A lively discussion has been taking place among commenters on Robert Reich's blog. We are fortunate to have there an international array of people who are in a position to do some comparative analyses among different countries. In particular we are fortunate to have Frank Thomas, an American expat who lives in Holland and is familiar with both Holland and American social policies. The following comments appeared first on Reich's blog and are presented again here:
Frank Thomas said:
Jack Lohman, John Lawrence:
February 19 I gave a lengthy discription of the Dutch Health Care system on this blog (which appeared also on John Lawrence's blog: Will Blog For Food). The basic package covers 100% of the population for $115 per month per individual with no charge for children up to 18 years.
If you should have the time and interest, I would greatly welcome your comparative analysis/overview of the Dutch largely private system -- ranked the BEST in Europe -- with the US system and your thoughts why our country can't learn something constructively applicable from a society whose basic individual health care monthly premium cost is ONE-FOURTH that of the US! (Of course, nearby Canada has also an excellent system that costs much less).
No rush with this request. Thanks in advance.
Frank Thomas The Netherlands
Anon said
If Medicare is so great for everyone, why do many doctors, physical therapists, and other providers not accept patients with Medicare or only allow a capped number of their patients to be Medicare?
Because the Bush administration was doing a stealth privatization of Medicare by introducing the Medicare Advantage program a completely privatized program replacing Medicare for those who chose it (even the name is suggestive) and then paying doctors who accept Advantage patients more for the same service than they were paying doctors who accepted traditional Medicare patients. All the government literature suggested that the Advantage plan was better than traditional Medicare. The Advantage plan offered some additional bennies for the same money as traditional Medicare making it seemingly more attractive. For example, it offered a yearly free physical which Medicare doesn't (but should). So by paying the private health insurance companies more per service so they could offer more bennies, govt colluded with private corporations to wean patients away from traditional Medicare and onto Advantage plans.
The Republican plan was, once everyone was weaned away, then the private corporations' rates could go through the roof and a Repub Congress could legislate that recipients could not go back to traditional Medicare. Medicare would then die.
Obama's plan is just the opposite: introduce a government health care plan for everyone alongside the private corporate plans but with more attractive bennies. So instead of a single payer health care plan, we would have a multi-payer health care plan. But then, eventually, the private plans would die as everyone chose the government plan which supposedly cost less and offered more features. Of course, the whole competition between public and private would depend on who controlled Congress and who was able to rig the multi-payer plans toward either the public or private sectors.
The Medicare Advantage plan is only one way the government (under Bush and the Republicans) has stealth privatized Medicare. In addition Medicare Part B (the part that pays for doctors) requires a monthly premium of around $100 while paying only 80% of doctor expenses. Compare this with Holland's plan which Frank Thomas has expostulated here which covers everybody for everything for $115. a month. But that's not all. There is still a deductible - $135 last year - which you have to pay before Medicare kicks in at 80%. A one day stay in a hospital for a broken arm can result in a bill for $25,000. You would pay $5000. out of pocket.
Now another way Bush and the Repuiblicans have sought to stealth privatize Medicare is "supplementary insurance." This is insurance only available from a private company to cover the other 20% of doctors' bills. So it's private insurance for Medicare Advantage plan and also for supplementary plans.
And you still have to pay for Medicare Part D, the drug plan which again is supplied by private insurance companies. And then there's the notorious "donut hole" designed by and for Republicans. According to Medicare and I quote:
Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." A coverage gap means that after you and your plan have spent a certain amount of money for covered drugs (no more than $2,700), you have to pay out-of-pocket all costs for your drugs while you are in the "gap." The most you have to pay out-of-pocket in the coverage gap is $4,350 . This amount doesn't include your plan's monthly premium that you must continue to pay even while you are in the coverage gap. Once you've reached your plan's out-of-pocket limit, you will have "catastrophic coverage." This means that you only pay a coinsurance amount (like 5% of the drug cost) or a copayment (like $2.40 or $6.00 for each prescription) for the rest of the calendar year.
So even though you are paying private companies for drug coverage, they can still get you via the donut hole and also copays.
Oh, copays apply to Medicare Part B also. So when you see a doctor, you are paying monthly premiums, a yearly deductible and copays as well as monthly premiums and copays for drugs. And don't forget the donut hole.
