A historically high amount of around 10 billion euros, which is how much the new government wants to cut back on healthcare to slow rising costs. However, the minority cabinet needs support from opposition parties for this and most do not want to cut back on healthcare at all. In fact, they actually want to spend extra. This week, Sophie Hermans (VVD), in her second week as Minister of Health, Welfare and Sport, must convince the opposition during the budget discussion. The cabinet especially needs the support of GroenLinks-PvdA; especially in the Senate, where the party is the largest. That will be difficult. “As it stands now, it will become one njet“, says Julian Bushoff, healthcare spokesperson for the party.
We now mainly see personal contributions and cuts that affect lower and middle incomes. That is a no-go for us
In recent years, political parties have hardly dared to put their hands on cuts in healthcare because this is a difficult message from an electoral perspective. That’s different now. The cabinet of D66, CDA and VVD has devised a series of austerity measures that should yield billions. Moreover, costs will continue to rise in the coming years, even if they are all introduced – just less rapidly.
Isn’t it brave that a government finally dares to make cuts?
Bushoff: “These cuts are not brave, but stupid.”
Due to the double aging of the population (more and more older people living longer), healthcare is facing major problems: long waiting lists, a growing staff shortage, expanding demand and rising healthcare costs. “All responsible parties see those challenges,” says Bushoff. “We have to reform, otherwise everything will come to a standstill. But I now mainly see an enormous accumulation of personal contributions and cuts that affect lower and middle incomes. That is a no-go for us.”
For example, the government wants to increase the personal contribution to community nursing and the deductible, which will reduce the demand for care. That’s good, right?
“No. The demand remains the same, except that lower and middle income people avoid care because they can no longer afford it. They are being squeezed out. That actually leads to higher health care costs in the long term, because people go to the doctor too late. Then they end up in the hospital with much more serious problems or they end up on the sidelines completely.”
Despite his criticism of the proposed “blunt cuts”, Bushoff, following party leader Jesse Klaver, speaks of “an outstretched hand”. While GroenLinks-PvdA wanted to spend an additional 4.5 billion annually on healthcare in the election manifesto, Bushoff is now also talking about savings. “It is legitimate to say that you want to reduce the demand for care and save money, that is really possible. That is something to talk about. You can spend every euro you save on sports, inequality of opportunity or tackling mold in homes, for example.”
Bushoff calls “some health care savings quite good.” “But the order is wrong. The starting point now seems to be: first write down how much money you want to raise and then see where the ship ends up. Without thinking, a large amount is taken away. It is visionless cuts. Turn it around: first look at measures and ideas that improve healthcare, then look at how much that saves. I am convinced that that also saves money.”
What is an example of a good budget cut?
“Take uncontracted care. The government no longer wants to reimburse that. Our starting point is also that you should contract every healthcare provider. As long as you take into account the indispensable, small-scale providers in mental health care, who often have difficulty getting a contract.”
You see perverse financial incentives everywhere; light, cost-effective care is taken up, while complex problems end up elsewhere
Bushoff also points to domestic help, which is financed under the Social Care Act (Wmo). There is now a fixed subscription rate of around 20 euros per month. Bushoff: “It’s logical that you want to do something about it. But the government wants to remove domestic help from the Wmo without a second thought, so that almost everyone has to pay for it themselves. Not a good idea. Then make the contribution income-related, so that it remains accessible to everyone. That’s how it was until a few years ago.”
And cutting the basic package?
“I am not going to list here: we can support this cabinet proposal and we cannot support this one.”
Would you like to take a critical look at the basic package?
“We also want to remove ineffective or less effective treatments from the package, absolutely. But do not write down in advance what exactly it should deliver before you have checked whether it is desirable and feasible.”
Bushoff also mentions youth care. He is against the introduction of a personal contribution, a plan by the Schoof cabinet that the minority cabinet wants to continue. His party is looking forward to the bill to limit the scope of that care. “Some of the children now receive light youth care, which is not actually care at all. Determine what does and does not fall under youth care, so that you have to pay less. That generates money. It is comparable to, for example, elderly care or private clinics in hospital care. Everywhere you see perverse financial incentives: light, profitable care is taken up, while complex problems end up elsewhere.”
The government wants to raise the most money, almost 6 billion euros, by reversing the proposed reduction in the deductible, and even increasing it from 385 euros to 460 euros per year. The amount will also be indexed annually from now on.
Do you support that proposal?
“That is unwise. We want a reduction, as stated in our election manifesto.”
And if the government proposes not to increase the deductible, but to freeze it at 385 euros?
“I would say: come and talk to us and we will see what comes out of it. I am not going to anticipate that now. Ultimately, we are looking at the accumulation of healthcare costs.”
Bushoff also mentions measures that the minority cabinet is not taking, but which he believes could generate money. Much more can be done about health care fraud, he says. He also points to the little money allocated for prevention. For example, the significant cuts in pandemic preparedness of the previous Schoof cabinet, such as the number of intensive care beds, will not be reversed by this cabinet.
Last week, after the transfer to the ministry, Minister Hermans repeatedly called her assignment “difficult” and “complicated”. She also said she understands that “water has to be compromised.”
How much water should be added, do you think?
“A lot. But this is also a message to the opposition: don’t just reject the cabinet’s plans, also come up with ideas that will reform healthcare and generate money. We all have a responsibility to make healthcare better: the cabinet, the coalition and the opposition.”
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Healthcare must make 10 billion cuts, Minister Hermans hopes that ‘everyone will go into it with an open mind’
