Universal Mandatory Health Insurance In The Netherlands: A Model For The United States?

[mzmolly]

Wynand P.M.M. van de Ven and Frederik T. Schut

http://content.healthaffairs.org/cgi/content/abstract/27/3/771?ijkey=DsTX9syExLZLc&keytype=ref&siteid=healthaff">HEALTHAFFAIRS.ORG

Policy analysts consider the Netherlands health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual health insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with health care providers. Subsidies make health insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the health insurance market. The challenge is now to successfully reform the market for the provision of health care.

Interesting to note, the Netherlands ranks above Canada in Health Care according to the WHO: http://www.photius.com/rankings/healthranks.html

Dean specifically mentioned the Netherlands as a model of successful use of private insurance to provide universal health care. Seems to me the US just took a leap in this direction?

[brentspeak]

1. For-profit insurance is illegal in the Netherlands

just as it is everywhere else where a mandate exists -- excepting the United States, of course.

You are therefore comparing Heaven to Hell.

[mzmolly]

9. I'm saying this is simply a START.

:hi:

[brentspeak]

20. No, it's an end

Obama has stated that he wants to be the last American president to tackle health care reform. He has no intention to revisit any of this after the corporate giveaway is signed into law.

[mzmolly]

28. Obama said he wants to be the first to succeed.

Not the last to ever touch the issue.

[Political Heretic]

41. Oh my god.. WRONG WRONG WRONG WRONG WRONG WRONG.

You are like... always wrong.

QUOTE: "I am not the first President to take up this cause, but I am determined to be the last. "

http://www.whitehouse.gov/the_press_office/remarks-by-the-president-to-a-joint-session-of-congress-on-health-care/

Maybe you should just stop talking for a while.

[mzmolly]

48. LOL

Talk about spin. The last to attempt a solution, to get it done so to speak, not the last to ever touch the damn subject.

Night...

[Political Heretic]

55. "LAST TO TAKE UP THE CAUSE" Who's spinning now?

Last to take up the cause.

Last to take up the cause.

Last to take up the cause.

Last to take up the cause.

[mzmolly]

60. Desperate

much?

Obama will work to improve current legislation as needed and he will not control future Presidents.

[Political Heretic]

62. There's nothing desperate about telling the truth.

You said "Obama never said he wanted to be the last person to work on the issue."

Obama said "I will be the last to take up the cause."

You are wrong.

It's not a big deal. People make mistakes all the time. What's humorous though is your steadfast refusal to acknowledge it. Even in the face of a direct quote.

Obama did say he wanted to be the last President to take up the cause of health care. And that's not that big of a deal, maybe he could have chosen words for his speech more carefully or something - whatever. But he did say it. For you to say "no he didn't" when look, there it is - right in the transcript - is what's so silly.

[mzmolly]

65. But you're not. What I said was Obama did not say that he'd be the last to "EVER TOUCH THE ISSUE."

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7288743&mesg_id=7303199

To suggest that Obama has some cosmic control that sets this bill in stone is absurd. Even for you.

[Political Heretic]

69. "I was not the first president to take up the cause, but I will be the last" - what does that mean?

I'm just curious.

[mzmolly]

75. I would imagine you actually know what that means?

Here's a bit of context for you in case you're not simply feigning ignorance:

http://www.mediaite.com/online/i-am-not-the-first-president-to-take-up-this-cause-but-i-am-determined-to-be-the-last/

I am not the first President to take up this cause, but I am determined to be the last. (Applause.) It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session. (Applause.)

Our collective failure to meet this challenge — year after year, decade after decade — has led us to the breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can’t get insurance on the job. Others are self-employed, and can’t afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or too expensive to cover.

We are the only democracy — the only advanced democracy on Earth — the only wealthy nation — that allows such hardship for millions of its people. There are now more than 30 million American citizens who cannot get coverage. In just a two-year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care. It happens every day.

[Political Heretic]

77. Where does he say that he is not determined to be the last president ot take up the cause?

After saying that he was determined to be the last president to take up the cause.

And I'm asking you for a simple interpretation of english: what does the sentence "I am not the first President to take up the cause, but I am determined to be the last" mean in plain english?

Here's the simple truth: he said a tough line because it was a speech designed to motivate and encourage people to keep fighting the tough fight. It's not some terrible indictment that he said it. It's silly to use that statement as some sort of a "gotcha" against Obama. It was a speech, some rhetorical flourish, and it wasn't the most carefully thought through thing he's ever said.

It's not some sort of magic "ah ha" that critics should use to criticize the man, because that's just silly. But guess what, he did say it. And it means what it means. And you look ridiculous trying to spin your way out of it. He said it, it wasn't a big deal, but it was a little poorly chosen as Obama will probably not be the last president to take up this cause if this is the kind of bill he chooses to sign.

He said he wanted to be the last president to take up the cause of health care. There's no what you can spin that to mean anything else than what it simply quite literally says. Just own up to it but then rightfully tell people making some big deal out of it that they are being fools.

I'm not making a big deal out of the fact that he said it in a motivational speech - I'm making a big deal out of the fact that you are so blindly devoted to advocating for a person or position that you won't even admit to basic facts.

Sad and really scary to me.

[mzmolly]

79. What it means is he's going to get it done. It does not mean we are not

EVER going to improve upon the foundation.

