patrick.net

HEYYOU says

No form of healthcare beats Dimwit's winning MAGA Dimwitcare

Oh thanks, that's super helpful!

Not.

Managed competition uses a combination of private markets and government regulations to try to reduce health care costs and improve the quality of care. The Netherlands strives to have the different parts of its system — the general practitioners, private insurers, home nurses, the emergency department — work together seamlessly. The Dutch have sought to use a tightly managed market to achieve universal health care, rather than a more socialized system like those seen elsewhere in Europe.

OK, at least the article gives some details, though I didn't get a very clear picture of how the Dutch medical system works.

I know a bit on this topic. Care for the young is exceptional, while care for the elderly is rationed, cancer diagnostics particularly so. If one needs a CAT scan or MRI, he may receive a narrow image that omits key neighboring lymph nodes (cancer spreads). The number of late-stage cancer diagnoses that I personally am familiar with (through extended family) is extraordinary -- about ten people with lung or gastric cancers 'missed' until too late. Routine bloodwork is rationed as well, despite its usefulness in identifying immune shifts.

I've talked at length with one of the rationing bean-counters, a mathematically-talented but medically-uneducated woman (a friend), who sees preventive and diagnostic care through a "whole-population" lens. In other words, what might make sense for a 55+ Dutchman (routine bloodwork, for one) cannot be generalized to younger people, and therefore should not be recommended in aggregate. Absent a medical community directive (like colonoscopies over age 50, or mammograms over 40), the Dutch system will not give special treatment to older patients.

The Vox article is a puff piece, but has telling quotes like the following about rationed care:

"There are cost constraints for hospitals. Insurers can set a cap on how much will be paid out for medical services provided in a given year, known as a global budget, and the government can impose budget cuts if spending goes over that limit."

That budgeting results in rationing. The results are tragic for the relatively trusting elderly.

On the other hand, what the Dutch do right (that we in America don't) is control what hospitals and providers may charge for a given procedure. Our rates are exorbitant because the ACA merely instructs that a percentage of profits be reallocated to care (80%, I believe) -- so of course the medical industry charges more overall. We have no price limitations.

Gen Xer: "Kill the olds. It's the only solution."
Millenial: "But the olds have all the money! I'll get it when they die!"
Boomer: "Not after the big Pharma and Med are done with them!"
GenXer and Millenial: "So USA health care is just a wealth transfer system to moneyed interests?"
Boomer: "Took ya this long to figure it out? I'm moving to Mexico, or maybe India."