A ‘Third Way’ On Health Care That Works From the Netherlands
Critics of national health care models warn of British or Canadian situations, and they are correct to be suspicious of truly socialized medicine. Government commissions should not decide upon patients’ treatments. On the other hand, should insurance companies have the right to cut off treatments and end the coverage of high-risk patients, and operate as any other industry in a free society?
Health care may be the number one issue at the moment in America. Those who are left-of-center favor a “single payer” model, in which the federal government creates a new and frighteningly strong power as the keeper of the nation’s health. Those right-of-center want to keep the present system, which demands from the (lower) middle classes excessive chunks of their income.
Is there a third way? Is it possible for a mature and self-conscious society to organize national health care without unnecessarily limiting the freedoms of both the healthy and the sick?
Yes, it exists. The third way is the Dutch way — a functioning and greatly performing model that is regarded at the moment as the best answer to the question of universal health care.
The Netherlands has a population of only 16 million, but it nevertheless has the 16th biggest economy in the world. It is a perfectly organized and diverse society with well-educated citizens who, in the last decade, have been introducing the pressure of competition and the marketplace to their welfare state. They have renovated and redesigned their once “socialized” health care system.
And it works.
In the Dutch health care system, the essential module is the so-called Base Care Insurance (BCI), set by the government (and approved by parliament) and completely executed by private health insurance companies. This BCI — obligatory for every citizen — is financed by taxes and a personal monthly payment to the insurance company of choice (most of them offer extra items in their base package to attract business) of about 90 euros and a yearly deduction of 150 euros. Children under 18 are free.
The BCI covers everything a 21st century patient needs — including limitless visits to his own local GP of choice (who also can visit the patient at home), visits to specialists, surgery, transplants, medication, hospitalization, ambulance costs, ER costs, and the whole extended range of modern health care a wealthy society should be able to offer to its demanding citizens. And there are more options on top of this base level. As an individual citizen you are free to extend the vast care that already exists within the BCI with exotic therapies (like acupuncture), individual rooms in hospitals, a choice of menus, and IVF/ICSI treatments. A complete “luxury package” with dozens of perks for a family of four is being offered by insurance companies for under 400 euros per month, including the base fee.
This health care model costs about 9 percent of the GNP of the Netherlands — more than 6 percent cheaper than the American model. Life expectancy is 79.4 years; in the U.S. it is 78.11. Not only do the Dutch on average live longer, but the quality of life of their elderly easily beats that of Americans because of the easy access to excellent health care.
Um, possibly because they’re a small f***ing country, dumb ass (16 million verses 300 million, duh). And they have positive population growth because of mass immigration (Eurabia anyone?). And just like every other government compulsory scheme they will need government cash to make it work.
Didn’t work in Tennessee. Didn’t work in Massachusetts. Didn’t work in Oregon. Oh, but we’re supposed to believe it will work now because some stupid Dutch f**ks say this new program works in the Netherlands. Yeah, let’s see where you are in five years.
FAIL.
Thomas Paine
“some stupid Dutch f**ks”
You let your country down and live up to the stereotype. “Stupid yank”.
Holland is an amazing country. America is trash. Utterly.
No thanks. I’m not rich and I love my private health care coverage. I believe in personal responsibility. If I can pay for my own health coverage then so can everyone else in this country. These government run “private businesses” are a farce. There’s no way they’d be anywhere near as innovative as American companies in improving health care not just for Americans but for people of the entire world. What’s the last great medical advancement to come out of the Netherlands? America churns out medical break throughs like they were cars on an assembly line. Besides, most of this “health care reform” is just a guise to give free universal health care to illegal aliens and inner city crackheads off the backs of hard working Americans who earned the right to enjoy the fruits of their own labor thank you very much. I don’t want to give away 60%+ of my income in taxes like the Dutch in order to provide incentives for even more illegal aliens to invade and squat in our country. I can barely earn a living and pay the bills after local, state and national taxes as it is. How about we focus on fixing our military veterans health care instead?
Sorry, Leon(s), while I won’t write in the harsh manner of other people who disagree with you, the fact of the matter is the Dutch healthcare system is a ponzi scheme. As you admitted, it depends on there being young workers. All developed countries are aging and the rampant immigration of the Dutch are leading to serious problems down the road for your society…where basic freedoms could be jeapordized, let alone healthcare. And since you bring up the point of a youthful population, it should be pointed out that the Dutch have been emigrating OUT, more than people have been coming in your country since 2003. So, regardless of how wonderful the healthcare is, other life factors are motivating people to leave. Clearly, it takes more than a good healthcare system to make life attractive in any given place.
To some degree, it’s disingenuous to write an article aimed at Americans telling them how they should support universal healthcare because the Dutch model seems so great in your opinion. Clearly, the Dutch model is not being looked at in any of the plans being considered by Congress.
So, in other words, we SHOULD oppose U.S. universal healthcare, right? Because we won’t be getting the Dutch model by any stretch of the imagination. If your answer to this question is YES, then I can at least give you the credit of sincerely not wanting to increase needless human suffering on a societal scale. If your answer to that question is NO, then your whole article was dishonest in the first place and you both really are idealogues corrupted by your “good” intentions.
In terms of providing basic coverage for everyone with reasonable waiting periods for various special tests, the Israeli system works well. There are four competing private companies operating networks of clinics who provide care. You pay a monthly fee to the government based on income with a cap but then you can purchase the premium service for a not large additional sum, and most people take that. That’s where these companies make their money. You can switch between companies, you can go to a private doctor, and there are other still insurers who will cover that. The government operates I think most of the hospitals. No one is going broke here and the only controversies you hear about are which medicines are on the list of subsidized prescriptions.
The catch is that the Israeli doctors earn much less than American doctors on average. And Israel does not have the problem that Canada has of having to provide service to a vast geographical area where it sometimes difficult to attract GPs into some remote places. I’m not an expert on this but since Israel brought in this system about 15 years ago, health care ceased to be a major political issue.
According to this article, the proposed USA Healthcare Plan is very similar.
Besides, this type of legislation is not cast in stone. If something doesn’t work, legislators can fix it if they are too lax to get it right the first time.
Is American culture driven by “get it right the first time”?
No.
Americans get things done in a rush and then spend a lifetime fixing things (remember software upgrades, new & improved, warranties, the day after Xmas gift exchanges, new car models every year, elections recounts?).
Also, as the writers state, the great danger to such a system is the “graying” of the population, which is exactly what is happening in Europe and the English-speaking world due to falling birthrates.
A similar malady struck the Western Roman Empire in the 3rd through 5th Centuries A.D., and the reason was the same; a bloated bureaucracy that demanded ever-higher taxes to support it. Higher taxes= less money= people have fewer children because they can’t afford same. The result was smaller populations in successive generations; the government, seeing its tax revenues shrinking (because there were fewer taxpayers) raised taxes instead of cutting expenses. (Then as now, most government posts, elected or otherwise, were sinecures for life; some were even hereditary.) The final “negative patient-case outcome” was a societal collapse by the year 480.
The fact that the writers don’t want to talk about is that the Netherlands’ solution to this basically economic problem is to encourage euthanasia for the old, ostensibly to allow “death with dignity” for the sick, but mainly just to get them off the books. In short, they’re practicing the basic philosophy of the society described in William F. Nolan and George Clayton Johnson’s 1967 SF novel, “Logan’s Run”; once you get “too old”, the government would prefer you “go gently into that good night”, as Frost would say.
Otherwise, their financial house of cards comes tumbling down.
(I am somehow irresistibly reminded of The One’s remark about, “Give your mother a pain pill”.)
It would be interesting to see how eagerly our elected Representatives and Senators would sign on to such a “system”. My estimate is, their delicately-tuned sense of self-preservation would tell them to “Just Say No”. (Especially the “wise heads” who have been around a while; under this system, Sen. Edward Kennedy probably wouldn’t be around now.)
Anyone who wants the U.S. to copy the Netherlands brand of “government-mandated” health care needs to consider an iceberg, in all its aspects, as E.E. “Doc” Smith would say.
What’s below the surface is more significant than what’s visible on top.
clear ether
eon
A system less than three years doesn’t demonstrate much. However, some of the ideas are better than what Obama is pushing.
