(02-11-2020 10:30 AM)mrbig Wrote: 69/70/75 - if you can do this without getting overly political, I'd really appreciate it (and I would absorb the information better). What are the primary differences between the Dutch health care system and Obamacare? I ask because I read this and this and this I'm trying to figure out where you think Obamacare went wrong. I mean, Lou Dobbs seems to be a fan (or have been a fan) of the Dutch system (based on the 1st link).
What would be really helpful for me to understand what needs improvement over what we have now is a quick bullet-point list of the major differences between what we have now and the Dutch system and then a separate bullet-point list of the major ways in which our current system falls short of the Dutch system. Hopefully my brain can match the two lists to determine cause-and-effect, but feel free to provide your thoughts as well.
And before tanq accuses me of proposing a government takeover of healthcare with this inquiry, I'm just asking 69/70/75 some questions.
Not trying to speak for 69/70/75... but like you I want something that works. I consider myself an 'expert of sorts' in healthcare finance... but not in the Dutch system (or any other one than ours)
I did a cursory read of the articles. There is lots behind what some of them say that is not verified, but I'm trying to just go with it.
First, it must be noted that The Netherlands is a small country with few places (and thus few people) who don't have easy access to quality care. You can build (and staff) just a few centers and provide service to the entire nation. This matters because as an example... if a provider (not to mention nurses etc etc etc) can see 0-17 patients per day in an inpatient setting or 0-35 patients per day in an outpatient setting, then the goal should be to have 17 or 35 patients for them each day. That's much easier to do in larger population centers.
They are also an extremely homogeneous people and they have a very different approach to things like sex, drugs and 'extreme' activities which are large contributors to outlyers in the 'amount of care needed' categories.
It seems that the Dutch don't have something like Medicare that sets the bar for all costs, but instead has caps and hospitals can do what they want below those caps. I suspect they don't have situations like we do where a single service can have a meaningfully different cost based on where in the country (not to mention where in the system) you recieve it. It also doesn't have a single pooled risk, but it has a risk equalization fund for the INSURERS (as opposed to the insured which is what we used to have, and was blended into Obamacare to handle PEC's and high utilizers). It also seems that from 1940-1970, they were already on this path, at least for the majority of people... so they're literally 50+ years ahead of us.
The biggest problem with the ACA is that it increased demand while doing almost nothing to increase supply. It arguably reduced supply, at least for a number of specialties and areas.
The US has not really promoted healthy lifestyles like Europe has. To the extent that we have, we often have taken it to an extreme which makes it unhealthy.
The ACA thus has also DECREASED rather than increased the desire for healthy living by taking away the financial disincentive to hurt yourself... other than going to your PCP more regularly to catch diseases early... which only helps if you can actually get into your PCP. The welfare programs also encourage (or at least don't discourage) larger families (or earlier families) for those who can least afford it, while the Dutch does not. The subsidy is per family, regardless of size. Because of the legacy issues here, this is where their time/culture makes such a difference.
The ACA should have focused on supply, but that would be good for hospitals and doctors... instead it focused on demand... because they are voters.
The Dutch plan is actually closer to what McCain proposed because of the way the individual subsidies work... there are so many other differences noted above that wouldn't change, I don't want to say it was really 'close' either.
The reason we can't or shouldn't try to emulate what anyone else is doing now is because they were never where we started from... and you somehow must get 'there' from 'here'.
We need to 'punish' poor choices. I suggest higher copays for diseases/injuries of 'choice' and 'family' subsidies.
We need to encourage good choices. High deductible plans do this, but only if you're paying the premium which is also where 'family' subsidies come in
We need to address price transparency. It sounds like it should be simple, but it's not. In the easiest example, we don't want people coming in and treating MUCH healthcare like they're ordering a Subway sandwich.
I understand (but have not experienced) that the standard of care is also an issue for some areas. I'm a little out of my depth here in terms of SOC, but as an obvious example... A 70 yr old with 20% arterial blockage would be treated with medication in most of Europe for little cost, and we would do artherectomy for tens of thousands for little in terms of outcome differential... because that outcome is a voter.... and Medicare (the government) sets most standards.
I also wonder if population ages are meaningfully different. We're an aging population and I'm not sure they are. War babies created boomers in this country, but we lost overwhelmingly men in the US, while Europe lost many women and children as well.
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The Case for Medicare for All
