This is a continuation of a series of inter-societal comparisons between the US and the Netherlands. Frank Thomas supplied the information about the Netherlands and John Lawrence supplied the information about the US. Proceeding parts can be found here: Part 1, Part 2, Part 3, Part 4, Part 5.
The Dutch Occupational Disability Insurance System
In the Netherlands all workers are insured against loss of earnings due to occupational disability. Ocupational disability is defined as the loss of earning capacity from inability to perform work tasks due to disease or infirmity.
Dutch social safety-net programs are very closely integrated to cover most contingencies. The trend has been to slowly tighten benefits when and where appropriate while retaining prudently fair and humane coverages. The aging of society has also made tightening necessary.
This summary will clarify the Dutch Occupational Disability Insurance System. It is comprised of four connected pieces of legislation: ZW, WIA, WGA, IVA:
I. ZW: Sickness Benefits Act
II. WIA: The Work and Income According to Labor Capacity Act (Including the WGA and IVA Acts)
I. ZW: Sickness Benefits Act
An employee judged less than 35% occupationally disabled, in principle, continues to exercise employment. Employers are thus obligated to continue paying 70% of an employee’s last wage up to a maximum of Euro 183.00 or $235.00 per day for the first 104 consecutive weeks (under the WULBZ Act). Under collective bargaining agreements, a higher percentage than 70% is possible up to 100% of the employee's last salary depending on the employer, and 100% is paid for absence due to childbirth.
Responsibility for maximizing the employment capacity of the employee lies with the employee’s company. Only in cases where employers have no possibilities whatsoever to further employ the employee can the latter be discharged following permission by the Center for Work Income. In such cases, the employee can register an appeal for an Unemployment Insurance benefit (WW). Employee is also entitled to social assistance under the Supplemental Benefits Act if the total of the ZW and WIA benefits and any other family income is less than the statutory social minimum income. An appeal must be made to the Social Security Institution for the supplemental benefit.
II. WIA: The Work & Income According to Labor Capacity Act
The WIA was put into effect January 1, 2006 and replaced the Occupational Disability Act or WAO. The WAO continues to exist for persons who currently benefit from WAO conditions. The new WIA legislation covers all the risks of inability to work above an occupational disability level of 35% up to 80% per related WGA act and disability between 80% and 100% per related IVA act.
The new WIA act emphasizes return to work, putting emphasis on people’s capabilities and less on their disabilities. This is a break with traditional WAO legislation where the stress was mainly on income support. The new law responds to a growing number of disability recipients and further increase expected with aging population. Over past years, the Dutch have taken serious steps to solve this problem in their Social Security system by stimulating claimants and beneficiaries to work to the extent that their medical situation permits.
The WIA consists of two provisions:
A. The regulation governing the Re-Employment of people with a partial disability called the WGA
B. The regulation governing Income Protection for people who have been registered as being completely incapable of work due to disability called the IVA.
As noted above, the WIA is applied following the first two years (104 consecutive weeks) of an employee’s sick leave. During the first two years, rehabilitation and effecting a return to work is the
responsibility of the employer and the employee. The employer is obligated during these two years to continue paying the employee’s wages (sick leave) at a level of 70% of the employee's last wage up to a maximum of $235 per day. At the end of the two-year period, a government unemployment agency will judge whether employer/employee have done their best to keep the sick employee at work. This includes a medical examination.
As noted also, the WIA makes a distinction between partial occupational disability (WGA) and long-term and full occupational disability (IVA). Criteria assessing work capability have been tightened as demonstrated in the following Sub-Acts of the WIA Act.
IIa. WGA (Reintegration Act Benefit for Partially Disabled Persons)
Under WGA, all employees under and up to age 65, including civil servants, are insured for loss of income due to disability. Persons who are partially disabled or temporarily fully disabled may apply for a benefit allowance under WGA. Qualification for a WGA allowance applies to an employee who is incapable of working with a degree of disability between 35% and 80%. A person who recovers and can earn 65% or more of former earnings will lose the WGA benefit.
The act provides incentives to encourage both employer/employee to endeavor to rehabilitate the employee. For the employee, the incentive lies in the fact that the wage earnings are only partly taken into account in terms of deductions in the benefit allowance. For the employer, the advantage is that the firm is not obligated to pay sick leave to an employee with a WGA benefit if the employee becomes ill within 5 years of commencement of the benefit. Employers also get a discount on social insurance premiums if they employ, or retain in employment, a partially disabled person.
