Passing health care reform by mattsteinglass
July 26, 2009, 11:56 am
Filed under: Health

I must confess that I’ve found it increasingly difficult to follow the intricacies of the health care reform debate in the US over the past two months as it’s moved through Congress. (I think I’m for putting Medicare compensation rates in the hands of an independent agency rather than Congress, but since Henry Waxman is against it and the Blue Dogs are for it I feel I may be missing something; in any case it’s clear that without being based in Washington I can’t follow the details closely enough.) But I still think it worthwhile to keep posting occasionally based on my personal experience of European health insurance and health care systems.

The system the US is going to end up with if the current House bill becomes law will look something like the system in the Netherlands: a combination of private insurance plans sometimes linked to one’s employer, a public plan, a mandate that everyone must purchase health insurance, and a mix of public and private health care providers (doctors and hospitals). When I moved from the US to the Netherlands in 1999, I switched from an American HMO to a Dutch health insurance plan. In both cases I was buying insurance as an individual on the private market. My premiums dropped 75%, from somewhere over $2000 a year to a little over $500. During the course of the following year and half, I visited a private-practice primary care doctor three times, which was about three times as often as I visited one in the US. On each occasion I saw the doctor the day I called with no appointment. The cost was somewhere between $25 and $50 per visit, I can’t remember the exact figure. The doctor’s office was a spiffy one located in a gorgeous canal house in the center of Amsterdam.

Since leaving the Netherlands to live in first Togo and now Vietnam, our family health insurance plan has come through private insurers paid by my wife’s jobs. Our current plan is with a company headquartered in the Netherlands and, because my wife is Dutch and works for a Dutch employer, functions within that framework. It initially gave us global coverage everywhere in the world except for two countries where health care costs are so far out of line with the rest of the planet that they demanded a higher premium for coverage there. Those two countries were Switzerland and the United States, which also happen to have the most deregulated and private-sector-oriented health insurance systems in the developed world.

Because we spend several weeks each year in the US and didn’t want to run the risk of bankrupting ourselves in case of an accident, we eventually kicked in the higher premiums to get coverage in the US as well. Our coverage includes full reimbursement for all doctors’ visits and prescription medicine, major dental, the occasional pair of eyeglasses, and various other routine expenses that actually entail rather perverse incentives and perhaps shouldn’t be included in insurance plans if one wants to hold costs down. While on this plan, we have had two children in Dutch hospitals. We have had one very serious medical intervention in which my then 9-month-old son had to be medevac’d from Hanoi to Bangkok for a life-threatening respiratory infection. We have had one other hospital visit and minor operation for him, and various other significant expenses. The cost of our all-embracing gold-plated global coverage is in the range of 6000 euro per year for our family of four — currently about 70% of the average cost of family health insurance in the US. That’s at the historically high level of 1.4 dollars to the euro. If the dollar regains any strength against the euro, the plan will look even cheaper.

At some level, I’m not sure why I care whether the US finally gets a sane health insurance system. If people who live in the US want to waste 5% of their annual income on a full employment program for health insurance company call center workers and pharmaceuticals executives’ golf course memberships, that’s their prerogative. But my passport says “United States of America”, I vote in the State of New York, and to make a long story short, it’s my country and I love it. The insanity of the US’s health insurance system, and the inability of the US’s political system to get a handle on problems caused by corporate interests that run against the public welfare, is wrecking the government’s budget and rendering the country unable to act on issues of global urgency. The US needs that money to fight climate change and to fund development aid in Afghanistan. And more broadly, I don’t like it when people from other countries consider my country stupid, and are right about it. It feels much better having a president who people from other countries respect. It’d be nice if on this issue too, when people from Vietnam asked how health insurance works in the US, I could explain it to them as a positive model, not as a warning of how not to do things.


9 Comments so far
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Well, it’s good to read that one such as you finds the whole matter confusing. Lord! I listen and I read and I listen and I read and my head spins. I don’t understand why it’s so convoluted. People say because insurance is BIG money….that’s why. I love knowing that in other countries there is effective health care. I’ve experienced it on a tiny scale in Europe once and I’ve had friends who have lived it more in the realm you and your family have.

