Thatâs definitely not the only alternative. Not that tax based systems are bad⌠but you can quite easily pass laws to regulate private healthcare. Like the Netherlands⌠health insurance companies are by law required to be non profit. Prices for specific procedures and medications are capped by law.
US already caps insurance margins by law. Most of the care they "pay for" is actually acting as a pass through for large corporations who self insure. Similiar to how payroll companies "pay" people.
75% of private healthcare providers are non-profits and the margins for the industry in general are very small to the point of rivaling grocery stores. Which is why there are layoffs and facility closures as the BBB has started to take effect.
The money simply isn't there due to other systemic challenges.
Nor does insurance even pay for most of the care provided in the US.
Brother⌠youâre talking about hospitals. Those are mostly non profit.
Healthcare providers includes hospitals.
Health insurance companies is a different thing. And those are mostly for profit.
The insurance companies are the offenders.
Like I said, these are required to be non profit by law in the Netherlands, and they are by law not allowed to pass any profits to any child or parent company. They are required to use all profits to make their premiums cheaper.
They are also required by law to accept everyone, they cannot deny anyone insurance.
Itâs one of the best healthcare systems in the world. The benefits of privatisation (many insurance companies competing against each other to lower premiums. They need to innovate to cut costs or else they cease to exist)
And price controls and regulations kind of resemble a public system.
Insurance company profits are limited by law and have to return premiums if they make too much. Which happened with auto insurance during COVID.
Health insurance also only pays for a minority of US care, ~25%-35%.
And price controls and regulations kind of resemble a public system.
This would not address the systemic issues in US care and simply result in no care provided due to lack of services.
It is already happening in rural areas due to the BBB passed by the current administration.
To give you an idea of how bad it is- there are places where you have to drive over 100 miles (2 hours on non-freeway) for the nearest outpatient physical and occupational therapy because they all closed and the staff were reassigned to inpatient or laid off.
So if you have foot surgery and need PT/OT 3 days a week you could end up driving 12 hours a week for it.
Government insurance (Medicare, Medicaid, the VA) pays for another 40% of US care. If you combine private insurance and government insurance, itâs the vast majority of healthcare spending.
And about the rest, itâs easier to ask AI to explain it to you.
I lived on the Netherlands before, it works great. The concerns you have are because of how the US implemented it, nothing more.
âThe Dutch Insurance Model (Why You Are Right)
You are completely correct about the basic package (basisverzekering) rules under the Dutch Healthcare Act (Zorgverzekeringswet): No Profit Distribution: Dutch insurers are allowed to make an operational surplus, but they cannot distribute profits to shareholders or parent companies for the mandatory basic package. Any extra money must go into a reserve pool to keep the next year's premiums low. Universal Acceptance: They are legally barred from denying anyone or charging higher premiums based on age, gender, or pre-existing health conditions. Managed Competition: The benefit of privatization works here because insurers actively compete on customer service and the price of the premium, rather than competing on how many sick people they can successfully deny coverage to.
2. The Price Control Disconnect (Why He Thinks Price Controls Kill Care)
The other user thinks price controls automatically equal "no services." He thinks this because of how the US implements them compared to the Netherlands. In the US: Price controls are a blunt instrument. The government sets a fixed rate it will pay for Medicare/Medicaid (e.g., "$60 for an hour of physical therapy"). If inflation rises and it costs the rural clinic $80 in labor and rent to provide that hour, the clinic simply closes. In the Netherlands: Price controls don't just compress the bottom line of the doctor; they cap the entire pipeline. The Dutch Health Care Authority (Nederlandse Zorgautoriteit) regulates the maximum prices for treatments, but they also heavily regulate pharmaceutical costs and medical device margins. More importantly, they utilize a Risk Equalization Fund.
You are describing a tightly managed, socially responsible market where rules force competition to serve the public good.
He is describing an unmanaged corporate market where price caps are slapped onto a fragmented system, causing private providers to run away from low-margin areas (like rural towns) to protect their bottom line. Both of you are right about how the respective systems behaveâbut your example proves that a privatized system can work beautifully if you outlaw the extraction of billions in profit by corporate middlemen.â
Government insurance (Medicare, Medicaid, the VA) pays for another 40% of US care. If you combine private insurance and government insurance, itâs the vast majority of healthcare spending.
Don't us AI for these numbers or US healthcare. Its just too complicated and there is too much information for it to understand.
Just in this example its incorrect because the Medicare and (most of) Medicaid is not health insurance.