America’s system has some problems and we need some solutions. At least the Dutch system gives some options. Personally, I believe we need to start with tort reform. The high cost of health-care has a lot to do with lawsuits. Just good luck getting all the lawyers in Congress to do something productive in that area.
Exactly how much does this cost the Dutch taxpayer? 90 Euros per month for a family of four is far below the cost of basic Blue Cross/Blue Shield coverage anywhere in the U.S.
Having lived in Holland for many years, married into a Dutch family I can tell you the system does not work as well as advertised. The authors nelglect to mention the costs, which are many, including co-pays. The problems that arise from “House Doctors” who have to rubber stamp visits to specialists or the hospital in some cases can be fatal, as it was with my father in law. The quality of Dutch care is not bad, yet, but as in all things in Holland, when entitlements come calling the money has to come from somewhere. Hollands method may work for them now, they are small, and their people accept the high taxes they pay. Though the under the table economy in Holland grows with every increase, and increasing the Dutch are paying for immigrants who do not carry thier share of the burden.
This is how it works in Switzerland and has been working well there for years. The basic insurance is major medical and you can purchase a variety of boutique plans for a higher price. There are quite a few insurance companies to choose from. Oh yes, taxes are low in Switzerland, lower than here.
Thomas Paine, all of the states you mentioned have a population much smaller than the Netherlands, smaller than Switzerland even. Size is not the issue. Every state in the Union has mandatory auto insurance and that has been working well. Sorry, your counter argument is an epic fail.
I suggest the authors take off their rose coloured glasses and actually do a little research. For example, over 60% of the cost is bourne by government (not the private payments), which really means it’s paid for by those in the Netherlands who bother to work (especially those that bother to work full time, an increasing rarity). That’s done by charging a minimum of 33.5% income tax (on those earning under ~25K US) rising to 52% on those earning over ~75k US. Plus a 19% VAT (i.e. sales tax), and corporate rates in the 20-25% range. Plus a host of others…
Meanwhile, about 2% of deaths are euthenasia (i.e. when someone else decides it’s time for you to die) and growing; and the gov’t is ventuting into mandating the cheapest generic drugs for treatment (after originally allowing doctor/patient free choice). (Aside from the health issue, ask yourself who is going to be inventing new drugs – most of which now come only from the States – if drug companies no longer have a reason to do research).
You can’t escape the tragedy of the commons, and you can’t escape the fact that under socialism, you soon run out of other people’s money.
Some comments have pointed out (more or less politely) that the Dutch system relies on young people supporting retired people. That is true, but it is also true of Medicare as well as the UK and Canadian systems: somebody has to pay, and unless people buy insurance for their retirement years during their working years, that means that the current workers have to pay.
A more serious criticism is that the authors do not compare this compulsory insurance scheme to the Massachusetts scheme. In principle, it seems to me that compulsory insurance is as free-market as health care can be: it is the current US system that is a 3rd way, a bad compromise between free market and socialism (the socialism comes from Medicare, Medicaid, and tax breaks for employer health care). But Massachusetts seems to show that compulsory insurance does not always work.
U.S. HEALTHCARE: CUT YOUR LIFE SHORT
Obama promised HOPE and CHANGE. The media never asked what frightening changes Obama planned for Americans.
WORLDNETDAILY.COM
July 22, 2009
Obamacare for old folks: Just ‘cut your life short’
Health plan provision demands ‘end-of-life’ counseling
By Bob Unruh
The version of President Obama’s universal health care plan pending in the U.S. House would require “end-of-life” counseling for senior citizens, and the former lieutenant governor for the state of New York is warning people to “protect their parents” from the measure.
At issue is section 1233 of the legislative proposal that deals with a government requirement for an “Advance Care Planning Consultation.”
Betsy McCaughey, the former New York state officer, told former president candidate Fred Thompson during an interview on his radio program the “consultation” is no more or less than an attempt to convince seniors to die.
“One of the most shocking things is page 425, where the Congress would make it mandatory absolutely that every five years people in Medicare have a required counseling session,” she said. “They will tell [them] how to end their life sooner.”
McCaughey also said the Obama administration is suggesting that medical care be withheld from seniors based on the expected years they have left to live.
http://www.wnd.com/index.php?fa=PAGE.printable&pageId=104719
Obama’s Civilian National Security Force
Obama promised change. The End of America as we know it:
Obama: “We cannot continue to rely on our military in order to achieve the national security objectives we’ve set. We’ve got to have a civilian national security force that’s just as powerful, just as strong, just as well-funded.”
http://www.youtube.com/watch?v=gwaAVJITx1Y
PRAVDA: America’s Descent into Marxism – Brief Video
http://www.solutionsfromscience.com/
It’s SOS. It’s a mandatory tax on all people. It’s a loss of freedom. The progressive-leftists are desperate to find some country they can point to and say that is a socialistic system that works. All they have found so far are socialistic system that don’t work. And how are we going to know whether the Dutch system works or not,not because two unknown writers recommend an unknown system. The progressive-left hasn’t found a socialist health care systen yet it didn’t like or one that worked,which doesn’t exist,like their leftist utopia. Lots of people in high places have been recommending the British or Canadian model,but we’ve learned that the facts about them are scary. The lib-left wants any system but a private system. This article is probably part of a new push. Look out for a lot of propaganda about some pig in a poke socialist system that works.
Thanks 10 & 11 for info. So I wonder how the people making under 25k in America will like the 33% tax. As it is now most in that bracket hardly pay any income tax. Of course everyone pays taxes. Income tax is only part of the taxes we pay. At that tax rate, many present insurance plans are looking affordable.
Another suggestion. Medical expenses need to be up front. There need to be more consumer options. When you go into the hospital/doctor’s office … it is as if you are signing a blank check. If you have insurance, the insurance will get the bill down very substantially. If you are paying cash, good luck. You are on your own and maybe they might give you a 10% discount.
Please take a look at the Israeli healthcare system. Everyone has health insurance and pays for it, with subsidies for the poor. Yes, the gov’t funds it but its excellent care.
Half of the uninsured problem could be solved by addressing the illegal imigration in our country. The administration and the medial quote 46 million uninsured Americans. The fact is 22 to 24 million uninsured are here illegally draining our healthcare system. I believe the numbers were 7 to 9 million of those who prefer not to have healthcare coverage. Is the number of uninsured getting more managageable? Remember healthcare insurance provided by most companies was major medical not the coverage we currently have to run to the doctors for a runny nose. That coverage didn’t start until the 80′s. And before anyone says that I am against imigration, I’m not. I am for legal immigration into this country. It’s still the greatest country in the world. My thoughts on immigration go along the lines of Teddy Roosevelt:
“In the first place, we should insist that if the immigrant who comes here in good faith becomes an American and assimilates himself to us, he shall be treated on an exact equality with everyone else, for it is an outrage to discriminate against any such man because of creed, or birthplace, or origin. But this is predicated upon the person’s becoming in every facet an American, and nothing but an American…There can be no divided allegiance here. Any man who says he is an American, but something else also, isn’t an American at all. We have room for but one flag, the American flag… We have room for but one language here, and that is the English language… and we have room for but one sole loyalty and that is a loyalty to the American people.”
Theodore Roosevelt 1907
Remember anything the government runs has been ineffeciently run, elaborately over cost, and generally corrupt at some level. Do we really need government mandated healthcare.
Let’s see,
1. Dutch population 16 million not even equal to US ILLEGAL population
2. Perfectly organized … wow
3. Well educated … wowow
4. Diverse population …. wowowow
5. BCI includes everything for everyone, for almost nothing (gee, that sounds vaguely familiar)
6. Introducing competition in the last decade, and yet BCI is only 3 years old
7. It is a “Dutch Treat!”
I tell you what, why don’t you come back in a generation or so and we can discuss the results of your great system. Good luck with that residency promotion program. I’m not sure the Muslims will want it when they take over though.
The problem is NOT insurance unless you mean malpractice insurance. Want to reduce medical costs? Disbar 50% of the ambulance chasing lawyers, institute caps on payouts and loser pays laws, write laws ending contingency percentages forcing lawyers to charge on the basis of hours spent not on ‘jackpot’ (or ‘crackpot’) awards.
