"Oh Beautiful for Specious Claims"

In 2010, the United States passed, for the first time, a universal health care bill. Known as the Affordable Care Act (aka "individual mandate"), it basically stipulated that everybody in the US was required to have some kind of health insurance, and it reformed the insurance industry so that they couldn't refuse coverage for pre-existing conditions and pull some of the recission crap that they had been, as seen in Sicko. If you were too poor for it, you could get your insurance subsidized. It was, in other words, hardly extraordinary. It did not put the federal government in charge of the hospitals, as in a single-payer system. It left people able to make the decision to go without insurance (an extra tax would have been added to their tax forms) if they so chose. People in the Netherlands might recognize it as the Dutch system, and I'd venture to guess that most of them/us thinks it works quite well. Or at least, it's not terrible, and certainly better than having no system at all.

And for some reason, it's being seen as the worst thing to happen to the US healthcare "system". What there was of one, to begin with. It is now in danger of being deemed unconstitutional by the Supreme Court.

A bit of a primer on US politics for the internationals: Their are two systems at work in the US, the federal system, and the state system. States have jurisdiction over whatever goes on within their borders, and the federal government has jurisidiction over whatever concerns the nations as a whole (waging war and international trade, that sort of thing). What sounds cut-and-dry has been debated since the nation was conceived 223 years ago, with Gibbons v. Ogden as the first substantive case in which the federal government was granted authority over and above the state governments.

The main gist of the argument against "Obamacare", as the ACA is called, is that the federal government simply doesn't have the authority to mandate that individuals must buy insurance (what is erroneously viewed as a private product), never mind that hurricane insurance is mandatory in areas like Florida. People kvetch and moan about how stupid it is that they, who are perfectly healthy (until they're not) must subsidize the care for the fat, lazy, and diseased. They completely ignore the fact that people with insurance already subsidize the care for those without, in one of the most expensive, unfair ways possible.

But logic makes for a poor argument, at least when the Constitutionality of a matter is at stake. No--far more impressive is to worry about the federal government mandating that you eat broccoli, and death panels denying care to granny (like they already do--in Texas and Arizona, of all states, no less--but apparently if it's a state government doing this it's perfectly okay). Never mind that none of these have any basis in reality, nor are they within the scope of the ACA.

But perhaps most ironic of all, is that the ACA, which essentially puts into law the requirement that you be a good (Christian) person and help out your fellow man, is being attacked by the very same Christians who would require transvaginal ultrasounds for abortions(state-mandated rape) and permission notes for birth control. If it weren't so sad, it'd be funny.

For What Ails Ye

I'm usually not thrilled about living in the Netherlands. I mean, I have a job which is okay, and I have things to blog about, which is fun, but it's not like I go skydiving every weekend or fight pirates or discover a new element every weekend. In terms of excitement, on a scale of 1 to 10, life here averages out at a modest 6, and it's only that high because the NS somehow manages to screw up even the most simplest schedules from time to time (and somehow only ever when you're in a rush) and royally f*cks you over.

But every now and then I am reminded of why I love this country: the fact that you literally cross a street and go from an urban to a rural environment, the tree-hugging ethos of the country as a whole, and health insurance. Especially health insurance:

I was reminded of this in a recent discussion with online friends from the US. The conversation was ostensibly about money, but largely had to do with health care expenditures. All I can say is: OH MY GOD am I glad I don't have to deal with any of that. From my experience, the health insurance policies in the Netherlands are a) affordable, b) comprehensive, c) easily understood, and d) rarely (if ever--I don't think it's even legal) rescinded. It's a far cry from health insurance in the US, which is insanely priced, cover everything except what you actually need, and immersed in medical-ese the likes of which my boyfriend, who is a doctor, hasn't got the slightest clue of.

But most of all, it's simple: I just filled in an easy-to-understand form, and received my insurance card in the mail a few weeks later. When I went to the dentist, I just presented my card, and the receptionist presented me with a bill when I was finished (I have a low premium, but a middling deductible--for dentist visits it's €120, and my bill was about half that). When I need to get my allergy medication refilled, I present my prescription and insurance card at any apotheek, and get pills--with my first insurance company I didn't have to pay at all, but with my current company I get charged all of €10 for my allergy meds (it lasts me about 6 months). I actually haven't had much experience with Dutch doctors--I usually just tell my boyfriend what I need, and he writes me a script.

Compared to some crazy-ass insane policies in the US--where health insurance for a family of 4 can run to $7000/month, and prescription drugs--well, suffice it to say that they're not cheap. Despite the popular image of the spendy-trendy American, the real reason why most Americans who declare bankruptcy are forced to do so are...you guessed it, medical bills. And then you have things like Health Savings Accounts--where you put, say, $80 in an account, so that when you visit a doctor and your co-pay is $60, then that $60 comes out of the account, and you can use the remaining $20 for your medication. ON TOP OF your health insurance. Which of course never covers dental, or vision (though here, glasses are pretty cheap--mine were €85, complete with thin, non-reflective lenses, frame, and exam). And then there's always the question about what does your insurer cover, and what doesn't it, and can you afford this test, etc...not a one of which comes up here.

This is not to suggest that all is well in the state of the Netherlands: rising health care costs are a major headache for everybody, and while doctors in the Netherlands do tend to be more prudent about over-testing and big pharma is forbidden to make TV commercials advertising the latest drugs, the cost of care is increasing dramatically. I don't quite know how the Dutch are going to solve this issue, but rest assured--the people who came up with the Dutch auction undoubtedly have some other accounting tricks up their sleeve.