This system was designed by sick, twisted misanthropes. Did I mention it was designed by Republicans? In addition if you don't sign up for any of these plans wihtin a specified "window," you will pay penalties (or you may not be able to sign up at all!) and you can only change plans during a 45 day period from November 15 to December 31 in any given year. And the deductibles, copays and premiums keep rising on an annual basis.
Contrast this with the Canadian system where all you do is present your card to any doctor or hospital and you get taken care of without any monthly premiums or deductibles or copays for 100% coverage or with the Dutch system where you get taken care of for a $115 monthly premium. Oh, and they cover everybody not just those 65 and older.
The American Medicare system sucks, it's a piece of crap with no preventable coverage like an annual physical (not covered) but it is cheaper than the health insurance people under 65 are forced to buy which can truly bankrupt you just paying the monthly premiums with huge deductibles.
Obama's health plan will hopefully correct these unconscionable "features" of Medicare. As I mentioned previously, his plan would turn the Republican designed Medicare plan which represents stealth privatization on its head, and provide a multi-payer stealth publicization plan. That is, eventually, the private health plans would phase themselves out as more people switched to the government sponsored plan. But it all depends on who controls Congress and the Presidency. There will probably be a tug-of-war between Republicans and Democrats over this one. And of course, the lobbyists for the health insurance corporations will be on the side of the Republicans. The middle class will be on Obama's side, but do they have any money for lobbyists? Perhaps.
See my blog - Will Blog For Food - under the Health Care category for more on this subject.
Jack Lohman, John Lawrence,
Couldn't respond to your posts On US Health Care System vs the Dutch system because of work. Haven't proper time now also.
Just want to claify quickly some important points. All operations of any kind and drugs and hospital bed and other services are priced THE SAME througout Holland. A hip replacement operation costs the same in any hospital here ... although some hospitals may be specializing on hip operations.
Want to clarify that the Basic monthly health care premium cost is $115 per individual (excluding dental or $135 including dental), BUT there are Upgrades. Our daughter has one of the highest upgrades that includes psychiatric treatment, for example, and the total monthly cost for her and two children INCLUDING dental care is $275.00 per month.
Let me repeat. Throughout Holland, a drug, an operation, a bed at a hospital has the SAME price everywhere. Hospitals compete on quality of service and specialities. Same for Insurers.
Advise strongly you both see the video I mentioned of the Dutch system.
Would be interesting to compare the monthly premiums I´ve quoted for Holland to some general range of Basic and Upgrade monthly premiums for an individual and children in the US, including and excluding dental care.
We need to bring comparative Facts of Health Care costs in different countries to the attention of the American people, including thsoe for Canada. This might encourage us to look deeper into System differences and LEARN something constructively useful. Presume Obama´s Administration is doing this, but am not sure.
Frank Thomas said:
Would be interesting to compare the monthly premiums I´ve quoted for Holland to some general range of Basic and Upgrade monthly premiums for an individual and children in the US, including and excluding dental care.
Frank, the monthly premium for a family of four with a $5000. deductible would be about $5000 excluding dental. Even with Medicare for those 65 and older, you are paying here $100. a month premium plus copays every time you go to a doctor plus a one time $135. a year deductible excluding dental care and drugs. And then that only covers 80% of your doctor's bills! There's just no comparison even when comparing US Medicare to Dutch health care for the entire population.
And dental care is another huge rip-off and farce. You have to buy dental insurance separately, but then it doesn't cover anywhere near the price of most dental services. I go to Mexico and without dental insurance the cost is about one third what it is in the states with dental insurance.
Of course, during the last 28 years of Reaganomics, there has been a stealth privatization of the Medicare system.
Please see my series of blog posts on health care in the US here.
See what Donna Smith had to say about Medicare Advantage. Here's an excerpt:
Good thing Humana and all the other insurance giants got to call the plans "Medicare Advantage," because that's exactly what they do. The insurance plans take advantage of seniors and disabled people. And though President Obama's healthcare policy plans include asking the Humana gang to have to bid for the business in the future, many of the disabled and elderly are suffering and will die waiting for care they thought they had and they thought they paid for under Medicare.
