Universal Healthcare: Going Dutch, Anyone?

The American people and the companies they work for help finance almost one-half of the nation’s healthcare system today. Together, they purchase group and individual plans with different copays, deductibles, and premium rates from organizations who lack unified goals or coordinate their services with one another, leading to what industry experts term “fragmentation.”Steep out-of-pocket expenses for many Americans add a second layer of fragmentation to this already complex mix of healthcare financing.

Suppose then, for argument’s sake, that we reconfigured the way individuals and companies paid into our medical system by replicating what the Netherlands does to finance its universal healthcare plan. How would what we are paying right now compare to what the Dutch people are paying if we both follow the same set of financing rules?

To begin, all individuals over 18 would purchase a standard benefit plan from a private insurance company. A standard plan would include primary and specialist care, hospital visits, prescription drugs, along with other features such as home nursing care. Insurance carriers would have to accept all applicants who would then pay the same premium regardless of age or health status.

Additionally, each standard plan would have a $443 deductible¹ that would apply to hospital stays, specialty care, and prescription drugs. Primary and pediatric care would be free of cost.

Companies, meanwhile, would pay a payroll tax for each of their employees. The tax would be 6.1 percent of an employee’s income up to a cap of $91,320.

Below is a side-by-side illustration of the United States and the Netherlands using the Dutch funding formula.

	Netherlands	United States
	Universal Care	Fragmented Care
Average Premium	$179/mth²	$284/mth⁵
Out-of-pocket	$76/mth³	$172/mth⁶
Employer Payroll Tax	6.1%	8.26%⁷
Employer Payroll Cap	$92,320/yr	No Cap⁸

Interestingly, Americans pay 79 percent more a month for their healthcare than the Dutch do. This is similar to health spending as a percent of GDP, where the Netherlands is 10 percent and the United States is 18 percent, an 80 percent difference in spending.

Second, the Dutch funding formula is relatively simple to grasp. The United State can copy it. A 19 second elevator pitch might sound something like this:

“With “All-American Care,” three things happen.

• 1. All adults must purchase a standard insurance plan for $179 a month.
• 2. Employers pay a 6.1 percent tax for each of their workers up to a cap of $92,000 a year.
• 3. The government helps out when need be.”

Simple! America just needs to go on a healthcare diet.

Notes and Math Calculations

¹(Euros) 385 x 1.15 (conversion rate) = $443/year deductible

The Netherlands

²Monthly Premium (Eur0s) 156 x 1.15 = $179

³Out of pocket—¤113,403m (total healthcare spending) x 12% (percent of total spending) = $13,608m

Note: You can find the 12% figure from: OECD/European Observatory, Netherlands: Country Health Profile 2025, p. 1 of the report; PDF p. 3.

$13,608m/15m (population over 18) = $907/12 = $76 a month

⁴Employer Payroll Cap (Euros) 79,409 x 1.15 = $91,320

The United States

⁵$1,458tn – $556.6bn = $902.3bn/270m (population over 18) = $3,409/12 =$284/month (NHE Table 05-2, 2024)

⁶$556.6m/270 = $2,061/12 = $172/month

⁷ $967.4/$11,709t (total US wages)= 8.26 percent (NHE Table 5-1, 2024)

⁸$11,709t x 8.26% = 967.4m (All wages must be taxed in order to reach the amount business now pays to finance our current health care system; hence, no cap.)