"Nothing Like the Netherlands"

One objection to critiques of mandates is that mandates work quite well in the Netherlands.

True. But the Netherlands implementation is quite a bit different, as Jon Walker points out. He even has a handy chart.

This bill is a sham BS imitation of a true universal health care systems built on the government guarantee of access to quality, affordable health insurance and an individual mandate. Countries like the Netherlands have important regulations ensuring all their citizens have access to quality, affordable health insurance, regulations that are completely lacking in this bill. Things such as:

Dutch Health Care System	Senate Bill
True community ratings where everyone is charged the same premiums	Very large age rating ratios that allow insurance companies to charge old people three times as much as the young
The government mandates only the sale of strictly defined high quality insurances and all basic policies must have identical coverage rules	Gives insurers wide latitude in design policies and allows for the sale of very low 60% actuarial junk insurance and “catastrophic plans”
Premiums are very affordable (roughly €100 a month for basic coverage)	People will be force to pay 9.8% of their income for a low value insurance plan
Extremely strong national regulator	Basically no direct national regulator
Deductible of €150	No maximum deductible but based on 70% actuarial values the deductible should be well over a thousand dollars for most silver plans
Extremely robust risk adjustment mechanisms that force insurers to compete based on quality and not risk selection	Weak risk adjuster that would not stop insurers from trying to game the system and cherry pick customers
Achieves near universal coverage with 98.5% of people in the country covered	Achieves only 93%-94% coverage
Allows for drug re-importation to keep drug prices low	Not permitted
Central government provider negotiator for most procedures	No central provider negotiator

Listed here are only some of the ways the system produced by the Senate bill falls way short of the Dutch health care system. If the government promised everyone access to well regulated, high quality insurance with a $200 deductible and monthly premiums of $150, I would definitely be supporting the individual mandate. The problem is that the Senate bill will force people to buy extremely expensive poorly regulated junk insurance. The individual mandate is morally and politically wrong until the government lives up to its end of the social contract. On that front, the Senate bill is a failure.

I'd say that the political context is the bigger problem. Jonathan Cohn seems to think that if you do something weak like this, then that's okay, because it will eventually be improved upon. But let's be honest: that isn't what happened here. The bill started out weak, then got weaker and weaker, to the point where the Republicans relish the opportunity to run against it and the public hates it.

Does Cohn really think it will be improved under those conditions? Has he been paying attention at all?