Costs would be lowered across the board. We don’t need socialized medicine where there is no choice and no recourse – we need tort reform. The ‘insurance’ argument is a bunny trail.
Wow, other than the encroachment of Sharia Law, the Netherlands sounds like a paradise. I for one did not know “[i]t is a perfectly organized and diverse society . . . .” One question, do the dehimmi pay more for their health insrance in Holland? It would only be fair.
Thomas Paine,
The tone of your reply was embarassing. I have read quite a few pieces by Leon de Winter over the years. He is a thoughtful man. Obviously, there are big differences between our countries, just as there are big differences between individual states with regard to population density and availability of doctors. The authors are correct in saying we should look at many systems. I would be interested in hearing how the Dutch deal with malpractice. This does not mean that we have to adopt another system in toto, but the broader our information is, the better our chances of getting rid of some of our biggest health care problems.
Cool. Hey, what do the Dutch do about all the Mexicans who come into Holland illegally?
A combination of public and private plans is what many on the left have been advocating for decades.
It’s what works. It what the other 27 industrialized countries use to deliver the same level of care as the U.S. for half the cost.
And no the U.K. and Canada do not use this model.
Mandatory tax, forced subsidy from young to old, government subsidies to private industry – what could go wrong?
Enjoy it Netherlands, for now.
What, exactly, is the argument against the following steps:
1) de-link health insurance from employment
2) open up the market for individually purchased health insurance
3) make insurance insurance, like home or car insurance–for use in emergencies, with routine costs paid out of pocket
4) loosen up licensing of medical professionals, so you don’t need to go to doctors for every simple procedure
5) accelerate the diffusion of the extremely expensive new health technologies and procedures so that they can be brought into practitioners offices and people’s homes
6) cap punitive damages in malpractice lawsuits and lawsuits against pharmaceutical companies
7) charity takes care of the indigent; with perhaps government subsidies for purchasing insurance for those least insurable
What am I missing?
23. jharp:
A combination of public and private plans is what many on the left have been advocating for decades.
A combination of public and private plans is what the USA already has; and a pretty poor combination, at that.
The credibility of this article is undermined by ignoring problems that are already evident in the Netherlands health care, like euthanasia.
Tort reform and immigration enforcement are needed to reduce costs that show up as health care costs. That is not happening in the US until Obama is removed from office and congress is replaced.
prospero (25)
“6) cap punitive damages in malpractice lawsuits and lawsuits against pharmaceutical companies”
This should be the very first step, as it would ripple through everything quite rapidly and would enable the other steps to be carried out more rapidly.
Good points, all.
Regards.
Damn complex issue…
The countries that have programs different from the failures in Canada and the UK must be studied carefully and thoroughly to know what aspects of these nations’ plans work and which do not. There must be a way to make the aspects that work in countries like Holland and Israel work in the US. Is it just the size of these nations that make their plans work? Are all industrialized countries plans failures when there aren’t enough young people and too many older people? Must industrialized nations sell their souls by encouraging or mandating euthanasia? When does a country reach the point of “too much government control” in health-care? These systems in Holland and Isreal that we’re looking at must be examined by the US and considered as test-cases on a small scale (when compared to the size and population of the US). At least those nations and their governments are trying something different from the failed single-payer systems. Science, whether it is biology or sociology, advances from the hypothesis/experimentation model. I DO NOT in any way mean to denegrate other countries, but their plans and policies must be examined and studied by the US in the same way as scientists use the laboratory experiments of their peers to advance understanding of a science.
“Those right-of-center want to keep the present system, which demands from the (lower) middle classes excessive chunks of their income.”.
FALSE, FALSE, FALSE. Right of center would prefer a changed system where you could buy insurance across state lines, reformed medical liability so doctors could order tests without fear, more health savings accounts and plans.
If the authors can not get this BASIC fact correct, then how can anyone trust the accuracy of what they write about the Dutch system. They lost all credibility with me.
“It is a perfectly organized and diverse society with well-educated citizens ..”. Holland is PERFECTLY ORGANIZED??? There is absolutely no room for improvement in how Holland is structured? Wow, what a statement!!!
*** The Dutch have recently instituted a mandatory private health insurance program that appears to be working well. ***
Destruction of freedom is never working well.
Forcing people to buy something they may neither want nor need is never working well.
Universal coverage is easy to accomplish when all you do is make it illegal to not obtain insurance. But such tyrannical thuggery isn’t “working well.”
What if I would rather spend that 90 euros on rent? What if I would rather spend it on utilities, like heat and water? What if I would rather spend it on food?
You know, what if I would rather spend that money on those things that are absolutely necessary to live, to survive? TOO DAMN BAD! Government says you are going to cough up that money for whatever the government says you will. If government says that a perfectly healthy young person paying for health insurance takes priority over everything else in like, then you will do it and be happy about it.
How about this? Instead of destroying feedom, we get the government the hell out of the healthcare system, including the healthcare finance system?? How about, in this so-called “land of the free” (HA!), we try freedom as the answer?
This much is certain, we don’t need to be taking lessons from some country that has a healthcare system that include euthanasia and assisted “suicide.” Yeah, that’s the Dutch way. Some improvement.
JAH666,
I think Israel’s plan could work here but we’ll have to change some things. Here are my thoughts.
1. Build more med schools. Israel has more doctor’s per person than we do. more doctors = more competition = savings.
2. Insurance is compulsory. No pre-existing conditions, no refusal of coverage. Limit the program to 4 or 5 different companies/plans. Patients can chose the coverage their family needs and can only change during their state’s yearly enrollment period. Costs are close with some adjustment for cost of living in each state. All plans will cover well child, prenatal and basic care. Some will provide more care.
3. The federal government funds research and provides basic funding to each plan.
4. The state governments pay in part or completely those who cannot afford their payments.
5. Payment is automatically withdrawn from each paycheck from your primary employer. Either adult can provide coverage for the entire family. Those who are unemployed or self-employed can enroll online or through the local unemployment office. All employees who currently have health insurance will have the employer costs added to their pay when the transition is made.
6. Billing to plans should be simplified.
7. Since the federal government already funds almost half of all pharmaceutical research costs, the government will set the rate for prescriptions. All prescriptions will be made in the United States. There will be no importing.
Of course, the idea is that by simplifying administration we will save money. If that is the case, why aren’t we getting rid of the IRS and going to a straight flat income tax rate with no deductions? That would save a fortune.
23. jharp:
A combination of public and private plans is what many on the left have been advocating for decades.
A combination of public and private plans is what the USA already has; and a pretty poor combination, at that.
_________________________________________________
You are correct. Yet our seniors on the public plan get along fine, and the poor also get along fine. Both on the public plan.
It’s time to reform the plan for the rest of us. And that is exactly what Obama is doing.
prospero:
What, exactly, is the argument against the following steps:
1) de-link health insurance from employment
Agreed
2) open up the market for individually purchased health insurance
Does nothing to address costs. And insurers will still only insure healthy people. That’s just good business.
3) make insurance insurance, like home or car insurance–for use in emergencies, with routine costs paid out of pocket
Fair enough. But offer the catastrophic insurance to everyone equally and take the profit out. (make it a public plan)
4) loosen up licensing of medical professionals, so you don’t need to go to doctors for every simple procedure
OK with me.
5) accelerate the diffusion of the extremely expensive new health technologies and procedures so that they can be brought into practitioners offices and people’s homes
No comment
6) cap punitive damages in malpractice lawsuits and lawsuits against pharmaceutical companies
Malpractice insurance is 1% of our health care costs. It doesn’t amount to a hill of beans.
7) charity takes care of the indigent; with perhaps government subsidies for purchasing insurance for those least insurable
First part is ridiculous. Second part is OK with me.
“6) cap punitive damages in malpractice lawsuits and lawsuits against pharmaceutical companies
Malpractice insurance is 1% of our health care costs. It doesn’t amount to a hill of beans.”
I’ve heard this statistic before, and it seems to me to be meaningless. How do you account for the cost of the ways in which doctors and hospitals need to protect themselves against possible lawsuits. The point, in other words, is the incentives and disincentives put in place, not the measurable cost.
