The Netherlands is a small nation of only 16 million, and yet they have a record in International soccer that’s better than many three times their size. laws about drugs and prostitution that reduce crime, violence and embody toleration, and now they probably have the most advanced health care financing system in the world.

How so? It’s essentially Enthoven’s original managed competition idea in action (circa 1987). Even the Wall Street Journal thinks good things. The key is you need to ban underwriting, and implement risk adjustment (not that it’s easy but it is doable) between plans. Then you have to give the insurer and the insured incentives to realize that the way that population health is managed has ramifications for both the population’s health and its wealth. Then you get rational trade-offs made at a population level.

Can it happen here? I think so, unless you think that Americans cannot handle rational choice. Of course the people who claim to value choice in health care here can’t abide by the concept of the rational structure that the Dutch have put in place which allows choice to be made about the right things. So "choice" here in health care financing means, as the WSJ put it:

In the U.S., competition among insurers often means competition to find
the healthiest customers, especially in the individual market.

But of course if you don’t allow individuals to make the choice of what they spend collectively on a monthly basis to be the point of decision on how much is spent on health care (and put those intermediaries in the middle in the position of benefiting from lowering that amount in the "right" way), then the only other rational allocation is to have the government do it via the tax system.

CODA: I wrote extensively earlier this year on my comparison between the two and how different they both are from typical American notions of competition.