Dutch Universal Health Care and Obamacare

6 November 2013

Being a relatively new avid follower of Matt Walsh, I almost choked on my morning coffee when stumbling upon his post “The Definitive Guide to How Obamacare is Destroying American Lives“.

Walsh writes, ” This is about people. People with kids, and bills, and health problems. This is about people who can no longer afford their health coverage, their mortgages, their lifesaving medication. This is about doctors and nurses leaving medicine behind, driven away by destructive bureaucratic interference.”

Unable to digest Walsh’s tirade over Obamacare, my sleep-deprived mommy brain started trying (in vain)  to process his rhetoric.  Are the lives of American people truly being destroyed because of Obamacare?

ghentGhent, Belgium

Unbeknownst to many and probably Walsh himself, the closest foreign analogue to the Affordable Healthcare Act (Obamacare) is the Dutch system.

Ironically, the ideas of Stanford Health Economist Alain Enthoven , specifically the theory of managed competition, was one of the main founding principles of the Dutch health care reform, an important source of inspiration for the Heritage Foundation and considered in the development of the Affordable Health Care Act.

The two goals of any health policy according to Enthoven, should revolve around the ideas of equity and efficiency:

” By equity I mean that a just and humane society can define a minimum standard of medical care that should be available to all its members -essentially all the cost-worthy medical care that can effectively prevent or cure diseases, relieve suffering, and correct dysfunction. (By “cost-worthy” I mean that marginal benefits equal marginal costs for persons of
average incomes). ” Alain Enthoven

“An efficient allocation of health care resources is one that minimizes the social cost of illness, including its treatment. This is achieved when the marginal dollar spent on health care produces the same value to society as the marginal dollar spent on defense, education, consumption, or other uses. Relevant costs include the suffering and inconvenience of patients as well as the resources used in producing care.” Alain Enthoven

How Enthoven’s theories turned to real world practice is where the contention lies. Implemented in 2006, the Dutch Healthcare Act required everyone who legally lived, or worked in the Netherlands to buy health insurance from a private insurance company. Insurers are required to accept each applicant at a community-rated premium regardless of preexisting conditions. The plan is financed with individuals’ annual income-based contributions to taxes. Employers are required to compensate their employees for these contributions. In addition, all adults are required to pay premiums directly to the selected insurer, which sets its own community-rated premium. Children under the age of 18 are not required to pay any premiums. For more information regarding the Dutch health care system as it applies to ordinary residents and citizens of the Netherlands, click here.


Obamacare appears to be a much more convoluted system under the premise that insurers offer four varieties of basic insurance packages, bronze, silver, gold, and platinum, with different deductibles and different levels of coverage. Unless you’re an expert in health care, tax policy and health economics, it’s pretty challenging to fully comprehend how all the essential parts of Obamacare fit together. In fact, even experts have difficulty comprehending it, less alone be able to explain it in simple terms. Health Policy correspondent for NPR Julie Rovner admits that  “another reason for the confusion is that both supporters and opponents of the law have exaggerated and misrepresented things about the law“. She does her best in elucidating actual truths about the affordable health care act here.

I’m not sure what Walsh’s motivations were for writing such a sensationalist piece. I admit that he’s a brilliant writer, one that is able to illicit discourse and emotions – it’s why I was drawn to him in the first place. However, his rants in the month of October about Obamacare have deeply disheartened me as a fellow American, as a parent, as a liberal and as a Christian. Does he really speak for the average American collective whose lives will be ruined from Obamacare?

I doubt that the stories that Walsh shares with his audience are fabricated. It’s part of why I find what’s happening on the other side of the pond disheartening. Universal health insurance is not supposed to inflict a heavy economic burden.  However, rather than simply join the masses in a heated debate, I had expected him to be a voice of reason.

