Welfare paradise is debating itself, but is it still about welfare?

In 1983, a band that called themselves 'The Dutch', had a modest hit with their catchy song "This is Welfare (Paradise)". It was, as you might have guessed, a Dutch band from Amstelveen, and the subject of their song was, as you guessed again, their country, my country, The Netherlands. What you did not guess is that their song was not picturing The Netherlands as a welfare paradise, au contraire, but The Netherlands were seen by many as Welfare Paradise at the time, with an excellent social system only topped by Scandinavian countries.

In the Dutch language, the word 'welfare' can be translated by 'prosperous', as referred to by the Dutch in their song, but it can also be translated by 'well-being, in good health'. That is the meaning I am referring to in this blog, as health these days, ironically enough, is more and more linked to prosperity and finance.



From the endless discussions in the seventies and eighties of the last century on welfare as in prosperity for all, a stream of thought emerged, the stream that questioned the ancient value on human life and who should control it. From the days of Hippocrates,the central value was that God was controlling human life. Medicine was supposed to act in the patients best interest, to do no harm (primum nil nocere) and to treat everyone equally while keeping the medical status of patients a secret. Respect for human life, translated into the renowned Hippocratic Oath.

In the nineties, the progressive laws on allowing euthanasia followed the woman's right to have an abortion. The pro-life values of showing the utmost respect for human life starting from insemination were replaced by very pure and well thought through medical ethical standpoints that placed human beings in control of human life.

Although Albert Schweitzer meant the opposite when he chose his central moral principle 'to respect life' (as in respect for our inner will to live), Dutch medical ethical authorities like senator Heleen Dupuis used Schweitzer's moral principle to argue that if one loses the inner will to live, we should respect that person's wish to die. The principle stood, the discussions were more on the perimeters and constraints for legislation that would honor this principle.

While we accept and embrace our progressive pro-humanity medical ethical achievements in The Netherlands, a new phenomena has reached the surface. The financial situation in The Netherlands after the Banking crisis of 2008 and the following Euro crisis we are still experiencing is not good. It is in such a state that no stone is left unturned in search of budget cuts and other ways to lower the deficit.

The Society for Health Insurance Companies advises to no longer pay for the extremely expensive medication that is available for people suffering from Pompe and Fabry disease. Treatments for these diseases cost € 200.000 up to € 700.000 per person per year. To prolong the life of a patient suffering from Pompe disease by two years, 40 years of treatment is required. By now you will be figuring that it takes 28 million euro to prolong one person's life and you feel the doubt entering your system: is one person worth all that money?

The Society for Health Insurance Companies wants to make a point: there is only so much money to spend on covering medical expenses, even for us. Given the fact that we all have to cut back, while costs for medical expenses keep rising every year, they want to signal that there is an end to what they can do. They don't want to stop helping people, they want to signal politicians (6 weeks before the elections).

Nonetheless, the discussion has started in The Netherlands. Should there be a cap for medical support. Should a human life be valued by a threshold that we can calculate? From what age should we stop spending money on life prolonging treatments? 80? 85? Although Dutch people love to argue about the cost of living and money related subjects, this is a tough one. Polls show that 4 out of 10 people (in some newspapers it is 50/50) would choose for a cap to human life, as we can only spend our Euro once.

I say respect life, as Heleen Dupuis did, respect life and give the patient a right to choose how he or she is to be treated. But do not squander that right by putting it in the hands of Insurance Companies! Human life does not have a price, if there is a medicine that can treat a patient in need of that medicine, provide it to the patient! If the medicine is too expensive, find ways to make a less expensive version of the medicine. Innovate, but do not disrespect patients.

Yes, we should lower the percentage of the gross national income we spend on health care, certainly if the gross national income is decreasing, but we should look for as many possible options as available (o.a. cutting management layers from health care institutions; introducing the digital world to health care logistics; fighting the huge inefficiencies and stop wasting money on preset arrangements that people misuse for their own benefit).

It is time for doctors and nurses to treat their patients again, not just act on protocols and directives. We now live in a country where patients are faced with quota for specific treatments. If a hospital reaches the quota, patients are put on a waiting list or sent to another hospital. We have over organised our hospitals, creating bureaucracy and management layers who need to oversee all procedures and run continuous change programs, while getting paid more that the Prime Minister (who has a quite similar job description).

Although I am glad that there is a discussion and that the arguments that are being made are predominantly balanced, sensitive, creative and valuable, the discussion should not be about money. The discussion should be about welfare in the sense of well-being, in good health. That is where I stand: if you want to be treated and there is a treatment available, Dr Hippocrates needs to provide the treatment.

The economical side of the discussion should not be about money spent by insurance companies, it should be about the potential for new entrants on a market where one company is able to produce medication at the cost of € 700.000 per person per year.Economic laws tell me that € 700.000 per person per year is not the equilibrium for this medical treatment. Health insurance companies should look for innovative companies to research cheaper treatment opportunities. Or trigger hospitals to put the patient first in their set-up, not procedures.

 As for us Dutchies? We should keep arguing about money and about medical ethical matters at hand, as long as we do remember that we still live in (relative) paradise, and that, although our social welfare is at the table in the political debate on cost cutting, our personal welfare is still a given and that is how it should stay.