I have actually evolved on this issue. I am not a blind devotee simply because I disagree with the cynics among us.

[Political Heretic]

86. You're interpretation of his meaning is irrelevant. What did he say?

[mzmolly]

88. Give it up.

It's a dead in the water argument, dude.

Cheers. :hi:

[Political Heretic]

90. There's nothing to give up when you have verbatim word-for-word transcript on your side.

Pretty easy.

[mzmolly]

99. Agreed.

:hi:

[dflprincess]

82. "Obama will work to improve current legislation "

yeah, like he's been working so hard to get real reform passed to begin with.

[mzmolly]

83. I think he HAS worked

hard.

[Political Heretic]

87. Based on what evidence?

[mzmolly]

100. Based upon numerous appearances

and speeches, reiterating the desire for a public option, among other things. You, of course are free to disagree.

[Political Heretic]

103. But don't you think that's more for the benefit of the public?

I'm not sure what that has to do with "working" for reform or being involved in the process of shaping legislation? Seems like rhetoric and not direct involvement, to me.

[mzmolly]

105. I think that does involve work

yes. Of course my example was not all encompassing.

[Political Heretic]

107. Well fair enough. I think he could have and should have been more involved.

[mzmolly]

111. I honestly

don't believe we yet know how involved he is/was, just yet?

[laughingliberal]

108. Already covered in the responses but let me just emphasize

This is NOT the Netherlands model. Nor is it the Swiss model. They may well use private industry as the base of their systems but they are not for-profit and they are HIGHLY regulated and not with a few ambiguous regulations with loopholes you can drive a semi through.

[mzmolly]

110. Please read my responses

to this point as well.

Happy Holidays. :hi:

[mcablue]

30. Well, did the Netherlands mandate START with a for-profit system?

Or was the non-profit system there the first day the mandate was implemented?

[mzmolly]

33. Yes, and it's still a profit driven

system to my understanding? That said, it's heavily regulated.

[Political Heretic]

37. No, it's not.

[mzmolly]

46. Yes it is.

The profit margins are low (5%) but they exist.

[Political Heretic]

56. No...... It is not.

It is not profit driven.

[mzmolly]

61. The Dutch system allows for a 5% profit margin,

ours allows for 10% ala the Rockefeller amendment. If you want to feign that this alone makes for a vast difference, be my guest.

[Political Heretic]

64. That's not the only reason why its not profit driven.

The difference between our profit margins and there's is not the only factor of why there system is not profit driven while ours is.

The other reasons would include comprehensive requirements on coverage and thorough, loop-hole free, strict regulation so dramatic that it practically looks like a completely different system from what we have here in the untied states.

[mzmolly]

66. Uh huh.

As I've said this bill is a beginning. You can feign otherwise if you choose, just don't ask me to join you.

[Political Heretic]

70. I didn't say anything about the bill. I said the Dutch system is not profit driven.

Because it isn't.

But since you mentioned the bill, tragically I believe the bill will not be a beginning. Rather I believe it will actively make things worse for millions of Americans in the long run, and further cripple our already failing system. I believe it will force us back to the drawing board again in another decade after wasting trillions on this corporate giveaway.

[mzmolly]

80. I have to say, I don't consider you an expert on the

Dutch system.

[Political Heretic]

89. How would you know?

:shrug:

[mzmolly]

101. Based upon

your incorrect assertions here.

[Phoebe Loosinhouse]

97. It's my understanding the 90% ratio in the Rockefeller amendment got whittled down to

80 in Harry Reid's manager's amendment. What the final ratio will be I guess will be determined in conference reconciliation. If I had to predict I would go with old Harry's numbers preserving the insurance company profits.

[mzmolly]

102. It was reinstated which is why Dean said he could support the bill

going to conference.

[laughingliberal]

112. It stands at 85% which is the level at which Wendall Potter stated the industry

feels they can most find the wiggle room to manipulate the accounting. He also said he knows of no one in the federal government, no agency, no person with a knowledge base to police this adequately. And that is IF they had even put a mechanism for enforcement in place, which they didn't.

[mzmolly]

114. It stands at 90%

as of late.

Though I like Wendel Potter and I hope he'll be a consultant on continuing reform.

[laughingliberal]

120. No. The OMB came back when it was at 90 and said that would amount to nationalization of the system

and it was whittled to 85%. Or did they change it yesterday?

[mzmolly]

121. They reinstated the amendment in question, within the past week according to Dean.

He said the reinstatement of the Rockefeller/Franken amendment made it possible for him to support the bill getting through the Senate.

http://franken.senate.gov/press/?page=release&release_item=Franken_Rockefeller_Introduce_Health_Reform_Amendment_to_Ensure_Value_For_Premiums

"Currently, Minnesota’s non-profit plans lead the nation in keeping administrative costs low, spending 91 cents of every premium dollar on actual health services. This amendment would set a 90 percent standard on insurance companies nationwide, allowing only the remaining portion to be spent on administrative costs, marketing campaigns, and profits."

