Freedom of Choice Is Priceless

This week I was in the Midwest of America to discuss the health system in the Netherlands. Americans know that something is wrong with the way they deal with medical expenses, and they are very interested in European alternatives. Of course, their attention is dictated by the fierce debate in Washington on reforming American health care. But what I found out is that Americans are not yet ready for a frank conversation about the health topic.

Not only is the discussion unnecessarily polarized, American people are still calling out from everywhere to oppose socialized medicine. But the discussion is limited. It is mainly about the many Americans who are uninsured and the financial feasibility of comprehensive health care. On television, there are commercials about the “compulsion” to insurance, in which the government would interfere in private life. This discussion ended in the Netherlands in the 1940s, when the German occupiers claimed compulsory medical insurance.

Americans spend huge sums on health care. These expenditures by the government and, especially, the private sector amount to 17 percent of America’s Gross National Product, in contrast to that of the Netherlands, which is 8.5 percent. If Dutch workers with average incomes pay 100 Euros for basic insurance, 300 Euros a month to the AWBZ (public insurance for health risks),and 175 per month through their employers for health care, how much higher are the health costs in the Netherlands than in America? Americans really do not want this debate with each other.

According to the journalist T.R. Reid of the Washington Post, the costs of health care are too high because an army of bureaucrats is needed to untangle the regulations and price agreements. In addition, private insurers in the U.S. go for profit, often seeking to pay not more than eighty percent of premiums for medical expenses. So Reid states that tens of billions are wasted on the largest and most inefficient administrative system of the western world.

Obviously, the U.S. health system is not only doom and gloom. It is one of the most highly trained and well-equipped medical systems in the world. It is no wonder that rich foreigners want to come to the United States for specialized care. But the high costs of that care are passed on to the patients. If you have a permanent, full-time job, your employer may pay your health costs, as in my friend’s situation in St. Paul. His family medical insurance is only $65 a month. But self-employed and part-time workers will have to pay for health costs themselves. One of my friends in Grand Rapids pays $650 per month for limited family medical insurance.

Yet Americans are reluctant to talk about lowering costs. If less money is spent on health care in America, is there still a place for prominent institutions such as the Mayo Clinic, a world renowned private hospital? Furthermore, it seems almost impossible to lower prices set by pharmaceutical companies, which are even more powerful than the insurers. It will also be an enormous task to apply an efficient system to an industry consisting of thousands of organizations and very different regional markets.

Despite the costs, most Americans are very satisfied with their excellent medical insurance. They want to maintain optimal medical care and personal choice. Medical insurers shamelessly advertise their medical insurance products and encourage customers to choose their own care while demanding specific medication from their doctors. When some insurers offered managed health care in the ’90s – lower premiums and limited choice – Americans responded negatively. They value freedom of choice and want to spend their money. They are not ready for change, not even in 2009.