If we're going to go with private insurance, we need much stricter regulations, like the Netherlands

[flpoljunkie]

There is no premium for children under the age of 18 in the Netherlands.

Dutch Health Care System

1. True community ratings where everyone is charged the same premiums
2. Premiums are very affordable (roughly €100 a month for basic coverage)
3. Extremely strong national regulator
4. Deductible of €150
5. Extremely robust risk adjustment mechanisms that force insurers to compete based on quality and not risk selection
6. Achieves near universal coverage with 98.5% of people in the country covered
7. Allows for drug re-importation to keep drug prices low
8. Central government provider negotiator for most procedures

Senate Bill

1. Very large age rating ratios that allow insurance companies to charge old people three times as much as the young. The government mandates only the sale of strictly defined high quality insurances and all basic policies must have identical coverage rules. Gives insurers wide latitude in design policies and allows for the sale of very low 60% actuarial junk insurance and “catastrophic plans”
2. People will be force to pay 9.8% of their income for a low value insurance plan
3. Basically no direct national regulator
4. No maximum deductible but based on 70% actuarial values the deductible should be well over a thousand dollars for most silver plans
5. Weak risk adjuster that would not stop insurers from trying to game the system and cherry pick customers
6. Achieves only 93%-94% coverage
7. Drug Reimportation not permitted
8. No central provider negotiator

http://fdlaction.firedoglake.com/2009/12/17/this-is-nothing-like-the-netherlands-that-is-why-individual-mandate-is-unacceptable/

[Armstead]

1. We are getting the worst aspect (mandates) without the advantages

The US seems determined to pursue the worst course that gives us the sticks without the carrots.

But I guess we can't have that kind of "socialism" that actually controls the behavior of corporations.

[flpoljunkie]

14. See below and post #13 comparing health care costs in the U.S. to Netherlands, other countries

http://voices.washingtonpost.com/ezra-klein/2009/11/an_insurance_industry_ceo_expl.html

[baldguy]

2. If the insurance co.s had been regulated, none of this would've happened.

Another example of conservatism destroying the country.

[kcass1954]

11. But... but... but... but... If you leave big business alone, they'll do the right thing.

I don't need this :sarcasm:, do I?

[joeprogressive]

24. Now we are complicit.

We can't claim they are completely to blame anymore. We just gave a gift to insurance companies while the republicans voted against giving them a gift. Try spinning that one when this all fails.

[Laelth]

3. Of course, we'll never get those kinds of strict regulations.

As such, our best alternative is to ...

Kill the bill.

Forcing people to buy insurance is no more the answer to a failed health care system than forcing people to buy houses is the solution to homelessness.

:dem:

-Laelth

[flpoljunkie]

5. We need to work to make improvements in the Senate bill in conference--starting with the age ratio.

Dean's first suggestion was that the final bill needs to apply cost controls to the hospitals, as well. His second suggestion was the lowering the age ration of 3:1 in the Senate bill to even lower than the House bill ration of 2:1. In Vermont, insurance companies are allowed to charge only 20% more for age. That won't happen, of course, but 3:1 is a huge giveaway to insurance companies.

[Laelth]

6. It's unlikely that any substantive changes can be made at this point.

Now, the only real question is, "Up or down?"

I vote down, but, obviously, I don't get to vote.

Kill the bill.

Forcing people to buy insurance is no more the answer to a failed health care system than forcing people to buy houses is the solution to homelessness.

:dem:

-Laelth

[donco6]

4. And if anyone EVER thinks that will happen -

I will buy a bridge, just so I can say "I have this bridge to sell you . . . "

[ima_sinnic]

7. funny how the shills never want to talk about that

A contentious thread can be killed by asking what regulations are in the bill to control insurance co. profits. Suddenly the most vociferous supporters stop posting, ostensibly hoping the thread will die and sink out of sight.

[Vinca]

8. If big insurance was regulated like a utility this might work,

but since that might curb the checks going to politicians, they're pretty much going to be free to rape and pillage the poor suckers delivered into their web.

[flpoljunkie]

9. That is definitely a big concern.

[dkf]

10. This is exactly what I was thinking. Any mandated fees to a monopoly needs to be in

The category of the most regulated companies we have out there. The difficulty is that states regulate insurance cos but the mandate is federal. The entire structure of who oversees what must be overhauled before any mandate becomes effective. Really this is necessarily only the first step of regulation or the process will be corrupted.

[andym]

12. How do they achieve their low cost?

If I remember they had payroll taxes pay for 50% Is that correct?
But that would only be about 100 euros too, correct?

But even so, they must be paying their doctors and hospitals substantially less than we are, if care only costs 200 euros/worker. How could we bend the cost curve that much? Even Medicare (when unsubsidized) is far more expensive ($600?/month). Doctors and hospitals are already complaining about Medicare paying too little.

[flpoljunkie]

13. Evidently, they also set lower payment rates to health care providers. Remember these charts.

http://voices.washingtonpost.com/ezra-klein/2009/11/an_insurance_industry_ceo_expl.html

[andym]

15. OK-- but this is a big problem (as you have pointed out before)

This part of reform (lowering provider costs) will likely be very difficult without single-payer, or at least government negotiated rates for everyone.

[eridani]

20. Yes, they regulate health care prices as well

In 1996, my husband got a root canal in Groeningen for 100 guilders, or $25 American. Likely the dentists have petitioned for higher rates since then.

[treestar]

16. the Dutch are way ahead of us

They obviously don't have a population like ours. Much more liberal and progressive and empathetic to their fellow citizens.

