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Friday, December 17, 2010

Dutch Style Health Care

It sounds less scary than American style health care:

The Fraser Institute wants Canada to lift a page from the Swiss and Dutch health-care playbooks.

According to the institute's Mark Rovere, both Switzerland and the Netherlands have a public health-care system, but all health insurance is private.

"Of course, the devil's in the details," Rovere said. "You have to regulate the insurance industry, but those are two countries that have zero wait lists and a universal health care system."

It's government run health care, it's just less government run. Taking your poison in milimetres rather than troy ounces. Make what you will of the Dutch approach, the truly interesting bit in this article comes from this classic response by a Medicare defender:

He said the government "clearly needs to increase capacity" in the health-care system. The biggest problem, he explained, is a shortage of people willing to work in health care.

Now why would people be unwilling to work in health care? There are certainly shortages of skilled professionals in many fields, a result of public education school turning out sociology majors rather than engineers, and university graduates rather than skilled tradesmen. Central planning in education doesn't work much better than in other aspects of life.

The problem with Medicare, however, is the willingness of skilled professionals to enter the system. Might not the problem, then, be the system itself and not a minor aspect that can be fixed by the mystical force called "political will?"



Posted by Richard Anderson on December 17, 2010 | Permalink


When a nominally conservative party in power won't touch the gun registry or the Canadian Wheat Board, those interested in real reform of Health care can only dream about it.

The Feds should only be involved in ensuring inter-provincial availability in private insurance. The provinces should compete amongst themselves for health care policies, ideally minimal roles encouraging competing private delivery, private insurance and if politically necessary, means-tested vouchers for the uninsured, indigent and un-insurable. If small local governments can't entice adequate private delivery, then that is the only level of government involvement that hopefully doesn't turn into the current monopoly delivery of unionized sloth. Oh....there goes the alarm clock! Never mind!

Posted by: John Chittick | 2010-12-17 10:21:11 AM

The reverse of the Dutch and Swiss models would be preferable. Let each provincial government, or federal if you must, be restricted to operating the health care insurance and stay totally out of health care provision. For example in BC it could be run like ICBC. It is not perfect but far better than what we now have where the government runs the provision and collects the money as though it was the insurance agent.

Posted by: Alain | 2010-12-17 12:17:27 PM

One more thing is that people would also be allowed to take out extra private health care insurance in case they need to top up what the government insurance provides.

Posted by: Alain | 2010-12-17 12:20:01 PM

One of the biggest problems in the provision of health care is that provincial governments have treated jobs in the health care system as some sort of make-work program. We have more clerks than we can shake a stick at and they are definitely underemployed. Why not hand a large proportion of these people mops and brooms and at least our hospitals would be cleaner than they are now.

I have questions about things which doctors use to make money: fees for referring a patient to a specialist - why? Isn't it logical that a referral is just part of the service if a specialist is needed.

Why not declare habitual residents in the emergency room as a nuisance and turf them out using a triage system. Surely our emergency rooms should serve dangerously ill people, not act as a flop house for alcoholics and street bums.

Posted by: Jon Coates | 2010-12-17 4:46:45 PM

Jon Coates, I suggest that a much bigger problem with the government administrating the provision of health care is the huge amount of money wasted on the top administrators. The dollars wasted on the top level bureaucrats far outnumber what may be wasted on clerks. I am not saying there are not too many clerks, only that all this is representative of government administering the actual provision of health care.

Posted by: Alain | 2010-12-17 6:24:09 PM

Canadians will never go to a purely private medical system. They have been too brainwashed on medical socialism. However, they might be open to the more open Swiss model. Canadians seem to be gradually moving to the right on economic issues. Yet, the pace seems to be rather slow. A private system is too radical for them at this time.

The Swiss healthcare model is permissible because the left is considerably weaker in Switzerland. Switzerland has four main parties. The strongest one is the right-wing Swiss People's Party. It is for smaller government but takes a hard line on crime and immigration. The second party is the FDP which is a center-right libertarian party(though it supports tougher measures against immigration law breakers). The third party is the CVP or Christian Democrats. They are also kind of center-right. They support a mixed social market like in Germany but tend to have some conservative social views. The only powerful left-wing party is the Social Democrats. The average Swiss voter leans center-right. The right parties regularly outpoll the left. The Social Democrats(center-left) typically place 2nd or 3rd in polling. The FDP or Liberals(or center-right Libertarians in north american political lingo) often compete with them for the number 2 slot.

