6 ms·

The Netherlands has mandatory private insurance and it works well for them. The insurers are heavily regulated though.

by Tarq0n 7y ago

mikepurvis 7y ago
"Mandatory" is the key thing, though. The system doesn't work if all the healthy people opt out until they have a crisis and show up uninsured at the emergency room. See: https://www.kff.org/health-costs/issue-brief/how-repeal-of-the-individual-mandate-and-expansion-of-loosely-regulated-plans-are-affecting-2019-premiums/ https://www.kff.org/health-costs/issue-brief/how-repeal-of-t...
m0zg 7y ago
Do the Netherlands also have doctors who expect to make $300k-$1M/yr and drugs that cost 10x what they do in any other country?
- wil421 7y ago
  No but they are high up on a recent list of doctors salaries[1]. US is #3 and the top spots are the usual European countries for top salaries. [1]https://www.careeraddict.com/top-5-countries-with-the-highest-paid-salaries-for-doctors https://www.careeraddict.com/top-5-countries-with-the-highes...
  - m0zg 7y ago
    Before clicking on the link, I guessed Switzerland would be ahead of the US, and I was right. Switzerland has ACA-like mandatory insurance that's even more expensive than ACA. Notice how for the US the article doesn't even mention the upper bound for specialists. That's because there is none, and they expect that. GPs are quite affordable, if it was just the GPs I wouldn't mind paying them $200-300 directly for a visit. But the specialists can really get you crying for mercy, especially if there's no insurance company between you and them. I broke a leg a few years ago, and if I did not have insurance, the cost to me would be $55K (probably more, this doesn't count the follow-up visits). Surgery alone was $30K+ for about 2 hours of work, not including cost of anesthesia ($5K). Insurance got the total down to about $7K, which is still a lot of money for a relatively run-of-the-mill surgery. Cost to me was my deductible: $1K.
    - mikepurvis 7y ago
      As a Canadian, it just baffles me reading these kinds of posts. Like, I could break my leg on the way home from work today and any surgery I needed would be completely covered other than a $45 ambulance charge and maybe $50 for painkillers or whatever was needed afterward. (And prescription drug coverage is on the radar going into this fall's federal election, see: https://www.ndp.ca/pharmacare https://www.ndp.ca/pharmacare, https://www.greenparty.ca/en/our-vision/health-care https://www.greenparty.ca/en/our-vision/health-care) No drama, no discussion, no appeals or scary forms to fill out. Is this really what Americans mean when they talk about "freedom of choice"?
      - m0zg 7y ago
        As a US citizen, your tax rates and multi-month waiting lists baffle me as well.
        mikepurvis 7y ago
        Well, that is the perspective that is preventing the situation from improving. However, if you take the time to look into it, you may find that the situation is not as dire as conservative talk radio pundits would have you believe. For starters, nobody waits in an emergency. If you need urgent care, you get it— with no second mortgage needed. Waiting times vary a lot across the provinces and depending what kind of care is needed. Cancer treatment, for example, is very fast. Generally speaking, wait times are a function of overall funding, and funding has been cut repeatedly over the past three decades, as Canadians have consistently voted for tax cuts over investing in health care. See the decline as reported by the Fraser Institute: https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2018 https://www.fraserinstitute.org/studies/waiting-your-turn-wa... (Although of course, they're a right-wing think tank, so their agenda is further tax cuts and privatization... take from it what you will.) As far as taxes, again beware of what you hear from US-based commentators about how bad it is. In fact, the income tax we pay is almost identical: https://en.wikipedia.org/wiki/Comparison_of_Canadian_and_American_economies#Taxation https://en.wikipedia.org/wiki/Comparison_of_Canadian_and_Ame...
        7y ago
thanatos519 7y ago
What also works in The Netherlands is that insurance is not tied to employment. I've heard that many American workers quit in the early days of the month, so that their ex-employer is still covering their health insurance that month, and their next employer (presuming they have another job to go to) picks it up in the next month. I can't imagine how many people are stuck in jobs they hate just because they are afraid to be without insurance. It can't be good for anyone.
- graedus 7y ago
  > I can't imagine how many people are stuck in jobs they hate just because they are afraid to be without insurance. It can't be good for anyone. It seems like it is good for employers for employees to be more precarious and dependent on them.
- bluedino 7y ago
  I really doubt anyone times their quitting to the start of the month. People just up and quit because they don't want to work. Also, many health insurance plans from your employer don't start immediately. Sometimes you have to tiptoe around for 90 days until you get coverage. Source: American, and it's always funny to hear what people in other countires 'think' about the USA
  - joshypants 7y ago
    Actually it's worse, I've done much more involved backbending and hoop jumping to make sure I was covered between jobs than just quitting around the beginning of the month.
  - jedberg 7y ago
    I've most definitely timed my job changes to insurance coverage. And luckily in the software industry, insurance tends to kick in on day 1.
  - mAEStro-paNDa 7y ago
    >I really doubt anyone times their quitting to the start of the month. People just up and quit because they don't want to work. I won't defend the specific scenario given but the second sentence there is a huge generalization. You're correct that insurance plans don't start immediately, but that also leaves people in a difficult, even if temporary, situation. Europeans however are correct to think that the healthcare system in the US is abysmal, because it is. All this goes without saying that employment-tied insurance puts people in precarious positions, which is obvious.