[laughingliberal]

122. As of the evening of the 22nd, it stood at 85%. Wendall Potter was on with Lawrence O'Donnell

talking about it. Unless they changed it yesterday it is at 85%. The press release is from 12/4. The OMB knocked the 90% down saying it would amount to a nationalization of the system. Dean may see this as justification for allowing the bill to move to conference instead of killing it outright but I do not believe he or anyone else who sees the damage this bill will do is in favor of final passage unless some real change is made in conference. We are hanging on a thin thread of hope that some shred of progressivity can be added back but I don't think anyone expects it.

I'm sorry we don't agree here. But I worked in healthcare for many years. The pitfalls here are far worse than most imagine. And I am backed up in what I think I believe I am seeing here every time Mr. Potter speaks on it. More than anyone in this entire debate, he has the credibility on the issue. He came from the belly of this beast for no reason other than conscience. His own self interest would have been served by remaining in an extremely lucrative position and continuing to write the propaganda for the industry. The gravest problems with our current system were ignored or made worse. I wish this were not the case.

[mzmolly]

123. Dean was clear that the amendment in question was reinstated a couple of days ago.

We'll have to wait and see who's up on the latest? I know Dean is in contact with legislators, not sure about Potter?

People in health care disagree on this issue, like most Americans?

I do think Potter is an important voice, and I hope we'll continue to hear from him. I also support those who advocate for a stronger bill, including yourself.

Peace and Happy Holidays, I'm off to celebrate with family. :hi:

[laughingliberal]

124. The amendment was reinstated. It had been completely removed

It was reinstated at the lower figure of 85%.


Happy Holiday to you and your family

[Cessna Invesco Palin]

23. That is simply not true.

For-profit insurance is completely legal in the Netherlands.

[Political Heretic]

36. That is simply not true.

sorry. :shrug:

[Jeff In Milwaukee]

67. It's also legal in Switzerland

Another country with mandated health insurance. Their system has a basic level of insurance that is provided on a not-for-profit basis, but companies can then sell enhanced covered (Cadillac Plans - but I'm betting they don't call them that) for a profit.

And a simple Google search will confirm that for-profit health insurance companies exist in the Netherlands, as well. From a white paper produced by The Commonwealth Fund:

"The Netherlands operates a national insurance market for its 16 million residents. Plans may operate on a for-profit or nonprofit basis. The insurance market is highly concentrated, with the top five plans accounting for 82 percent of enrollment. Plans typically offer coverage in all areas of the country and include all providers, although selective contracting is allowed. Children are covered in full through public funds. Premiums charged for adults represent 50 percent of the expected annual costs. In addition, plans receive allotments from a national risk equalization fund, financed by income-related contributions. The allocation uses a sophisticated range of risk factors. As a result of this process, the premiums facing Dutch adults when selecting a plan vary within a narrow range."

[Political Heretic]

76. See the exchange right above this one to understand what I'm talking about.

I shouldn't have written flippantly back and said "its not true," but my point is that it isn't legal like it is here, and its not profit "driven" like it is here, and corporations aren't considered persons under the law like it is here - so the entire definition of what is "legal" over there is completely, totally different than what we have here. The Private insurance we have here would be illegal over there. There is no comparison.

That's what I should have taken the time to say.

[mzmolly]

78. I'm sorry, but you can't redefine "legal"

to suit your own definition of the word.

[Political Heretic]

84. No, but individiual countries can and do define "legal" to suit their own definition of the word.

First, about my post - apparently unlike you I can say, whoopse yeah, shouldn't have said that.

And to be even more clear - yes, I concede it is legal in the netherlands. I was wrong to make the post I made. Now, separate from that - its "legality" there is so completely totally different than our insurance system here that there's no comparison to be made. Their laws are completely different from ours. In order for our health care system or the HRC bill changes to look anything like their system we would require massive, sweeping changes to multiple laws including tax code laws, laws about corporate person hood and rights, regulator laws, changes to criminal penalties as well was changes to laws about campaign financing.

If we were to do all that, then YES we could have a partnership between state, private for profit and private non profit enterprises and have it work potentially very well.

But we're not doing all of that. So there is zero comparison to be made.


Now, I admit my previous flippant post was wrong. I was feeling too lazy to write something longer. But, hey I said it so I gotta own it. Because that's what I want to do when I make a mistake. How about you? Instead you redefine the word "cause" and refuse to acknowledge any sort of error no matter how ridiculous and silly you look.

[mzmolly]

106. When I say something I shouldn't have said

I'll be the first to admit it. ;)

Again, we'll agree to disagree on the notion of a comparison.

[mcablue]

29. There is also drug importation in the Netherlands

Not here. We killed it.

[mzmolly]

49. Yes we did. Obama is supposedly going to work on getting that into the final legislation,

we shall see.

[FormerDittoHead]

2. What's that? Other countries don't all use private insurance?

Geeze, I didn't KNOW we could look at other countries as models for working health systems! :sarcasm:

What? Their systems produce better results at lower costs? :sarcasm:

What? Not a single country which has turned their health system public has any intention of going back to private? :sarcasm:

Sarcasm off.

Just about every other country in the world (that you'd want live in) has better, cheaper health care than we do, and they cover everyone.

We already knew that, thanks.

[kenny blankenship]

3. The Dutch system is 4 years old. Any success it has owes to decades of FULL regulation

66% of Dutch households have govt subsidy to buy health insurance - on top of other subsidies for housing, food.

I find that misleading comparisons most often come from people who intend to mislead. Some are just stupid, but most have the intent to deceive.