The WGA benefit is at first a salary-related benefit, the duration of which is dependent on employee’s employment history. At the end of this period, there is a possibility of a follow-up or supplementary allowance.
An employee who works and earns at least half of his residual earning capacity is entitled to a supplement of 70% of the difference between his last wage and his residual earning capacity or new wage. However, an employee who is unemployed or who earns less than half of his residual earning capacity is entitled to a followup allowance of 70% of the legal minimum wage multipled by the percentage of occupational disability. In principle, an employee is entitled to one of these allowances until the retirement age of 65.
Structured benefit levels under WGA include:
(1) A person not working receives a wage-related benefit of 70% of the employee's last daily wage up to a maximum of Euro 183.00 /$235.00 per day and for no more than 38 months.
(2) A person working receives a wage-related benefit of 70% of the difference in comparison with the daily wage to a maximum of Euro 183.00/$235.00 per day.
(3) After the wage-related benefit has ended, the amount a person earns is taken into account. If this is at least 50% of the remaining earning capacity, the WGA will supplement the wage by 70% of difference between the last daily wage (to a maximum of Euro 183.00 /$235 per
day) and the remaining earning capacity or new wage.
(4) If a person is not working after the wage-related benefit has ended or if a person is earning less than 50% of the remaining earning capacity, the benefit is based on a percentage of the minimum wage : at 1 Euro = 1.30 USD, the current monthly gross statutory minimum wage is Euro 1,381.20 ( $1,795.50)
To repeat points (3) and (4): (3) a person who works and earns at least half of his/her so-called remaining earning capacity is entitled to a follow-up supplement of 70% of the difference between last wage (to a maximum of Euro 183.00/$235.00 per day) and the remaining earning capacity; (4) a person with partial disability who’s completely unemployed or who earns less than half of what he/she is capable of in light of that person’s occupational disability (called remaining or residual earning capacity) is entitled to a follow-up supplement based on a percentage of the minimum wage. In principle , an employee may qualify and be entitled to one or more of these WIA/WGA benefits up to the retirement age of 65.
IIb. IVA (Benefit for Fully Disabled Persons)
A person is considered completely disabled or long-term disabled if his/her residual earning capacity is less than 20% (over 80% disabled) of what it was before the disability occurred and if the chances of recovery are zero or negligible. In this case, income support is the primary responsibility of the government under the IVA benefit regulation for fully disabled with no prospect for return to work.
Following the first 104 week sick leave for which the employer is liable, an employee who is both fully and permanently incapacitated -- i.e., a degree of disability between 80% and 100% -- can qualify for an IVA benefit. The government believes this benefit should be a reasonable income provision suitable also for the future. The IVA benefit amounts to 75% of most recent maximum daily wage up to a maximum of Euro 183.00 or $235.00, effective 2009.
Eligible employees must undergo a medical exam every year during first five years of absenteeism to monitor possible recovery. If one is declared partially disabled during that period, he or she will no longer be eligible for the IVA benefit under the WIA insurance legislation. That person would then have to apply for a WGA benefit. If not partially disabled, her or she will retain the IVA benefit.
The following summarizes contributions under the various Employee Insurance schemes:
Employer Employee
I. WAO/WIA basis 5.65% --
II. WAO/WIA differentiated * -- --
III. WAO general 0.15% --
IV. WW general 4.75% 3.50%
V. WW differentiated * -- --
The contributions for above employee Insurance schemes are levied on wages and salaries up to €3,850.00 ($5,000.00) per month.
* differentiated = these percentages vary per company.
In principle, anyone employed in the Netherlands is compulsorily insured under the Employee Insurance schemes. If the total of any of of the three benefits – ZW, WIA, or WAO – and any other family income is less than the statutory social minimum income, the recipient is entitled to apply to the Social Security Institution (SVB) for a supplement under the Supplemental Benefits Act.
Self-Employed Persons:
All self-employed persons under 65, their spouses who assist in the business, professional practitioners, etc. can take out a private insurance contract to cover the risk of loss of income due to disability. Temporary and self-employed persons can take out a voluntary ZW-insurance.
In the Netherlands, a self-employed worker is a natural person who, according to the Dutch tax authority, earns an income by profit from a company that does not employ any other employees. Also, the director/shareholder, employed in his or her own business as the only employee is considered a self-employed worker.
