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Getting Health Care Right

When conservative opponents of health care reform aren’t talking about death panels, they’re talking about Europe. Their argument usually goes something like this: The Affordable Care Act will make our health care system like more like the ones across the Atlantic. And that would be bad: People will wait longer for treatments, pay more for it, and/or get inferior results.

Reality is, well, a little different. And I have some first-hand perspectives on this. A few years ago, I began a series of reporting trips abroad, to see upclose what health care is like in some of the better known European countries. I’ve sprinkled some of the findings into my previous writing. But now the Commonwealth Fund, which financed these trips, is publishing a series of extended blog posts about the different countries.

Up first is the Netherlands:

Of all the countries in Europe and, perhaps, the world, the Dutch health care system most closely resembles what architects of the Affordable Care Act hope to create for the U.S. The primary source of coverage for individuals in the Netherlands is private insurance, made available to all people, regardless of preexisting medical condition, through a highly regulated marketplace. In order to avoid adverse selection and promote universal coverage, the Netherlands has an individual mandate—a requirement that each person obtain insurance. In order to make that mandate work, and prevent hardship on people of lesser economic means, the Dutch government makes available subsidies on a sliding economic scale.
Like the Americans, the Dutch reorganized their health care system relatively recently—in 2006, when the government abandoned a prior system that combined a mandatory, government-run insurance program for lower income groups (about two-thirds of the population) with private insurance for everybody else. And, as in the U.S., a major goal of the restructuring was to create a market in which consumer pressure forced insurers to compete for business, promoting better quality at lower costs. These similarities are not entirely coincidental. American public officials, health industry leaders, and scholars made frequent visits to the Netherlands in the run-up to the debate over U.S. health care reform, borrowing ideas and, on occasion, citing the Dutch system as a model for what the U.S. might achieve.
The Dutch system is worthy of such attention: It provides virtually everybody with high-quality and convenient medical care, and at a much cheaper price than the U.S. system—per capita health spending in the Netherlands in 2009 was only $4,914, compared with $7,960 in the U.S. As Americans move from debating health care reform to implementing it, they would be wise to keep studying the Dutch system. But Americans should pay close attention to what the Dutch have done—and, more important, what they haven't done. Although the 2006 reforms expanded the role of market forces in health care, at least by European standards, it's not as if the Dutch have abandoned the basic principles of social insurance or been content to let the free market run amok. On the contrary, government in the Netherlands continues to play a central role in health care, both as financier and regulator. Recreating something that achieves the strong record of Dutch health care in the U.S. would likely require expanding government's reach into health care, even beyond the expansion under way as part of the Affordable Care Act.

The Commonwealth Fund's website has the full entry, along with the foundation's extensive library of research on health systems abroad. More blog installments to follow soon.