We have universal health care we don’t have universal insurance. Why do some people think that health care should be free from some segment of society. Food is essential, do we believe that food should be free for anyone under the age of 18? Why do we think we have to right to say that a service provider should be deprived of a profit? It’s the profit motive that encourages people to provide a service. What we need is a direct connection between the consumer and the service provider without the insurance middleman. The consumer needs help, the doctor can provide it – the insurance company only makes money if it pays less for services than it collects – the difference the profit is what the consumer pays to reduce personal risk. If you prefer to absorb the entire risk you can – you save money by not paying for insurance but you run the risk of a large payout to the doctor in an emergency. What’s the real problem- rising costs- that’s only a problem if it is unrelated to demand, quality and enhanced care. Uninsured – that’s only a problem if I want insurance and can’t get it. The government has exacerbated the problem of the uninsured by mandating that all pre-existing conditions must be covered. You could require everyone to buy insurance – like auto insurance – but that only overrides a personal choice. The conversation needs to focus on the specific problems that need to be addressed without interfering with the freedom of the consumer to make a choice and the medical professional to make a living.
#25 Prospero — VERY good! Why aren’t you running for office? And why haven’t any of the nimrods in Congress proposed any one of your very sensible and smart solutions? The health care “debate” in this country by our elected officials in pathetic. Truly pathetic.
Via Instapundit and Fortune, five reasons to hate the proposed sick care insurance plan:
http://money.cnn.com/2009/07/24/news/economy/health_care_reform_obama.fortune/index.htm
Oh, not talking windmills and dikes but the U.S. Congress plan.
Jharp, welcome back you sniveling Obama troll! You failed to address some of the things Ive requested of you in the past. So I’ll go ahead an ask again! Tell me, please, exactly why we should trust the plan of a man that got his political start on his knees in front of a slum lord? Little Barry and Big Daddy Tony! Woot! He got LOTS of money from his sugar daddy and got lots of money for his sugar daddy. Now were supposed to entrust our health to a man with such an…issue? Please, please, tell us!
Thank you Frank, but none of these ideas are original–just piecing together the commonsensical, market-based ideas one sees floating around the conservative blogosphere, and that have zero chance of consideration by elected officials without some very dramatic changes. They’re useful as a measure of how far we are from thinking in commonsensical, market-oriented terms, if for nothing else.
Ideology ( and not science, knowledge, and love) is driving this debate (at least in Congress) and from ideology stem all evils, problems, and troubles.
Set up a commission with NO POLITICIANS: only great managers from serious corporations, doctors, scientists, pastors and rabbis. And give them a deadline of six months and a lot of interns as ‘producers” to study in detail the existing systems.
That will do it.
And that is exactly what NO POLITICIAN will ever do.
They don’t serve us, they command us.
It shouldn’t be like this in our Free Republic.
Thank you for the opportunity to comment.
Yes Israel has a good system, if you’re visiting you have to have proof of medical insurance, which you can buy. How many illegals do they have sucking the system dry?
Pospero,
You are on the right path. Capping pain and suffering and other damages is key as is decoupleing and moving to individual tax credits for carrying insurance. The market place will maintain excellence and keep costs in check. Insurance should be there for the catastrophic events in life. I don’t mind copays if I get choice, access, and excellent care when I need it. Contrary to conventional wisdom, I want my Dr. to be wealthy because he is excellent. I want profit in the system, because that will attract the best. I believe Texas has capped damages for pain and suffering and Drs. are flocking to the Lone Star State.
“Perfectly organized”. According to whom? Does this mean that all 75-year-olds are sent to the gas chambers in neat rows? Only a totalitarian state can be “perfectly organized”. With freedom automatically comes disorganization. But govt healthcare is not about healthcare at all. It’s about govt control of every aspect of your life. Look at the people promoting it. Nasty control freaks without exception. Their distaste for the vast majority is palpable. Riff raff is what they think of us. Useless bread gobblers. I have never seen a more evil bunch of politicians than I’m seeing right now in the halls of DC.
Two important things to consider. probable ramifications of Obamacare:
1.)Expensive specialists like oncologists will go either to a cash only system (some in fact have already done this) or depart to places like mexico city or dubai.
2.)Foreign born doctors from places like india and china? They might seriously pack it up and go back to their home countries.
The bottom line? A shortage of physicians.
Right on,
It is absolutely intolerable that the United States government provides free health care to citizens of other countries.
Only life threatening care should be provide and then directly billed to the country of origin (mostly Mexico). If they refuse to pay these bills, we will not accept their goods. Period.
Of course, neither party will go for that. Their masters need the cheap labor.
“Malpractice insurance is 1% of our health care costs. It doesn’t amount to a hill of beans.”
Rubbish. 1% does not take into consideration the billions spent on defensive diagnostics on the off chance the providor will be sued.
The Democrat bill includes a pass through right of the tort lawyers to sue practioners in the public plan.
The crux of our problem is that insurance companies are constrained about how many insured they have. Allow these companies to operate nationaly. The larger the pool the less damage catastrophic care hurts the plan. Allow companies to either pay a certain amount to the person’s private insurance company or allow the worker to take the company plan.
Require all the insurance companies to list their “menu” of services provided at each cost point for comparison.
One regulation I would require is disallowing insurance companies from dropping policy holders that have expensive illness. That should be a cost of doing business.
Tort reform is a must. I don’t care what the percent is, it’s crazy to have malpractice insurance premiums in the 6 figures per year. We need less jackpot money for lawyers and more scrutiny of doctors with checkered records.
We are already having a shortage of GPs because the government pays a fraction of the billed cost. The cost of running an office, paying malpractice insurance, paying off astronomical student loans, working long hours, getting shortchanged on payments just isn’t worth it to more and more general practitioners.
jharp, what is it about charity that is ridiculous?
What nobody mentions is that the Dutch can spend more money on health care because they don’t have a military. The USA is subsidizing all those health-care systems with our military protection.
Being dutch, live in US since ’98.
Both sides of the healthcare debate are wrong. Opponents use the worst example to scare people away from Obama’s idea’s. Obama believes in a Utopia, created by him, that changes the USA in a wonderland, where everybody is happy and he will be honoured through the ages as the Great Savior of America and the World.
Reality is hitting him now right between the eyes. Somebody has to pay for it and the people have to like it. I hope he wakes up and comes out of his dream, because it will create a nighmare for the people living in the reality.
I hope his plans fail,because the current USA population cannot carry the load of his plans and it might destroy better chances in the future.
For what it is now, the healthcare we have still offers care for everybody. States even offer healthcare for every child.
Wait till the crisis is over and try again. Look for what is usable from the dutch system.
Haelthcare lesson for Obama:
If you do to many surgeries on a patient at once, chance is great he will die.
Lowest incomes in Netherlands pay 35% tax, highest 52%. But they can claim a lot of government support dependent on your need or income.
Problem are the parasites.
Ponzi effect is going to hit the dutch in the future when the working class cannot support the retired generation anymore. That will probably hit every western country.
We need solution for the future, not something that’s going to help for awhile.
Here’s what your missing, prospero:
What, exactly, is the argument against the following steps:
1) de-link health insurance from employment
Again, as with taxes, great idea to punish the productive members of society
2) open up the market for individually purchased health insurance
The whole point of the gov’t plan (so they tell us) is to reduce cost. So they’ll cap the payouts to providers. So what will the providers do? stick it to the private insurers. How exactly will that “open up” the markets?
3) make insurance insurance, like home or car insurance–for use in emergencies, with routine costs paid out of pocket
Fabulous idea! “Gee, you better get that looked at.”
“Naw, it’s just a sore. I don’t want to pay out the nose just to tell me its nothing.”
…6 Months Later…
“Damn, it was skin cancer.”
4) loosen up licensing of medical professionals, so you don’t need to go to doctors for every simple procedure
Again, another fantastic idea! See #3 above.
5) accelerate the diffusion of the extremely expensive new health technologies and procedures so that they can be brought into practitioners offices and people’s homes
How does one ‘acclerate the diffusion’ of expensive technologies? This is like saying “Let’s give everyone free healthcare!” It feels good to say it, but have a concrete idea about how to do it, please.
