The gap I see between the system in the Netherlands and Wildcat's proposal is that I get the feeling Wildcat doesn't want to dramatically increase government spending. Is that correct?
"In 2005, the Netherlands spent 9.2% of GDP on health care, or US$3,560 per capita. Of that, approximately 65% was government expenditure" source
"In 2007, the U.S. spent $2.26 trillion on health care"
source
So if we adopted an identical system to the Netherlands, and the government covered 65% of total health care expenditures that would amount to around $1.5 trillion a year. Since people already complain about the current cost of Medicare and things like "will the real 10 year cost of Obamacare be $6 trillion" I don't see how a far more expensive plan is a real solution.
I'm saying it would be more expensive than the current plan under discussion which is being falsely spun to be $6 trillion over the next 10 years or some such nonsense. Even if you believe those bogus numbers, your plan if done exactly like the Netherlands would be far more expensive.
Which is fine with me, and apparently the people of the Netherlands. I'm not worried about cost. But I think it's disingenuous of you to show support for a plan that you think is the cheap, efficient, market solution, when in fact, it requires large amounts of public spending raised through additional taxes to actually work.
I'm not sure how those numbers are calculated, and what is considered "government expenditure". But there are actually two different insurance systems for health in the Netherlands - one for "cure" and one for "care" as I recently heard someone succinctly label the difference. The reason there are two systems is that the "care" part consists of what were traditionally considered "uninsurable" risks.
The one we've been discussing is the "cure" system. It covers doctors, hospitals, drugs, dental care for children, physiotherapy, etc. Everyone has to buy compulsory insurance with one of the insurers.
Wiki says that the premiums people pay directly to their insurers cover 45% of the total costs. 50% is covered by the premiums collected as a percentage of your income by the tax office; and 5% is chipped in by the government from the general budget. Those 55% are distributed among the insurers by the risk equalization pool. With a typical premium of a little over € 1,000/year per adult, my guesstimate is that expenditures in this system are in the 20-25 bn/year range.
Prices used to be fixed, and are now (gradually) let free to negotiation between insurers and health care providers. The patient is billed by the insurer for things that are only partially covered (e.g., physiotherapy is covered for 80%) or for his deductible (€ 150-650 pro annum). From the point of view who actually pays, I'd say that's the insurers, and the government here merely act as a collection agent.
Sorry if this has been covered, but is there anything in place to make it mandatory to have insurance?
(Are low-risk people free to opt out of the system until they become high-risk people? I understand the relative risk is spread out among people who have insurance, but no premium costs less than even a fair premium.)
Yes, insurance is mandatory. The fine for not having insurance is 130% of the typical premium. You can't avoid, of course, the - on average - half of the premiums that is collected by the tax office. Nobody evades the tax office.
The "care" system covers things like nursing homes, psychiatric institutions, special housing for ex-psychiatric patients, and nursing care at home for disabled and elderly. Wiki (
Dutch link) says total expenditures in this system are also in the 20-25 bn/year range. Where possible, the government has also privatized the market. When someone needs nursing care at home or household help, he files with the government for that help, and then gets assigned a "personal budget". The patient himself then hires the actual care providers and pays them out of this budget.
Personally, I work as a speech-to-text-reporter (STTR) for deaf and hard-of-hearing. A deaf person applies with the "care office" for support by a sign language interpreter or STTR and gets the right to 30 hours/year of such support for non-work related use. The deaf person himself then hires an interpreter to his liking. When he hires me, he just signs off my form and I send my invoice to the "care office".
The insurance companies currently have an administrative role in the "care" system, and there are (at present vague) plans to unite the two systems.
