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 the reason Americans can’t get a European-style health care is not opposition from health insurers but the fears of 155 million Americans who currently get 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, but not entirely inaccurate; Britain’s National Health Service has a lot of problems — would undoubtedly be amplified by drug companies, health providers and insurance companies if the Democrats campaigned on “Medicare for all”.

So instead of having an abstract, and possibly pointless, debate about the merits of single-payer, why not see if its objectives can be met without eliminating private insurance?

Four goals

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

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

All of this can be done in 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 different 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 doctors and hospitals 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 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.