Are there no workhouses?

Prinsjesdag (“little princes’ day”) is the traditional opening of the Dutch parliament on the third Tuesday in September. All the women in attendance wear ridiculous hats, and the country’s new operating budget is presented. (It is a closely-guarded secret until then, but someone always manages to leak it to the papers.)

"het meisje met de hoed" by Gerard Stolk 64 on Flickr

This is not actually a hat from Prinsjesdag. It is a hat-like animal that has gained sentience and is eating a human.

One thing that the casual observer might not realize these events influence is the coverage of health insurance plans.

Health insurance in the Netherlands works like this: every insurer offers a standard policy, called the “basic package.” Almost everything about it is controlled by the government: most notably, what care it is supposed to cover, and what the deductible is. The government gets to dictate this, because in this country you are legally required to have health insurance, and so by specifying the what the basic package covers, the government ensures that every resident not only has health insurance, but also that the most important care is all covered. Health insurers also receive a government subsidy to help them keep the premiums low for the basic package.

Insurers are free to charge whatever premium they want for the basic package, but (with a few exceptions) they are not allowed to change what it covers. Instead, they sell an “auxiliary package” that covers health care and dental care not in the basic package. Most people who can afford one do so, since the coverage of the basic package is — well, pretty basic. Every insurer offers a different auxiliary package; most of them have more than one, for example one for students, one for families with children, one for seniors, etc. (I’ve gotten annoyed every year that I can’t find an insurance company whose auxiliary package won’t cover alternative medicine, but that’s a different story.)

The day after Prinsjesdag, my insurance company sent out an e-mail to their clients with a link to a webpage explaining what the government announced would change in the basic package in 2012. (Which is excellent customer service if you ask me. But don’t think I’m plugging my health insurer — they do other stuff I’m annoyed about.)

The most concerning changes were in the area of psychiatric care. In the past, they already distinguished between first-line and second-line care; first-line care is provided by GPs and mental health professionals such as psychologists, whereas second-line care is for those with serious mental illnesses. (I hope I got these definitions right; I’m not an expert.) Starting in 2012, the number of first-line therapy sessions covered by the basic package will decrease, and the co-payment will increase. There was previously no co-payment for second-line psychiatric care, but there will be one from now on.

These reductions of coverage and increased co-payments are supplemented by various small changes that seem designed to add insult to injury. Here’s one example from the above-linked list (translation mine):

If a patient doesn’t show up to an appointment in second-line psychiatric care, and doesn’t cancel the appointment in a timely fashion, then the insurance won’t cover the appointment starting in 2012.

I think it’s perfectly reasonable that if I’m delusional, and have shut myself in my attic where I can’t turn my back on the Tupperware in which I’ve cataloged my last five turds because otherwise the aliens will secretly alter them, then the very least that can be expected of me is that I will cancel all my appointments and clear my calendar. Suffering from a serious mental illness is no excuse for a lack of common decency.

This sort of thing is exactly what I was afraid of when Health minister Edith Schippers discussed these planned changes in a press conference in June 2011 (translation mine):

“If people have problems that are just part of life, why shouldn’t they have to figure them out in their own social circles, and why shouldn’t you only be able to call upon health care if you’re really sick?”

"Sigmund Freud" by Sebasian Niedlich (Grabthar) on Flickr

Just lie back and tell me all about your made-up problems.

That’s right. All those freeloaders who sit and sob on their therapists’ comfy couches every week on the taxpayers’ dime need to get a hold of themselves.

Except she wasn’t talking about just any old freeloaders. She was talking about patients in first-line psychiatric care. In other words, if you’ve got post-traumatic stress disorder, postpartum depression, chronic depression, bipolar disorder, or some other mood or anxiety disorder that can commonly occur in otherwise healthy people: you’re not sick. It’s part of life. Just have a good chat with your friends and pull yourself together. Suck it up!

Too bad that people with anxiety disorders or mood disorders often already think that they’re not sick — their state of mind is normal. Too bad that their disorders often alienate those self-same “social circles” who are supposed to help them “figure it out.” Too bad that often the only thing those “social circles” can or know how to do, is to convince the person to go to a therapist, which the Health Minister has of course just de-legitimized.

And that’s what infuriates me. It’s not the cuts in public spending, which we all have to suffer through in these times, it’s the shameless glee with which this administration denigrates those who can’t defend themselves. It’s the willful ignorance that leads a Health minister to say that psychiatric patients aren’t really sick, or a junior minister for Culture to be proud of not knowing anything about art. It’s not enough to slash budgets and cut subsidies, no, everyone has to believe the disappearing government expenditures were never deserved in the first place. Psychiatric patients, artists, scientists, and other practitioners of “left-wing hobbies” (a term often bandied about by the far-right Freedom Party) need to be ashamed of themselves for wasting so many public resources for so many years.

Perhaps the most telling is that measures for quitting smoking will be removed from the basic health insurance package. Never mind that this is false economizing, since we will be paying for all those cases of lung cancer down the road. The underlying message is clear:

Delft blue tile: "If you can't be a contributing member of society, then for God's sake just DIE"I would like to thank Madelon Verheij and Jeroen Latour for answering my questions about insurance technicalities, after my impassioned cry for help on Facebook.