by Political Editor John Tyler and US correspondent Reinout van Wagtendonk
12-11-2007
American policy makers are interested in the Dutch healthcare system. The combination of competition, universal healthcare coverage and relatively high quality impressed a delegation from the United States, visiting the Netherlands last week.
Kerry Weens, a senior official in the Department of Health led the US delegation. The Americans paid a visit to the kidney disease wing of the Leiden University Medical Centre (LUMC). Mr Weens said he was impressed with what he had seen.
"We're intrigued by many of the ideas that we see, such as moving toward more market based solutions. In general I think there's a lot of consistency between the Dutch system and the US system."
Competition introduced
Mr Weens was referring to a recent overhaul in the way Dutch people purchase health insurance which have made the Dutch system more competitive. Two years ago, a new law went into effect requiring every resident of the Netherlands to purchase their own health insurance, while the insurance companies were forced to embrace open market laws and offer competitive prices for their insurances. But unlike in the United States, for those who can't afford insurance, the Dutch state still chips in to cover part of the cost.
Insurance companies are required to provide coverage for anyone who applies for it, so no one can be refused due to pre-existing health problems. To help insurance companies cover some of the costs involved with selling coverage to all comers, the government has a formula in which it contributes to the cost incurred in certain cases.
So while competition has been introduced into the system, the Dutch system is not a completely market-based approach. The taxpayer still subsidizes a not insignificant percentage of care in the Netherlands. But competition helps keep overall costs down.
Confronting bills
Nolene Berkhout is a nurse practitioner, and served as one of the hosts of the American delegation at the LUMC. Referring to the new insurance arrangements here in the Netherlands, she pointed to the fact that
"We're now being confronted with the bills, which is a good thing - this way, we know exactly what we're paying for."
Although, she quickly added, individuals don't actually have to pay the bills themselves.
Ms Berkhout lamented the fact that in the US, more than 40 million people in are uninsured because they simply can't afford it.
"We would never have that kind of situation here." Prevention is important
Another major difference in the two systems, according to Ms Berkhout, is that
"We pay a lot more attention to prevention - we have a coordinated, multidisciplinary approach. In Holland there's quite a lot of proactive action attached to that aspect of health care."
A number of recent changes are meant to improve the quality of care here in the Netherlands. Doctors and hospitals are now required to publish information every year about their performance. That information is available to the public on a website, but it is still too soon to see how much effect it has on patients' choices.
Costs up, care down
Not everyone is happy with the changes. When the insurance market was liberalised, many complained that the cost of their insurance went up, while the care that was covered went down.
Kerry Weens, the US official, said several states in the US have already implemented a similar system, where individuals buy their own insurance. He sees it as an attractive option.
"I'm going back to the US with the message that the Dutch are solving some of the same problems that we're solving in the United States, and we should closely cooperate with them, especially in the arena of quality."
US election issue
Healthcare has become one of the issues in the US presidential campaign. As Democratic presidential candidate, Hillary Clinton promises to succeed in the White House where she failed as First Lady. Fifteen years ago she lead President Bill Clinton's healthcare reform efforts. It was a fiasco. She says she's learned a lot since then and will try again.
Some 47 million Americans do not have health insurance, 8 million of them children. Every four years presidential candidates offer ambitious plans to remedy this. It never happens. Hillary Clinton's new plan will cost $110 billion, her experts estimate. It mandates health insurance coverage for everyone.
But it's not a government-run health scheme. It offers incentives, carrots and sticks, for both individuals in need of insurance and private companies offering insurance to come together. Elements of her plan come from countries with universal healthcare coverage such as the Netherlands. She is very careful not to open herself up to the criticism of 15 years ago when her reform efforts failed partly because the insurance industry, hospitals and other players in the for-profit health business managed to label her plans socialized medicine, and thus un-American.
Republican policy
Republican presidential candidate Rudy Giuliani takes up this point in his own campaign, by evoking the supposed horrors of socialized medicine in other countries and linking them to Hillary Clinton's plans. Giuliani and other Republican presidential candidates use other countries' health systems as bad examples.
Giuliani uses statistics, such as the prostate cancer survival rates in the US and the UK, to back up his case. But various doctors and independent experts have debunked the statistics he quotes in his campaign commercial. They insist that in comparable situations there is no significant difference in prostate cancer survival rates between the US and the UK.
The Republicans want market-based solutions with large tax credits for individuals to go out and buy their own health insurance. Hillary Clinton and the other Democratic candidates also stay away from a government-run health system and also want the private sector involved. But unlike the Republicans, they don't believe that incorporating foreign examples in their health plans is un-American.