6) cap punitive damages in malpractice lawsuits and lawsuits against pharmaceutical companies
So pharmaceutical companies can easily factor in expected lawsuit awards to the price they charge. So if they can make more money than the cap on a dangerous drug, its worth it. Doesn’t this conflict with idea #5?
7) charity takes care of the indigent; with perhaps government subsidies for purchasing insurance for those least insurable
See medicare/medicaid
> Every state in the Union has mandatory auto insurance and that has been working well.
False argument.
Auto insurance is mandatory because I intend to perform an explicit action where others may be harmed ~ drive a car. The mandatory part of auto insurance is to protect the public, not me.
To be a valid comparison, your analogy would have to answer the question of how would mandatory health insurance protect the public but not me?
One of the Netherlands most famous writers was Hans Christian Andersen. His modern-day Dutch compratriots — actually, all Westerners — would do well to revisit his works.
One story in particular would provide some much needed wisdom and insight. It’s called “The Emperor’s New Clothes”. And even though it’s a only children’s tale, it’s a profoundly insightful warning to those who, either out of narcissism (Western elites) or complacency (the PC-infested Western masses), march along to fairy tales spun by dishonest swindlers (today’s political Left).
Saying “what a great health-care system the Dutch have!” is to ignore the forest for the trees: IOW, to ignore the fact that in another 50 years, there won’t be any Dutch health-care system. Why? Because there won’t be any Dutch! In fact, there won’t be any Netherlands…there will be Netherlandistan.
FACT: of the 20 countries on Earth with the fastest declining native populations, 19 are European.
FACT: not one native European population is replacing itself…not one.
But guess who is having children in Europe? Muslims.
Which European country has the healthiest fertility rate? France. And which European country has the most Muslims? France. Which European country is in second place? Denmark. And which European country has the second largest proportion of Muslims? Denmark.
Here’s the order of healthiest fertility rates for European countries (2005 official Eurostat figures):
1) France
2) Netherlands
3) Belgium
4) Switzerland
5) Austria
6) Germany
7) Italy
8) Spain
And here’s the order with the highest proportion of Muslims:
1) France
2) Netherlands
3) Belgium
4) Switzerland
5) Austria
6) Germany
7) Italy
8) Spain
Any questions?
Typical Leftist response: “But that doesn’t mean anything. You’re just a mean racist!”
FACT: wherever there is a majority-Muslim country bordering a non-Muslim majority country, there is some level of armed conflict.
FACT: wherever there is Muslim population of similiar size to a non-Muslim population living within the same borders, there is some level of armed conflict.
FACT: wherever there is a majority-Muslim population with a significantly smaller non-Muslim population living within the same borders, the non-Muslim population are legally relegated to second-class citizenship.
Here’s what the European’s are facing:
And here’s the type of “leaders” the Europeans have:
Open your eyes, people…and take a good, long look at the naked Emperor. And guess what? Obama, Pelosi, and Reid all have the same tailor.
I seem to have chased poor jharp away. It seems that there is actually a perfect formula for troll repellent. See my post (#41) to get the ingredients…
Sounds far better than the Canadian Medical Plans, forget Obamacare. It’s the mandatory angle that chaps my ass. 10th Amendment says I opt out at my pleasure.
Please CALL the Blue Dog Democrats and tell them you oppose the Health Care HR 3200 Bill. Small business in America will be doomed if it passes.
Jason Altmire Dem Labor BlueDog PA Washington DC (202) 225-2565
Michael Arcuri Dem BlueDog NY Washington DC (202) 225-3665
John Barrow Dem Energy BlueDog GA Washington DC (202) 225-2823
Marion Berry Dem BlueDog AR Washington DC (202) 225-4076
Sanford Bishop Dem BlueDog GA Washington DC (202) 225-3631
Dan Boren Dem BlueDog OK Washington DC (202) 225-2701
Allen Boyd Dem BlueDog FL Washington DC (202) 225-5235
Kevin Brady GOP Ways TX Washington DC (202) 225-4901
Bobby Bright Dem BlueDog AL Washington DC (202) 225-2901
Dennis Cardoza Dem BlueDog CA Washington DC (202) 225-6131
Christopher P. Carney Dem BlueDog PA Washington DC (202) 225-3731
Ben Chandler Dem BlueDog KY Washington DC (202) 225-4706
Travis Childers Dem BlueDog MS Washington DC (202) 225-4306
Jim Cooper Dem BlueDog TN Washington DC (202) 226-1035
Henry Cuellar Dem BlueDog TX Washington DC (202) 225-1640
Lincoln Davis Dem BlueDog TN Washington DC (202) 225-6931
Joe Donnelly Dem BlueDog IN Washington DC (202) 225-3915
Brad Ellsworth Dem BlueDog IN Washington DC (202) 225-4636
Gabrielle Giffords Dem BlueDog AZ Washington DC (202) 225-2542
Bart Gordon Dem Energy BlueDog TN Washington DC (202) 225-4231
Parker Griffith Dem BlueDog AL Washington DC (202) 225-4801
Jane Harman Dem Energy BlueDog CA Washington DC (202) 225-8220
Stephanie Herseth Sandlin Dem BlueDog SD Washington DC (202) 225-2801
Baron Hill Dem Energy BlueDog IN Washington DC (202) 226-6866
Tim Holden Dem BlueDog PA Washington DC (202) 225-5546
Frank M. Kratovil, Jr. Dem BlueDog MD Washington DC (202) 225-5311
Jim Marshall Dem BlueDog GA Washington DC (202) 225-6531
Charlie Melancon Dem Energy BlueDog LA Washington DC (202) 225-4031
Mike Michaud Dem BlueDog ME Washington DC (202) 225-6306
Dennis Moore Dem BlueDog KS Washington DC (202) 225-2865
Patrick J. Murphy Dem BlueDog PA Washington DC (202) 225-4276
Glenn Nye Dem BlueDog VA Washington DC (202) 225-4215
Collin Peterson Dem BlueDog MN Washington DC (202) 225-2165
Mike Ross Dem Energy BlueDog AR Washington DC (202) 225-3772
John Salazar Dem BlueDog CO Washington DC (202) 225-4761
Loretta Sanchez Dem BlueDog CA Washington DC (202) 225-2965
Adam Schiff Dem BlueDog CA Washington DC (202) 225-4176
David Scott Dem BlueDog GA Washington DC (202) 225-2939
Zack Space Dem Energy BlueDog OH Washington DC (202) 225-6265
John Tanner Dem Ways BlueDog TN Washington DC (202) 225-4714
Gene Taylor Dem BlueDog MS Washington DC (202) 225-5772
Mike Thompson Dem Ways BlueDog CA Washington DC (202) 225-3311
Charlie Wilson Dem BlueDog OH Washington DC (202) 225-5705
More socialized medicine misinformation:
Item 1:
“Yet our seniors on the public plan get along fine, and the poor also get along fine. Both on the public plan.” Nevermind that these “public plans” are being very much subsidized by those paying for insurance and out of pocket. Also, lets not forget that the way they have “controlled” admin costs is by just paying billions in fraudulent claims. There is a reason why more and more practitioners are not taking medicare patients. Putting everyone on this kind of plan is not sustainable. (Ain’t it fun to use the lefts weapons against them!)
Item 2:
“A combination of public and private plans….” This combination will turn shortly into only public plans. To make this fantasy work, the insurance companies will have to be allowed to print their own money and absorb whatever amount of the rest of the economy they see fit – just like the current out of control public sector.
Item 3:
“Malpractice insurance is 1% of our health care costs. It doesn’t amount to a hill of beans.” Somewhere between misleading and completely false. In many specialties like OBGYN and Orthopoedic surgery, the rates for insurance are astronomical and it causes many out of the fields where good doctors are needed most. It also causes doctors to practice defensive medicine which adds up to 9% to the cost of medical care. That the left will not budge on this shows that they are completely in the pocket of trial lawyers.
Item 4:
Taking the profit motive out of healthcare is the solution…
That means a virtual end to innovation and possibly will preclude many lifesaving cures. Its a path to failure shown again and again, yet leftists think we just need to try again – but this time with your health and your life.