[mzmolly]

8. Who's intent to deceive? Mine? Deans?

The article authors, in 2006?

Regarding regulation and subsidies, there's no reason we can't reach the same goals. I have no idea what percentage the government will subsidize here. But, given the threshold is about 88K (right?) I think we'll do better than 60%.

[Sebastian Doyle]

4. Three things would need to happen before you could fairly compare it to the Dutch system

1) Insurance companies would have to be non profit, by law.

2) Insurance companies would need to be tightly regulated.

3) Pot would be legal so we could all go to the coffee shop, get high, and forget about how the corporations are fucking us.

[mzmolly]

6. I'm for all three!

;) And, I don't smoke pot, but I'm fine with you doing so.

I think we could be well on our way to #'s 1 and 2, however?

[Sebastian Doyle]

11. The same corporatists in congress who allowed the insurance lobbyists to write a "reform" bill

aren't about to regulate that corrupt industry?

As for legalizing pot.... that's mostly corporate involvement there too, from big pharma, but aside from that, it's about the overall potential of the hemp plant (and corporations who would lose money from that) than it is just the green bud variety.

[mzmolly]

16. One step

at a time my friend. That said, I'm about to call my house rep and tell her to fight for the public option. I think we can do even better than the Netherlands, ultimately. ;)

[kirby]

5. But our Tax dollar subsidize the Insurance Co Profits...

"For some, healthcare in the Netherlands has become more expensive as a result of the changes. The Dutch government compensates these cases by offering a care grant ( zorgtoeslag). The Tax Administration ( belastingdienst) determines if you are eligible by examining your income. Foreigners are also entitled to this grant if they qualify."

Source: http://www.justlanded.com/english/Netherlands/Netherlands-Guide/Health/Healthcare

Personally, I just do not see what value is added by the insurance company paper pushers.

[mzmolly]

7. I think we're headed in

this direction, and it's a good system according to the WHO.

I think the value in keeping the industry in place is that we're maintaining jobs, and they're already established. JMHO

[kirby]

12. But they are useless jobs...

Why maintain jobs that are inefficient and useless?

If I passed a law that required everyone to submit their DU posts to a third-party to key them in and press the submit button, well that maintain jobs but adds nothing!

And I doubt the WHO made a recommendation that this is a good system. They release statistics related to outcomes, but not endorsements.

[mzmolly]

15. We need

more jobs, period.

I don't know that the WHO endorses various systems, but the rankings are pretty clear. Dean mentioned Switzerland as a country that uses private insurance co.s as well, which ranks just under the Netherlands.

[Selatius]

51. But the WHO rankings were published years before privatization in the Netherlands.

The current system that the Netherlands has is less than five years old, yet the rankings the WHO did came out in 2000.

You're neglecting the timeframe in the WHO rankings.

[mzmolly]

52. But the current system improved upon the previous.

"Prior to 2006 (and since 1941) there were two separate systems of (short-term) health insurance: public and private. The public insurance system was executed by non-profit "health funds", and financed by premiums taken directly out of the wages (together with income taxes). Everyone earning less than a certain threshold income could make use of the public insurance system. However, anyone with income over that threshold was obliged to have private insurance instead.<2>."

http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

[Selatius]

96. See post 95. nt

[Doctor_J]

25. You need a sarcasm tag on this insipid post

"Let's keep a few million Americans without health care because some profiteering bureaucrats might lose thier jobs".

:wtf:

If we had national health care, millions of entrepenuers would be able to leave their corporate jobs and create an economic boom the likes of which the country has never seen. Millions of creative people are stuck in their corporations because of health care.

If I didn't know you better, mm, I would say you've been listening to Limpballs.

[mzmolly]

26. I'm sorry

who the hell said that we should keep Americans without health care?

I actually support a single payer system.

In my response I simply pointed out the rationale for working within the current system. Further, I'd like to see EVERYONE covered via subsidies or by any means necessary.

[LeftishBrit]

10. I was in the Netherlands in August...

and was informed by a Dutch woman who had recently spent time in America that the system was:

(1) Significantly worse than pre-2006 when there was much less private company involvement

(2) A whole lot better than the situation in America.

[mzmolly]

19. Very interesting.

Thanks. :hi:

[kirby]

22. One survey

said only 42% of the people in the Netherlands were satisfied with their health care system.

[mzmolly]

32. EEK!

Do you have a link?

[Bluenorthwest]

13. But their Insurance Companies are non profit when dealing with

basic health care by law. Here, the law demands that we pay their profits. It is the opposite of the Dutch system.
You are comparing apples and turds.
And my Dutch friends liked their system better before 06, their current system is that new. You left that part out, about it being a new system.

[mzmolly]

17. We're beginning to limit profits

with the new legislation. I don't think they're entirely non-profit, but profits are limited as they are with utility companies?

[OHdem10]

14. The government in the Scandinavian countries treat Insurance Cos as

public utilities. This makes a big difference. Our Insurance
Companies are independent for profit businesses.

[mzmolly]

18. My point

is that we may be moving in this direction.

[Hannah Bell]

21. lol.

[Doctor_J]

24. THere are lots of models in Europe, Canada, Mexico, and Asia

We don't have it because Big Insurance and the criminals in DC don't want us to have it.