Jack Lohman said:
From a Harvard doctor:
DR. DAVID HIMMELSTEIN: Well, what we’re hearing is that they’re going to do something like what we have here in Massachusetts, which keeps the private insurance companies right in the middle of the healthcare system, and it can’t work. Basically, you throw away so much money on profit in the bureaucratic waste of the insurance industry and the bureaucratic waste they inflict on doctors and patients in the hospitals that you can’t afford decent care for the American people if you do it that way. And we’re hearing that they’re not really ready to challenge the insurance industry head on. That’s the only way you can make the health system work.
http://tinyurl.com/d3ebwj
But Jack, Holland has a very swell system and it's based on private insurance. Watch the video that Frank recommends.
Go figure! Your response?
I don't like it, John. 50% of costs are picked up by employers, and it should be zero. That makes employers uncompetitive with foreign products and we lose jobs in the process. Also far too much complexity, which leads to higher wasteful spending.
Medicare-for-all is simple. You get sick, you get care, and the caregiver gets paid. Nothing could be more efficient. 100% of the people are covered. When Taiwan studied all systems in the world, they settled on the medicare model, not the Dutch.
Jack Lohman:
But why then can the Dutch offer such cost effective health care based on a private system? You haven't answered that.
And as I have pointed out, Medicare as it stands today is an abortion of a health care system and not the idealized single payer system that you seem to be romanticizing. It represents the stealth privatization of public health care.
I hope you don't want Medicare in its present form for everybody.
John, any private system needs CEO salaries and bonuses and shareholder profits. That automatically drains dollars from the providing of patient care. Medicare is not perfect, but after 40 years in the healthcare business, 15-20 as a provider to both Medicare and the privates insurers, I'll take Medicare any day.
But don't you worry, the insurance industry is paying big cash bribes to ensure that single-payer does not pass, and they have enough corrupt politicians on their side to ensure that they get their way. That's all the more reason the people should want it. If the private system was good, bribes would not be necessary. (Good congress we have, what say?)
Medicare is not perfect either. See Ten needed fixes for the health care system
Jack Lohman, John Lawrence:
I may have confused you both about how the new Dutch Health Care system is financed. It's not an easy system to explain.
In brief, the Dutch BASIC Health Plan statutorily required for all citizens is paid 45% by an Employee fixed insurance premium amounting to +-$135 monthly ($1,650annually) including dental care.
In addition, 50% of the funds come from a 6.5% payroll tax withheld on an Employee's monthly income ... up to a ceiling annual income of $37,500. This gives a maximum Employee contribution of $2,500.
Employers must compensate their Employees for half (50% of 6.5%) of this amount or $1,250. Latter is considered taxable income for Employees. So the Employee is paying a total of up to $2,900 annually for the basic package ... plus, in some cases, the cost of complementary and supplementary private health insurance from the same health insurers who provide the statutory required basic insurance. These upgrades can lead to added premiums of $100 - $175 monthly or $1,200 - $2,100 annually.
Dutch law forbids "co-payments" for services provided under the basic health care package unless the insured seeks treatment from an out-of-network provider.
A Risk Equalization scheme (paid by the income-related tax contributions) is used to prevent direct or indirect Risk Selection by insurers. This means the government compensates insurers for expensive customers based on a risk adjusted capitation formula that reflects age, sex, pharmaceutical consumption, and major diagnostic groups. Insurers may compete for applicants on basis of price and quality but are prohibited from distinguishing applicants or charging them a higher premium based on Risk. Each applicant pays the same insurance premium for same coverage under the BASIC plan, irregardless of the individual's personal health history. This scheme also facilitates fair competition among insurers.
Finally, there is a 5% government contribution in the form of an income-related subsidy or "Care Allowance" for low income groups. The government pays this allowance monthly directly to the insured after checking recipient's filed income status.
Physicians practice directly or indirectly under contracts negotiated with private health insurers. GPs receive a capitation payment for each patient on their practice list and a set fee per consultation. One needs a referral from the GP to receive non-urgent medical treatment from a hospital or other specialist health provider. Most specialists are hospital-based ... two-thirds of whom are self-employed, organized in partnerships, and paid on a capped-fee-for-service basis. The remainder are salaried. It's expected that future payments will more and more be related to activity known as Diagnosis Treatment Combinations (DTCs), somewhat the Dutch version of DRGs.
Most hospitals are private non-profit organizations. The remainder (e.g., Academic Hospitals) are government owned. The budgets of hospitals are developed using a formula that pays a fixed amount per bed, patient volume, and number of licensed specialists, in addition to other factors. Added government funds are provided for Capital Investment, although hospitals are increasingly encouraged to obtain capital via the private markets.
