Verkiezingen!

That's right, Verkiezingen (fair-KEYS-ing-n) -- Elections!


As you may have heard, the Dutch government dissolved in February over a disagreement about continued Dutch participation in the war in Afghanistan. This dissolution nonsense is foreign to American politics, but the basic idea is that the "government" is always a coalition of parties in Parliament who agree on a common platform and work together toward their shared goals. This is necessary because unlike the two-party system in the US, in which one is always a majority, there are a dozen political parties here so no party can have its way without cooperation. Apparently before the previous elections in 2006, the Labor party, PVdA (Partij voor de Arbeid) promised to pull out of Afghanistan once the present commitment expired. However, PVdA, as part of the governing coalition, did not get the other major party, CDA (Christen Democratisch Appèl, literally Christian Democratic Appeal, a centrist, conservative-leaning and actually not Bible-thumpingly Christian party), to agree to this pull out. In February, de poep sloeg de ventilator aan (the shit hit the fan) on the issue, no agreement could be made, and poof, the coalition dissolved.

The only solution to a dissolved coalition is a new election, after which a new pecking order is established among the parties, and they can negotiate new agreements to forge a better coalition. This election is coming next week, on June 9. And yes, that means that from February until now, the Netherlands has not had a functioning parliament. Apparently this is no problem?! As everywhere, voters are reactionary and have short memories, so in the current election CDA is expected to be punished, PVdA is likely to gain seats for standing up for the pull-out from an unpopular conflict, and various other parties will win or lose a bit. It will remain quite a mystery which (and how many -- it might require 4 parties this time) parties will join the first-place party to form a governing coalition.

I don't get to vote, of course, but if I did, the party best suited to me is Partij voor de Dieren (Party for the Animals)! Surprised? Me too, but that was the result of an interesting online election guide in which I had to agree or disagree with a bunch of issue questions. Go animals! Actually, as you can see below, my preference for the animals is really quite small. In fact, judging from this graph, there really isn't any party in the Netherlands for me. I suppose that means there's room in the political landscape for a new party - the Grumpy Americans Party (and we'll shop at the GAP).

Hassle-Free Healthcare

No one can avoid joining the debate about healthcare happening now in the USA. Not even me, safely healthy in Holland. In our stay here so far, my wife and I have made good use of the system, with sick and well visits to doctors and specialists as well as a complicated childbirth. I can say unambiguously that we are satisfied customers, and I really hope the US gets healthcare straightened out before I come back!

If you don't read anything further, read this: the Dutch healthcare system is better than the American one, costing less per person with better results and 100% coverage. It's not perfect, but the US could plagiarize it wholesale and everyone would be better off.

One important reason the Dutch system is good, if you ignore being cheaper and more effective, is that it is nearly entirely hassle-free. It is a semi-socialized system with obligatory private insurance. That means that everyone has to buy health insurance from a private insurer of their choice, and those who are unable to pay get subsidized premiums (and yes, that means that I am funding some less fortunate people's healthcare, but even so, overall I pay less than I did last year in the US). The result is simple: I go to whatever doctor I want to see, everything is covered, and there are no bills. The premium is deducted pre-tax from my paycheck, with no copays, no prescription costs, no receipts to save, no claim forms, no bills whatsoever. It is amazingly hassle-free! The only exception to this rule is care from non- or atypically-medical services, such as a reflexologist. They fall outside the system, so you pay out-of-pocket and request reimbursal.
Compared to the high-deductible insurance I had my last year in USA, with a Health Savings Account, endless online forms, and the IRS forcing me to save receipts to prove they were medical expenses, I am loving the lack of hassle. Really.

What's that? You don't buy the "cheaper and more effective" claim? If you'd like to have a look for yourself, the World Health Organization makes data freely available here. The database search takes a few steps to configure, so I've saved you the trouble, exporting a list of interesting statistics for a few relevant countries: USA and the Netherlands, of course, plus Canada and the UK, whose systems have been ridiculed by many in the current debate, and France, for some reason always treated as the antithesis to Americanism, whose system received the second-highest user satisfaction ratings in a recent poll. I put the entire data file online here for you, in case you're interested, but my summary is this:

First, cost: per capita total expenditure on healthcare, in 2006, in US$: UK leads with $3300, Holland is next at $3700, Canada & France are both about $4000, and the USA totals up to $6700. Pretty obvious comparison, eh?

Next, effectiveness, which of course is impossible to measure with one number. How about a few numbers, instead? Looking at life expectancy at birth, there is actually a pretty small range among these nations: Canada & France both expect 81 years, Holland and UK follow with 80 and 79, respectively, and USA is not far behind, with 78 years. Two statistics that show a clearer difference and were especially relevant to my wife and baby daughter this year are infant mortality and maternal mortality, in both of which the USA's rate is nearly two times that of the Netherlands. Again from 2006, France and the Netherlands have infant mortality rates of 4 per 1000 live births, Canada and UK 5, and USA posts a 7. From 2005 (the years chosen were "latest available data" for each statistic), the maternal mortality rate, which I assume means death via childbirth, in the Netherlands was 6 per 100,000 live births. In Canada, France, and the UK, the numbers were 7, 8, and 8, respectively, while in USA the rate is 11 maternal deaths per 100,000 births! Not exactly an effectiveness measure, but interesting for well-informed mamas to consider, is that the American c-section rate is 23%, while the Dutch is 14% (2000 and 2002, respectively, and I think the American rate is even higher now, perhaps 30%). This goes along with Holland's emphasis on natural childbirth, which obviously works well for both mothers and babies.

