Is the Dutch model the right reform for U.S. healthcare?

Is the Dutch model the right reform for U.S. healthcare?

Summary: The Dutch system combines heavy public spending and private insurance.The government offers subsidies covering dozens of pre-existing conditions so the private market can accept all patients.


Netherlands map image from ThinkQuestAmericans hate their health care system and want major reform.

To many this means Americans are ripe for a single payer system controlled by the government. (Image from ThinkQuest.)

But there's another model which seems to be pleasing its customers, and which retains a large role for the private sector.

In the same survey showing Americans are ready to scrap their system, the Dutch system stood out as a success story. While only 12% of Americans want just minor tweaks with their health care, 42% of the Dutch would be happy with that.

The Dutch system combines heavy public spending and private insurance, according to a 2004 Commonwealth Fund study.

Everyone must have insurance, but employers don't have to provide it. The government offers subsidies covering dozens of pre-existing conditions so the private market can accept all patients.

The biggest difference, the one which would take the most time to implement here, is an emphasis on primary care physicians and nurses.

Everyone has a family doctor who acts as a gatekeeper to the rest of the system. When Massachusetts tried this reform it found it had a dire shortage of such physicians.

Thus any reform like this would have to be phased-in, with incentives for doctors to move toward family medicine and away from other disciplines.

In the Netherlands carrots-and-sticks are used to wean people from unhealthy lifestyles. You can get a refund on a gym membership, for instance, if you actually lose the weight.

A Wall Street Journal feature on the Dutch plan noted that state reform plans like that of Massachusetts place more burdens on employers, and indicated the Dutch plan is closest to a California plan shot down by that state's legislature.

While the original Dutch reform emphasized competition, in practice consolidation occurred quickly, so there are now fewer than a half-dozen insurance carriers there.

It must be emphasized that the Dutch plan has only been in force for two years but there is something in it to please both the left and the right.

For the left it's universal. Everyone can get coverage. Drugs are covered. The wealthy are taxed to assure this.

For the right businesses don't have to provide coverage, costs are controlled, and the new system is loaded with market incentives.

There's a long road to reach a Dutch-style system in the U.S., and even the Dutch system has problems, like its lack of coverage for some conditions and its short track record.

But to many Americans it looks interesting.

Topics: Health, CXO, Enterprise Software, Government, Government US, Software, IT Employment

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  • a little better

    It's better, in that it involves some competition between private companies, and not full government involvement. It's also good that it provides coverage to everyone.

    However, as you stated, much of it is paid for by "the wealthy", which is just more class-warfare socialism. By demonizing those that make more money, it makes for an easy way to pay for things by taking more from the Evil Rich.

    But the Dutch are trying, which is more than I can say for currently proposed solutions in the US. The US government allowed the HMOs to take over the medical care nationwide and drive it into the ground, and now they want to insure everyone (eventually) through the government, who are about the only group that could do even worse than the HMOs.
    • The wealthy have the money and the incentive

      Look at it this way. As company owners the wealthy have an enormous incentive to have a healthy work force. And can you please keep your charges of class-warfare socialism in the closet alongside your Ayn Rand poster?
      • Long live John Galt

        "Americans hate their health care system and want major reform."

        Prove it

        Me thinks ye doth watcheth too much Micheal Moore
  • Where did you get the inspiration for this article from?

    because the article isn't objective. Every story has 2 sides and you're telling only 1.

    BTW: I'm dutch
    Arnout Groen
    • Every story has 2 sides and you're telling only 1

      Blogs are like that. Just don't put much faith in them.
      • So What?

        Dind't you notice there are plenty enough other people telling the other side?
    • I was reporting the views of U.S. policymakers

      As the article noted, some U.S. states have already moved toward this kind of plan. I noted some of their problems, and some other concerns.

      What are yours? You mean if I go with this plan I won't grow as tall as Ruud van Nistelrooy?
      • the problem with that is that

        the views of US policymakers don't always reflect the views of those of us that have to live wiht their policies.
      • California Plan?

