It is illegal in the current system for an insurance company to refuse to accept a client, or to charge more for a client based on age or health.
Or to put it another way - "It is required in the current system, for insurance companies to shaft young healthy people in order to provide large subsidies to old sick people."
The "or health part" moves it away from being an insurance issue at all. Paying for people who already have severe conditions is charity of welfare not insurance.
It seems to work. A study by the Commonwealth Fund found that 54 percent of chronically ill patients in the United States avoided some form of medical attention in 2008 because of costs, while only 7 percent of chronically ill people in the Netherlands did so for financial reasons.
A very low percentage of people avoiding some form of treatment because of cost, may be more of a bug than a feature.
The Dutch are free-marketers, but they also have a keen sense of fairness. As Hoogervorst noted, “The average Dutch person finds it completely unacceptable that people with more money would get better health care.”
Than on that issue they simply aren't free-marketers.
Also its unlikely that their objective is met. A nation simply won't have the resources to give the best possible medical care to everyone. It costs to much, and even ignoring money, and however much you throw in to the effort some resources will still be limited. Adding more doctors or bringing up the average skill level of doctors, sill leaves you with a limited number of doctors who are the best. Not everyone can see them, so some people will get better treatment than others. Well I suppose you could artificially limit the level of care the wealthy can get, but that's rather totalitarian, and unless your running a prison state the wealthy can get care elsewhere.
to which people can add supplemental coverage that they pay extra for.
So the wealthy can get better care.
The amazing thing is that virtually every experience has been more pleasant than in the U.S. There you have the bureaucracy, the endless forms, the fear of malpractice suits.
That is largely because of things outside of the health insurance system. It involves medical culture, tort laws, legal culture etc. If we grafted the Dutch insurance system on to the US we would still have the same legal culture, and largely still the same medical culture. I believe that the Dutch may have some real advantages in these areas, but those things are hard to change and have little or nothing to do with the idea of universal coverage. |