[mmonk]

27. Doubt it will work here. Corporations here don't like being regulated.

They can buy the votes to make regulations go away like the financial industry did.

[eridani]

31. Yes. Their government DICTATES what must be covered--

--in a basic comprehensive plan, and DICTATES what it must cost. Namely 100 euros/month, or $140-$150 US dollars. I'd call that the same ballpark as HR 676 $125/month. Single payer would be like a publicly owned utility; the Netherlands has the equivalent of a tough Public Utilities Commission dictating terms to private insurance. Either would work, though my bias is always in favor of public ownership.

[mzmolly]

34. The new legislation we have subsidies and cost controls which will help.

Dean stated that improvements have been made in terms of cost control and regulation as well, thankfully.

[eridani]

35. Oh, please!

Imagine if the PUC worked that way. "Dear grandma: we are ever so sorry to hear of your death when your respirator shut down due to our artificially induced power 'shortage,' but the government has just determined that last year we didn't spend enough of our gross on actual electricity. Here's your refund!"

Look, this bill, lacking direct dictation of insurance prices by the government, is NOT the Netherlands. What reasoning leads you to conclude that, though Congress lacks the backbone to impose such controls now, they will magically acquire it after giving those useless insurance shitstains a trillion dollars?

[mzmolly]

40. What?

:crazy: Dean said there are cost controls in the legislation. I'll defer to him on this.

G'night.

[eridani]

42. They are not DUTCH cost controls, which are the only kind that can possibly work n/t

[mzmolly]

44. Ahhh.

:freak:

[eridani]

47. Was that an answer?

Anything short of direct government control over insurance simply cannot work.

[mzmolly]

54. You're wrong.

http://www.ihsglobalinsight.com/SDA/SDADetail17699.htm

Note the headline? "Netherlands Tops European Health Consumer Poll for Second Successive Year"

[eridani]

126. I'm wondering what is is about NO DEDUCTIBLES, NO CO-PAYS

--and NO AGE RATING that you are having trouble understanding. The Dutch dictate terms to private insurance, unlike the gutless whores over here who have rubber-stamped the dictatorship of murderers by spreadsheet over the general public.

[mzmolly]

128. What part of moving TOWARD the Dutch model

don't you understand?

Also, are you aware that the Netherlands has a very harsh penalty for non-compliance?

All individuals are required to purchase the basic package of health insurance or face a fine worth 130% of the premium.

More food for thought...

The lessons of the Netherlands

An Economist blogger writes:

Americans are still not used to the way universal health-insurance systems work ... I remember what it felt like to move to the Netherlands and be told that I would have to buy health insurance, or I'd be kicked out of the country. For an American, it certainly felt ... different. Then I encountered the other difference: I signed up for a plan, and found my premium cost me a quarter what I'd been paying in America. That was the result of decades of constituent pressure on politicians to get health-insurance costs down. Mr Olbermann and Mr Moulitsas are still thinking like free-market consumers of health insurance: they don't like it, so they want out. Of Albert Hirschman's trio of options for consumers in failing organisations, "Exit, Voice, and Loyalty", they're choosing "exit". When you move to universal health insurance, you have to get used to choosing "voice": if you don't like it, you fix it.

Of course, you are free to disagree with me, but you're not free to INSIST that I agree with you. My point is not that the plan as is, is fabulous. My point is that we can build on the Dutch model and we appear to be heading in that direction.

[eridani]

129. The Dutch pay 100 euros/month ferchrissakes!!

That includes EVERYTHING! That is because the Dutch government DICTATES prices to insurance companies, much like public utilities commissions dictate the utility prices of privately owned utilities here. The public has an institutional means to push back on prices precisely because of this direct control. In 1996, my husband got an emergency root canal in Groeningen for $25 American, so low costs are not a brand new feature of Dutch medical costs.

I just don't understand how you can observe that Congress absolutely refuses to take that regulatory role vis a vis insurance companies now, but somehow think it will be magically easier once we have given the parasitic sociopaths a trillion dollars. Of course if you start paying blackmail, we all know it's way easier to refuse the second and third payments. Not.

[eridani]

127. There most certainly are not. If there were, insurance companies wouldn't be so happy

And, no, requiring refunds if MLRs are not met is essentially locking the barn door after the horse got away.

[Political Heretic]

39. Wow. You simply can't afford to be this uninformed

3. An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.

[mzmolly]

43. That figure does not take into account federal subsidies.

http://healthreform.kff.org/SubsidyCalculator.aspx

According to the calculator at KFF, the cost would be about $4000 for the family - $5000 would be subsidized. It would appear that the article authors are "uninformed" in this case?

Good night. :hi:

[Political Heretic]

57. Yes... it DOES take into effect federal subsidies.

1) The subsidies have been lowered in ending legislation and are not accurately calculated by that tool anymore.

2) the subsidies would not start until 2014 in the senate proposal, and yet costs are figured in 2009 dollars.

3) subsidies take the form of TAX credits, leaving the OUT OF POCKET COST exactly as I said it was.

4) I even ran the tool. You're completely wrong. AGAIN

A family of four at 145% of federal poverty line would pay $8,322 - though the figure has gone up since the most recent changes to the senate proposal.

Poor families with employers who offer coverage at cost of 10% or lower of income are not eligible for subsidies at all. That makes our family in question on the hook for 3,192 dollars annually of expenses without any available assistance of any kind, and a mandate to spent that money.

