The debate over the Affordable Care Act was largely a debate about improving America’s morally bankrupt and economically inefficient health insurance system. But there’s more to health care than insurance payment mechanisms. A recent Commonwealth Fund report compared health systems and concluded that the Netherlands has the best performing one, which certainly makes the fact that ACA establishes a Dutch-style insurance system for non-seniors look good. But as I observed in my original post on the matter, the quality of Dutch health care likely derives from how its providers work rather than from the structure of its insurance payments.
Eric Voeten backs this up with some anecdata:
Last summer, I had to bring my daughter to a Dutch doctor. Not only did I succeed in seeing someone that same morning but the cost were less than my regular co-payment in the USA, even though I have no insurance in the Netherlands and had never seen that doctor before.
The key is that the Dutch have an extensive system of family doctors, who generally operate a practice from their homes with minimal administrative assistance. These family doctors provide basic health care, do house visits, and are the gatekeepers for (more expensive) specialized care. This keeps a lot of people out of hospitals who do not need to go to hospitals. Of course, reforming insurance is relatively easy in comparison with making the type of structural reforms that would create a similar system in the US. Yet, these may well be the types of reforms that have a broader impact on quality of life.
And there’s the rub. It’s much more feasible to provide affordable insurance to everyone if the per unit costs of medical services are lower. In America, they’re very high. In part that’s because the American consumer disproportionately subsidized medical innovation from which the whole world benefits. And in part it’s because our system is simply inefficient.