Decision Time
PUBLISHED August 24, 2026
We are at a fork in the road. Do we start fresh with All-American Care or do we continue down the path we are now on?
All-American Care would provide a basic health insurance plan similar to what the people in the Netherlands now receive. A standard package would include visits to a family doctor, hospital stays, mental health counselling, and prescription drugs.
There would be a $447 annual deductible and insurance companies could require co-pays for some prescription medication. Copays would be capped at $290 a year.1
All legal residents 18 and above would have to purchase a basic plan. The average plan would cost about $181 a month. If a person could not afford their premium payment, they could apply for a government subsidy. The maximum subsidy would be $150 a month.
Yet, it is unlikely that everyone will be on-board with All-American Care. Here’s why.
Objection 1: Mandating that people purchase insurance coverage violates individual freedom.
Response: No one likes to be told what to do, yet Americans have a history of honoring federal mandates. Men have to sign up for the draft and all Americans have to fill out tax returns and report for federal jury duty when summonsed.
On a deeper level, almost everybody will visit a doctor sooner or later. Accidents and heart attacks can occur at any time. If they do, federal law requires that hospitals and physicians provide the necessary care, regardless of a patient’s ability to pay. Unpaid medical bills, however, eventually increase premium payments for those who do take out health insurance.
Americans are used to carrying their own weight. Investing in a health insurance policy should be no different.
Objection 2: Insurance companies are interested in profit, not providing care.
Response: All-American Care would be a multi-payer plan, so there is a need for insurance companies. The question is how much should they be able to claim for profit, administrative costs, and marketing expenses. Under Obamacare rules, large group insurers can set aside up to 15 percent of their premium income for non-medical expenses.
The contrast with the Dutch system is stark. Marketing costs, on average, make up only 0.6 percent of total costs. Achmea, a major Dutch health insurer, had administrative expenses of 1.5 percent of revenues and paid approximately 98.4 percent of its premium income to health care claims in 2025. It still made money.
As a general rule, administrative costs make up the bulk of non-medical expenses. A standard benefit plan and coordinated care should help make our current health care system more efficient. In the meantime, government regulators and insurance companies will have to work closely together.
Objection 3: We should tax the rich.
Response: The problem here is that there are not enough wealthy families to go around. If we had a 70 percent marginal tax rate on all households making over $10 million a year in earned and unearned income2 and an estate tax of 77 percent on all inheritances over $1 billion,3 we would still need more money.
According to my calculations, those two taxes combined would generate only $829 billion a year at most, far short of the $5.3 trillion we spend annually on health care.
A diversified funding mix of individual premiums, employer payroll taxes, a VAT, state contributions, and federal assistance provides more predictability and stability.
Objection 4: We need an amendment.
Response: Under the Constitution, a minimum of 38 states must ratify an amendment. As of now, 40 states have shown a willingness to help their people by expanding Medicaid coverage. That is a good start.
The bigger challenge is getting two-thirds of the House and Senate to go along. Some representatives may not be interested in universal coverage, but they are interested in cutting health care costs. We need to emphasize that the Dutch have been able to trim their health care costs to 10 percent of GDP. We can follow in their footsteps, in part, by better coordinating primary and specialty care.
Objection 5: Small businesses will have difficulty complying with VAT requirements.
Response: New Zealand doesn’t require businesses with annual sales below $35,300 to register for its VAT.4 It also has simplified accounting rules for small businesses. We should do the same.
Objection 6: There is no dental coverage.
Response: In fact, a recent Wall Street Journal article explained how bacteria from diseased gums can lead to heart disease, diabetes, and cognitive decline. The article recommends breaking down traditional barriers between doctors and dentists to support “whole-person care.”
No one ever said the Dutch health care system was perfect.
Note: This is an ongoing series of blogs to develop an affordable, universal health care plan before the 2028 presidential election.
Author’s Calculations
1The deductible is EUR 385 and the copay cap is EUR 250. I converted those numbers by using the current exchange rate: EUR 385 x $1.16 = $447; EUR 250 x $1.16 = $290.
2For the 70 percent tax rate, I referred to Publication 1304. I opened up Table 1.1, 2023 and looked at Line 29 for $10,000,000 or more. I used the adjusted gross income $909,900,917,000. I multiplied that number by .7 to get approximately $637 billion. This gives an upper-bound estimate and includes both capital gains and ordinary dividends. See Table 1.4 for a breakdown of unearned income.
3For the estate tax figure, I used IRS data from SOI Tax Stats, Table 1, 2024. The data does not break down into inheritances over $1 billion, so I included the total for “Gross estate for tax purpose,” $248,944,039,000 (column 2). Multiplying that figure by an estate tax rate of 77 percent, I got $192 billion, also an upper-bound estimate.
I then added the two numbers together: $637 billion + $192 billion = $829 billion. My figures represent an upper bound that taxing the rich at a 70 percent marginal tax rate for income and a 77 percent rate for estate tax can attain.
4New Zealand does not require businesses making less than 60,000 New Zealand dollars to register for its VAT. I converted 60,000 to US dollars (60,000 x .587 = $35,300).
References
Achmea. (2026, March 11). Achmea reports strong 2025 results and is well positioned for further growth (p. 15).
Buxbaum, J. D., Arnold, D. R., Fuse Brown, E. C., Whaley, C. M., & Ryan, A. M. (2026). Substantial variation in administrative spending and profit across state insurance markets, 2023. Health Affairs, 45(3), 331–340. https://doi.org/10.1377/hlthaff.2025.00779
Commonwealth Fund. (2026, May). International Health Care System Profiles: Netherlands. https://doi.org/10.26099/CRPY-MJ09
Government of the Netherlands. (n.d.). More Q&As about health insurance in the Netherlands. Government.nl.
Inland Revenue New Zealand. Inland Revenue. New Zealand Government.
Internal Revenue Service. Statistics of Income: Individual Income Tax Returns Complete Report (Publication 1304). U.S. Department of the Treasury.
Internal Revenue Service. SOI Tax Stats: Estate Tax Filing Year Tables. U.S. Department of the Treasury.
Jeurissen, P., & Maarse, H. (2021). Health insurance reform in practice. In The market reform in Dutch health care: Results, lessons and prospects (Chap. 3, pp. 41–64). European Observatory on Health Systems and Policies.
Landro, Laura. “Your Mouth Could Hold the Secrets to a Longer and Healthier Life.” The Wall Street Journal, August 13, 2026.
McGough, M., Ortaliza, J., & Cox, C. (2026, July 13). 2026 medical loss ratio rebates. KFF.
National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012).
OECD. (2025). Health at a Glance 2025: Netherlands. OECD Publishing. OECD — Health at a Glance 2025: Netherlands
OECD/European Observatory on Health Systems and Policies. (2025). Country Health Profile 2025: The Netherlands. OECD Publishing, Paris. Sanders, B. (2019). Financing Medicare for All. United States Senate. Financing Medicare for All