Thursday, September 13, 2012

Universal Health Care

I am of the belief that the one percenters want President Obama re-elected. ON every major issue of interest to them he has bowed, not least on health care. Having abandoned single payer early on, then public health exchanges in favor of industry supported mandates he is bringing some kind of painstaking piecemeal reform, much needed but entirely too complex and inadequate. I grew up with single payer and I still miss it even though I have good insurance through my job. I always have because to go without insurance was bizarre to my European rooted brain. Here is an American writer in Europe telling The Progressive magazine why single payer makes the world go round properly. Note: it's not free, just affordable and sensible and anxiety reducing.

I live in Amsterdam. When I first came here in 2006, I noticed immediately how much more civilized it felt to be living in a country where I knew that everyone had health care. I used to joke that I’d move back to the States only when a similar system was finally in place there.

So I was naturally thrilled when it seemed like the United States was moving towards a more progressive system with President Obama’s health care overhaul. When it passed, I even started looking at apartment prices in New York.

As the plan moved through the Supreme Court, however, I listened with special interest (via podcast and downloads) to the debates about the controversy over the “individual mandate” because Holland’s health care system is built on something very akin to the “individual mandate” approach.

Every person who lives in the Netherlands is required to buy medical insurance from one of many private insurance companies. Employees can receive medical coverage via their job, individuals can buy it for themselves, and those who can’t afford it receive a subsidy from the government to purchase it privately. As a condition of my visa, I had to prove that I had purchased medical insurance.

I pay out of pocket, but because of the economies of scale built into the universal health care system, I found that the premiums are very reasonable. Basic insurance (known as basisverzekering) can be secured for little as 90 euros a month (about $110), and I used a free website to compare and contrast plans offered by various insurers. All of them covered primary care with a general practitioner, specialist care on referral, hospital inpatient and outpatient and emergency services, as well as prescription medication—all without a co-pay. And under Dutch law, no one can be denied basisverzekering because of any preexisting conditions.

There are options for plans that are more expensive and offer more bells and whistles, so you can buy Honda insurance or Cadillac insurance, depending on your style and your cash at hand.

Because it was relatively inexpensive, I went for a slightly higher-end plan that also covers all dental expenses (procedures up to about $2,000 a year), eyeglasses, physical and psychiatric therapy, and longer hospital stays. I didn’t splurge on the “premium” plan that would also have covered all elective and plastic surgeries.

My current plan costs me 153 euros a month (about $200) and covers pretty much everything I’ve ever needed. Well, not everything. . . . This year, I bought a new pair of glasses, and my insurer covered 200 euros but I had to pay 100 euros or so extra for the Ralph Lauren frames. There was also a genetic test I had decided I wanted to have done when I was trying to get pregnant that my insurance company didn’t deem necessary. So I paid for that on my own.

I started using the Dutch health care system as every Dutch person would. I first signed up with a local huisarts, or house doctor, a general practitioner in my neighborhood, within walking distance of my house. (They used to make house calls regularly, and still do in some circumstances.)

When I nervously called to make my first appointment for intake, a brusque receptionist on the phone said, “Well, we can’t see you right away!” I said that was all right, assuming that it would be a few weeks before I’d get in to meet my new doctor. But then she asked: “How about tomorrow afternoon at three?”

My huisarts wears street clothes rather than a white lab coat, and she welcomes me into her office for a conversation that could last anywhere from five minutes to a half hour, depending on my complaint, then treats what she can on the spot. I do my gynecological exams with her, and she treats me if I have something ordinary, such as the flu or an infection, and I get my vaccinations there when I go on trips. If my huisarts feels there’s something she can’t handle, she refers me to a specialist.

Getting medications in the Netherlands is a particular treat. My huisarts writes prescriptions for medication, I walk to the local pharmacy, I hand it to the pharmacist, and I get my meds. No money is ever exchanged.

This year I got pregnant, and all of my medical expenses were covered under my plan, from weekly visits to my team of midwives (doctors don’t get involved in pregnancy and birthing here unless there are medical complications) to ultrasounds, blood tests, delivery, and post-natal care. That may not sound remarkable unless you consider that for ten days after giving birth, I was also provided with a home health care nurse called a kraamzorg.

She arrived every morning at 9 a.m. and stayed until 3 p.m. She checked on me and my baby, helped me master the art of breastfeeding, showed me how to wash, change, and put my child to bed, prepared lunch, did my laundry, cleaned my apartment, and looked after the baby in the afternoon so that I could take much-needed naps.

I’m not lying about this. The kraamzorg service, which is unique to the Netherlands, was entirely covered under my insurance—as it is for every woman who gives birth in Holland.

There’s a certain peace of mind that comes from knowing that every mother and every child born in the country where you live gets this kind of personalized attention. It’s been perspective-altering to experience how well the “individual mandate” operates to provide universal quality care literally from cradle to grave.

I won’t argue that there’s nothing wrong with the Dutch health care system, of course. Other expat friends complain bitterly about many doctors’ bias against prescribing antibiotics (typically, the advice is to go home and wait a week to see if it isn’t a viral infection first). I’ve heard some people argue that you have to fight hard for referrals to get highly specialized care.

But at least I know that I won’t be denied services because of a preexisting condition or because some administrator somewhere is poring over my individual itemized bills, or that my doctor can’t prescribe me medications because they’re too expensive for my insurer. Or even that I’ll have annoying little $10 or $40 co-pays for meds.

I no longer joke about returning to the United States only when there’s a decent health care system in place. I’m serious: It’s a huge quality of life issue.

I can’t imagine going back and finding the old system still in place if, somehow, Mitt Romney were to become President and succeed in his vow to repeal the Affordable Care Act.

Listening to the Supreme Court debate and the commentary that went along with it, I was surprised by the level of outrage among some pundits about the fact that so-called Obamacare would require everyone to buy into the system, as if this were a completely untested idea.

I’d like to point out to all those myopic pundits and politicians who oppose the Affordable Care Act that this idea has already been tested. And as an American living abroad and experiencing it firsthand, I can say that I’m completely satisfied with the results.

Nina Siegal is an American journalist and writer living in the Netherlands.

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