SUMMARY:
In 2007, public (meaning non-governmental) sources of finance accounted for approximately 78% of total health care expenditure in The Netherlands.
The main approach enforced by government oversight agencies, under the Health Insurance Act, is to improve Dutch health care efficiency by a system of Regulated Competition among insurers/providers combined with Central Steering on Performance and Transparency about outcomes with the use of performance indicators. As time goes on, most care costs are expected to be increasingly controlled and reimbursed by the new DTC system in which hospitals must also compete on price for specific services. The system already is encouraging some hospitals to become specialized in certain services ... hence improving quality, efficiency, and thus competition.
There's still lots of debate on some aspects of the system and some vulnerable points ... but the Dutch are austere and direct in taking very seriously their control responsibilities for the highest quality at a reasonable price for such critical societal services.
P.S. John: Is your comparative average MONTHLY U.S. health care cost for a family of four $5,000 or $500 ?? I'm stunned if former is true!
Frank,
I just checked with my daughter, and for their family of four, non-employer based health insurance was about $500.00 a month for a family of four with a $10,000. deductible. So they got no reimbursement until their medical expenses were over $10,000.
The interesting thing about the Dutch system is that it's based on private health insurtance i.e. multi-payer and not single payer like Medicare. The health insurance industry must be highly regulated to keep costs so reasonable - no multi-million CEO salaries.
Jack Lohman:
I've read your Ten Needed Fixes to the Health Care System and Medicare for All. I don't think you're critical enough of the Medicare system as it exists today.
Here are my Ten Fixes for Medicare:
1) Eliminate the Medicare Advantage program which is a stealth privatization of Medicare and makes Medicare NOT a single payer system.
2) Make Medicare Part B, the part that pays doctors, 100% payable instead of 80% eliminating the need for supplementary insurance which again is private insurance.
3) Eliminate the Medicare Part A deductible which is currently $1068. per illness. And it only covers 60 days; after that you pay through the nose.
4) Eliminate the Part B deductible which is currently $135. per year.
5) Eliminate or reduce and standardize co-pays.
6) Make preventive medicine like an annual physical exam payable by Medicare. Currently Medicare doesn't pay for an annual physical exam except for one time when you enter the program. This alone could bring the cost of Medicare down as it would detect illness at an earlier stage.
7) Require doctors to give pricing information and put it online at the Medicare website. This would allow patients to make decisions about their health care taking finances into account. It would discourage doctors from recommending unneeded procedures. Patients should have access to information about recommended procedures for their illness.
8) Include drugs without a separate private drug policy necessitating yet another insurance payment to a private insurer.
9) Include dental within Medicare. Dental insurance in the US is a farce which has just allowed dentists to jack up the price collecting both from insurers and from patients with the result that dentistry is more expensive than it was before most patients had dental insurance.
10) Include visual care within Medicare. Annual eye exams, optometry and ophthamalogy should be included as well as glasses and contacts.
If Medicare was brought up to the standards of the quality of care of other country's health care systems, then it would be something to brag about. In it's current form, it's not. It gives you meager, not all inclusive, coverage, and it costs you a lot more than other country's systems which cover 100% not 80% of doctors' costs, don't charge deductibles, and charge no or very small copays.
And, as the example of Holland shows, it's not the fact of a single payer system that's the panacea since they provide all inclusive care at a cost to the individual less than US Medicare while utilizing private insurance companies. However, they are highly regulated by their government and obviously have little to no lobbying influence.
John, Frank
You have an interesting discussion going on health care systems. There is well researched PBS Frontline episode called "Sick Around the World," from a few months back (?) that compares 6 or 7 different health care systems that work. All of them achieve a higher standard of health, greater longevity, at a fraction of the price Americans pay. In Japan (the most efficient system) health care costs were cut to the level that a hospital visit was $10 per night and an MRI just $12.
You can view it here.
John,
Let's now compare your daughter's family of four Basic Health Care insurance premium cost to our daughter's family of three cost, adjusted to four family members.
First, a couple of points. The very maximum range of deductibles (own risk) allowed in The Netherlands is €100 ($125) to €500 ($625). This compares to your daughter's family deductible possibility of $10,000!
Such an extremely high deductible would be considered an utterly obscene and quality care destructive policy in Holland --that can´t be explained by standard of living differences.