Perhaps if Walsh spent a bit more time advocating for more simple pragmatic solutions, the United States could be one step closer to joining the rest of the world in providing universal health care. Change, from what I recall living in America, happens from discussions at home, between friends, in the classrooms, and at local town hall meetings. Americans need real-life solutions and alternatives, not more rhetoric on the dangers and evils of what universal health care can bring.

Where Walsh fails to enlighten and empower his audience, I see it as an opportunity to pick up his slack and provide a more balanced view of a feasible alternative right across the pond. I’d love to share with the rest of the world what I’ve learned living in the Netherlands. Part of it involves living in a country where my husband (a self-employed entrepreneur) and I (a stay-at-home mom) only pay 100 euros each month for what equates to a silver package under Obamacare.

While the Dutch system is far from perfect, I have to give it to the Dutch for being a just and humane society that has defined a minimum standard of medical care available to all its members that can effectively prevent or cure diseases and relieve suffering. Doesn’t that fit into Christian ideals Matt Walsh?

Obviously I hit a landmine deciding to write about this. There’s so much to write about this topic and other related topics that cannot be covered under one blog post. Please stay tuned in the next following weeks (every Wednesday) as I share with you how the Dutch do healthcare. Maybe, just maybe, my ramblings might inspire Americans to think of another alternative, one that doesn’t create such polarizing experiences.

Like what you read thus far? Come join me on my Facebook Page Finding Dutchland to connect.

  • Maria Olivares Babin

    Looking forward to those future posts! As an American living in France, this topic interests me!

    • rinamae

      Thanks Maria! Are you happy with your health insurance in France? Are you also a bit confused with what’s going on in the U.S.?

  • Lana Jelenjev

    another well written piece! keep it up 🙂

    • rinamae

      Thanks ate Lana!

  • Marthe

    Good piece! But I think the first picture is Belgium (Gent). Not The Netherlands.

    • rinamae

      True! 😉 I should label it – thanks for letting me know. Though…don’t you love the American irony? (Americans are notorious for not knowing their geography)

  • The Dutch system has worked well for me so far but I’ve heard stories that make my blood crawl. Prevention doesn’t really exist here! And, why do we have to try to do everything the “natural” way- whatever that means??? And I just don’t like the way how there is no choice, for example if you’re pregnant, there only way to go is the midwivery way (which can be great for some but not so great for others), while in Germany for example, you can choose between a midwife and a doctor- or you can have both!I wish there were more choices in the Dutch healthcare system! And I also wish doctors would listen better- although that is probably an issue everywhere, but here it is very hard to get something more than Paracetamol regardless whether your condition is bad or not. Have you seen “The Zorg of Holland?” It’s on youtube, it is funny but unfortunately quite true!

    • rinamae

      Hey Olga!! Thanks for sharing this! 😉 It’s why I’m taking on the challenge and making it a personal mission to help other expats navigate the Dutch health care system.

      I know your frustration intimately too well until I decided to analyze the situation myself and use it to my advantage. I have a totally different perspective, one that has made me have very positive experiences with the Dutch health care system. Part of it is because I’m neurotic and basically use my pre-med knowledge as an advantage, the other part because I’ve gotten “insider knowledge” having a Dutch husband. It also helps being surrounded by tons and tons of Dutch doctors/specialists (surgeons, general practitioners, pediatricians, psychiatrists, etc) to have gotten their insight and use it to my advantage.

      Stay tuned for upcoming posts, probably every Wednesday or so, elucidating the Dutch health care system.

    • Dorit Uebachs

      I watched it… great, and so true. I grew up in Germany and there we where spoiled with prevention and possibilities to choose our own specialists. Here I often had to fight (“I won’t leave this room before you send me to a specialist”) to get what I thought I needed and mostly I get it. But sometimes you really have to stand up for yourself. But sometimes I think this doctor just thought he knew everything because now I’ve a really good doctor and no problems with getting a specialist if I think I need one.

  • Anna Sorrell-van Ast

    Great job!

    • rinamae