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Gary Busby,
garybusby_2000@yahoo.com,
01-01-2008
- TN
Here is how private for profit medical insurance is the US. My elderly mother (72) fell and fractured her hip. This happened while she was still working and paying for private medical insurance coverage through her employer. Her insurance was with AETNA. AETNA paid its CEO $30 million dollars last year. For 3 years AETNA refused to pay the $17,500 cost of surgery, hospitalization, and medical care. I got involved with communicating with AETNA. After threatening to sue them, a lower level claims employee with AETNA agreed that AETNA was responsible for the bill. During my communications with this lower level claims manager, I wrote a letter on my mother's behalf to this idiot CEO. He stated he would turn the claim over to their Executive Resolution Team. During this time, we received notice from the hospital and doctors that their bills had been paid by AETNA. About three weeks later, we received a letter from this so called Executive Resolution Team that AETNA was refusing to pay the charges. This, after knowing AETNA had paid the charges. This CEO and his executives evidently do not know how to access their very own data base. In this instance, they had paid ALL charges, but yet these Executive idiots did not even know it. Beware of business criminals, particularly AETNA Insurance Comany, posing as insurance providers. This is the sort of treatment Americans receive from this for profit greedy money grubbing shitheads running US insurance companies.
Samuel R. Ganczaruk,
31-12-2007
- USA
Profit and markets have absolutely nothing to do with health care! How dare anybody assume that life and death matters are up to money grubbers. Let the individual and the doctors operate the system!
jude,
24-11-2007
- USA
In America, our elected senators and congress have excellent health insurance which we as taxpayers help to pay through our taxes. But when it comes to the common ordinary people, you are lucky to have any insurance.
People are terrified of losing their insurance so often stay in unsatisfactory jobs because of this fear.
If your poor, forget it! If you middle class, it is an extreme struggle to keep your family members covered often costing as much as your mortgage payment...emergency rooms are overwhelmed with sick people with no insurance. It is shameful that this could happen in what we like to call ourselves "the most powerful country in the world". Hopefully things will get better under the Democrats but only John Edwards is really talking about single payer health plans. Everyone else is terrified of the big insurance companies, etc. It will take some strong
willed elected officials to make the changes necessary... it will probably be business as usual.
davepet,
23-11-2007
-
I live in the3 US. I currently pay more for my private health insurance than I pay in income tax (& the coverage only keeps us from bankruptcy if we get sick... there are no benefits until we've spent US $5,000 out of pocket), so it seems unclear how the US will finance any solution without either raising taxes or controlling costs.
Paul V,
13-11-2007
- USA
"The Republicans want market-based solutions with large tax credits for individuals to go out and buy their own health insurance. Hillary Clinton and the other Democratic candidates also stay away from a government-run health system and also want the private sector involved. But unlike the Republicans, they don't believe that incorporating foreign examples in their health plans is un-American."
The Republican consumer-oriented model includes health savings accounts, which have already been working in South Africa for some time, so your ' un-American' comment seems misguided and biased. The Republicans are attempting to inject the market forces that the Dutch apparently recognize are necessary to a healthy healthcare system.
Paul V,
13-11-2007
- USA
As pointed out in the article, competition is a good thing. The free market is responsible in large part for the advances that we have made in medicine. The rank generalizations of jacksmith seem to ignore the fact that Medicaid/Medicare already makes the US one of the world leaders in socialized medicine, and when one looks at health outcomes in the various sectors, the privately insured do better than Medicare and Medicaid. In fact, in some areas, such as survival for certain cancers, the uninsured do better than those covered by the government. The uninsured in the US by and large do have free access to heathcare, paid for by the padding providers bill to private insurance and Medicare/Medicaid. The providers take advantage of the fact that the government cannot adjust charges to market conditions fast enough to keep the fat trimmed. The upside is that those same providers can then write off care to the uninsured. Truly a dysfunctional system but it makes healthcare available to some who cannot afford it. If I have advanced cancer and want access to the best research hospitals in the US - being unemployed and uninsured actually improves one's chances of admission. The idea that life expectancy is down in the US as the result of the healthcare system is truly short-sighted; with few exceptions, the US is still the best place to be if faced with a serious illness. That said, obesity rates are skyrocketing, we are bombarded with stress and exposure to all kinds of environmental hazards, many of us have sedentary lifestyles and by and large take no personal responsibility for their own wellness; this probably has much more to do with life expectancy statistics than anything else. And infant mortality reporting in the US is the most liberal in the world. Most countries do not even count as births stillborn infants or those born before 28 weeks of gestation in their stats. The US reports almost every blob of tissue that makes a proper exit. They try to save the unsaveable - and US statistics take a large hit for that and their accuracy.