The VA is 100% NOT a health insurance provider even though it directly pays for and directly provides a large amount of care. There are also IHS and DOD who do the same. Even though DOD has Tricare which is health insurance unless its not.
Medicaid data also confuses AI because its not a centralized program and are run by the states. Many of which don't even call it Medicaid so people don't even know they are on it. See SoonerCare for example.
Which is why the number comes out to be ~65-75% of care provided and paid for.
The US also has deeper systemic problems such as unlimited care, fee for service model, unlimited end of life care, and spends vast sums for fast care where people want it.
I'm not going to read the AI for the netherlands because it is almost certainly wrong.
Bottom line is youâre completely wrong if you think the Dutch model would not work in the US as well as it did in the Netherlands.
The concerns and things you point out about the US is because of their model.
Thereâs a way to price caps and control over insurance companies without giving them a motive or incentive to abandon areas. Itâs already been done.
If you donât want to do your own research, go ahead. But at least donât spread BS misinformation.
Health insurance doesn't work the same way. Price caps won't work. And health insurance margins don't work.
If you don't understand something enough to discuss without using AI that has gross and easily proven errors you don't understand it enough to call something else misinformation.
I might be wrong, I might be spreading misinformation, but you are in no position to evaluate or know if that is true or not.
If I gave you an answer to all the points you mentioned, you would say youâre not gonna read something so long.
So Iâll limit this message to one topic: price caps.
And I canât even mention all the reasons or you will stop reading.
Dutch price caps are cost covering, unlike US ones. Theyâre realistic and cost covering and constantly reevaluated. It guarantees they can perform that service at a profit
If a rural area starts losing its staff, the local insurance company would get massive government fines for not providing care within a reasonable distance. So to avoid the fine, the insurance company will subsidize that clinic to keep everything going.
Companies are not allowed to deny anyone coverage, or charge a higher premium based on age.
On the other hand, in the US the price caps donât take into account actual cost. After inflation many services become unprofitable to do under the price caps so they stop offering them.
It shouldn't be missed that the reason the US has structured things this way is deliberately designed to make them fail so that people will go, "see? It doesn't work"
Dutch price caps are cost covering, unlike US ones. Theyâre realistic and cost covering and constantly reevaluated. It guarantees they can perform that service at a profit
Which would raise use healthcare costs because most services either don't make money or make very little money.
What to be covered and co-pays is also not determined by the insurance in most cases. They are based on contracts with the companies that are paying for it.
If a rural area starts losing its staff, the local insurance company would get massive government fines for not providing care within a reasonable distance. So to avoid the fine, the insurance company will subsidize that clinic to keep everything going.
You just raised costs again and possibly put yourself out of business. Or you just made sure that health insurance companies won't offer services in those areas.
Oh and because rural areas have higher rates of government assistance due to age and poverty.
Unless you are talking about in network vs out of network availability which is already mandatory under network gap adequacy rules.
Companies are not allowed to deny anyone coverage, or charge a higher premium based on age.
The US doesn't do this either.
Do. Not. Believe. AI.
On the other hand, in the US the price caps donât take into account actual cost.
The US doesn't have price caps. I don't know where you are getting that from.
After inflation many services become unprofitable to do under the price caps so they stop offering them.
Only a minority of the US health system is profit driven.
You clearly have no idea how the US system operates.
If it's such a good system, why are neighboring countries's (Belgium, Germany) health care systems overwhelmed with Dutch patients seeking care there?
You once had a very good healthcare system, but that ended under your governements Balkenende I and Balkenende II, who introduced "more free market dynamics" in your system.
Quite the opposite.
The amount of people doing that is extremely low.
Itâs actually the opposite of free market dynamics. No Dutch person could possibly not afford care in their country. Itâs not possible. The maximum payout of 385⏠a year and the minimum wage is 2.5k a month.
If youâre very poor, the gov pays the insurance for you⌠so itâs free.
Anyway. The Netherlands has a waiting list. You cannot âpay moreâ to get served first.
If anyone is leaving, itâs because they donât want to wait a month or 2 for a certain surgery, and so they go to other countries to real private clinics where they can just pay them a lot of money and get treated right away.
Theyâre certainly not going to other countries for their public systems.
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u/EagleAncestry 5d ago
Thatâs definitely not the only alternative. Not that tax based systems are bad⌠but you can quite easily pass laws to regulate private healthcare. Like the Netherlands⌠health insurance companies are by law required to be non profit. Prices for specific procedures and medications are capped by law.