        I'm not flaming. Just curious as to why the California Plan did not pass.
        Ruud van Nistilrooy?? Who he??
  • so essentially there is little competition over there in insurance

    which means, your back to one insurer eventually. Might as well be uncle sam then... cause companies have to make money and uncle sam doesnt.
    • There is less competition than before...

      ...but there remains some. This is one of the criticisms of the plan, that in time there will be none. Because there is now less than before.
      • Not true

        If anything there's more competition now in the Netherlands, because with the reforms came LESS government interference than before.

        I admit when you would implement a system as this in the US, you'd get more government interference, how much exactly is debatable, but for us it was a step backwards, which more competition, but also steeply rising prices.

        But just wanted to clarify there's still more than plenty competition, the number of six insurance companies is false.
    • Non sequitur

      No, that does not follow. Remember the days when AT&T had a monopoly on the phone system? Sure, we paid too much to rent the phone from the phone company, but we did still have the highest quality phone service -- even international service of any country.

      Compare that to any country where the government itself was allowed to run the phone system. Remember all the Benny Hill jokes about British Telecom? In those days, BT was directly owned and run by the government. Thatcher had not privatized it yet. Soon after she did, BT got a lot better, even able to compete outside of Britain.

      So why does a government regulated company running a monopoly do better than when government itself runs it? I don't know, but I do know from examples that it often does, at least when the monopoly is a natural one due to 'externalities'.
      • ATT was pretty cheap back then

        For years it cost $8 to have a line installed and the
        monthly bill was $5.40 per line before long distance
        charges. And, yes, there was competition on the
        long distance market. Now the taxes on my phone
        bill are greater than ATT used to charge. We were
        basically financially screwed by the ATT breakup -
        you just have to be old enough to realize it.
  • RE: Is the Dutch model the right reform for U.S. healthcare?

    I sure hope not for your sake! I live in Holland and have been horrified to see a working health-care system turn into a bureaucracy machine. I used to pay about 150 dollars a month for health care for me alone (man aged 58). That has rocketed to about 500 dollars a month. And all I see is that bureaucracy reigns. Instead of helping patients, doctors have to fill in forms and justify every action they take. This is NOT the way to go, but maybe it's heading in the right direction for the US system.
    • Why do you think the poll found people were more satisfied?

      The real reason for the interest in the new Dutch system is the increased level of satisfaction expressed in recent opinion polls on the subject. As noted in the links.
      • I don't know who they asked

        ... but another Dutch here that was happier before the reforms. A lot of people are unhappy with the new system and preferred the old way, that was like Martin said, way less bureaucratic and more affordable for everyone, except businesses were subsidizing. Though not really subsidizing, but taking it out of your paycheck before taxes.

        I used to pay about 50 euros a month before the reforms, right now I am paying 96 euro a month. Almost doubled in two years on about the same paycheck.

        I realize it is not a bad system, as in a lot of people have it a lot worse then us. It's for the most part affordable for everyone and no one can be denied. Also the system of family doctors is great and takes a huge burden of specialists and hospitals.

        It did however change for the worse for us, compared to what we were used to. Hence 58% does want changes, opposed to the 42% that was currently satisfied.

        That's what the poll means to me. We realize how lucky we are compared to large portions of the world, but we also don't want to slide down a slope we feel the government has started.
  • So now it's the Dutch model that's perfect...

    Let's see. First it was the British system. Then it was the Canadian
    system. Then it was the German system. Then it was the French
    system. Now it's the Dutch system.

    You're running out of countries....
    • No system is perfect...

      ...but Americans are very dissatisfied with their system, as all polls show, and are examining alternatives. I am describing some of the alternatives, and not endorsing any one of them.
      • Americans are always dissatisfied

        It is our nature as Americans to be dissatisfied. That means nothing. We always want better treatment at a better price. We want better everything at a better price.

        I am confident if you take cost out of it, Americans are very satisfied with their health care. I am self-employed and am now looking at a monthly cost of $700 for a family of four. But, what can I want? More government, more taxes? No way.

        Maybe the governments role can be to set boundries for insurers and then get out of the way (i.e. no more pre-existing conditions).

        Let's not forget a large portion of the problem is a majority healthy population is paying for a illegal alien healthcare and it is a big expense in California.