Until people are required to have some skin in the game for paying for their day to day healthcare (I am not talking about the disabled or those those unable to work) we are not going to control costs. Catastrophic care insurance should be required and pooling of purchasing power between businesses, in Coop’s, and across state lines should be allowed and promoted.
Replacing corporate pinheads rationing your care with government pinheads rationing your care will be a disaster because there will be no alternative to the government pinhead. Competition for premium dollars works and should be the way we go.
Government does have a role it can play in basic common sense regulation, but putting them in charge of the whole shooting match which is where this is headed (Obamacare AKA socialized medicine) will mean less health care and lower quality of life for the vast majority of Americans.
I don’t know about that 1% stat (no link given by the writer), but here’s some sobering information regarding litigation and tort:
http://www.heartland.org/policybot/results/18270/Litigation_Raising_Health_Care_Costs_Study_Says.html
The rules of malpractice liability produce unnecessarily high costs, simply because the standard they are trying to meet is too close to perfection. Anything that is “ironclad” can only be heavier, simple as that! Reasonable rules would be less onerous, and just as useful. This is just an example of improvement possible by loosening government controls instead of tightening them.
The same applies to local restrictions that forces one to purchase health insurance from the same states he lives in. If this arbitrary constraint is removed, the overall premiums will come down, simply as the result of increased competition.
Same thing with employer provided health insurance. That old practice complicates everything, unnecessarily. Government can help by setting simple and transparent rules of the game. There is no need to complicate eberything by getting the government involved in the financing heath care.
If there was such a thing as common sense, by definition it would not depend on whether your are dutch or american. The europeans are desperately hoping to backtrack on the mindless excesses of their “perfect” public systems. Let’s not commit the same errors so we don’t need to switch into reverse later on. So much can be done in the way of cutting cost without the governement particicpating in the financial equation of it all.
Reducing cost is the simplest and most effective way to increase availability. There is no such thing as perfect health and perfect redress of the shortcomings and vulnerabilities of one’s health. So many mistakes are committed in the name of creating perfection where no such thing is possible. More public entanglement is an obstacle to improvement, by no means a guarantor of it.
“1) de-link health insurance from employment
Again, as with taxes, great idea to punish the productive members of society”
I don’t understand this–how does having everyone purchase their own insurance punish the productive members of society? For that matter, those who don’t want to purchase don’t have to.
“2) open up the market for individually purchased health insurance
The whole point of the gov’t plan (so they tell us) is to reduce cost. So they’ll cap the payouts to providers. So what will the providers do? stick it to the private insurers. How exactly will that “open up” the markets?”
I don’t understand this either. How does the government plan come into it? Allowing anyone to buy insurance from anywhere–across state, or, for that matter, national, lines, will open up markets.
“3) make insurance insurance, like home or car insurance–for use in emergencies, with routine costs paid out of pocket
Fabulous idea! “Gee, you better get that looked at.”
“Naw, it’s just a sore. I don’t want to pay out the nose just to tell me its nothing.”
…6 Months Later…
“Damn, it was skin cancer.””
Here, you’re just saying that people will be irresponsible, so let’s make their decisions for them. Even so, I don’t understand your point–I’m guessing most people would want cancer covered by their insurance.
“4) loosen up licensing of medical professionals, so you don’t need to go to doctors for every simple procedure
Again, another fantastic idea! See #3 above.”
OK, I’m getting tired of this–others can join in if they want. Health care can be arranged in all kinds of ways, with different hierarchies of expertise dealing with different kinds of problems. My suggestion here is just a basic assumption of a free society–that people can choose to go where they want for health care.
Just one more:
“5) accelerate the diffusion of the extremely expensive new health technologies and procedures so that they can be brought into practitioners offices and people’s homes
How does one ‘acclerate the diffusion’ of expensive technologies? This is like saying “Let’s give everyone free healthcare!” It feels good to say it, but have a concrete idea about how to do it, please.”
Here, you have a point–this is vague, and not really within the purview of a government’s responsibility. But I have read that a large part of the reason for escalating health care costs is the technological revolution that has taken place in medicine over the past generation. The first generation of a new technology is always highly centralized and expensive; as the technology is improved, it becomes more decentralized and cheaper. I don’t know if we can do anything to accelerate this, but I would guess that a freer market would help here as well. Or maybe we should just factor in the likelihood that it will happen.
Otherwise, I don’t see why it’s bad that pharmaceuticals can better anticipate future costs; or why medicare shouldn’t be means tested.
56. Notan Idjit: “To be a valid comparison, your analogy would have to answer the question of how would mandatory health insurance protect the public but not me?”
I am sympathetic to your argument. I hate the idea of government mandating something that should be a personal choice. But if we are going to mandate that we care for people that are injured or extremely ill, then we there has to be a way to pay for it. I may be a 25 year old triathlete (I’m not) and think I don’t need health insurance, but if I get hit by a car or have a aneurysm, my bill is going to be a whopper. I don’t think there is going to be a lot of sympathy for saying “too bad, you did not get an insurance policy. Out you go.” Just not going to happen.
I see protecting the health care facilities from inevitable ruin as protecting the public.
myth buster:
jharp, what is it about charity that is ridiculous?
It’s not that charities are ridiculous. It’s that expecting charities to fill in the gaps is a pipe dream.
They’ve been doing it for 50 years and though their efforts have been valiant. They don’t even come close to plugging all the holes.
There is no reason to believe that somehow this would magically change.
JHARP Returns! Please Jharp, tell me, tell me, tell me why we should trust the guy (Barry) who got his start servicing the slumlord? Heck, Larry Craig didn’t seem to be requiring an exchange of money for the exchange of services in the bathroom at the airport, but BHO sure did with Big Daddy Tony….what’s your answer?
The Netherlands is a perfectly organized and diverse society? Right. Try telling that to Theo Van Gogh, Geert Wilders and Ayaan Hirsi Ali. (And what, pray tell, constitutes “perfectly organized?” Sounds a little ominous to me.)
The Dutch health care system is a functioning and greatly performing model that is regarded at the moment as the best answer to the question of universal health care and the quality of life of their elderly easily beats that of Americans because of the easy access to excellent health care.. Right. Try telling that to your senior citizens who find it advisable to display medic alerts instructing “Do Not Euthanize.”
Look, most any health care delivery system has at least some good points which may, in some part, be adaptable to the US system. But no one system is transferable to the US in toto. We are a unique nation with a unique population and occupy a unique position in this world (and our society, far from being “perfectly organized,” can be messy, chaotic and haphazard–and that’s the way we like it). As it stands now, people flock here from all over the world (even the Netherlands) to avail themselves of our health care. We supply most of the medical/drug innovation to the world. Why is everyone so intent in killing the goose that lays most of health care’s golden eggs? What if instead of expending all this time, energy and effort on these ridiculous proposals that ultimately will go nowhere, we concentrate on formulating real, market-based reform?
And finally, I laughed out loud when I got to this part: The Dutch model was introduced in 2006… So, it’s been up and running for, at maximum, a whole two and a half years and you’re so comfortable drawing categorical conclusions that you want to sell it wholesale to us? Well, you’ll have to forgive us if we’re not buying just yet.
22. Kenny / Hanford: Cool. Hey, what do the Dutch do about all the Mexicans who come into Holland illegally?
LOL–good one.
“Malpractice insurance is 1% of our health care costs. It doesn’t amount to a hill of beans.”
Oh, crap. It’s not the cost of the policy that is the problem, it’s the risk avoidance policies that are in place to avoid being the one that loses the lotto and pays millions over not giving a test that might have been beneficial. Insurance companies reduce your premium if you follow a long, long, list of practices that help ensure that you are taking the minimum of risk(risk to the doctor and the insurance company) when treating a patient. If you follow those recommended practices, then you get a reduced premium. Now, the doctors pay the premium, but that pass on to the patient and the patient’s insurance the costs of avoiding the risk. So, you have about 12% of the cost of treatment going to avoiding the risk to the doctor and keeping that premium the doctor pays down to 1%.
