Washblog

If Dutch private insurance costs out to individuals and employers only slightly more that the 100% public single payer proposals at state and national levels, that suggests to me a comparison between public utility companies and tightly regulated private ones. The latter are a little more expensive, but pretty much work. I'm OK with that despite my preference for public systems. The real issue here is the WILL TO BREAK THE ENRON MODEL that is the current way private insurance operates here. Private insurers bankrupt and kill people for profit by denying care and refusing to cover sick people; and I don't give a flying fuck that death and bankruptcy happen only to a very small percentage of the total population. Obama and Congress could stop this by imposing Dutch-style regulation on private insurance, by passing single payer, or by implementing within a year a public option open to anybody and run like Medicare, with no "tiers," restricted provider lists, or doubling the premium for older people. Any two out of three would be nice. I'm not seeing any of these options.

I'll support HR 3200 if the ERISA waiver for state single payer stays, or if they make the public option truly robust, which it isn't at the moment. The bottom line is that expenses to individuals, particularly people who are older or who are actually sick, are still outrageously high. Cost controls are automatic with single payer, and could be imposed on private insurance. There is no reason in hell why anyone's monthly expenses, including out of pocket, should be higher than $150 ($1800/year).

If only incremetal reform is possible on the grounds that we have to start from where we are, why not just scrap all of this and have a simple bill which will reduce Medicare age eligibility to 55? Who would dare claim that Medicare is new and untried?

Type of insurance
3200--mandated private insurance with public option available only in 2013
WHST--public insurance, with private supplementation for things not covered by WHST allowed
Netherlands--mandated government regulated private insurance, except for chronically ill and long term care

Monthly charge
3200--$416 for basic individual plan; subsidies for incomes up to 4 x poverty level
WHST--$75 per adult; subsidies available
Netherlands--100 euros per adult; subsidies available

Coverage
3200--drugs, providers, hospitalization, mental health, maternity, dental and vision for under 21
WHST--all of above plus long term care, and dental and vision for adults
Netherlands--dental not included. Chronic and long term illness care paid for by government

Benefit levels
3200--4 benefit levels above basic in the public option
WHST--only 1 comprehensive level; extras available from private insurance
Netherlands--only 1 comprehensive level; extras also available

Recission
3200--allowed for cases of fraud; reviewed by government board
WHST--not allowed at all
Netherlands--not allowed at all

Allowed rating differentials
3200--eliminates pre-existing conditions, but allows charging twice as much for older people
WHST--no differences in premiums for any condition, including age
Netherlands-- no differences in premiums for any condition, including age

Preferred provider lists
3200--allowed, meaning that insurers still pick your doctors. Doctors will not be required to see people
enrolled in the public option.
WHST--free choice of any qualified practitioner or hospital
Netherlands-- free choice of any qualified practitioner or hospital

Copays
3200--basic benefits cover 70% of health care expenses, with more expensive plans paying a higher
percentage. The rest is paid by the individual
WHST--small co-pays for drugs and emergency care, levels TBD
Netherlands-- no co-pays or deductibles allowed

Funding from other than individual sources
3200--employers and individuals, with government subsidy, not including Medicare, Medicaid and Tricare.
Government now pays ~60%. Not possible to tell how this would change.
WHST--in addition to individual assessment, a sliding scale 10% payroll tax on employers plus Medicare , Medicaid
and Tricare
Netherlands-- 50% paid by tax on employers, 5% direct government tax subsidy, 45% from individuals

http://thomas.loc.gov/cgi-bin/query/z?c111:h3200 : HR 3200
http://www.healthcareforallwa.org/health-security-trust /: WA State single payer proposal
http://en.wikipedia.org/wiki/Health_care_in_the_Netherl... Insurance in the Netherlands