Employers generally pay half of insurance premiums, with individual workers picking up the other half. Individual premiums are tax deductible. Subsidies, or care allowances, that help low- and middle-income income workers purchase the basic insurance plan are extensive and reach well into the middle class. Currently, 5 million Dutch citizens qualify for some level of subsidy on a sliding scale based on income. Those subsidies are financed through a tax on salaried workers. Because of the high levels of subsidy, the Dutch government remains a large source of health spending, one area of significant difference with the Swiss system.

Insurers negotiate quality, quantity, and price of services with providers. Notably, many insurers require providers to document the quality of the care they provide, frequently relying on evidence-based guidelines and performance metrics.

Some insurers provide care directly, using their own staffs and their own facilities, such as primary care centers and pharmacies. Other insurers contract with a network of providers similar to U.S. preferred provider organizations (PPOs). Patients can go out of network but will receive only partial reimbursement. Most insurers require a referral from a primary care provider before a patient can see a specialist. Pharmaceutical prices are capped nationwide at the average price of medicines in a therapeutic class. Individuals may choose more expensive drugs but must pay the difference out of pocket.

I think the part about the gov’t subsidizing sicker people is risky for those people.

Certainly if you’re part of a vocal block your subsidy will be adequate because you’ll be vocal about it. What if you have an orphan health issue? Washington will decided X is what your subsidy should be. The market will have treatments that are X + a hundred thousand, and your insurer won’t cover it. Not that it doesn’t happen now, but I don’t see that this fixes that.

How forward thinking are they about new treatments? I’ve read accounts of women in Israel and Australia who have difficulty getting Taxol or Herceptin for breast cancer treatments, and Dutch women who travel to the US for re constructive services.

I am all for improving the individual market for health coverage. If you have ever been to a Dr. for anything getting individual coverage comes with exclusions and limitations, and is terrifically expensive. Making the entire country part of the risk pool might help with that.

Remember that the Dutch allow euthanasia. They are far more practical about life and money than we are. I question whether the standard of treatment in the Netherlands meets American expectations. Before you tout their system as a good solution I’d like to know more.

To date, the plan has attracted attention among policy wonks but has made virtually no headway in the public dialogue. Under this plan (read more about it on our Website), everyone receives a healthcare voucher from the Federal government redeemable for a standard health plan that meets government-established minimum requirements (FEHBP at a minimum). Health plans can be offered by insurance companies, HMO’s or other health organizations, thus keeping delivery in the private sector, but overseen by a public entity. No one can be refused entry to a health plan for any reason. The voucher plan also calls for a proactive government role in encouraging quality improvement and cost containment.

Employers would no longer have a role in health care. Means testing would be a thing of the past. Individuals would be free to purchase additional coverage, to an already rich set of benefits, but would receive no tax incentives to do so. Anyone not signed up to on of a number of competing plans a plan would be enrolled on one by the government. The proposal provides for state funded universal coverage delivered by a more competitive private sector administered in the public interest.