The subsidy suggested to be 6,000$ takes the form of tax credit. Meaning poor families are still on the hook for a nine thousand dollar bill up front. Most people can't afford to pay nearly 20% of their income even if they could, under the right conditions, get some of it back in next year's taxes, still can't afford it.

[mzmolly]

63. You're wrong.

Unless you have a source that proves otherwise? The tool I provided gave the cost I noted above. I've seen other references which show the same basic numbers. However as we both know, the bill is not finalized and the house/senate versions differ.

In addition, I'd like your reference that the subsidies would come in the form of a tax rebate? If true, I was not aware of this.

Regarding the costs being figured into 2009 dollars, what specifically are you saying? If you're asserting the same thing FDL has in the past, (taxes are paid now, benefits come later) Ezra Klein has debunked that and more.

http://voices.washingtonpost.com/ezra-klein/2009/12/jane_hamshers_10_reaons_to_kil.html

The main tax in the bill is the excise tax, which starts in 2013, not "now." And the bill isn't funded primarily by taxes. It's funded primarily by changes to Medicare. It would be useful if Hamsher explained what tax changes people are going to notice in, say, 2011. My understanding is that the answer to that is, essentially, "none at all." The word "many" is obscuring a lot more than it's illuminating here, making it seem as if the majority of the bill's funding mechanisms trigger immediately. They do not.

I'm out for the night.

Cheers :hi:

[Political Heretic]

71. First off, reference for tax credits - the text of the Senate Bill:

Subtitle “E” of title I of Senate healthcare bill has following sections.

PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS

SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS.

Sec. 1401. Refundable tax credit providing premium assistance for coverage under a qualified health plan. This sections discussed the tax credit offered to individuals with income less than 400% of the federal poverty guidelines. HHS Secretary is also required to commission for a follow up study on affordability of health premiums to individuals.

The bill bars any benefit to illegal aliens and also does not permit anyone to take deductions based on illegal aliens.

(Copied from my pdf of the bill.)

[mzmolly]

81. I'd need to see more to be convinced that the tax credit is the only means of subsidizing.

Your note does not mean the system is built entirely around tax credits. However even IF this is the case, it's a refundable credit, which means cash in your pocket, to buy insurance.

[Political Heretic]

92. Thanks interesting.

Refundable tax credit means they give you cash up front without strings to buy insurance with?

[mzmolly]

109. It means that you get a tax credit which

CAN result in cash in your pocket, yes.

http://www.1040.com/site/federaltaxes/taxcredits/tabid/80/default.aspx

Refundable Tax Credits

A refundable tax credit is a tax credit that can reduce your tax liability below zero(0). Because it is possible to receive a refund based on these types of credits, the credits are referred to as refundable.

Refundable tax credits include:

* Earned Income Credit
* Excess Social Security Credit
* Additional Child Tax Credit
* Health Coverage Tax Credit

And frankly, depending upon how the credit is calculated, it MAY be given upfront initially, and one MAY actually end up with more than enough to cover the cost of health insurance from year to year. Again, I look forward to learning more.

[Political Heretic]

72. Second, I'm wrong on what? That I used the tool YOU provided to explain things for you?

I used your tool. Your tool. Please, by all means, plug in the numbers yourself.

So let me just repeat myself:

A family of four at 145% of federal poverty line would pay $8,322 - though the figure has gone up since the most recent changes to the senate proposal. Type "145" into the tool and choose the "% of poverty"

Poor families with employers who offer coverage at cost of 10% or lower of income are not eligible for subsidies at all. That makes our family in question on the hook for 3,192 dollars annually of expenses without any available assistance of any kind, and a mandate to spent that money. This information is written right on the tool itself, which explains what I just said

The subsidy suggested to be 6,000$ takes the form of tax credit. Meaning poor families are still on the hook for a nine thousand dollar bill up front. Most people can't afford to pay nearly 20% of their income even if they could, under the right conditions, get some of it back in next year's taxes, still can't afford it.

So my "source that proves otherwise" is the SOURCE THAT YOU PROVIDED

Damn man.... does it ever get embarrassing to be you? :)

[mzmolly]

85. I did plug in the numbers. I used annual income. The figure that you used in your example.

And, YOU were incorrect. I also noted the exact figures of subsidies vs. out of pocket in my original response.

I'm being beckoned, I'll check back later.

[Political Heretic]

91. I'm not incorrect at all. Do I need to take a screen shot for you? Will that help?

[Political Heretic]

93. HERE IS A SCREEN SHOT FOR YOU

[mzmolly]

113. The premium in your sample is 1,399 annually after subsidies. Here is a screen shot with my example.

You need to look at the "Person/family premium payment:" section in order to determine the amount paid by the family in question. Add that amount to the subsidy and you have the full cost of insurance.

Edited to say, pardon the rancor, I just saw your apology and you have mine as well.

[davekriss]

125. I think you are reading the tool incorrectly, Heretic

At 145% of the FPL, a family of 4 (if the primary insured was 35), pays $1,339 in yearly premiums. The subsidy amounts to $7,237 per year. The total paid to the insurer is $8,636. It represents the bill as voted on, including Reid's Management Amendment of December 19.