For one thing, it makes the system very expensive for those who cannot afford the $10,000 risk exposure and likely results in a substantially higher monthly premium if one were to choose for a $1,000 deductible in the U.S., for example. Maybe you know what the difference would be?
Prudence is further inherent in the Dutch system in the modest 20% lowering in the Basic Plan monthly premium from $135 per individual (including dental care and children up to 18) to $105 using the maximum deductible allowed of $625.
As mentioned earlier, The Basic Plan offered by most insurers has 1to 4 or 5 star Upgrades(complementary-supplementary insurance coverages). These range from a 10% increase in the Basic Plan monthly premium for a one star Upgrade to a 75% increase for a 4 star Upgrade ... bringing the standard $135 premium per individual plus children up to 18 to a monthly premium cost of $240.
I don´t know what your daughter´s family premium cost would be with a $1,000 deductible, for example ... but our daughter´s current four star monthly premium of $275 for a family of three is not based on any deductible being taken.
If I adjust our daughter´s $275 4-star Upgrade rate (her son has a mild form of ADAD requiring specialist docters and special medications) to a family of four the monthly premium would increase to about $475 with no deductibles or $380 with the maximum $625 deductible.
To complicate matters further for you, both of the above rates for our daughter, reflecting some serious upgrades, would reduce to $275 per family of four with no upgrades or deductibles. I will use this figure to compare to your daughter´s plan assuming they represent similar coverage(?).
In summary, the U.S. and Dutch Basic Plan systems appear to differ massively in monthly insurance premium costs for a family of four as follows:
A...Your daughter´s.....$500.00 with a $10,000 deductible or ??? with a $1,000 deductible.
B...Our daughter´s.......$275.00 with no deductible or $220.00 with a $625 deductible (and children free up to 18).
The above comparison omits the Employee 6.5% payroll tax withheld for health care system costs, 50% of which is reimbursed by the Employer. I don´t know what the comparable Federal taxes are per individual wage earner for Medicare in the U.S.
As also mentioned, the Basic Plan cost can be lowered up to 50% in form of a direct allowance from the government depending on an applicant's confirmed income.
Your last remark was that the Dutch system must be heavily regulated to be so cost efficient.
Well, as mentioned, hospital, doctor, drug billing costs are FIXED and agreed in negotiations among the three parties to the Health Care system: the service providers, the doctors, and the insurers with government agencies acting as the final Arbitor and Overseer to assure no monopoly practices, or unfair play take place to the detriment of universal quality basic health care at a reasonable price. The job of achieving these goals in The Netherlands may be easier as the number of qualified, prime insurers is relatively small in 5-6 range.
Thus, the system is based on Regulated Competition where parties are free up to a point to come up with their prices upon which final insurer premiums are set each for the Basic Plans and the 4-5 star Upgrades (i.e., complementary/supplementary insurance coverages).
As also mentioned, competitively developed reasonable premiums are stimulated by fact the Basic Plans provided by all insurers are based on the exact SAME definition of coverage items and services. Hence, competitive insurer premiums for the Basic Plan required for all citizens do not differ much.
This reflects a deep Dutch (and Canadian, for example) cultural value of social SOLIDARITY ... a value we Americans often conveniently bastardize with that attack word, `Socialism´ vs. the European meaning of basic and decent general-welfare thinking.
As I said before, if this Basic Health Plan is Socialism, then I applaud its prudent, cost and quality effective availability for all Dutch citizens. Is it perfect? NO. Will the Dutch constantly take care to correct its rough spots and inequities. YES!
Frank,
I will reply in more detail later, but here is a typical policy for my daughter's family:
Insurer: Blue Cross. Type of plan: PPO. Deductible $5000. Premium $397. Coinsurance 30%. Office visit $30. Drug deductible $500.
Coinsurance means that they still have to pay 30% in addition to copays after deductible is met.
You can get this information online.
I'll repond in more detail later.
Frank Thomas:
I have done the research and now we can compare the costs of the Dutch health care system with the US for a typical family of four.
First the US plans don't include dental so I will compare the Dutch plans without dental. I assume for a Dutch family of four it would be twice the individual rate of $115 with the two children being free. So it would be $230. for a Dutch family without upgrades with a deductible of $125.