Self-employed workers with no employees differ from employees on the following social-security issues:
(a) There is no agreement to perform labor for a certain period
of time.
(b) There is no employer obliged to pay a salary.
(c) There is no dependency relationship.
In brief, self-employed workers are solely responsible for the financial risks related to loss of income when ill and/or unemployed, and for old-age pension insurance.
About 50% of self-employed persons in the Netherlands suscribe to some form of private occupational disability insurance. Average annual premiums are currently around €3,000 ($3,900) … although the range is €675 ($875) a year for some individuals to as high as €7,200 ($8,775) a year for others.
So cost is one factor, but there are two other factors behind why just 50% of the self-employed take out private occupational disability insurance. The first has to do with the relation of cost and benefit to income. The benefit is linked to income levels. In general, a large number of the self-employed have a “limited income” meaning that many only have a right to limited occupational insurance benefits. This makes the cost-benefit ratio more unattactive.
The second factor is that insurance companies require applicants not only to have a medical examination but also to submit a “health certificate,” which in some cases is highly detailed. In addition, private disability insurance policy conditions often include exclusion clauses, premium surcharges, and qualifying periods … all making such policies uninteresting to some self-employed persons. For example, some insurance companies may specify a qualifying period of 2 years before covering risks related to pregnancy. As a result, self-employed women who have taken out occupational disability insurance are not covered for maternity leave within the first two-year period of policy commencement.
On the positive side, in recent years some trade unions in the Netherlands have been reaching agreements with insurance companies resulting in “collective” occupational disability insurance schemes for self-employed persons.These insurance schemes include maternity leave benefits for pregnancy.
A similarly positive development is new legislation effective July 1, 2008 which provides a benefit for self-employed women wishing to take maternity leave, called the ZEZ-regulation or Self-Employed and Pregnant regulation. This benefit is dependent on income in the prior year, up to a maximum amount equal to the current monthly gross statutory minimum wage of €1,381.20 or $1,795.50. The self-employed doesn’t have to pay a premium to be eligible for this benefit. This regulation also applies to co-working partners.
WW ( Unemployment Insurance Act)
The WW or Unemployment Insurance Act insures employees against the financial consequences of unemployment. Two requirements must be met: (1) he/she must have been employed for a period of at least 26 weeks over the 36 weeks immediately prior to becoming unemployed, and (2) he/she must have received wages over 52 days or more in at least four of the five calendar years prior to the year in which he/she became unemployed.
If only the first requirement is met, the employee will receive a WW benefit during the first two months of unemployment that is set at 70% of last earned wage (to maximum of $235.00 per day) and then a one-month WW benefit up to $235.00 per day.
If both requirements are met, he/she will receive, in addition to the three -month benefit, a wage related WW benefit of 70% of the maximum daily wage up to $235.00. The duration of the benefit depends on the employee's employment history, but in total cannot exceed 38 months.
Following is the table of benefits:
EMPLOYMENT DURATION PERIOD OF BENEFITS
4 Years or Less 6 Months
5-9 Years 9 Months
10-14 Years 1 Year
15-19 Years 1.5 Years
20-24 Years 2 Years
25-29 Years 2.5 Years
30-34 Years 3 Years
35-38 Years 38 Months Maximum
The WW unemployment benefit is well-synchronized with the Dutch Occupational Disability benefits. There are no conflicts or doubling up of entitlements. The Dutch are prudent, pragmatic and creative administrators of these social-net systems. The government is generally always adjusting them in a timely manner to new economic realities while also assuring fair and humanly decent programs for those in trouble. And all entitlements are based on closely controlled “reintegration into the work force” and "get back to work program initiatives"to the extent physically possible for the disabled employee.
Occupational Disability in the US
The Social Security and Supplemental Security Income (SSI) disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.
Social Security Disability Insurance pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes.
Supplemental Security Income pays benefits based on financial need.
When you apply for either program, we will collect medical and other information will be collected from you from you and a decision will be made about whether or not you meet Social Security's definition of disability.
If you have limited income and resources, you may be able to get SSI. SSI is a federal program that provides monthly payments to people age 65 or older and to people who are blind or disabled. If you get SSI, you also may be able to get other benefits, such as Medicaid and food stamps.
A Word About Medicare
After you receive disability benefits for 24 months, you will be eligible for Medicare. You will get information about Medicare several months before your coverage starts. If you have permanent kidney failure requiring regular dialysis or a transplant or you have amyotrophic lateral sclerosis (Lou Gehrig’s disease), you may qualify for Medicare almost immediately.
