By Gena Akers
During the last few years, our health care system has undergone several transformations. Now with all the chatter about Medicaid, Medicare, insurance premiums, etc., we are on the brink of another metamorphosis. Unfortunately, even though we know what creature entered the cocoon, it is difficult to tell what will emerge, flapping.
Fortunately, it’s not too late to petition our elected politicians as they make up their minds on our winged national beast.
An article I read over a year ago argued that “Jersey Shore” and other reality TV shows (the more outlandish and drama filled the better) are popular because they confirm our belief that we are in fact better than at least some people. Perhaps this comparison happens only at a superficial level (probably for the best), but there is still something to learn.
This make me wonder: if we get our entertainment from comparing ourselves to others, can we get better national policies by looking closely at comparable countries?
In the United States, health care expenditures account for over 17 percent of our economy. In the Netherlands, that number is 12 percent. Even though they spend less, the Dutch are much healthier on the whole than we are.
Winners on health’s playground arise from balancing cost, care, choice and culture. I won’t delve into that last C, but at a systems level in the Netherlands, every citizen is required to purchase an approved private insurance plan. Insurers must also cover everyone; forget about the phrase “pre-existing conditions.” Citizens pay part, and an income adjusted levy pays part. If people use less than a certain amount of care each year, they get a partial refund.
Why does this system work? Two reasons:
- It’s mandatory. Free-riders are not allowed, therefore no cost shifting.
- Since everyone is insured, insurers have a healthy pool of customers (therefore, more purchasing power with health care providers)
“Well, I’m an American. Don’t compare me to the Dutch.” some might say.
True. But, what we have right now isn’t working so well. Medicaid and Medicare are on the chopping block. Every other day another article is published about our high childhood obesity rate, diabetes rate, heart disease rate.
We may produce most of the world’s prescription drugs and Nobel laureates in medicine, but for John and Jane in the street, that’s not enough.
Though the presidential election is still 13 months away, soon your TV, radio, favorite web-based news site, twitter feed — every place you get your information — will start buzzing with campaign coverage. Don’t be side-tracked by appearances, promises, or who would be more fun to have a beer with. Our health care system has real problems that demand real solutions. Your health deserves to be more than the center of a blame game or the budget line item that saves our economy.
Stay up-to-date on the issues that affect you and your family’s health. If you haven’t already, sign up for our e-newsletter. Contact your elected officials. Tell your friends.
Election or not, it’s time to act now.
Gena Akers is the project coordinator for SanLuisValleyHealth.org, an education and advocacy website dedicated to increasing access to health for all residents in Colorado’s San Luis Valley. SanLuisValleyHealth.org is a project of the San Luis Valley Regional Medical Center and funded through The Colorado Trust.
Readers who find the Dutch model even mildly appealing should head for the Tattered Cover – or their local library – for a copy of T.R. Reid’s “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” It’s the best and most comprehensive look I’ve come across at how health care works in other industrialized countries, virtually all of which, like The Netherlands, have better health care outcomes and at lower cost, than we’ve so far been able to manage here.
It’s not all “socialized,” and it’s not all “nonprofit,” but it IS, on the whole, better than what we currently inflict upon ourselves.
Gena Akers of the San Luis Valley Regional Medical Center writes that requiring people to buy politician-approved health plan “works” because “free-riders are not allowed, therefore no cost-shifting.” This common justification for mandatory insurance (a.k.a., the individual mandate) is flawed at best and misleading at worst.
In Colorado, the cost-shift from the uninsured is just $85 per insured person [1]. An Urban Institute study provides further evidence that uninsured cost-shifting is small — at most “only 1.7% of private insurance premiums” [2]
Mandatory health plans impose a larger cost shift by requiring people to buy plans with benefits they would not otherwise want to pay extra for. The 2010 health control bill requires that all plans include at least ten mandated benefits, such as maternity care and substance abuse treatment (HR 3590, sec. 1302). A typical mandated benefit increases premiums by about 0.75%, concludes a 2008 study by Amanda E. Kowalski of MIT [3].
Oddly, many proponents of mandatory insurance support Medicaid and Medicare, even though they impose large cost shifts — even when not counting the taxes the insured pay to fund these programs. For a family of four, which already pays taxes for Medicare and Medicaid, the cost-shift from them adds $1788 to its annual insurance premiums. So says a 2008 study by the Milliman actuarial firm [4], which concludes that “if there were no cost shift commercial hospital and physician costs would be 15% lower.”
[1] The uninsured cost-shift scam,
http://www.patientpowernow.org/2008/05/uninsured-cost-shift-scam/
[2] Jack Hadley, et al, “Covering the Uninsured in 2008: A Detailed Examination of Current Costsand Sources of Payment, and Incremental Costs of Expanding Coverage,”
http://www.kff.org/uninsured/upload/7809.pdf
[3] “State Health Insurance Regulations and the Price of High-Deductible Policies, http://www.bepress.com/fhep/11/2/8
[4] Hosptial and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid, and Commercial Payers, http://www.publications.milliman.com/research/health-rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf
Perhaps Ms. Akers is unfamiliar with reports Dutch hospitals have been so free with the physician assisted suicide that the elderly are afraid of them.