The Dutch system
"You can’t really have reform without a public option," former governor Howard Dean, a prominent public-option advocate, said recently. "If you really want to fix the health care system, you’ve got to give the public the choice of having such an option." Promising as this sounds, it seems increasingly likely that the public option will be a liberal dream deferred. Republicans and conservative Democrats, panicked that the government plan will squash competition and the medical industry as we know it, are slowly killing the idea. Even President Obama, who has endorsed the idea unambiguously, has indicated a willingness to compromise on the issue.
Liberals, understandably, are in agony. But they can take at least some comfort in looking overseas–where one tiny country has managed to build a popular and successful universal health care program based entirely on private insurance. That country is the Netherlands, which several years ago overhauled its health care system and achieved most of the goals the liberal reform movement holds dear: near-universal coverage, affordable insurance, and quality health care.
Under the new system, the Dutch government has required that everybody gets insurance; in return, it makes sure insurance is available to everybody, regardless of pre-existing medical conditions or income. Although the government finances long-term care through a public program, it has turned over the job of providing basic medical coverage exclusively to private insurers, including some for-profit companies. Surveys show that the Dutch are happier with their health care than are Americans—or the people of any other developed country, for that matter. There are even signs, albeit faint ones, that the insurers are achieving what’s become the Holy Grail of health reform: using their leverage to improve the quality of care that doctors and hospitals provide—by improving the coordination of treatments for the chronically ill or steering patients to providers that get the best outcomes.
Still, there’s a catch. A big catch. Private insurance in the Netherlands works because it operates more or less like a public utility. The Dutch government regulates industry practices tightly—more tightly than the reforms now moving through Congress propose to do in the United States. The public insurance option was supposed to make up for that deficiency, at least in part, by setting a standard for service and affordability that the private industry would have to meet—and by offering a fail-safe option in case the private plans simply couldn’t keep up. If Congress ends up gutting the public plan, in part or in whole, then it needs to work even harder on making private insurance work. And it’s an open question whether that will happen.
What makes private insurance work in the Netherlands? It starts with …
Continue reading. Thanks to Jack in Greece for the pointer. Typical cost for family of two: $180/month.