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Share this pageUwe Reinhardt on the Dutch system
Posted by Don McCanne MD on Monday, Jul 14, 2008This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.
Americans down on the U.S. health-care system
By Kristen Gerencher
MarketWatch
July 13, 2008Americans are fed up with the headaches in their system, but that’s generally not due to the quality of care they receive, said Uwe Reinhardt, professor of economic and public affairs at Princeton University.
“What Americans are upset about is the unbelievable hassle of having to select health insurance, maybe not getting it … losing insurance when they lose their job,” Reinhardt said. “The American citizen is massively insecure.”
Doctors and nurses routinely hear demoralizing news that U.S. medicine is inferior “when the real problem is the way we finance health care and the hassle of claiming insurance,” he said.
The Dutch financing system has been transitioning to a new model in the last year, where residents contribute payroll taxes into a central fund, Reinhardt said. Then they receive a voucher to buy coverage from nonprofit or for-profit private insurers.
“The system is so tightly regulated and so many transfers are made among people to make sure everyone can afford the insurance and everyone has access to the same care that it’s really just a social insurance system in disguise,” Reinhardt said. “It’s not even vaguely close to the U.S. system.”
The United States currently has a private insurance system that has proven to be quite inadequate in ensuring that all of us receive the health care that we need. Some single out the new Dutch system as a model demonstrating that private plans could work for us if we merely improve the insurance markets and provide a competing public insurance option.
As Professor Reinhardt states, the Dutch system is not even vaguely close to the U.S. system, but rather is a social insurance system in disguise. Merely expanding our private plans to cover more people would not in any way emulate the Dutch system.
Some claim that a single payer system is not politically feasible because it would be too disruptive to our existing health care financing system. Yet they concede that the private insurance industry would have to undergo a massive transformation to eliminate the profound inefficiencies, inadequacies and inequities in our current system. Tight regulation of a totally transformed private insurance industry would certainly be disruptive to these players in our current financing system.
Is disruption really all that bad? The technology industry advances and thrives on innovative disruptions. New, improved, lower-cost technology replaces older, less effective, and more expensive technology. New technology is certainly disruptive to the establishment, but we shed few tears for those older companies that are no longer relevant and are replaced by newer firms.
Our current private insurance industry is functioning so poorly that, at a minimum, it requires wholesale disruption by being transformed into a highly-regulated program of social insurance. But then why should we try to revive an obsolete, last-century system of health care financing when a modern, single payer national health program would be so much more efficient?
Isn’t single payer precisely the disruptive innovation that we now need? And really, who would shed tears over the demise of the private insurers as we know them?
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Jeoffry B. Gordon, MD, MPH
July 15th, 2008 at 5:20 am
As a solo practicing family doc I spend about 5% of my time and my staff spends 10 to 20 % of their time exploring and untangling multiple insurance company snarls (many within a well structured HMO system) which interfere with the appropriate and adequate provision of care. Examples: Just today we had to take care of two patients with corneal abrasions who had difficulty getting to see an ophthamologist due to insurance company rules and we have spent the last week trying to bring a patient who had a laceration of his orbit into his HMO system for care. Just consider how much time is lost from clinical services and is spent on this kind of wasteful bureaucracy. Another time consuming problem is that each insurance company has its own formulary (and I strongly believe in formularies) causing huge amounts of time to be spent working the system to get the right equivalent medicine that I already prescribed paid for. This is not to mention the 25 per cent of my office overhead that is spent dealing with multiple insurance payors. The American health system maximizes insurance company profit; is a full employment system for health bureaucrats; and is hugely inefficient.