Maximum out-of-pocket on top of these premiums is approximately $3,950 for a family of 4 at 145% of the FPL. So a worst case example at this income level is the need to shell out up to nearly $5,300 if family members got major, expensive care.

I believe also that there are provisions to advance the tax credit at the start of a year, not make the family shell out the full premium awaiting a refund at the end of the year. On this, though, I would have to double check (to make sure it is still in the bill).

ON EDIT: Oops, I see Mzmolly covered this and made the clear pt to you already, PH.

[Fumesucker]

38. Are corporations considered persons in the Netherlands?

They are in the US and if they aren't in the Netherlands then the two situations are not comparable.

http://en.wikipedia.org/wiki/Corporate_personhood_debate

[mzmolly]

45. That does need to change.

:hi:

[Political Heretic]

73. Thus the two situations are not compatible.

:hi:

[mzmolly]

117. People have to abide by laws as well as corporations.

However, we'll have to see how the case before the SCOTUS plays out. Hopefully in favor of human beings.

[Selatius]

50. The WHO rankings for the Netherlands came out NINE YEARS AGO...BEFORE PRIVATIZATION.

Netherland's current system is much younger than that.

[mzmolly]

53. However, it would appear that the system has improved?

http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Though, your point is well taken. We'll see what the WHO does in 2010.

While we're on the subject:

"Netherlands Tops European Health Consumer Poll for Second Successive Year"

http://www.ihsglobalinsight.com/SDA/SDADetail17699.htm

The system in the Netherlands currently has the highest level of consumer satisfaction. I can understand why we've gone in this direction, under the circumstances.

[Selatius]

58. We're not going in that direction.

For us to even approach what the Netherlands has now, we would have to mandate that health insurance companies are a) non-profit, and b) offer standardized health insurance policies that are affordable to all with strict cost containment measures, and c) non-discriminatory in the levying of premiums (i.e. social insurance, where everyone pays the same rate regardless of risk). As it stands, insurance companies are still rather free to charge higher premiums on older people and people with pre-existing conditions.

[mzmolly]

59. The ins co.s in the Netherlands are allowed a 5% profit margin,

the Rockefeller amendment allows for 10%.

[Selatius]

95. Well, point A has been taken down, but cost containment is still an issue. See here:

The first lesson for the United States is that the new (post-2006) Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives..If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?

http://jhppl.dukejournals.org/cgi/content/abstract/33/6/1031

[mzmolly]

104. To my understanding the author you cite

is a single payer advocate? I tend to trust the impartial, international body I quoted more than ideologues on this issue. That said, as a person would prefer a single payer system, I'm glad to hear what experts who support single payer, have to say. Thanks for sharing.

[quiller4]

68. Why? Health insurance cos in Netherlands are for profit. n/t

[Political Heretic]

74. We're not going in "their direction." That's the lie that is disgusting and shameful.

You ought to be disgusted with yourself for perpetuating such horse shit.

[mzmolly]

119. Thus the apology I

presume?

Have a splendid Holiday if you're celebrating today PH. :hi:

[Political Heretic]

94. mzmolly, I owe you an apology.

So, I've been having a bad couple days, and I let it reflect in my posting. I've been condescending and personal and I've insulted you at times. I've been wrong on certain points (the netherlands allows for 5% profit, as you stated.) And though I've been right on some points too, it doesn't really matter when I don't express myself in an adult manner.

I don't want to be someone who just decides to "hate" the bill and then goes around looking for any sort of proof-texting examples to support that ideological agenda. I started off excited about HRC and wanting it to pass. I didn't start out all or nothing, I didn't become a critic of reform efforts the moment any compromise was made. But now, having followed this entire process exhaustively for the better part of a year, I feel very sorrowful and very disappoint because I believe - based on the limited but best efforts to analyze policy, that what is being proposed in the Senate falls so short that it will do more harm overall than good.

Now, I know others disagree - and they are not stupid or inferior just because they do. And if I'm really serious about caring about the needs of poor and working class individuals and families first, then I can only hope that they are right and I am wrong. In other words, I can only hope that the reform that is enacted will be a foundation for continuing steps in the right direction.

What I believe though, is that there's enough well-identified concerns raised about the shape of this bill, that people who feel very doubtful that it will serve as a good starting point have some reasonable grounds for feeling that way. But we also can't know for certain. Given the sheer scope of this bill, and its complexity, and the scores of different voices all with their own agenda trying to tell us what to think, I feel like certainly on this simply isn't possible.

But there is, without question, cause for serious concern. Maybe some would argue that we should pass it and then work to "fix" it, because something is better than nothing. I'm not sure that is the case. Sometimes after we pass "something" that on its own would not be sufficient - or possibly even not better than nothing - all the political will to return to the issue and improve the policy is lost for many years. Sometimes decades. Sometimes generations.

The Family Medical Leave Act is one example that comes to my mind right away. Paid family leave was desperately needed. We lag behind most of the rest of the industrialized world in failing to honor our working class families by providing responsible means to take care of children without losing jobs or slipping into poverty. Back in the 90s the argument that succeeded was that we couldn't get paid leave "now," and that the FMLA was not perfect, but it was a good "starting" point that would be built on later.

But then all political will to address the issue was lost. Now it is over a decade later and there have been no serious attempts to improve anything. So we remain stuck with a leave system that lags behind most of the rest of the industrialized world and does not effectively benefit working families.