I went to ehealthinsurance on the web and put in my daughter's family's info including one smoker. Here are some quotes:
Insurer: Blue Cross PPO
1) Deductible $1000. Coinsurance 30% Office Visit $30. Premium $513.
2) Deductible $2000. Coinsurance 30% Office Visit $40. Premium $680.
3) Deductible $3000. Coinsurance 0% Office Visit $40. Premium $524.
4) Deductible $2900. Coinsurance 40% Office Visit $40. Premium $255.
5) Deductible $8000. Coinsurance 0% Office Visit $0 after deductible. Premium $309.
6) Deductible $500. Coinsurance 25% Office Visit $30 after deductible. Premium $1557.
Now I assume that your daughter would pay 0% coinsurance and $0. for an office visit.
As far as payroll taxes, here they are 1.45% from each employee for Medicare (but that doesn't go to support my daughter's family's health care). They also pay a 6.2% payroll tax sor social security. The employer matches both of these.
You said:
If I adjust our daughter´s $275 4-star Upgrade rate (her son has a mild form of ADAD requiring specialist docters and special medications) to a family of four, the monthly premium would increase to about $475 with no deductibles or $380 with the maximum $625 deductible.
Your daughter would pay a $380. monthly premium with a $625 deductible with no charge for an office visit and no coinsuirance. My daughter would pay a $1557. monthly premium with a $500 deductible with 25% coinsurance and $30. for an office visit (with no upgrades!). So, after deductibles, my daughter would pay about four times the monthly premium for 70% of the coverage plus $30. every time a family member went to the doctor. Using simple math, my daughter would pay $2224 for 100% coverage plus the $30 for office visits.
I think your daughter is getting the better deal!
I will also put this information on Will Blog For Food.
Frank:
If I used the $230 figure for the monthly premium for a typical Dutch family of four, then my daughter would be paying almost seven times as much in monthly premiums plus 25% coinsurance and $30. per office visit. For comparable 100% coverage (no coinsurance) she would be paying about 10 times as much for the monthly premium plus the office visits.
One error in previous calculations: my daughter would pay $2076 not $2224 for comparable 100% coverage (I figured 30% instead of 25% coinsurance). So she would be paying about 9 times as much (not 10 times) as your daughter for 100% coverage.
John Lawrence;
I would not pay too much attention to the health insurance premiums quoted on the internet or in prepackaged literature. You don't get the real cost until you actually apply. That's when it gets interesting, particularly if you are an older American with perhaps controlled blood pressure and anything else, also controlled with cheap medication. Then you start to see the actual premiums, with $20,000.00 a year not uncommon and deductabiles running to $5,000.00.
Can't really blame the insurance companies, though. That "end of life" medical care can run into the hundreds of thousands of dollars.
I would rather see a universal healthcare system based on a sliding scale of cost compared to ability to pay. A median income family earning $50,000.00 should be able to pay 4% or 5% of their money for healthcare. Beyond that let the government take over.
That would discourage wasteful spending or over burdening medical facilities, but provide real life sustaining coverage for all.
John,
Just one immediate question: your premium quotes for a $1000 deductible (1) vs. a $500 deductible (6) show a monthly premium of $500 sharply increasing to $1557.
Is this correct?
The difference in government payroll taxes for health care is about $75/monthly bringimg my daughter's Basic premium with no deductible of $230 (excluding dental) to +-$305 or a substantial ONE-SIXTH of the cost of your daughter's monthly premium for 100%coverage.
Above assumes same basic coverages which we can easily confirm to be professional in our comparative analysis.
Even my daughter's 4-star package (which is a very lux special health service coverage) is ONE-FOURTH your daughter's monthly premium for a Basic coverage.
SIMPLY DISGUSTING and too unbelievable for words!
But must say I've known about this for years and have written much about it to no listening avail in the states.
Frank and John,
To improve your comparisons, I'd be interested in the following:
1. other funding sources besides premiums (general fund perhaps?) that may contribute to Netherlands healthcare
2. per capita income of Netherlands vs. USA
3. Age demographics and obesity rates of Netherlands vs. USA
4. average malpractice insurance premiums in each country
5. average wait time for major, non-emergency procedures
Just one immediate question: your premium quotes for a $1000 deductible (1) vs. a $500 deductible (6) show a monthly premium of $500 sharply increasing to $1557.
