|
Type |
% of GDP |
Per Capita Cost |
Australia |
2-tier |
9.6% |
$ 4,798 |
Canada |
single |
10.6% |
$4,752.00 |
France |
2-tier |
11.0% |
$4,600.00 |
Germany |
mandate |
11.3% |
$5,550.00 |
Netherlands |
mandate |
13.3% |
$5,691.00 |
Switzerland |
mandate |
12.4% |
$7,919.00 |
UK |
single |
9.7% |
$ 4,193 |
US |
private |
18.0% |
$9,892.00 |
The Dutch total healthcare system is operated according to four basic related healthcare Acts: the 2006 Health Insurance Act, the Long-Term Act, the Social Support Act, and the Youth Act. The Health Insurance Act is the Dutch comprehensive Basic Healthcare Insurance package required for All and administered by private insurers.
I believe a credible variation to Sanders’ Medicare for All without insurers is a Medicare Basic Healthcare Option” (MBHO) for All. This would be a standard healthcare package contractually competed for by insurers, sold to the public and administered by private insurers. I see this approach, or some variation thereof, as a potential credible alternative to Sanders’ Medicare for All without insurers. The MBHO insurance plan is similar to the Dutch mandatory Basic Plan for All with one Big exception – it’s optional. It would be a marked improvement on Obama’s healthcare plan option which has been made worse by the Trump Administration’s changes. Despite that and other obvious weaknesses in Obamacare, millions of Americans are very thankful Obama’s plan is alive and doing well.
The Dutch Basic Healthcare Plan for ALL, a ‘radical reform’ that took place with passage of the 2006 Health Insurance Act, has following key policy principles:
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Access to quality, affordable Basic healthcare has no preconditions.
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Standardization of a Basic coverage package is government set and required for All for comprehensive short-term medical services, hospital care and prescribed medications - vastly improving efficiency, quality and lowering system administrative costs.
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Focuses healthcare policy on managed competition given the inherently imperfectly competitive nature of healthcare markets
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The Health Insurance Act entitles all residents to a comprehensive Basic standard health insurance package at a standard premium/deductible cost – implemented by private, competitive health insurers and healthcare providers where quality, price, coverage are government oversight-controlled.
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Insurance firms offering the Basic plan are not-for-profit cooperatives; profits made on the standard Basic plan are allocated to the reserves or they are returned in the form of stable, if not lower, premiums. Hospitals are also generally non-profit entities.
The Dutch hospital market has gotten increasingly concentrated through mergers the past few decades. Competition can lead to much-improved efficiencies, quality and accessibility if adequate alternatives are available to consumers and/or insurers. But studies have shown that on-going, unstoppable hospital consolidation enhances hospitals’ market power. That can undermine the objective of introducing more competition into the market. That’s why Dutch government policy focuses on regulating the hospital market and insurers, while also simultaneously introducing incentives for competition between providers and insurers.
In conclusion, I don’t see why a practical scale variation of the Dutch (or Canadian) universal public-private healthcare models cannot be achieved in our country by MEDICARE BASIC HEALTHCARE OPTION. If structured well, over time such a plan could potentially vastly improve our comparatively exceptionally inefficient, costly, poor coverage, non-standard healthcare system.
This Medicare Basic Healthcare Option (MBHO) would encompass following key policies:
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A Basic standard optional insurance plan for All with no preconditions. The standard coverage package would be defined and set by Medicare.
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Upgrades ‘not covered by the Basic Option would be the primary responsibility of insurers with oversight control by Medicare.
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A standard national premium structure would be set for the Basic Option that is adjusted on a regional basis up or down by an average income and/or cost-of-living index.
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The standard premium for low income people would be subsidized by Medicare.
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Medicare would be the chief purchasing agent and awarder of regional contracts to providers/insurers who meet MBHO provisions on access, price, quality, medical services, hospital care, prescribed medications available to All who choose the Basic Option.
It’s incredible how talented and advanced our nation is in its medical research, in our precision-reaching of a planet millions of miles away, in our landing of a missile within one meter of the target thousands of miles away.
BUT, here we are … unable to come together on a quality, cost-effective, affordable Basic healthcare system for all our citizens! The Netherlands’ standard Basic Plan system for All is simple, with good coverage at a reasonable annual premium cost for every individual age 18 and above of $1,630 (euro 1,440) and the deductible is $435 (euro 385). This compares to a much higher U.S. average individual insurance cost … and for less coverage. Also there are no co-pays in the Netherlands on the Basic plan while they are considerable in the US.
I think Sanders’ single-payer Medicare Plan without insurers is the right thing given our deeply sick, complex, for-profit healthcare system. Unfortunately, this ideal solution appears to be politically impossible. Apparently it’s too big a step; there’s simply much resistance by many people who do not want their healthcare insurance plan changed. If the U.S. healthcare insurers and hospitals were mainly non-profit entities as is the case in the Netherlands, this resistance might disappear. Perhaps in this situation, Biden’s solution to seriously repair Obamacare is a credible first step - providing substantive changes are indeed made along lines, for example, of incorporating some of the best parts of Holland’s radically reformed 2006 standard Basic healthcare system.
Potentially considerable cost and quality improvements from a Medicare Basic Healthcare Option that standardizes quality, coverage and affordable prices for All. This would encourage more and more people of all income levels to eventually go for the Medicare Basic Healthcare Option. This in turn will expand opportunities to further improve provider purchase costs, coverage and quality. It’s important to note that Holland’s universal Basic Healthcare plan package covers at least 80% of all possible short-term medical services and prescription drugs needed for people of all income levels and health conditions. Upgrades like physical therapy or cosmetic surgery can be purchased direct from insurers at an adjusted premium.
The U.S. battle is between Sanders’ universal single-payer solution without the high profit-making insurers and Biden’s serious repair solution to Obamacare working in cooperation with insurers and local communities in establishing a national standard Medicare Basic Healthcare Option. Even Canada’s so-called single-payer system works well with insurers who come up with market prices for good coverages that don’t vary wildly among provinces at a very competitive premium-deductible cost per individual or family that’s one-half the cost of a typical U.S. insurer.
We are buried in a brutally polarized political system – that’s demonstrating an outright deplorable incompetence in creating and playing politics with an insanely costly, poor standard coverage, super complex national healthcare system. The system is shamefully the most costly for less coverage compared to European systems and systems of economically advanced nations like Japan and Australia.
We could learn a lot from the quality, comprehensive medical coverage and affordability of the Netherlands’ standard Basic healthcare insurance package required for ALL … and generally approved by all citizens. I would say the same about Germany’s or UK’s, or Canada’s healthcare systems or any of the Scandinavian country systems. We Americans think we know it all … but we don’t, especially when it comes to the development and management of humanly fundamental social protection legislation for all Americans.