[Betty Karlson]

31. It's nothing to do with liberalism.

Or progressive-ism, or empathy, for that matter.

While you make them (and me) a compliment, you don't see the real reason the Dutch are different. Probably because you think in terms of binary opposites. That's a very American way of thinking.

The Dutch way of thinking, also called "the Rhineland model", is that the entire community depends on the condition of its every member. Everyone must have something to lose, otherwise the community as a whole will lose people willing to stand up for the existing conditions.

By consequence, the Dutch emphasise the need for consensus - which is like bipartisanship, only with ten parties. From this consensus comes gradual change. And because the change is gradual, most changes are left alone, even if the government changes from center-left to center-right or back.

The most radical prime-minister the Netherlands had (Joop den Uyl, 1973 - 1977) is still remembered as a bad one because he simply was too radical (except of course for his old supporters, who revere his memory for the same reason). Even so, proposing radical measures won't endear you with the majority of the Dutch. And neither will proposals like: let's do it the American way. That last party to propose a binary parliamentary system was immediately ousted from power (Den Uyl's social democrats, 1977)

Most Dutch prefer tomorrow to be like today, only a little better. And it has not happened since 1919 that the government was replaced by a coalition consisting entirely of the former opposition. In all of those 90 years, there was always one (or more) party to remain in power.

The Binary thinking comes from a binary political system: the U.S. has only two big parties. The netherlands have at least three big parties (sometimes four), some mid-range parties and some small ones. And due to the most representative system in the world, any party that garners over 0.68 % of the votes (nationally) will be represented in the parliament. Hence the need for consensus.

The self-identified liberals and who-ever call themselves "progressives" are just two interested parties in that consensus.

[SpartanDem]

17. I agree there is more that needs to be done

but I also beleive this is a good start. You point to the age rating while 3 to 1 seems outragoues you have to understnd that people are charged much more than to today. The Netherlands gives us something to strive for, but we aren't going the get their in one swoop.

[flpoljunkie]

19. Then let's work to get the House 2:1 age ratio. Beats the heck out of 3:1.

[SpartanDem]

21. Absolutely

lowering the ratio is something I would love to see.

[Vidar]

18. Well said. Recommended.

[levander]

22. We should also adopt their tax structure for health benefits

In the Netherlands, employers don't get tax breaks for buying their employees health insurance. The employees (and other individuals) buy the insurance themselves. The individuals get the tax break, and can keep the same insurance no matter what job they have.

Plus, the employer tax break for health insurance benefits the people who are better off. People who have a nice job. And, making it an employer tax break, your letting them deduct from much higher tax rates than if it were an individual who got the tax break. If you make it an individual only tax break, you can target much more specifically those who need the help.

This by the way was the basis of the Healthy Americans Act. A bipartisan bill that provided universal coverage that the Democratic leadership decided not to use as a basis for the health care debate. They'd rather just scream about Republicans not participating than to actually use a bill that the Republicans could get on board with.

To read about the Healthy Americans Act:

http://www.huffingtonpost.com/lanny-davis/the-healthy-americans-act_b_301962.html
http://www.huffingtonpost.com/lanny-davis/the-wyden---bennett-healt_b_293117.html
http://www.huffingtonpost.com/lanny-davis/a-plan-for-universal-cove_b_309513.html

The Healthy Americans Act was largely based on the Netherlands system.

[Betty Karlson]

23. Sometimes, I'm just proud of being Dutch

And even prouder of voting for the Christian-Democratic prime-minister under who's watch this system was introduced.

[GreenPartyVoter]

25. What system did you have before this? Was it as awful as ours is now?

[Betty Karlson]

27. Just a different one:

There was a government-owned insurance company that covered everyone who could not afford to pay the "usual" (and already captioned) fees - be they elderly, infirm, or unemployed.

The drawback of the previous system was that it put the Middle Class in the hot spot - they were to pay for the bulk of the "usual" fees, and corporations would look for any way to make as many as possible of their part-time workers eligeable for the government plan. As such, the cost of the system became a too heavy toll on universal coverage. (The problem, by the way, was not the universal coverage - after all an even heavier toll is now exacted on the U.S. system, which is far from universal coverage.)

The drawback of the current system is the bureaucracy involved. The treasury is responsible for both subsidising the insurance of everyone below the minimum, and for taxing everyone above it. The junior Finance Minister announced in 2007 that his organisation had been stretched to the max to make it all work, and could not take on any additional tasks.

However, it could be that the organisational problems of the current system have been created by the (absolutely superfluous and devastating) organisation reforms that H.R. manager Jenny Thunnissen had pushed through just before the subsidies were added to the task list. She was later silently demoted.

[GreenPartyVoter]

28. Thank you for that explanation. Clearly no system is perfect but

yours is still head and shoulders above ours.

[Betty Karlson]

29. You're welcome.

Nice to make your acquaintance.

[Blue_Tires]

26. the swiss system is a good model to follow, too

[Betty Karlson]

30. As an afterthought, could I please add one more

great feature of the Dutch system?

Any large group of people, be it a company, a students' organisation, or even an internet community, can agree with one or more insurance companies that in exchange for recruiting consumers - i.e. the colleagues, students, or digital friends that have organised themselves - the insurance company offers a reduction on the premiums* of up to 15 %.

Some communities are so big, all the insurers are banging on their doors to be considered. Naturally, these communities know to get the full 15 % reduction on ALL parts of the health care package, with ALL insurers.

* May not apply to all extensions on your health care insurance package.