Yes, in order to reduce the deductible by $500. you would have to pay triple the premium. But there is a 5% reduction in coinsurance. It would probably be lower if they offered a policy with a 30% coinsurance in both cases.
Anonymous,
You asked some 5 general questions about the Netherlands' Health Care system.
I've written at least three long posts describing the system. So, I have not much time to go into more documented details now except to add some thoughts concerning your questions: (John may be able to fill in the gaps).
1....funding of system is about 45% by fixed premium contributions; 50%by Employees through a 6.5% payroll tax of which 50% is compensated by the Employer; 5% by a government Care Allowance for low-income applicants. That's it, pure and simple.
2....Per Capita Income in US and the Netherlands was about the same at $46,000 in 2007.
3....as of 2005, 13% of Dutch population was above 65; this is expected to grow to 23% by 2040; have no idea what comparable US statistics are.
Some time agoI posted facts about Dutch obesity. Sorry, but I don't have data before me. The Dutch measure overweight statistics according to an international formula. This shows that 46% of the Dutch population exceed a weight average of 175 lbs based on a certain average height. The American % overweight figure would certainly be substantially higher. In this regard, the Dutch Health Care program focuses heavily on Preventative Medicine through good all-around health practices.
4....I don't have any idea of mal-practice insurance law and premium differences between the two countries ... but can assure you the lawsuit culture is at a very low level here for everything. Holland is by far not a lawyers' lawsuit paradise in that
respect.
My brother-in-law was surgeon in urology in Holland for a time and since has been in practice in Florida for many years. His US mal-practice premium exceeds $140,000 a year. He informed me that this would be less than $10,000-15,000 in Holland today.
5....have no idea of average wait times but have heard no big complaints about this; should there be problems the Dutch insured can go to Belgium, for example, or any other country nearby. This is a stimulus for efficiency.
Summary:
Equally if not much more important than above facts is fact that Administrative costs for US Health Care system are about $7200, or +30% of total costs, for each of the current 45 million uninsured Americans (ignoring the +30 million underinsured). These figures compare to less than a 9% Administrative cost as a % of total costs in Holland.
The Urban Institure estimates that the cost of insuring the 45 million unsured would be +-$75 billion versus a conservative Savings of +-$300 billion if the system were streamlined into a "single-payer" one similar to the highly administrative cost-efficient single-payer-setup by province in Canada, e.g., where insurers send virtually all bills to a single payer using a simple billing form.
Similarly in Holland, tight regulation of basic health care insurance markets, with requirements for open enrollment and community rating lead to relatively low overhead costs. Administration and profit margins are reported to account for less than 6% of profit margins.
In 2008, the US spent about 17% of its GDP on health care or +-$7100 per capita. In contrast, Holland spent about 9% of its GDP on health care in 2008, or +-$2900 per capita.
Further, data show that health care expenditures are growing over three times as fast as GDP growth in the US ... compared to a rate slightly less than GDP growth in Holland (and only slightly greater than GDP growth in Canada).
The US complex and fragmented payment structures built around thousands of different insurance plans -- each with its own regulations on coverage, elgibility, and documentation is --intrinsically far, far more costly than a single-payer system.
The Dutch new largely private Health Care system is based on "Managed Competition" among care providers, insurers, and applicants ... including a "risk-equalization scheme" that helps reduce incentives for insurers to seek healthier applicants and prevents the imposition of more expensive premiums on less healthy applicants.
The system combats high costs of private health care insurance through, as mentioned, a well thought out program of "Regulated or Managed Competition" (developed to great extent by Alain Enthoven, a Stanford Professor). Insurers may compete on basis of price and quality, but, under the principle of Solidarity, are not allowed to separate applicants based on risk.
Ultimate result: our daughter's family of 3 pays a monthly premium of $275 for 100% coverage for a family of three including dental care, no deductibles, and no charges for children up to 18 years. This premium level is for a 4 star Upgrade coverage (vs. Basic Plan premium cost for everyone including dental care of +- $135) due to specialists' çare and special medicine needed for our young grandson.
Pretty impressive universal Health Care approach based on a combination of private and public inputs!
See video of program by going to Google under title: "New Dutch Health Care System."
Thank you so very much for your work.
also to "John" who also gave the US estimate numbers
I would hope? That the few here would spread the numbers, Maybe Dr. Reich will notice and He can speak on TV and radio, to this wide difference of premium and coverage too.
