismarck had the questionable advantage of just decreeing it. At about the same time, the 1880's, Germany instituted health insurance, too.)

[CTyankee]

25. I have no problem with us adopting the Swiss private nonprofit model.

And I, too, want single payer. But since the right wing has brainwashed the public against "government run health care" then I say "OK, fine. Let's get the Swiss model." For those rwingers who moan and groan about "one sixth of our economy in the hands of the government" it is a pretty strong argument. Then let 'em stew over that for a while...

[TreasonousBastard]

27. Nonprofit, or mutual, insurance might be the best way...

although I'm having trouble identifying the reasons health insurance has taken of on this dark road other forms of insurance have avoided.

Around 250 million people are covered by some form of insurance right now, and I don't trust Congress, or anyone else, to come up with a massive change in the system that wouldn't disrupt their coverage more than fix it-- it's just too big a job for 535 lawyers who hate each other and are looking to keep their jobs at election time.

What I would like to see is enough of a change to guarantee universal coverage at affordable prices, and while I don't give a damn how, it seems aiming at the abuses of the insurance companies is the easiest way to go about it now. But, underlying costs must be controlled, and the abuses of the medical profession have to be dealt with-- my mother went into the hospital for 2 hours for a test one morning and got a bill for $7,500, and that sort of thing is happening far too often.

[subterranean]

21. The Swiss and Dutch systems are apparently too radical and "disruptive" for the U.S.

because they take the profit out of basic health insurance. Their governments also compensate insurers that end up with an above-average number of high-risk customers, so the insurance companies have no incentive to avoid customers who have health issues. There are no age ratings either. The insurance costs the same for everybody. And the insurance companies still make money by selling supplementary policies for extra benefits to those who can afford them.

I wouldn't have any problem with us adopting that kind of system.

[Hello_Kitty]

22. Yep. I prefer one single payer system but would definitely be okay with this. eom

[Lydia Leftcoast]

28. Under the German system, your copays are limited to a certain amount per year

as they are under the Japanese system.

Under the Japanese system, you can even get government reimbursement for expensive services that your insurer doesn't pay for, and the government assumes all expenses for a list of chronic and catastrophic conditions.

Furthermore, while most people receive insurance through their employers, Japan has a public option that you sign up for at your city hall.

But the key point is that countries that use private insurance companiesregulate the hell out of them. For example, there are NO DEDUCTIBLES under these systems, although there usually are co-pays, sometimes on a sliding scale.