Rarely has a report on the welfare state elicited so much recognition, sympathy and acclaim from readers and experts as the recent NRCstory about uncle Cees who grew older and more needy. And who happened to have a cousin who was a care editor, who acted as administrator on behalf of the family and tried to provide Cees with help through the appropriate channels.
Since roughly 2015, this has in principle been a municipal task, supplemented by the health insurer and co-administered by bodies such as the Social Insurance Bank and the Central Administration Office. Welcome to the world of the personal budget, the needs assessment for the Long-Term Care Act, the statutory personal contribution, the municipal care counter, the Social Support Act, including ‘case managers’, ‘care coaches’, customer mediators and ‘informal care brokers’.
An army of healthcare workers and health professionals functions within it, constricted in a web of regulators who must keep expenditure under control and prevent overconsumption and abuse. Mutual communication is a problem – distrust and control set the tone. Time and again, citizens have to plead for their care needs – is the wheelchair, home care or stairlift still necessary, are you really no longer able to do it yourself, et cetera… And what were the name, address, date of birth or citizen service number again?
The needy citizen or his representative must have above-average bureaucratic skills, verbal talent and resilience to reach the finish line. The ‘purple crocodile’, invented in 2004 by insurer Ohra as an anti-symbol of customer friendliness, not only exists, but swims around in the health care system in perfect health. Where citizens, healthcare providers and their administrators become cynical, desperate or just angry. It is not very risky to point out the operation of the care maze as a factor in the crisis of confidence between citizens and the government, in addition to the Supplementary Affair and the Groningen gas crisis. And thus as a factor in the ballot box uprising earlier this month.
The moral of uncle Cees’ progress in NRC is that the health care system is too complex, has too many separate regulations and budgets, with too many administrators and probably too high implementation costs. And it is fundamentally not accessible enough for citizens who need care, usually at the time when they are least able to ask for it. Certainly not for those who are not used to dealing with the government or with healthcare. Moreover, that government is increasingly hiding behind a selection menu, DigiD-secured access or in telephone service centers where understanding was available, but rarely the authority to really change or adjust anything. The entire system bears witness to a drive for control and accountability that has gotten out of hand and a lack of empathy for the needy citizen.
This automatically reflects the ‘zeitgeist’, in which the ‘hard-working Dutchman’ has been the electoral benchmark for years. A dog whistle to the alleged profiteers of the welfare state. To the ‘hand-holders’ with whom many do not wish to associate, until, of course, a case arises in their own circle in which cleaning assistance, district nursing or day care proves essential. In recent decades, the welfare state has overarmed itself against overconsumption and abuse. In addition to high bureaucratic thresholds and strict supervision, this was politically translated into an emphasis on self-reliance, personal responsibility and more informal care – in other words, passing the burden on to one’s own family circle.
It now seems time to give the concept of ‘human dimension’ a revaluation, a new start, in the health care system as well. Could it perhaps also be simpler, less suspicious, more customer-friendly, more accessible? With less accountability and control? Where politicians, public opinion and the media have to accept that overconsumption, unwanted or superfluous use will also occur more often? But that that is the price that must be paid to guide Uncle Cees to the right arrangement more easily? Or do we prefer to organize bureaucratic hoops to keep jumping through, with our ailing parents, uncles and neighbors across the street? It’s time to look for a new balance – and to moderate the desire for control itself.
A version of this article also appeared in the newspaper of April 1, 2023