Going Dutch

All industrialized countries other than the US offer universal health care, but they do in different ways. England has an entirely government-run system. But several countries manage to cover everyone with a more market-oriented system. Here's what the Dutch have to say:

Between meetings, Mr. Klink sat down with The New York Times. The Dutch are in the midst of a significant health overhaul to inject greater competition into the nation’s insurance and hospital markets, but Mr. Klink also offered some pointed observations of the health system in the United States.

His first official visit to the United States as health minister came in 2007, and he came with the usual European preconceptions that this country had a wide open and fiercely competitive health insurance market with a myriad choices.

“And what struck me,” he said, “is actually the lack of competition you have.”

Mr. Klink pointed out that nearly 40 percent of the nation’s population gets care fromMedicare, Medicaid and Veterans Affairs, all of which have significant restrictions on the choices available to patients. “We don’t have these kind of public insurance groups in our country,” he said.

And even among those in the United States who get insurance from their work, he went on, “it’s the employer who is making the choices of the health plans from which you can choose.”

The Swiss have a similar system. Singapore has one that's even more free market--people have health savings accounts to pay for most routine care--and they also spend the least out of any industrialized country on Healthcare as a percent of GDP. What's common across all three is that subsidies are targeted through means-tested vouchers, rather than with a public plan, Medicaid, or Medicare.

Yet somehow we get caught in a debate where one side yells at the other for throwing people at the mercy of markets; and the other refuses to tinker with the system. Ensuring Universal Coverage should be the premise of the health care debate, and there are a range of options both to the left and the right on how to get there. Yelling at John Mackey for expanding health coverage and cutting costs isn't going to help; there are issues here beyond the purely moral.