Stepping away from childbirth-related statistics, the American emphasis on oncology does seem to make a difference, because as of 2002, the US has the lowest of all five countries in cancer death rate with 134 per 100,000 population. The Netherlands is the highest at 155, and the other three are all at about 140. The US doesn't fare so well for cardiovascular death rate, possibly related to obesity rates, with 188 deaths per 100,000 population. The Netherlands is mid-pack with 171, and France somehow pulls off a 118. Maybe it's the wine!

Correlating more with effectiveness than cost are some infrastructure statistics. Notably, the USA, despite all the cost, has the fewest hospital beds of the five: 32 per 10,000 population. France leads with 73, and the Netherlands is next with 50. Also interesting, though aggregating data from different years, the Netherlands leads with 37 physicians per 10,000 population, while the USA is mid-pack with 26. Single-payer UK and Canada have 23 and 19, respectively.

Enough statistics for one blog. There's more to say, though, so stay tuned.

Happy Election Day, USA!

On the eve of Election Day, I urge all Americans to get out and vote! I don't care whom you vote for -- well, okay, I do, but I'm not going to push -- as long as you put some thought into it and do what you think is right. My wife and I already voted, nearly a month ago, before we left the US to come to the Netherlands. We filled in advance absentee ballots, declaring that we would be out of the country on Election Day, and sealing them into official envelopes to wait for the big day.

I've spoken quite a bit to my Dutch and non-Dutch colleagues about the US election, and it really is amazing how much they know about US politics and the US political and government systems. It is humbling, really, because while I suppose I know the prime ministers of a few nations that are often in the American news, such as the UK, Russia, Italy, Israel, and the Netherlands (and the latter only because I just moved here!), I honestly don't know a whole lot about opposition parties, the various coalition governments, and such. I doubt that many Americans do. Granted, US policy has more effect on the Netherlands than vice-versa, but their awareness still seems humbling, in the same way that everyone's excellent English language skills make me feel both lucky and embarrassed that English is my only language, not counting my classroom-level Spanish.

Currently, there is strong support for Barack Obama here. It is well-documented that the European community has been quite critical of George W. Bush's policies, especially the Iraq war. Remember Freedom Fries, the American response to France's reticence to participate? Now, it is clear that Europeans by and large want change, and it is also clear which of the change-proclaiming candidates they believe. The following table shows the result of one recent survey of sentiments in France, Germany, UK, Italy, Spain, and USA. Coincidentally, lest you fear that this was biased in some way, the poll was done by Harris Interactive, a well-respected market research company from Rochester, NY! The entire poll report can be found here.


Look closely at the numbers. In France, 78% favor of Obama, which sounds pretty impressive, but when you see that only 1% support McCain, that's a serious landslide! France is the most extreme example, but Germany, Italy, and Spain show a similar trend, and even in the UK, where Obama's number falls below 50%, McCain's is merely 11. Unfortunately, the Netherlands was not included in this poll, but I can report that my personal discussions with people gives me the impression that the attitude here is much like that in France: serious support for Obama and the change he promises.

Today at work, I was chatting about Election Day with two colleagues: one Dutch, and one Macedonian. They asked me to explain the basic differences between McCain and Obama, so I listed taxes, health care, and the Iraq war, and tried to put the candidate's platforms (and vague proposals) into the context of what is typical of Republican and Democrat positions. Interestingly, they both see the Republican pro-business, unbridled capitalism as characteristically American, and see the Democratic ideals of tax-funded social programs and regulated economics as less "American," in fact trending more toward Socialism. It seems that the USA is viewed as somewhat of a young, brash, frontier-oriented nation, one that may dig itself a pretty big hole (for example, via financial crisis) if it's not careful. Interesting insight, eh?

So as I said, I already voted, and yes, I'll say it -- I voted for the one who starts with "O" and ends with "bama" -- much to the relief of my Dutch friends! Because of a timing quirk in when I voted in Monroe County, an absentee ballot had already been mailed, so now I have it at work to show to my colleagues. We discussed the sad hilarity of the "hanging chads" fiasco (and this poor guy) and the many different voting machines and methods in use across the United States. In defense of many confused-in-2000 American voters, my workmates did agree that the ballot layout, with candidates in a column and some offices allowing multiple votes across two adjacent columns, pretty un-intuitive. But alas, they won't be voting tomorrow, nor the hordes of Obamaphilic French... So, if you have the right to vote in the USA, get out and do it. Don't let the opportunity pass you by. And really, vote for whomever yOu think is Best, no mAtter which Man it mAy be!