"The Dutch health care system was drastically revamped in 2006, and its new incarnation has come in for a lot of international scrutiny. “The previous system was actually introduced in 1944 by the Germans, while they were paying our country a visit,” said Hans Hoogervorst, the former minister of public health who developed and implemented the new system three years ago. The old system involved a vast patchwork of insurers and depended on heavy government regulation to keep costs down. Hoogervorst — a conservative economist and devout believer in the powers of the free market — wanted to streamline and privatize the system, to offer consumers their choice of insurers and plans but also to ensure that certain conditions were maintained via regulation and oversight. 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. Where in the United States insurance companies try to wriggle out of covering chronically ill patients, in the Dutch system the government oversees a fund from which insurers that take on more high-cost clients can be compensated. 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.
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.” The solution to balancing these opposing tendencies was to have one guaranteed base level of coverage in the new health scheme, to which people can add supplemental coverage that they pay extra for. Each insurance company offers its own packages of supplements.
Nobody thinks the Dutch health care system is perfect. Many people complain that the new insurance costs more than the old. “That’s true, but that’s because the old system just didn’t charge enough, so society ended up paying for it in other ways,” said Anais Rubingh, who works as a general practitioner in Amsterdam. The complaint I hear from some expat Americans is that while the Dutch system covers everyone, and does a good job with broken bones and ruptured appendixes, it falls behind American care when it comes to conditions that involve complicated procedures. Hoogervorst acknowledged this — to a point. “There is no doubt the U.S. has the best medical care in the world — for those who can pay the top prices,” he said. “I’m sure the top 5 percent of hospitals there are better than the top 5 percent here. But with that exception, I would say overall quality is the same in the two countries.”
If they were served up the Canadian system, they’d scream at the tax rates, and become hysterical at the inability to trade up to a platinum level of care for those who have “earned it.” They would not accept the long lines for care and would immediately start a scheme for off-shoring medicine to circumvent the lines.
If Americans were offered the French system, they’d be immediately annoyed by the inconvenience of the office hours (months of vacation are taken at a time by all members of society, including doctors), they’d never use the preventive health measures (they don’t have time for that stuff), and although they’d be glad to receive home health aides for no more excuse than - “I just had a baby and I’d like a government worker to clean my house” – when they
saw the tax rates it would take to make this available to all, they’d find it unacceptable, especially with such high copays and out of pocket expenses..
But the main problem with Moore's policy solution is that a national health system wouldn't fix one of our health care system's main flaws—one that people really hate—the denial of service. It just changes who decides, so that the government makes the call.
In one heart-wrenching case in the movie, a woman whose husband has kidney cancer is told by the insurance people that they won't allow an experimental treatment that might save his life. But that scene would likely play out just the same way in a nationalized health system. In those systems, cost-effectiveness decisions get made all the time. Care is rationed. That's what happens if you offer something for free—you have to make rules about who is allowed to get it. So, you forbid smokers from having heart bypasses, or, in a more recent debate in the U.K. about a new hay fever medicine, you just say the medicine is too expensive to be used.
So, to do as Moore wants in the United States, you would need to do more than just overcome the insurance industry. You would need to cut the salaries of doctors, reform the legal system, enrage our allies by causing their prescription drug costs to escalate, and accustom patients to a central decision-maker authorized to determine what procedures they are and are not allowed to get. Unless every one of these changes comes together, Moore's new system would end up costing an enormous amount of money.
A NHS surgeon today exposed how cash-strapped hospitals were being barred from operating on cancer patients who had not waited long enough.
Wayne Jaffe laid the blame for the appalling state of affairs at the feet of Tony Blair, with his vision of reduced waiting times and 24-hour surgery. In a withering assessment of the financial management of the health service, Mr Jaffe said that doctors were being restricted in getting waiting lists down by financial limitations and ever-changing targets.
The consultant plastic and reconstructive surgeon, who specialises in skin cancer and breast reconstruction, said he and his colleagues are being prohibited from operating in non-urgent cases unless the patient has been waiting for a minimum of 20 weeks.