Hopefully, slowly (better if swiftly…but…) something better for All will come to roost here in the US.

I’m glad your son is okay! 🙂

Comment by Forrester McLeod

According to the CBO, the overall spending on health care will increase (not decrease as you imply to “to fight climate change and to fund development aid in Afghanistan”) if the House plan is passed.

The money is in the global security budget which rings in at $800 billion a year and which you are loathe to talk about.

Comment by Frank

I’m loth to spell it “loathe” because that implies that one loathes to talk about it, which is not at all true. “Loathe” is listed as a variant spelling on M-W online but, correctly in my view, does not list it at all; the options are “loth” or “loath”. “You are loathe to” is to my eye every bit as erroneous as “lynchpin” or “give free reign”.

I also reject the contention that I’m loth to talk about it! Hooray for the death of the F-22, and down with missile defense and carrier battle groups. Satisfied?

Comment by mattsteinglass

Hey, great job of filibustering!

What did we save on discontinuing or pausing the F-22 program? According to Chris Dodd, it was $1.75 billion. And that was already accounted for in an official DOD budget that increased 4% from the previous year.

Most of the DOD budget goes to personnel costs, so you aren’t going to cut the defense budget unless you cut back on the number of people in the military – and that means reducing troops around the world and especially in Europe. Cutting weapons systems won’t get you there.

How about having the average American spend the same on military as the average European does so that the additional health care costs you are talking about can be covered with DOD budget cuts alone?

Comment by Frank

Frank, the per-plane flyaway cost of the F-22 is $140 million. The DDX and FCS programs are also in the tens of billions – there’s definitely more that can be cut.

Currently the US government disposes of about 41% of GDP, as compared to about 45% for the UK and 45.5% for the Netherlands. Total healthcare (public and private) spending in the US is about 15% of GDP as compared to 8% in the UK and 9% in the Netherlands. The fact is that were it possible for the US government to introduce a healthcare system comparable to either of these countries hey would create an eventual saving of about 5% of GDP.

We’ve spoken before about the accusation that high US spending on pharmaceuticals R&D subsidises European spending. So far no data I’ve seen actually supports this, and everything I’ve seen suggests that it is not true. In this survey of top eight pharmaceuticals R&D spending companies ( ) three are American, two are Swiss, two are British, and one is French. When you dig into the statistics you find that much of this private expenditure is not actually productive but spent on ‘evergreening’ (that is, modifying currently existing pharmaceuticals in a minor way so as retain patent coverage) in an effort to block generics. AstraZeneca’s attempts at ever-greening its world-wide best-selling pharmaceutical Losec/Prilosec are a classic example of this.

Comment by FOARP

1) Overall health care spending in the USA is 17% – 19% of GDP – not 15%.

2) The issue is additional spending on the F-22 which according to Dodd is $1.75 billion. That is what was stopped by Congress and that is what the debate was all about.

3) The global security budget is $800 billion a year. We don’t need one troop in Bosnia or Kosovo or the rest of Europe for that matter. This budget won’t be cut unless there is a large pull back in American “responsiblities” around the world.

Comment by Frank

1) Depends which figures you use, but anyway you add it up, Americans spend way more but receive way less.

2) + 3) None of which really has that much to do with healthcare, except that America can afford to save money in the area of defence.

Comment by FOARP

The intricacies are certainly hard to follow. The major points are not, it seems to me.

In general, Americans are proud of the VA healthcare system, and support Medicaid and Medicare. Then, something funny happens to their thinking and they get scared of change. Its not about what the rest of the budget goes to. Its about waste and inequality. Massive, massive amounts of waste – administrative waste, productivity waste due to illness, life/health wasted in less measurable ways.

I often wonder whether or not I think Healthcare is a basic right, or just a really, really, really good idea. Im not sure. But I definitely agree with Hertzberg (New Yorker) that we are all born with a “pre-existing medical condition: mortality” and so the playing field should be more level than it is.

Comment by Joanna

Great Article. I believe health insurance should be available to everyone. I built a great website to help people find affordable health insurance.

Comment by bryan sam

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