Today's discussion about the news
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Private system, heavily regulated (ie can’t discriminate against illnesses, age etc) but if your income is below x you get a sliding scale subsidy for said insurance, until you are so poor you get it entirely paid for by the state.
Everyone has insurance - pretty sure there is no opt out but can’t confirm.
It is a system that generates significantly better health outcomes than the UK.
The philosophy underpinning the Dutch health care system is based on several more or less universal principles: access to care for all, solidarity through medical insurance (which is compulsory for all and available to all) and high-quality health care services.
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Did the Netherlands move from an NHS style system?
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It was hybrid for a long time, with state run healthcare alongside private - about 1/3rd could afford private, the rest didn't, but they found it too expensive and inefficiently run so in 2006 they moved to a fully private model, with safeguards to provide universal healthcare. ie. state paying for some or all of the insurance.
I think the insurers get some state subsidy from insuring obviously high risk patients (as they cannot discriminate on price or availability on any health ground and must provide insurance for anyone who wants it).
AFAIK it is a well run market with genuine competition between insurance providers and they do really compete with each other, with Dutch consumers regularly switching insurer.
An interesting note from the wiki: About 2.7% of the doctors are from overseas, as compared with the United Kingdom, where almost 30% are
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So would the transition be comparable to what we would need to achieve?
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it will be, but i'd expect the trail to lead to iran
iran has a brutal regime, without the loyalty of the majority of the population
before the fanatics took over, the shah (whose regime was also brutal) had friendly relations with israel
there are plenty of iranians willing to operate to undermine the current regime
there's a long list of acts of sabotage, assassinations etc. made possible because israel has broadly compromised iranian security
then there're the lebanese, many of whom would like nothing more than israel, iran, and others to stop using their country as a battlefield for their proxy wars
hezbollah could rely on iran's experience evading sanctions, using chains of shell companies and intermediaries to disguise buyers and payments, but that very process makes a supply chain more complicated and vulnerable to attack
my bike - faster than god's and twice as shiny0 -
Pfft I have no idea. I think realistically you would need a lot of time and space for private providers to build up a fully fledged parallel system, and then you could gradually scale back the state run stuff.
I do not think it is remotely politically possible in the UK, alas, and we are dying sooner as a result.
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Dutch healthcare system needs urgent reforms: Better insurance pricing & dental care
The Dutch healthcare system needs urgent reforms. More and more citizens are not getting the care they are entitled to, which will only cause more problems in the future, according to advice from the Council for Public Health and Society (RVS). Among other things, it suggested linking health insurance premiums and the deductible to people’s income and putting dental care back in the basic health insurance package, NRC and AD report.
To be fair I expect most systems have their problems, COVID obviously didn't help.
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Your argument presumes that there are no fixes for the NHS that could lead to similar outcomes. I tend towards believing that there are lots of ways to get to the same general place, including an NHS style model, but that we are doing our very best to cock it up with internal competition, poor procurement and trying to run modern hospitals dilapidated buildings.
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Yeah, I do presume that.
What evidence do you have that socialist models don't end up creating scarcity that, because it's socialist, ends up with enormous queues? Which is exactly what we have.
If I see evidence to the contrary, i'll change my mind, but for now I'll continue with the view that a socialist system in the long run ultimately ends up badly run. It's about an 70-80 year window. We're in the "late state communism" bit of the socialist healthcare experiment. ANd like all good socialist systems, it's not socially acceptable to criticise it.
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You only have one example of the NHS, and several "non socialist" (your terminology) models. Some seem good, based on what you say. Others do not. e.g. US.
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Are people dying as a result of the system or because we just spend a lot less on healthcare than they do in the Netherlands?
I imagine that if everyone in the UK paid a grand a year into the NHS rather than to an insurance company, outcomes would also improve. It wouldn't be popular either way of course.
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UK spends plenty on healthcare. The incentives in how its run are not aligned to the most optimum outcome.
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My incredibly detailed quick google search suggests that we spend a lot less than the Netherlands
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If only Spaffer and his cabal hadn't made off with the extra £350m per week as 'promised' on the side of a big red bus... IGMC
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We've had this discussion before. The argument that the UK just spends less on healthcare and that if it spent more it would all be fine, misses the fact a socialist model encourages underspending.
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Okay, we'll make the argument. Reason I'm less persuaded than you think I should be is the level of regulation required under the NL system.
Are there cost caps in place for insured individuals there? And do people who are manifestly higher risk from an insurance perspective, e.g. someone born with a congenital condition, end up paying more?
Fwiw the way to transition would be a tax break, e.g. in national insurance, together with a legal requirement for equivalent insurance. The NHS could claim back from an insurer like any other provider. Soon there would be competition.
Can't see how you would ever transition A&E, so good luck avoiding having all the shitty stressed out and underpaid doctors there.