The fact that such simple and obvious examples of waste are not addressed by the current crop of idiots screaming for reform and are irrationally explained away by those who support the idiots proves that reform is not the issue that they’re addressing. Control of the economy is the issue, and that’s what the real problem with medicine is already. The government controls the medical process far too much. That the democrats don’t care about solving the problem is proven by the democrat FP candidate who bilked millions out of insurance companies over treatment issues that are proven to have no impact whatsoever on the condition that fine VP wannabe sued over. That’s why good lawyers in the democrat party squirm and make up straw man arguments whenever the subject of suits comes up. They’re a party of vultures that from start to finish produce nothing and simply force it out of others by illegal, unconstitutional, or at a minimum, unethical means.
Have yet another lying to yourself day
“We kindly advise President Obama and the U.S. Congress to adopt the Dutch model.”
Or the German model, a highly efficient public-private hybrid system.
billslayer:
JHARP Returns! Please Jharp, tell me, tell me, tell me why we should trust the guy (Barry) who got his start servicing the slumlord? Heck, Larry Craig didn’t seem to be requiring an exchange of money for the exchange of services in the bathroom at the airport, but BHO sure did with Big Daddy Tony….what’s your answer?
My answer is we shouldn’t trust one man. That’s kind of the idea behind the United States Congress and the Supreme Court But you took 7th grade civics class, didn’t you? Or were you absent that day?
Philosophically I have a problem with the legal profession(of which most of Congress and the Administration are) trying to fix the medical profession. I have a great deal of respect for the latter and much less for the former. Most physicians and nurses that I have encountered earn their money; I can only say that about a small percentage of the lawyers that I have worked with.
Vishu, the mandatory car insurance is paid for by the individual so comparing it to something that is, at least in part, paid for by government funds is erroneous.
The truth is that given the delays and rationing of health care that takes place in countries with social medicine they tend to receive the same level of care as those in our own country that are uninsured. So we all fail to see the benefit of laying that bad egg in the laps of every American.Aside from that, American’s do not want to be like everyone else in the world. I thought we made that quite clear in the 18th century.
To the rest of you that have brought an excellent discussion, TORT reform is a huge factor but also let’s look at medicare and medicaid. If the government would cease underpaying for services received under these programs, average costs would also go down. We would also have a real number to work with when determining how these programs should be funded, not to mention the clear need for better regulation.
How many Mexicans and gangbangers with gun shot wounds and crack addicts do they have showing up in the emergency rooms in the Netherlands? Something tells me a program that works in a small country of educated white people won’t work here.
The Australian system has a few features that the USA might consider…..
1. Personal injury insurance (all parties) in a motor vehicle accident is covered by the mandatory insurance which is part of the vehicle registration. Ambulance chasing is eliminated totally. Medical bills (and some loss of wages) are not a concern.
2. The government selects a set of prescription drugs based on medical practice and medical evaluations of cost versus benefits. It then negotiates with the manufacturers to purchase the entire country’s usage. And they get pretty good prices. Individuals then pay about a standard AU$33 (US$26) per script. Those on pensions – age or welfare – pay about AU$4. Unless of course the real cost is less than that. The big pharma companies do not like that. But they must participate if they want to sell the generally available drugs. And yes you can get non listed drugs – just pay the full cost.
Two items which when removed from the USA general health insurance coverage would drastically reduce premiums.
But even here – the insurance coverage encourages some people to continue to make poor health choices – particularly in the areas of diet, excessive alcohol consumption and smoking.
Fred
“So what will the providers do? stick it to the private insurers.”
As a provider, allow me to say in response, “I wish.”
There is no “sticking it” to anyone BUT the provider in the current system. The insurance company offers a contract, typically a multiple of Medicare rates for a given year. This may be as high as 1.7x Medicare where I live, or less than 1x Medicare in some places like California and Florida. You do the work, you bill, and maybe you get paid within 60 days, assuming you file electronically with a clean claim and the insurance company deigns to pay.
In my first practice location, the payer mix was 70% Medicare/Medicaid/No-Pay. Our radiology practice regularly collected about 35% of our billed charges. In my current practice, we regularly collect 42-43% of charges (rule of thumb is 3x Medicare for determining a practice’s fees), a distinct improvement.
The throttle on the healthcare cost engine comes down to Medicare, and what they refer to as RUC (Reasonable, Usual and Customary) charges. If Medicare lowers RUC then all our private insurance plans, which are ultimately multiples of Medicare charges, will decrease by similar percentages.
It is the Kabuki theater of the process that bothers me, that the charges are X and we’re relatively happy with 0.4X. My radiology practice could institute a flat $38 cash fee for every procedure (professional services) from plain film to MRI to angiogram, send one of us to make a deposit each night and net out the same amount of money each month, once we don’t have to pay for billing. It would be more honest and up-front.
The creaking edifice that is the US healthcare insurance system was never designed, it grew like that old Winchester house in California. It too has metaphorical corridors that lead nowhere and stairs into the ceiling. The only thing that would be worse would be something on the Canadian model, and while the Dutch model sounds great, it’s only been in effect for less than five years. Heck even Obamacare could probably hold together that long, in fact it would be political suicide to make a less-generous system at the start. Once Humana and Aetna and United and the Blues are starved into bankruptcy, then the cuts will begin.
But by then, someone else will have to make the hard decisions and President Teleprompter McMomJeans will have retired to Chicago, where he can write a third memoir if Bill Ayers isn’t too busy.
The health care bill as it is now hamstrings private insurance companies breaking their ability to complete. Now why would that be part of the bill? The amendment to the bill that would disallow federal buracrats from dictating what treatments doctors would be allowed to do was eliminated. Why would they do that?
The Congress, President and all federal employees are exempt from this bill. Why would that be part of the bill? I must believe that our aristocrats belive that this bill is great for the peasants but not nearly good enough for themselves.
“But by then, someone else will have to make the hard decisions and President Teleprompter McMomJeans will have retired to Chicago, where he can write a third memoir if Bill Ayers isn’t too busy.”
Darren, you owe me one keyboard.
May be the funniest comment post all year.
I note that generally, those in favor of the public system and nationalization are oriented towards access. The overwhelming majority of Americans have coverage, a signifigant minority of those not covered have chosen to forgoe coverage even though they could get it. Then there are the illeagals who don’t deserve coverage at our expense. That leaves a small minority of the population who are uncovered, want coverage and can’t afford or acquire it.
Those in favor of a national solution are willing to compromise the current high quality of US health care for the rest of us to cover these people. There are alternative ways to expand coverage without socializing health care, but the liberals in Congress who are in charge instinctively reach for the socialized solution rather than look to more innovative alternatives to cover those who want and need but can’t afford. The Dutch model is but one of the paths to coverage.
The failure to study alternatives, to hide the ball and pass something before we know and understand offers comentary on the low caliber intellect and character of the majority party. Pelosi and company could create something they could be proud of and attract bipartisan support. Instead they strongarm and shut off dialogue. They reveal themselves to be small and petty. The President has rushed in and joined them which shows he ain’t capable of change he claimed to offer. Some of us were not fooled.
There was an editorial in the NEJM a few years ago laying out a similar model as the dutch.
http://www.robert-h-frank.com/PDFs/Emanuel-Fuchs.NEJM.3-24-05.pdf
Basically the idea would be to give everyone a voucher to buy a very basic plan and then allow people to buy additional coverage. This usually happens with medicare right now in that most people buy a secondary plan to help pick up the 20% Medicare doesn’t cover (no, Medicare only covers 80%, period). If you got rid of Medicare, Medicaid, Indian Health Services, VA, SCHIPs, WIC (did I miss any?) and gave every CITIZEN $2500 per year voucher, It would only cost $750 billion. OK, not chump change, but that is close to what we are paying now. Personally, I would prefer a tax break and be allowed to choose my own coverage. I guarantee if the government got out of health care entirely, it would be less expensive overall and the average joe would become a savvy consumer real fast.
Sorry, but, I don’t speak freaky deaky Dutch.
1.) Abolish class warfare, eliminate the unconstitutional graduated income tax.
2.) Establish the fair-tax, or a national sales tax.
3.) Tort reform
4.) Close down government healthcare bureaucracies that double the administration costs of hospitals.