Hello, Dr. Reich
It seems we in the US pay between 2-4 times what others pay, This not factoring in the dental care, co-pays, and a few other dollar costing pocket book busting problems.
Like 100% of people are covered!
It certainly was long, but the Anon's point of Greed is a factor to be considered.
One word to Frank though,
While the US has been behind on the health care, we certainly have led the way in selling a lot of stuff ( ????) to other parts of the world.
May I mention Fortis Bank, and ???????, Ouch!
So maybe the Europeans will actually be paying for the american's health care in a round about way?
What a sick thought!
Pun intended.
The health Care cost and the issue of just everyone getting care, is a rather large part of our economy's.
Again Thank All
who have been part of this discussion here, I'm sure more facts can arise. More questions to ask?
Thank you Frank. Your insight into the Dutch healthcare system is much appreciated. From reading your posts, it seems that the Dutch system is a very good compromise with what we currently have.
Unfortunately, misinformation and fear by the right and lack of getting out the message by those truly informed keeps us from moving forward. I hope that Obama will do the right thing when it comes to fixing our system, but so far he has disappointed me. His adminstration, from my perspective, is unwilling to communicate effectively with the American public and his stimulus and budget have failed to impress me (more like depress). So many are confused by what is going on with the economy and the governments' response, I shudder to think what will be lost in translation as he tries to do something for our healthcare system.
KCThinker,
Thank you.
My wife and I are completely satisfied with the coverage items of Holland's new Basic Care Plan. It costs us a reasonable $275 monthly including dental care and excluding a deductible. We don't need the upgrades as for years we've been blessed with excellent health ... knowing that the known unknowns of medical illness are not guaranteed for the elderly! Should we sometime decide to take a 2 or 3 star upgrade, the added cost is not overwhelming as I've shown in an earlier post.
It's the Dutch proving again their resourcefulness in prudently and humanistically managing their social-net systems ... with a sensible synthesis of public and private initiatives operating freely but under some fair and tight rules on how the game is played.
John Lawrence also summed it well to me recently: ``The Dutch health care reforms point out it´s not whether the health care system is Public or Private, but the way it´s set up that determines whether it works to provide high quality care at a reasonable cost.´´
We can do the same if we ever master the ``MY IDEA or DISASTER´´ cultural fixations that have been parallelizing constructive compromise and creativity on so many core issues affecting the general welfare of all Americans.
An obvious example is our insatiable appetite for debt to consume, consume, consume ... a habit unmoored in any common sense or discipline and also abetted by cheap money and irresponsible banks lending practices. Your gut knows that when the cost of credit, NOT the price of the home or one´s income determines affordability, it´s time to launch the lifeboats!
The Dutch can squeeze comfort out of a penny and they avoid dependence on debt like the plague ... conservative virtues we have left behind 25 years ago.
For many decades, Holland has had a very successful economy enjoying steady, although moderate, GDP growth per capita with respectable unemployment rates. Little wonder the country´s National Debt per capita is HALF ours, even adjusting for our exorbitant Defense expenditures in our role as the world´s sole protector.
I´m going to give Obama´s team a lot of rope given the co-terminous
and multiple dysfunctional social-economic maladies he has to deal with. I´ve been writing in some specificity since November 2007 about the systemic deficiences in our out-of-balance Social-Economic model ... concerning the excessive dependence on Consumption, declining Savings, rampant Debt in all directions, and deplorable lack of internal societal Investment.
So, I´m quite sensitive to what lies underneath the surface of things ... but am trying to find time for exploring solutions more deeply for debate with the awesome likes of Art, John, Linda, Fox, yourself, and others.
As Linda stated, it´s is not about ego, but workable Solutions ... practical instinct and innovation, with nominal time spent on dooms-day scenarios. I share the down-to-earth pragmatic optimism of Warren Buffet who just remarked, ``Five years from now, I can guarantee that the US economic machine will be running fine.´´
And I would add only if we invest wisely and fundamentally change those inherent deficiencies in our system ... like our ungodly expensive, complex, and inhuman health care system where cost savings in the $250 billion range can be realized and deployed for future debt reduction.
Like you, at times I´m clearly not my usual optimistic self ... doubting that certain fundamental system improvements will be made that confront soberly and effectively new world realities.
But, after a few drinks, I still seem able to find some room for hope and real change as welcomed bedfellows.
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