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Therein lies the problem. If we were building a system today it would almost certainly look different but any attempt to change it will be framed as 'destroying the NHS'. It's weird, most people trying to use it are critical of how it works but at the same time people are ridiculously protective of the concept.
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The NHS faces a PFI postcode lottery as some trusts are forced to spend up to £1 in every £6 on PFI payments with worrying consequences for patient safety, says the IPPR think tank. Decades of underinvestment, austerity, and the legacy of the privately financed capital projects has restricted long-term investment in buildings, maintenance and new life saving technology.
In a new report, IPPR outlines the ‘capital crisis’ facing the NHS and calls for the end of the ‘toxic’ legacy of PFI. IPPR analysis of latest HMRC data found that PFI, the scheme which funded capital spending through private finance, is costing the NHS an extortionate amount. For just £13bn of investment, the NHS has been landed with an £80bn bill.
Never should have happened, it's just kicking the can and putting off debt till the next administration. Major introduced it.
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That's not exactly glowing about the situation in the NL. Seems to suffer from a lot of the same problems as the other insurance models I'm vaguely familiar with.
Not a silver bullet.
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You would faint if you saw how much better the care is there. Honestly. Their standards are way way way higher than here. We have 14,000 people dying a year because of A&E queues alone. A YEAR. The enemies of Britain couldn't kill that many British soldiers in 75 years.
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Yeah, that's not to say I'm sure it has it's good points, but it adds a bit of parity to the situation.
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Until people actually realise how much better it is elsewhere they just won't get it tbh. They don't even read the British own review of its health system which puts it behind comparable country's health systems in terms of outcomes for pretty much everything.
So far the defenders can't come up with evidence that just changing how the NHS runs will be better somehow.
You think headlines like this will garner more money to the NHS?
Or this?
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You need to avoid the temptation to form your views immediately after a Tory government. How old were you in 2005? Or 2010? 15 and 20, respectively? You see, at that point, the NHS was in a much much better state and the Tories have had to work extremely hard to fuck it up this badly.
You probably weren't born in 1996, but rest assured the Thatcher years shaped my views on the way we treat the least fortunate in society.
Point is, these things go in cycles and I've seen at least two full cycles now. Consequently, I do not think there is anything intrinsic to the mechanism of funding healthcare one way or the other that makes it bad. To make a footballing analogy, it isn't always best to change manager is results are poor.
A more salient question is whether, when the NHS is working "well" what are the pros and cons, as compared to an insurance model.
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The Netherlands' right-wing government said on Wednesday it would seek to opt out from the European Union's migration rules if and when the bloc next renegotiates its core treaties - even though this is unlikely to happen any time soon.
In power since July, the government led by Geert Wilders' nationalist, anti-Islam PVV party has said it wants to clamp down on unwanted arrivals and aims for the "strictest-ever asylum regime", with stronger border checks and harsher rules for arriving asylum-seekers.
Immigration is a hot-button issue in the Netherlands, as in much of the 27-nation EU, and the PVV's hard line explains much of its popularity.
https://www.reuters.com/world/europe/netherlands-seeks-opt-out-eu-migration-rules-2024-09-18/-
Blimey, it doesn't sound very unifying.
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NHS suffers from treasury brain-itus, which absolutely cripples investment for short-term "keep the lights on" style spending, which ends up being hugely inefficient and costs in the long run.
I don't believe you can avoid that in a state-run enterprise over the long term.
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The Netherlands’ government plans to bring in drastic new anti-immigration measures, set to be some of the strictest in the European Union.
Its plans, announced Friday as a part of the ruling coalition’s program, include stricter border checks, “tit for tat” punishments of “troublemakers,” restrictions on family reunification that would bar adult children from joining their parents, and a focus on forced returns.
The Dutch government is the first to feature the far-right, anti-immigration Freedom Party of Geert Wilders, who won nearly a quarter of the Dutch parliament’s seats in November. His party delivered the government’s migration and asylum minister, Marjolein Faber.
“I’m aiming for the strictest asylum policy ever,” Faber said in a video message, citing bottlenecks in housing, health care and education as reasons to do so.
https://www.politico.eu/article/dutch-government-announces-strictest-asylum-policy-ever/
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What have the Tories failed to do to make things worse? They haven't cut funding; it has risen every year above inflation.
1985 Mercian King of Mercia - work in progress (Hah! Who am I kidding?)
Pinnacle Monzonite
Part of the anti-growth coalition1 -
My wife works for the NHS - I obviously speak to her all the time and on occasions to her colleagues. I also know a few other people who work or have worked in the NHS. I cannot remember a single one of them claiming that there is not enough money going into the NHS - however, all of them say that it is poorly spent.
Wilier Izoard XP0
