Let's Go Dutch
8:00 AM, Aug 18, 2009 • By STANLEY GOLDFARB
Rationing may also take the form of limits on payments for medications. An example of the latter occurred in Germany and was reported in the British journal, Lancet: The German government under terms of the Bonus Penalty Ruling embedded in their health care system set daily rates for drugs used to treat high blood pressure, depression, migraines, prostate illnesses, and osteoporosis. This was viewed as reforming a component of the German system. Only 37 cents per day were allowed for drugs used to treat depression, migraines, and hypertension. The plan inevitably led to a big problem as the Lancet article went on to explain: Ambulatory care doctors in Germany were allowed to prescribe only a set daily dosage at a set daily rate. Incredibly, doctors prescribing over 10% above the set rate, were penalized and fined. A physician explained, "What is really wrong is that even doctors who are being very, very economical with their budget are being affected".
Having said all this, perhaps the most surprising development in European healthcare reforms is the Dutch plan that is the diametric opposite of HR 3200 and the Obama hoped-for single payer plan. In the Netherlands, the buzz words are "overcome the limitations of centrally run healthcare systems" and "managed competition". The approach is not greater and greater limits on care, it is to provide a competitive environment where incentives to achieve better and more efficient care can flourish. The history of this, as described on an official Dutch government website, is quite fascinating given our country's debate:
Therefore, the Dutch health care system has converted from a centrally controlled, inefficient, and increasingly expensive government run system to a decentralized, private insurance based, competitive system.
The president has been quoted as first supporting a single payer system before he was against it. The truth is that whatever system is put in place is only the first step if the experience of nearly continuous health care reform in Europe is a guide. Those who fear change because it may lead to circumstances they abhor should not have their fears dismissed based on what is in HR 3200 or any other bill put forward now. Whatever is put forth now will change in the future.