Health Care by Nica Davidov

I am a thirty-one year old mother of an almost-three-year old. My partner and I and our son moved to the Netherlands from Boston two years ago. It was very much my idea, and for me it was very much about not wanting to raise my son with the constant anxieties about health insurance that I had experienced for years (thank you Aetna! I had to call you so often that you were #1 on my T-Mobile “top 5”! I wish I were kidding!).
As America takes baby steps towards some kind of healthcare reform (and it is quite possible that one of those steps is forward and two are back -- time will tell), I find myself frequently reflecting on the access to healthcare that I have now as a matter of course. For example, I've had this sinusitis, and I finally went to my doctor on Monday, and they gave me antibiotics, and I took them and started feeling better in a couple of days, and then on Friday I woke up with a rash, and went back to the doctor, and it looked like an allergic reaction to the antibiotic I was taking, so the doctor prescribed me a different antibiotic to finish up with. Then we were talking about allergies, and I told him about the scary experience with my throat closing up over Christmas when I was at Saint Alp's Teahouse with my friend Anna, and so he wrote me a prescription of an epi-pen just in case, and while we were at it he gave me a new prescription for the Albuterol inhaler, because I was out, and also I got my blood taken to do a foods allergy test (testing for 96 foods) -- they should have the results in 10 days. None of this, including the prescriptions themselves and the lab work, cost me a cent.
This is by no means a novel idea; it's just something I think about almost every time I go to the doctor here. The Dutch health care system is an existing, functioning testament to the fact that all of the "complicated" negotiations over "health care reform" in the US that we just witnessed, and are continuing to witness, are just bullshit, bullshit, and more bullshit. Okay, so Americans are atavistically in throes of The Red Scare, and politicians are using that to make sure that the US never has a government-run single-payer system like the NHS. But of course the real reason is that the politicians are bought and paid for by the HMOs, which run for profit, and now, in the awesome new synergy shat out by SCOTUS (by way of the Citizens United ruling in January), in some escalating loop from hell, they will be able to invest tons of money into "electing" politicians that will ensure greater and greater profit margins. That is the core of the health care problem in the US, and it's not that I am being reductionist; it's that there is no more sophisticated analysis available for this particular issue. The false binary between HMOnsters and The Red Scare is about disabling any attempts at regulating profit margins by having a distracting straw man debate about Free Market and Rugged Individualism vs. Collectivism & Stalin. Sure, there is other cultural stuff that maps onto that, like American willingness to embrace disenfranchisement, as long as their Black or Mexican neighbors are even MORE disenfranchised... but mostly it's about corporate profits in the large sense of What It's All About. American cultural false consciousness and penchant for voting against one's own interests is quirky and sometimes useful, but it's, like, not even on the radar of Why Things Really Happen.
Forget single-payer, forget the incredibly complicated multi-layer calculations with subsidizing a percentage of some health care plans and taxing some other health care plans, and some states getting funding in some complicated dealings over abortion in some other states. The point is, a reform where the end product would look like the Dutch system would be totally non-controversial, because there is nothing in it to use as fuel for inflating phobias and ignorant half-baked "applied politics" that are an American culture-bound syndrome.
In the Netherlands health care is privatized, and it is mandatory for every individual over 18 to purchase it. The Dutch state also REGULATES THE FUCK OUT OF ITS HEALTHCARE SECTOR. There are 4 insurance companies in the country; they are all required by law to provide the same basic package to everyone, for the same price (around 90 EU/month). There is also a 150 EU annual deductible. That includes every kind of medical care you may need from your GP or specialist, any hospital visit, any test your doctor orders, and all prescriptions you have to fill. It covers limited dental and eye expenses (you can buy top-ups to get more covered) and unlimited therapy/mental health. There are no co-pays. There are things that insurance companies won't cover. For example, my coworker was complaining that her insurance company wouldn't pay for her to have a baby at the hospital, because she didn't have any medical indication for a hospital birth. I asked what she would do and she said she would have to pay for it out of pocket. I was, like, OMG because, of course, I am still in the US frame of mind where it costs thousands to have a baby (I saw my bill, which was accidentally sent to me instead of MassHealth, for my son's birth, which was midwife, rather than doctor-attended, and involved no medical interventions of any kind, and it was like $7000), but no, it turns out that here it costs around 300 EU to have a baby, out of pocket.
The companies definitely compete with each other; with one you may get a discount on a membership to a specific health club chain. With another you might get a discount towards a cruise or a spa. There are slightly different levels of coverage for alternative medicine. I pay about 20 EU more/month for my plan because I choose to have one that will reimburse me for medical care I may receive outside the Netherlands.
In terms of care, I have never had to wait longer than 24 hours for an appointment with my GP's office (with the only exception being when I request to see a specific doctor out of the three available there--then I might have to wait 2 or 3 days); usually if I call in the morning I can be seen the same day. The few times I've had to see specialists I had to wait between 7 and 10 days for an appointment. The only exception was a gynecologist, where I would have had to wait 3 weeks for an appointment, and I ended up going to see a doctor in Germany instead, where an appointment was available the next business day, and the insurance will reimburse me. I have a wonderful therapist that I see every week, and there is no limit of sessions per year.
All the US would have to do to get this kind of model implemented would be to regulate the insurance companies. No boogeyman of the "government running healthcare," no phobias about socialism, no new insurance companies, no new agencies, just regulation: everyone has to buy a policy, and the basic policy has to cost the same reasonable amount, and cover everyone in the same way. And the public would love it -- Gov't Protects People From Bloodsuckers! Gov't Reigns In Insurance Companies! People could have their Aetna or Blue Cross or whatever, they would just all pay something like $150/month, and never worry about co-pays or preexisting conditions or annual or lifetime spending caps or any of that bullshit.
There are systems that function well that fall that are neither the NHS nor the American HMOstrosity. It's just that "socialism" makes for a good scarecrow, and is better for obfuscating that the single, the ONLY reason that health care reform is so difficult to achieve in America is that both health care lobbies and politicians prioritize HMO profits, even as they pathetically try to append some secondary concerns about public impression management. Maybe the real question that people should be asking is--why is the American government unwilling to regulate the health care industry on the level of basic consumer protection? Well, because the more Aetna and BCBS make, the more money they can put into politicians' pockets, of course! Especially now! Thanks, SCOTUS!
Nica Davidov lives in the Netherlands with her partner and son, although she loves spending time in her old home, New York City, whenever possible. She studies culture for a living, and takes photographs for the soul.