The conservative Swiss Democrats and the libertarian FDP are the two major parties whose influence has grown over the last 15 years. The reason is that the average Swiss voter understands that government has to have some limits placed on it. Also, the Swiss Democrats have been able to appeal to the natural conservatism of voters through the referendum process. The Swiss Democrats have used referendums to push for tougher crime legislation, crack down on illegal immigration, radical islamists, and welfare abuses. The result is that Switzerland is a place that is both more conservative and more free than Canada. My taxes are lower here. I get a lot less flak from the government for owning firearms. Also, I have the power through referendum to truly decide public policy. In turn, public referendums have shown support for allowing religious instruction and school prayer in our schools. Public referendums have upheld the continued existence of the Swiss army in which all Swiss men are conscripted into. Public referendums have even allowed the legalization of abortion but put practical limits on it(abortion legal up to 12th week but there are some restrictions). The point is that there is far more fertile ground in Switzerland for the right than in Canada.

Posted by: Karl | 2010-12-17 6:59:01 PM

Ultimately, the greatest failing of public health care (While there are many failures of public health care) is that it assures that the sick are rewarded for being sick. The nature of the system assures that those who should not live, live to the cost of others. A completely private, for-profit health care system will assure that the sickly and the stupid not survive and infect society.

Posted by: AB Patriot | 2010-12-19 12:35:06 AM

"A completely private, for-profit health care system will assure that the sickly and the stupid not survive and infect society." - AB Patriot

A completely private for profit health care system could not exclude not-for-profit delivery from charities, churches, and individuals. What you describe is actually Eugenics as practiced in the Third Reich.

Posted by: John Chittick | 2010-12-19 10:48:36 AM

No. What I prescribe is an adherence to reality. Those you harm their own health (and these same people are likely socety's stupid) should not impose the cost of their care upon others. Moreover, I would take it another step further and outlaw not-for-profit health care, as it will cause distortions in the marketplace. For-profit only health care will assure that the marketplace will work effectively.

Posted by: AB Patriot | 2010-12-19 3:20:07 PM

AB Patriot, your comment smacks of statism and totalitarianism. Who decides which activities or behaviour harms the person's health? I can imagine the regulations stating something like only people who use a bicycle or public transportation follow the approved lifestyle, or only those who do not eat meat, et cetera. To cap it all off, you want the state to outlaw "not-for-profit" health care.

Posted by: Alain | 2010-12-19 6:34:54 PM

That is where you are completely wrong. Anything that defies the profit-motive in the marketplace causes a distortion in that marketplace. Indeed, anything that operates with the intention of being a non-profit or a not-for-profit entity causes unfair competition for those that seek and compete for profit. Non-profits and not-for-profits offer have an unfair advantage in that they enjoy considerable benefits from the state, in the form of monetary grants and special tax considerations, that give them an unfair advantage over those that seek profit. For example, a faith-based not-for-profit clinic would compete against the for-profit one while enjoying tax-free operation (for being affiliated with a faith-based organization) along with other advantages not available to for-profits. The market distortions caused by the operation non-profits and not-for-profits is an obvious clear and present danger to the free market.

Posted by: AB Patriot | 2010-12-19 11:35:01 PM

As for who will decide what a healthy lifestyle is, it should never ever be the state. I suggest that (shockers) the individual should decide what their lifestyle should. And what will be the motivator for the individual? How about rising morality rates? Once it becomes clear (to the individual) that there are linkages between certain behaviours and mortality rates, they will make the appropriate adjustments. If they do not, they are among the stupid, will fall sick by their own doing, and throw off their mortal coils.

Posted by: AB Patriot | 2010-12-20 12:17:07 AM

AB Patriot, I am a free market proponent, yet I cannot reconcile the idea of banning not for profit health care in all its forms.

The freedom to trade with an individual also means the freedom to agree on the terms. I am free to charge what I can get, or am free to charge something less. Anything else is a restriction on trade.

Posted by: TM | 2010-12-20 7:51:13 AM

Simply put, if you choose to charge less for your health care, because of something as facile as faith-based values, then you will not be able to realistically sustain operations with the costs incurred offering your service at a lower price. Therefore, you will be required to lobby for and accept government handouts from statist maggots just to maintain your operations. In the end, it is you and your pithy notions of good deeds that will pave the way to statist encroachment into every aspect of society. Remember: the path to disaster and enslavement is always paved with good intentions. All individuals do enjoy the freedom to trade as they choose; but those you engage in obvious commercial stupidity, and then demand statist support, must be stopped or punished severely for their actions. More often than then not, the free market must be defended, and will be defended, with all violence available.

Posted by: AB Patriot | 2010-12-20 8:54:20 PM

AB Patriot, I think I am understanding you for the most part. Now what about a privately run hospital that makes allowances based on some criteria, to accept donations that are used for some that meet that critera. Would you deny the giver and the receiver of the charitible transaction?

Posted by: TM | 2010-12-20 11:04:41 PM

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