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.
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