Help for low-income Medicare beneficiaries
If you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other “out-of-pocket” medical expenses such as deductibles and coinsurance.
Generally, your household cannot have more than $2,000 in resources (things you own). But, if your household includes a disabled person or a person age 60 or older, the limit is $3,000. The resources of a person who is getting SSI or benefits under the Temporary Assistance for Needy Families (TANF) program are not counted for food stamp purposes either. Resources include cash, bank accounts and other property.
Not all resources count. For example, your home and the land it is on do not count for food stamp eligibility. A car or truck counts differently, depending on how it is used. Most states now use TANF rules in place of food stamp vehicle rules if the TANF rules are more beneficial to the food stamp household. Some states have also chosen to exclude certain resources excluded by TANF or Medicaid.
Most households also must meet an income limit. Certain things do not count and can be subtracted from your income. Your household may qualify for other income exclusions if it includes someone who is age 60 or older or disabled. The income limits vary by household size and may change each year.
What amount of food stamps can you get?
If your household is eligible, the amount of food stamps you get depends on your monthly household income and expenses for such things as:
• Mortgage or rent;
• Utilities; and
• Child care or elder care needed to allow someone to work.
Medical expenses of more than $35 a month for elderly and disabled people are deducted from your household income if they are not paid for by another party such as Medicaid, Medicare or an insurance company.
You can also find out how much you may be able to get online through the Pre-Screening Tool at www.foodstamps-step1.usda.gov .
Using the Tool I put in for a family of 4 with a $1500. monthly income, rent of $1000. a month, utility bill of $100. a month, no child care expense and no assets. The tool figured I would qualify for $400. a month in food stamps.
Homeless people and food stamps
If you are homeless you can still get food stamps even if you do not have an address, a place to stay or a place to cook meals. You are considered homeless if you do not have a fixed regular nighttime residence or your primary nighttime residence is a temporary accommodation in:
• A supervised shelter;
• A halfway house;
• The residence of another person; or
• A place not designed for regular sleeping, such as a hallway, bus station or lobby.
Other nutrition programs available
The food stamp program is just one of many nutrition programs available. The federal government and many state and local government agencies sponsor numerous programs that provide people with information about, and access to, a more nutritious diet. Many of these programs also are set up to improve the health and eating habits of children.
Here are two examples:
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
• The WIC program provides nutritious foods to supplement the diets of low-income pregnant, postpartum and breast-feeding women, infants and children up to five years of age. It also provides nutrition education and referrals to health services and other assistance programs.
• WIC is administered by the Department of Agriculture through state health departments. Eligibility is based on income and on nutritional risk as determined by a health professional.
You can contact your state or local health department for more information about this program.
Nutrition Services Incentive Program (NSIP)
• NSIP (formerly Nutrition Program for the Elderly or NPE) is a food program designed to help older people. It is run by the Department of Health and Human Services through the state agencies on aging. NPE is part of the Grants for State and Community Programs on Aging, which also authorizes in-home services for frail elderly people, support services and senior center operations. The nutrition services program provides elderly Americans with nutritious meals.
• If you are age 60 or older, you are eligible for the program and so is your spouse, even if he or she is not 60 years old. Age is the only factor used to decide if you are eligible. You do not have to meet any income limits to get meals through the program.
• Neighborhood centers for the elderly serve well-balanced, hot or cold meals at least once a day, five days a week. When possible, transportation is offered to and from the sites for those who need it. Home-delivered meals, usually called “Meals on Wheels,” are provided to elderly people who are homebound.
For more information about this program, contact your local Office on Aging or ask your local Social Security office.
More food programs
There are other food programs administered by the Department of Agriculture.
Several food distribution programs give commodities to needy households or to organizations that provide meal service to low-income people, including soup kitchens, churches and homeless shelters.
The Child and Adult Care Food Program offers meals and snacks to children in eligible day care centers, family day care homes and other care centers, as well as to functionally impaired adults and elderly people in day care situations.
The School Lunch and Breakfast Programs offer meals at schools to children. Low-income children get these meals free or at a reduced price, while other children have access to reasonably priced meals.
The Summer Food Service Program offers free meals and snacks to needy children during the months when school is not in session.
The Senior Farmers’ Market Nutrition Program provides low-income seniors (individuals who are at least 60 years old) with coupons during the harvest season that can be exchanged for eligible foods at farmers’ markets, roadside stands and community supported agriculture programs.