As the article so well illustrates even a more relatively socialist society such as the Netherlands recognizes that the free market is essential maintaining the quality and cost effectiveness of the healthcare system. If the US adopts universal healthcare, all the taxes in the world will not be able to guarantee the quality or availability of healthcare if no one wants to invest in the expensive education and dedication required to become a doctor, because they can't get adequately compensated for the stress of working 18 hour days making life and death decisions. The last person I want making the decision to prolong or end my life is a government bureaucrat in charge of cost containment for a universal healthcare system. The jacksmiths of the world who want Big Brother to take care of them and theirs will sooner be the ruin of the US's prominence than will the healthcare system.
Brother Mark,
13-11-2007
- USA
The state of US health care is so pathetic that life next to a polluted Chinese river promises a better medical care. Employers are stuck with providing this benefit, which automatically makes them $1,000/month less competitive PER EMPLOYEE than normal countries. Let's hope the next election will bring in a reform that is better for this country's citizens and worse for the insurance companies who have enslaved us.
Ronald Bosch RN MPH,
13-11-2007
- usa
Almost 50 million Americans are up the creek with no paddles. Helllllllo ? It's un-American to have some kind of 'socialized' health system? I think it is MORE un-American to have that many people with no insurance. We currently have the most stupid system possible. What would be wrong with some kind of Medicare/Medicaid system that ends all the needless suffering and enormous waste ?
jacksmith,
12-11-2007
-
For the first time in the history of America. The life expectancy of today's children is less than that of their parents. This is catastrophic. And our infant mortality is equal to that of a third world country. Current U.S. adult life expectancy is down from #1 to #42. And dropping fast. These facts are what is known as EXTINCTION! indicators. These are the early signs of the final phase of the EXTINCTION of the American people.
You have to take the profit motive out of health care delivery. The profit motive does not work with health care. Or any other essential public service like police, and fire. The sooner everyone faces this truth, the sooner you will be able to adopt a real solution to the problem. The days of paying for health care out of pocket are at an end. Just like the mob days of paying for protection out of pocket came to an end.
HR 676 is the way to go. Single payer Universal National Health Care For All. Medicare for all. Accept no substitutes. The sooner you face this. The sooner you begin to heal the Cancer of private for profit medicine that is destroying this entire society. Other developed countries realized this years ago. It's a no-brainer now. See sickocure.org
Money, greed, and the profit motive has just decimated health care in America. And killed, and injured millions needlessly. Just for profit. But that is what large amounts of money, greed, and a lust for power always does. No one is immune from this corrupting power. The smart ones know this. And avoid letting them-self be put in compromising positions. But that is easier said. Than done. And very few succeed.
Most in the US go into medicine primarily to become wealthy. That is who the medical schools mostly choose. Most of the medical schools faculty are in bed with the drug companies, and others. And like the story of Dr. Faustus. They end up selling their soles. One compromise at a time. Until Lucifer owns them.
In medicine. Compromised care means. Injury, disability, and death. It's sad really. But HR 676 can fix this disgrace. Like it has in other developed countries. The only question is. How many more millions will be hurt, injured, and killed. And how many more of your children will die before their time. Before we fix this disgrace of private for profit health care in America.
I realize there will be a few people that have what they believe is good health care coverage. Who will want to opt out of a single payer system like HR 676. But let me remind you we rank # 37 in quality of health care for all. Down from #1. Never the less. A few opting out is not a problem. As long as all other Americans are automatically covered at birth through life. Unless they choose to opt out of HR 676. The government takes out 1.4% from your paycheck now for Medicare. All they have to do is substitute for HR 676 what they now take out of your paychecks for private health insurance. Remember, we already spend more on health care than any other country in the world. Right Now. We are being ripped off. And raped.
The SCHIP program is a desperately needed program for Americas children. But with the impending EXTINCTION of Americas children. And their current catastrophic health care condition. SCHIP needs to be extended to cover all of Americas children, immediately. Parents should have no hesitations, or financial worries about seeking medical care for their children. Whenever they have any concerns about their children's health. Especially in the richest country in the world. I would submit that any President, or politician that fails to do this for the children. Betrays their most solemn oath to protect the American people. Especially when you consider that all other developed countries have done this. And that we are the richest country in the world.
So get on it America. Get it done. You have been doing great over the past several months. Keep it up. And step it up. You have to force it, and take it. It's the right fight, and the right thing to do. Now is the time... Take no prisoners.
