Democrats Should Campaign for Dutch-Style Health Reforms

Single-payer is too divisive. Many of its objectives can be met with a mixed public-private system.

Dutch girls cycling in Amsterdam, June 13, 2014
Dutch girls cycling in Amsterdam, June 13, 2014 (Shirley de Jong)

The other day, I explained that the reason Americans can’t get a European-style health-care system is not opposition from insurance companies but the fears of 155 million Americans who currently get health insurance through their employers. They worry that a single-payer system, like Britain’s, would mean higher taxes and lower-quality care.

Such fears — largely unfounded — would undoubtedly be amplified by drug companies, health providers and insurance companies if the Democrats campaigned for “Medicare for all”.

So instead of having an abstract, and probably pointless, debate about which health-care system is superior, why not look at what advocates of single-payer hope to achieve and see if this can’t be done without eliminating private insurance?

Four goals

In an op-ed for The New York Times, Senator Bernie Sanders, the driving force behind the single-payer legislation, lists four goals:

  1. Americans should not hesitate about going to the doctor because they do not have enough money.
  2. They should not worry that a hospital stay will bankrupt them or leave them deeply in debt.
  3. They should be able to go to the doctor they want, not just one in a particular network.
  4. They should not have to spend huge amounts of time filling out complicated forms and arguing with insurance companies as to whether or not they have the coverage they expected.

All of this can be achieved within a mixed system of private insurance and government controls.

I know, because it works in the Netherlands.

The Dutch system

  • The Dutch can choose from a variety of private health insurance companies and plans, so long as they get basic coverage.
  • Insurers cannot turn anyone down.
  • Consumers can only switch plans once per year.
  • Half the costs are paid by the consumer to the insurance company in the form of premiums. The other half is paid from payroll taxes.
  • The government sets the yearly maximum co-payment, which is currently equivalent to about three months’ worth of premiums.
  • There are insurance subsidies for low incomes.
  • Insurers can negotiate prices with health providers and charge a premium for care provided outside their network.
  • In most cases, doctors and hospitals will send their bills directly to the insurance company. Patients see little to no paperwork.
  • There are price controls for prescription drugs.

Next step for Democrats

If this sounds familiar to Obamacare, that’s because the Dutch system was one of the templates for the 2010 reforms.

One thing Obamacare didn’t do was sever the tie between employers and insurance. This should be the Democrats’ next step: a gradual shift from employer-sponsored to individual and family plans. Even small-government conservatives and libertarians could support that.

Campaigning for single-payer, by contrast, would be divisive and spook precisely those middle-income Americans Democrats need in order to win back the presidency in 2020.