5.) Inforce immigration laws already on the books.
6.) Sit back and watch our economy recover.
(Step 7. Optional*) Accuse your nearest hard working neighbor of racial prejedice, and then invite them over to the house to sit down for a beer like nothing ever happened and they should just be grateful to be in your presence.
Les,
Well thought out.
I believe what we need is affordable service, not insurance. We should be able to buy various plans to suit individual needs. I only get medical care when I get injured, infected, etc. I don’t want to go bankrupt by spending three days in a hospital bed. And I don’t want to pay for other people’s abortions, sex changes, face lifts, aroma therapy, etc. An honest discussion is needed to sort out reform. That won’t happen with an administration and Congress full of cheats, crooks, liars and Marxists. Reform government. Then sort out our health care service.
In a free market system, how do you folks propose covering people rejected by insurance companies because their illnesses are too expensive?
Linda Rivera:
You should at lesat try to check your facts before you distribute lies. There are these alternative explanations of your action: 1. You are too lazy to check the fact. 2. You don’t care if it the information is true as long as it fits your bias.
“The provision at issue would require Medicare, for the first time, to cover advanced care consultations for seniors once every five years, or more frequently if the patient has a life threatening disease. These consultations include “an explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.”
Seniors are in no way required to take advantage of this benefit. Indeed, the chief proponent of the notion that the consultations are required, reform opponent Betsy McCaughey, is reduced to arguing that, though they’re not technically mandated, seniors might feel pressured by doctors or nurses who suggest having such sessions.
Nor is there any reasonable basis for believing that these consultations, if chosen, would do anything to promote euthanasia — which is illegal in 48 states anyway. Discussions between sick or elderly people and their doctors about end-of-life treatment have long been an accepted part of modern patient care. As Politico itself notes, in 2003, a Bush administration agency “issued a 20-page report outlining a five-part process for physicians to discuss end-of-life care with their patients.” And since 1990, Congress has required health-care agencies to inform patients about state laws regarding advance directives such as a living wills.”
billslayer – the only thing you prove is that you are a dope
Abu-
What you point out is the ethical problem that people worry about. The libertarian side of me says: free market, free market, free market! But, most people would be appalled if an individual was denied emergent care just because they couldn’t pay for it. I have not experienced it first hand, but I have met people where this happens when they are visiting other countries, specifically in Mexico and Canada. One story in particular was an individual vacationing in Mexico who was bitten on the leg probably by a barricuda. He went to the local ER, bleeding fairly briskly but nobody saw him until the credit card cleared. I don’t think we want that kind of approach here. I suspect most people would prefer a “treat first, figure out coverage once stable second.” The debate is where does that stop. I have my opinions where it should be but that may be at a different point for another person.
And that leads to the big issue here. This is an extremely complex issue covering multiple different areas and affecting nearly everybody. The federal government is having trouble running the multiple health coverages as it is, let alone expand it. However, it should not be rushed through only along party lines. If so, as soon as the out of power party regains it they will change it again. If Obama tried to change to a Dutch system, I think there would probably be a significant bipartisan approval and thus more likely to be supported and continued no matter who is in charge. It would not be what I would choose, but political practicality is that it will have to be some sort of compromise.
Dave,
Sorry about that.
Les,
Field-expedient hemorrhage-stopper is Krazy Glue and a lot of pressure. Burns like a mofo but it does seal stuff up, assuming the ‘cuda didn’t get a major artery.
This is not medical advice, your mileage may vary, consult your personal physician before…etc.
good article…sounds reasonable
??????
The Dutch have been at the forefront of killing inconvenient old people and toddlers. If the Dutch healthcare system is so great, than I have to assume that the Dutch medical profession carries out these killings for the sheer sadistic pleasure of it. In America we call such “Angels of Death” serial killers and lock them up.
“Besides, this type of legislation is not cast in stone. If something doesn’t work, legislators can fix it if they are too lax to get it right the first time.”
Oh give me a break.
Like they fixed Social Security?
Like they fixed Medicaid?
Like they fixed Medicare?
Like they fixed S-CHIP?
Like they fixed welfare?
The exact problem with the Obama “I support pie-in-the-sky healthcare that makes me sound good, I’ll leave all the details to Congress, but force them to do it fast” approach is that once something is in, it’s in FOREVER. You can never get rid of a government entitlement, and very few people want to change it. Hell, Reagan (and to some extent Clinton, with a Republican Congress) did the most to reform government entitlements and he’s still hated by the left for daring to insist that in America you should be trying to get a job, not living off the system.
As for the Dutch system: maybe it is great. But as others have pointed out, it’s a small country; it relies on youth; but more importantly, the Netherlands is one of the most expensive places in the world to live. You can’t ignore factors like that and just look at the end result.
if the Dutch system is so great why is it that dutchwomen have less than one child per woman, while half the children born in Holland are non-dutch, mostly Muslim?
How long do you think will this most generous health package survive when most of these newcomers contribute almost nothing to the income side of the equation, and use benefits to their hearts content?
Wow.
Truly Amazing.
Fun and optimistic.
As I read these comments it seems most of the people who have been against revising the US health care are those who have coverage and are at least somewhat satisfied with it. It is not always a low life, irresponsible person who does not have health insurance. I worked over forty years in the health care field but it was with Mom and Pop type nursing homes. My reward was no pension plan and the moment I retired no health care plan. I will get medicare in three years but in the meantime I am playing Russian roulette with no coverage and not enough money to buy preventative medications. I am not and never have been a deadbeat and I am not an illegal immigrant. I just did not fit into the “taken care of” category. It is a travesty that good people are suffering with no health care in this country and no one really wants to fix it because they are too comfortable with their own lot in life. As a divorcee-let me just warn you that things can change and you may not always be so self assured.
Les;
Emergency care is not denied to anyone here.
But we still have the problem of people with chronic and expensive illnesses that many insurers won’t bother with. In the free market, insurers have the right to reject customers who cost more in outlays than they contribute in profits, so to speak.
But what do we do with these people? Clearly, the free market does not work in this case. As it stands, their only choice is to spend down their savings until they are eligible for Medicaid. And then the government picks up their expenses anyway.
The article mis-characterizes single-payer. All the advantages listed in the Dutch system (plus more) exist in the single payer system here in France. I chose my doctors, who are not government employees. And my doctors and I chose my treatments. I’ve had a lot of interaction with the medical system, and I’ve never had to wait for routine or emergency services. There is no problem with long waiting lists. The standrd of care is every bit as good as in the US, and the results are better.
There is almost no paperwork for me to deal with.
And everyone is covered.
And the cost per person is half that in the US.
And France is ranked number one in healthcare worldwide.
And a majority of Americans as well as thousands of doctors and nurses want a single payer system. A statistic made even more remarkable when you consider that single payer is not even being discussed in the maintream media or in Congress thanks to the influence of the private interests like insurance companies, and pharmaceutical companies who are willing to spend tens or hundreds of millions protecting their golden egg laying goose.
prospero–
main problem with your list is it doesn’t offer enough unearned economic “rent” to enough organized constituencies to create the special-interest support needed to move any large piece of legislation through our incredibly corrupt system.
Other than that, just in terms of doing the right thing for the country as a whole, it would be a very good place to start.
Hmm. Friends of mine who live under the Dutch system say their health care benefits have been being pared back–and new limitations seem to come every six months or so. Apparently 9% is much too low to sustain the original level of treatment. Are you stepping up to the plate to raise it to 17% to keep from cutting more and more benefits?
You are for government required health care, but what about the more essential needs of food, housing, clothing? Or how about reasonable paying jobs? Why is is that you have immigrant conclaves with high unemployment and poor housing?
http://rawstory.com/news/2007/Dutch_economic_growth_fails_to_bene_01302007.html
http://query.nytimes.com/gst/fullpage.html?res=940CE1DB1131F935A25750C0A9609C8B63&sec=&spon=&pagewanted=2
Maybe it would be better to think about how the Dutch can give residents really crucial fundamental rights like good housing and jobs before lecturing one of the best health care systems in the world (where everyone can receive free treatment in emergency rooms even for minor health needs) on copying a system which is already showing health care delivery problems in its underfunded system.