For more information about these programs contact your local social services, health, agriculture, aging office or school.
Getting Back to Work Incentives
If you are getting disability benefits, we have good news for you. Social Security’s work incentives and Ticket to Work programs can help you if you are interested in working.
Special rules make it possible for people receiving Social Security disability benefits or Supplemental Security Income (SSI) to work and still receive monthly payments.
And, if you cannot continue working because of your medical condition, your benefits can start again—you may not have to file a new application.
Work incentives include:
• Continued cash benefits for a time while you work;
• Continued Medicare or Medicaid while you work; and
• Help with education, training and rehabilitation to start a new line of work.
The rules are different under Social Security and SSI. But, whether you are receiving Social Security or SSI, it is important to let the authorities know promptly when you start or stop working, or if any other change occurs that could affect your benefits.
The Ticket to Work program may also help you if you would like to work. You can receive vocational rehabilitation, training, job referrals and other employment support services free of charge. You will not undergo medical reviews while you are using the ticket and making timely progress pursuing your return to work plan.
Social Security work incentives at a glance
Trial work period—The trial work period allows you to test your ability to work for at least nine months. During your trial work period, you will receive your full Social Security benefits regardless of how much you are earning as long as you report your work activity and you continue to have a disabling impairment. In 2009, a trial work month is any month in which your total earnings are $700 or more, or, if you are self-employed, you earn more than $700 (after expenses) or spend more than 80 hours in your own business. The trial work period continues until you have worked nine months within a 60-month period.
Extended period of eligibility—After your trial work period, you have 36 months during which you can work and still receive benefits for any month your earnings are not “substantial.” In 2009, earnings of $980 or more ($1,640 if you are blind) are considered substantial. No new application or disability decision is needed for you to receive a Social Security disability benefit during this period.
Expedited reinstatement—After your benefits stop because your earnings are substantial, you have five years during which you may ask us to start your benefits immediately if you find yourself unable to continue working because of your condition. You will not have to file a new disability application and you will not have to wait for your benefits to start while your medical condition is being reviewed to make sure you are still disabled.
Continuation of Medicare—If your Social Security disability benefits stop because of your earnings, but you are still disabled, your free Medicare Part A coverage will continue for at least 93 months after the nine-month trial work period. After that, you can buy Medicare Part A coverage by paying a monthly premium. If you have Medicare Part B coverage, you must continue to pay the premium. If you want to end your Part B coverage, you must request it in writing.
Work expenses related to your disability—If you work, you may have to pay for certain items and services that people without disabilities do not pay for. For example, because of your medical condition, you may need to take a taxi to work instead of public transportation. We may be able to deduct the cost of the taxi from your monthly earnings before we determine if you are still eligible for benefits.
How your earnings affect your Social Security benefits
During the trial work period, there are no limits on your earnings. During the 36-month extended period of eligibility, you usually can make no more than $980 a month or your benefits will stop. But, the work expenses you have as a result of your disability are deducted when we count your earnings to see if they can help you keep more of your benefits. If you have extra work expenses, your earnings could be substantially higher than $980 before they affect your benefits. This substantial earnings amount usually increases each year.
They deduct work expenses related to your disability from your earnings before they determine if you are still eligible for benefits. These expenses may include the cost of any item or service you need to work, even if the item or service also is useful to you in your daily living. Examples include prescription drugs, transportation to and from work (under certain conditions), a personal attendant or job coach, a wheelchair or any specialized work equipment.
If you lose your job
If you lose your job during a trial work period, your benefits are not affected. If you lose your job during the 36-month extended period of eligibility, call us and your benefits will be reinstated as long as you are still disabled.
Special rules for workers who are blind
If you are blind and you work while receiving your Social Security benefits, there are special rules.
• You can earn up to $1,640 a month in 2009 before your earnings may affect your benefits.
• If you earn too much to receive disability benefits, you are still eligible for a disability “freeze.” This means that we will not count those years in which you had little or no earnings because of your disability in figuring your future benefits.
This can help you because your benefits are based on your highest earnings over your work life. For more information on special rules for blind persons, ask for If You Are Blind Or Have Low Vision—How We Can Help (Publication No. 05-10052).
SSI work incentives at a glance
Continuation of SSI—SSI payments are made to people age 65, blind or disabled and have little income or resources. If you are disabled and work despite your disability, you may continue to receive payments until your earnings, added with any other income, exceed the SSI income limits. This limit is different in every state. Even if your SSI payments stop, your Medicaid coverage usually will continue if your earnings are less than your state level.