The Netherlands has mandatory private insurance and it works well for them. The insurers are heavily regulated though.

by Tarq0n 7y ago

The Netherlands has mandatory private insurance and it works well for them. The insurers are heavily regulated though.

"Mandatory" is the key thing, though. The system doesn't work if all the healthy people opt out until they have a crisis and show up uninsured at the emergency room. See: https://www.kff.org/health-costs/issue-brief/how-repeal-of-the-individual-mandate-and-expansion-of-loosely-regulated-plans-are-affecting-2019-premiums/ https://www.kff.org/health-costs/issue-brief/how-repeal-of-t...

m0zg 7y ago

Do the Netherlands also have doctors who expect to make $300k-$1M/yr and drugs that cost 10x what they do in any other country?

wil421 7y ago
No but they are high up on a recent list of doctors salaries[1]. US is #3 and the top spots are the usual European countries for top salaries. [1]https://www.careeraddict.com/top-5-countries-with-the-highest-paid-salaries-for-doctors https://www.careeraddict.com/top-5-countries-with-the-highes...
- m0zg 7y ago
  Before clicking on the link, I guessed Switzerland would be ahead of the US, and I was right. Switzerland has ACA-like mandatory insurance that's even more expensive than ACA. Notice how for the US the article doesn't even mention the upper bound for specialists. That's because there is none, and they expect that. GPs are quite affordable, if it was just the GPs I wouldn't mind paying them $200-300 directly for a visit. But the specialists can really get you crying for mercy, especially if there's no insurance company between you and them. I broke a leg a few years ago, and if I did not have insurance, the cost to me would be $55K (probably more, this doesn't count the follow-up visits). Surgery alone was $30K+ for about 2 hours of work, not including cost of anesthesia ($5K). Insurance got the total down to about $7K, which is still a lot of money for a relatively run-of-the-mill surgery. Cost to me was my deductible: $1K.
  - mikepurvis 7y ago
    As a Canadian, it just baffles me reading these kinds of posts. Like, I could break my leg on the way home from work today and any surgery I needed would be completely covered other than a $45 ambulance charge and maybe $50 for painkillers or whatever was needed afterward. (And prescription drug coverage is on the radar going into this fall's federal election, see: https://www.ndp.ca/pharmacare https://www.ndp.ca/pharmacare, https://www.greenparty.ca/en/our-vision/health-care https://www.greenparty.ca/en/our-vision/health-care) No drama, no discussion, no appeals or scary forms to fill out. Is this really what Americans mean when they talk about "freedom of choice"?
    - m0zg 7y ago
      As a US citizen, your tax rates and multi-month waiting lists baffle me as well.
      - mikepurvis 7y ago
        Well, that is the perspective that is preventing the situation from improving. However, if you take the time to look into it, you may find that the situation is not as dire as conservative talk radio pundits would have you believe. For starters, nobody waits in an emergency. If you need urgent care, you get it— with no second mortgage needed. Waiting times vary a lot across the provinces and depending what kind of care is needed. Cancer treatment, for example, is very fast. Generally speaking, wait times are a function of overall funding, and funding has been cut repeatedly over the past three decades, as Canadians have consistently voted for tax cuts over investing in health care. See the decline as reported by the Fraser Institute: https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2018 https://www.fraserinstitute.org/studies/waiting-your-turn-wa... (Although of course, they're a right-wing think tank, so their agenda is further tax cuts and privatization... take from it what you will.) As far as taxes, again beware of what you hear from US-based commentators about how bad it is. In fact, the income tax we pay is almost identical: https://en.wikipedia.org/wiki/Comparison_of_Canadian_and_American_economies#Taxation https://en.wikipedia.org/wiki/Comparison_of_Canadian_and_Ame...
      - 7y ago

thanatos519 7y ago

What also works in The Netherlands is that insurance is not tied to employment. I've heard that many American workers quit in the early days of the month, so that their ex-employer is still covering their health insurance that month, and their next employer (presuming they have another job to go to) picks it up in the next month. I can't imagine how many people are stuck in jobs they hate just because they are afraid to be without insurance. It can't be good for anyone.

graedus 7y ago
> I can't imagine how many people are stuck in jobs they hate just because they are afraid to be without insurance. It can't be good for anyone. It seems like it is good for employers for employees to be more precarious and dependent on them.
bluedino 7y ago
I really doubt anyone times their quitting to the start of the month. People just up and quit because they don't want to work. Also, many health insurance plans from your employer don't start immediately. Sometimes you have to tiptoe around for 90 days until you get coverage. Source: American, and it's always funny to hear what people in other countires 'think' about the USA
- joshypants 7y ago
  Actually it's worse, I've done much more involved backbending and hoop jumping to make sure I was covered between jobs than just quitting around the beginning of the month.
- jedberg 7y ago
  I've most definitely timed my job changes to insurance coverage. And luckily in the software industry, insurance tends to kick in on day 1.
- mAEStro-paNDa 7y ago
  >I really doubt anyone times their quitting to the start of the month. People just up and quit because they don't want to work. I won't defend the specific scenario given but the second sentence there is a huge generalization. You're correct that insurance plans don't start immediately, but that also leaves people in a difficult, even if temporary, situation. Europeans however are correct to think that the healthcare system in the US is abysmal, because it is. All this goes without saying that employment-tied insurance puts people in precarious positions, which is obvious.