Welfare reform is another example that comes to mind. While it is certainly true that democrats were facing a republican-controlled congress when welfare reform was being talked about, the democratic strategy back in that day was to attempt to co-opt Republican issues, and position democratic leaders as centrist and, to quote President Clinton, "pro-business pragmatists." I don't know if you remember, but back then there were many democrats arguing in favor of TANF (Temporary Assistance to Needy Families) as a replacement to AFDC (Aid to Families and Dependent Children, i.e. Welfare) by saying that it wasn't perfect, but it would serve as a positive foundation that could be built on in the future.

Now, I'm a social worker, with my masters degree in social work. So I'm very close to this issue. And I can tell you (and if you demand that I do this, back it up with published papers from peer reviewed journals, but no way am I going to do that research work until after Christmas) that TANF has been nothing but bad news for poor people. And all political will to address welfare has been lost. So now here it is, more than a decade later, and we are still suffering with this terrible situation that is only getting worse, not better.

So I think of these things, and then I think about what we are about to do with health care, and I feel like I've got legitimate grounds to be concerned.

I'd also like to mention the conversation about the Netherlands again. Like I said at the start of this post, I was wrong in my attitude and some of my posts here. I wrote back "that is simply not the case" without any explanation to someone who said profit insurers were legal in the Netherlands. That was wrong of me to do. And its a shame that I weakened my own credibility by saying something so silly and knee-jerk.

However, if you're willing to give me another chance, I tried to write something more serious and fair-minded later. I think that it is very difficult to try and claim that the bill currently being considered in the Senate is a foundation that moves us in the same direction as the Netherlands. That seems to be ignoring a wide array of differences between our two economic and political systems that make the comparison invalid.

One of the things I had the privilege of doing while getting my MSW was studying health care policy through the lens of family policy advocacy, including looking at international comparisons on key policy issues such as health care. The trouble with that is that when looking at European policy and thinking off the top of my head, sometimes it is confusing about which policies are for which countries. But some general patterns still exist....

First of all, in the Netherlands and in many European countries, corporations are not treated as persons under the law. National governmental regulation is exponentially more comprehensive, it is also has far less exemptions and loopholes, corporate taxation is greater (thus paying for higher standards of social services**) penalties for corporate abuse or lawbreaking are far more severe, and when it comes to health care, not for profit competitors are plentiful and well established.

In order for America to move in the direction of the Netherlands, or more broadly speaking in the general direction of Europe, we would have to do things that are not done in this bill. This bill can't lay a "foundation" for that direction. It would have to rest on an established foundation of comprehensive corporate regulation that we don't have, comprehensive investor regulation which we don't have (because investors-gone-wild drive most of our corporate nonsense) we would have to completely redefine our understanding of what corporations are (as non-persons) and the parameters of what they can and can not do and we would have to have campaign finance reform to untwist the unholy union of corporate money and politics.

Then, we could look at a health care reform bill that made a place for private for-profit insurers and possibly come up with something that, while not perfect, could potentially serve as an true beginning point for an ongoing health care revolution.

But we're not doing any of those things. So instead, this health care reform bill sits on top of a system that does not function as European systems to (or the Netherlands system does) and thus it will not lead to similar outcomes.

That's what I should have said and did not. I was wrong in what I said, and wrong to make it personal with you, and I again apologize.

**Certain right-wing think tanks like to make the statement that the US has the highest corporate tax rates in the industrialized world. First, this is false (Edit-I think) right on its face. But it is also false (Edit-I KNOW) in a different way. The only "rate" that matters is what's called the "effective tax rate." It means, the actual tax percentage a certain tax class pays on average after exemptions, credits, and deductions are factored in.

The effective rate for corporations, as of 2004 (I have more recent data somewhere but this comes from Christian Science Monitor article about how 61% of US-Based corporations pay zero taxes) is about 11%. That's lower than what many people right here at DU pay, and lower than most of the rest of the industrialized world. That's what the right-wing think tanks don't say. They take the listed tax rate of about 35%. But no one pays 35% - they actually about on average, about 11%.

[DFW]

98. Kudos for taking the time and effort for that

Few do that on either side of an argument, and yours was a Herculean post. I like to think that it's the sort of thing
that separates disagreement on our end with disagreement on the right, but disagreement on the right these days seems
to be a matter of how loud and often to shout "LIBBRUL!!" so it's not a valid comparison.

Anyway, if no one else will say it, let me be one to say your post definitely did not go unnoticed.

[mzmolly]

115. Apology accepted and extended as well.

I think you have very valid points, and obviously much knowledge on the issue. Far more than I do, frankly. But, I hope that you're wrong regarding your outlook on this legislation. ;)

You point about corporate person-hood is very important. Perhaps that's the most important issue facing our democracy as it lies at the heart of every debate.

I'm sorry that I did not see your post previously. :pals:

I will say, I'd be far more enthused about a single payer system personally. And as you know, Republicans fear we're on a slippery slope in that direction given the new legislative effort. If only that were true!

Peace and Happy Holidays Heretic.

[backscatter712]

116. To make the U.S. comparable, insurers will have to be far more strongly regulated.

The current health care bill gets us part of the way there...

[mzmolly]

118. Agreed

:hi: