Letters - Going Dutch - NYTimes.com

Letters - Going Dutch - NYTimes.com:

I didn't post about the original article, it's in my stack of reading material, but i liked the letters, especially the first one here:

"To me as a religious-studies professor and Lutheran minister, the most telling line in Russell Shorto’s article (May 3) was, “This system developed not after Karl Marx, but after Martin Luther and Francis of Assisi.” The last time I taught in the Semester at Sea program, I found it necessary to interpret for our students the rich “social capital” that runs through the Northern European societies we were visiting. What they knew and had read in their guide books was that not many people are in church on Sunday morning, especially compared to the florid religiosity of the United States. So their working assumption was that Americans take religion seriously and Europeans don’t. The new thought that amazed them was that the unchurched Europeans live in social democracies deeply saturated with historic Christian values, while the much-churched Americans celebrate a society characterized by a ruthless social Darwinism that the God of the Bible, Old and New Testament alike, denounces.
DONALD HEINZ
Gig Harbor, Wash."

As to the rest of the letters, particularly the critical ones, I simply say, "OMG, you mean there are trade-offs required? We can't have everything for nothing? Then count me out!"

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The Netherlands - OECD Summary

Summaries of summaries of healthcare systems based on the Commonwealth Fund reports.
Author(s) of the originals are:
Karsten Vrangbaek, Isabelle Durand-Zaleski, Reinhard Busse, Niek Klazinga, Sean Boyle, and Anders Anell

Netherlands
• The Netherlands will be experiencing major changes that began in 2006 due to dissatisfaction with the prior dual system of competing public and private health care.
• All residents are required to buy health insurance.
• Health insurance is "statutory" but provided by private health insurers and regulated under "private law".(?)
• Financing: statutory health insurance, or SHI or public insurance is funded by a 6.5% tax on taxable income up to €30,000. This 6.5% apparently must be reimbursed by the employer however.
• The self-employed pay a 4.4% rate of tax for their insurance on their income.
• The average annual premium as of 2006 was €1050
• The government completely covers children up to age 18.
• "Substitutive" private health insurance was abolished in 2006.
• The statutory health insurance fund distributes risk-adjusted funds to the insurers. These insurers also provide, for a fee, complementary/supplementary insurance. The premiums for these complementary policies are not yet regulated.
• Private insurers may be for-profit but must accept everyone in their geographic area. They are compensated for this by risk adjustment reimbursement by the government.
• 78% of total health care expenditure is public.
• The statutory health insurance covers usual healthcare and includes drugs but does not include routine dental care. The annual deductible is €150 per year.
• Out-of-pocket expenditures account for 8% of the total health expenditure of the Netherlands
• Physicians contract directly or indirectly with insurers. General practitioners income is a combination of capitation and fee-for-service and pay-for-performance is being tried. Specialists are two thirds self-employed even if hospital-based and one third are salaried.
• Hospitals are mostly private but not for profit.
• Cost controls: it sounds like they are working on a version of managed competition though I am not clear on that.

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Health Care System Profiles

Health Care System Profiles:

"The work of the Commonwealth Fund's international program highlights the valuable lessons the U.S. can learn from the health care systems in other industrialized countries. These country profiles provide overviews of the health care systems of several countries, including Denmark, France, Germany, the Netherlands, Sweden, and the U.K. Each profile includes descriptions of how each country organizes, finances, and delivers health services and highlights quality, efficiency, and cost-controlling policy initiatives and reforms"

Follow the link to this page at the Commonwealth Fund website to download individual country profiles or the whole thing.

Here is a remarkable slide presentation from the Commonwealth Fund aggregating in PowerPoint form, a large quantity of data on systems around the world.

Continuing my education in international comparative health policy...

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In Holland, Some See Model For U.S. Health-Care System - WSJ.com

In Holland, Some See Model For U.S. Health-Care System - WSJ.com:

"The Dutch system features two key rules: All adults must buy insurance, and all insurers must offer a policy to anyone who applies, no matter how old or how sick. Those who can't afford to pay the premiums get help from the state, financed by taxes on the well-off."

Sound familiar? Go to the link to see the accompanying graphic comparing the Netherlands, Massechusetts and (proposed) California plans. They are not too different. What is different is the minimum wage in the Netherlands-about 1.8 times ours.

So in order to avoid the pesky problem of deciding among insurance, food, and heating your home, we'd have to do a much better job against low wages and poverty in general. Thiis couldn't happen in most states, but I wonder if California could double its minimum wage and get away with it? Not a lot of egress from california, almost no matter what. So maybe that could be the state to experimant with a mandated living wage and mandated health insurance.

Cheers,

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