Expedited reinstatement—If we stopped your payments because of your earnings and you become unable to work again because of your medical condition, you may ask us to start your payments again. You will not have to file a new disability application if you make this request within five years after the month your benefits stopped.
Work expenses related to your disability—If you work, you may have to pay for certain items and services that people without disabilities do not pay for. For example, because of your medical condition, you may need to take a taxi to work, instead of public transportation. We may be able to deduct the cost of the taxi from your monthly earnings before we determine if you are still eligible for benefits.
Plan to achieve self-support—If they approve your plan for a work goal that will reduce your dependence on SSI or help you leave the SSI rolls, any money you use for this purpose will not be counted when they figure out how your current income and resources affect your payment amount. For more information, ask for Working While Disabled—A Guide To Plans For Achieving Self-Support (Publication No. 05-11017).
Students with disabilities—We do not count up to $1,640 of your earnings a month in 2009 (maximum of $6,600 for 2009) when we compute your SSI payment amount if you are under age 22 and go to school or are in a training program on a regular basis.
How your earnings affect your SSI payments
The amount of your SSI payments is based on how much other income you have. When your other income goes up, your SSI payments usually go down. So when you earn more than the SSI limit, your payments will stop for those months. But, your payments will automatically start again for any month your income drops to less than the SSI limits. Just tell us if your earnings are reduced, or if you stop working.
If your only income besides SSI is the money you make from your job, then we do not count the first $85 of your monthly earnings. We deduct from your SSI payments 50 cents of every dollar you earn after the $85 deduction.
Example: You work and earn $1,000 in a month. You receive no other income besides your earnings and your SSI.
$1,000
– $85 = $915 divided by 2 = $457.50
They would deduct $457.50 from your SSI payment.
You may be eligible for a “plan to achieve self-support” which allows you to use money and resources for a specific work goal. These funds do not count when we figure out how your current income and resources affect your benefit amount.
How long your Medicaid will continue
In general, your Medicaid coverage will continue, even after your SSI payments stop, until your income reaches a certain level. That level varies with each state and reflects the cost of health care in your state. (We can tell you the Medicaid level for your state.) However, if your health care costs are higher than this level, you can have more income and keep your Medicaid. In most states, for your Medicaid to continue, you must:
• Need it to work;
• Be unable to afford similar medical coverage without SSI;
• Continue to have a disabling condition; and
• Meet all other SSI eligibility requirements.
If you qualify for Medicaid under these rules, they will review your case from time to time to see if you are still disabled or blind and still earn less than your state’s allowable level.
Work Incentives Planning and Assistance program
Social Security has a Work Incentives Planning and Assistance program (WIPA)that will help answer questions about Social Security’s work incentives and help you make a decision about working.
Community-based organizations provide information and work incentives planning and assistance to people who are receiving Social Security or SSI disability benefits and who are working or considering work. Their community work incentive coordinators can help you understand how work affects your payments and explain what other federal, state and local supports there are for people with disabilities who want to work.
A GENERAL COMPARISON
In general the Dutch system seems much more simplified and straightforward. The American system is much more fraught with bureaucratic red tape, rules and regulations. It seems designed more to exclude people than to include them. The American system places great emphsis on food security as there are several different nutritional assistance programs. But beyond that there is cash assistance for the truly needy, but probably not at the same level as the Dutch system. There is a hodge podge of various programs in the American system. One must learn to navigate a maze of bureaucracy. The Dutch system is streamlined and straightforward. Medicare in the US is available for the needy but again the rules and regulations seem designed to exclude as many people as they include, and one must navigate a maddening tangle of bureaucratic red tape. In general the simpler the system, the better. Often times people who are in need of help don't have the patience, perseverance or time luxury required to actually qualify for any benefits. The emphasis on food assistance in the American system but paltry benefits for little else bespeaks the notion that the US doesn't want homeless people dying on the streets due to starvation, but other than that, they don't much care if a certain segment of their population lives on the streets. There are, however, similar to the Dutch, incentives for getting back to work and off of social security and SSI assistance. There is not anything as sophisticated as the Dutch system for adjusting the assistance required to the particular level of disability. The US websites provide you with tools for computing your eligibility but not with complete information so that you can make an analysis of eligibility requirements and benefits and compare them with another country's.
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