Privatization, Exploitation, and an Oligarchy of Insurers

In the 1980s, the idea that encouraging competition between private insurers would best regulate the health-care sector began to gain stream across the Netherlands. In 2006, Prime Minister Jan Peter Balkanende’s conservative government privatized the formerly semi-public system.

The reforms allowed insurance companies and hospitals to collect profits and encouraged competition. This triggered a wave of mergers: today, four companies dominate 90 percent of the insurance market. Individual costs have risen tremendously, as patients pay for surgeries, prescription drugs, and other services out of pocket. This so-called personal risk payment has risen from €150 to €385. Rather than use this new income stream to increase access or improve services, the insurers chose to profit. In 2014, they made €1.9 billion.

The Netherlands now has a two-tiered health-care system, as insurers offer different policy “packages” that range from an affordable basic plan to more expensive versions that cover additional treatments. The companies can also raise deductibles to €885 in exchange for lower monthly premiums, which attracts low-income customers.

Hospitals and care providers also focus on profits. They compete with each other for contracts with insurers, which strengthens the insurance industry’s position. Critics fear that this competition has pushed hospitals to systematically ignore medical errors, not wanting to risk their public image.

Working conditions in the health-care sector declined in the wake of the reforms. Insurers use detailed descriptions of a given illness’s individual treatment steps — the so-called Diagnose Behandel Combinatie — to determine precisely which services they will cover. They then negotiate the exact cost with the health-care provider. This has massively increased providers’ paperwork, and overhead costs have ballooned: Dutch hospitals, on average, spend 4 percent more at the executive level than their British or Canadian counterparts.

These reforms have also put intense pressure on care workers. Health insurance companies refuse to pay for services they deem “non-medical.” In the context of elderly care, this means that providers are no longer remunerated for cleaning their facilities or shopping for patients. The reforms forced many retirement homes and care institutions into bankruptcy. Across the sector, unskilled workers, students, and temporary employees replaced the trained staff that once performed these “non-medical” tasks. New firms often hired displaced care workers at significantly lower pay and under worse conditions.

This widespread hollowing-out of labor standards worried the FNV trade unions, one of the SP’s most important coalition partners. The unionists highlighted the fact that low pay came directly out of privatization, extending their agenda beyond wages and toward a complete transformation of the health-care system.

Starting Small

Since forming as a Maoist group in the 1970s, the SP has consistently fought for health care. Several parliamentarians are doctors and medical researchers, and the SP tends to have disproportionately high levels of support on this issue.

In the early 2000s, as neoliberal reforms began to appear on the horizon, health-care workers launched a grassroots network of action committees. Centered around the slogan “Zorg voor jedereen” (“Medical Care for All”), they attempted to fight hospital closures and other cutbacks. The SP, which had grown into a modern party with parliamentary representation, supported the campaign, laying the foundations for long-term political cooperation.

In 2004, the SP launched the “Zorg geen Maarkt” (“Health is Not a Market”) campaign against the privatization bill. The Socialists collected thirteen thousand signatures over several years and organized a coalition that planned demonstrations, conducted symposia, and published academic studies on the topic. Held together by various employee associations, the movement attracted care workers, nurses, physical therapists, doctors, and pharmacists. Many of them subsequently joined the party.

After the reforms went into effect, the SP concentrated on outpatient care, where working conditions had declined dramatically. In 2007, it initiated a joint campaign with nurses and trade unions called “Stop Uitverkoop Thuiszorg” (“Stop Selling Off Outpatient Care”). The SP crowned its public relations coup with a television commercial that features an elderly woman undressing in front of the camera. She informs viewers:

Conny helped me bathe for years, but now they say Conny is too expensive. So now a random person comes. After that, another random person. I might as well undress in front of the whole Netherlands.

Breaking social taboos around nudity, the video made waves and won the Gouden Locki for best television commercial in 2008. The SP used the ensuing media storm to introduce three parliamentary initiatives to improve elderly care.

Working With The Unions

These campaigns have strengthened ties between the SP and the FNV trade union. Once a confederation of individual unions, the FNV recently reorganized into a unified whole — “one big union.”

The federation historically pursued a corporatist line, oriented toward compromise and closely linked to the Labour Party. This process halted in 2011 when chairperson Anges Jongerius supported raising the retirement age to sixty-six, going against the membership’s wishes. This event triggered a deep crisis and launched the subsequent restructuring process. Today, only FNV leadership remains close to Labour; more and more members identify with the Socialists, including, notably, SP chairperson and former FNV organizer Meyer.

The SP now regularly supports FNV campaigns. In 2015, paramedics conducted a successful four-week strike that raised wages 7.5 percent, prohibited temporary employment, and excused workers above fifty-seven years old from night shifts. The SP delivered a petition to parliament with the strikers, prompting the minister of health to withdraw further privatization plans until 2020.

Last year, paramedics occupied city halls in various Dutch municipalities to draw attention to problems in the health-care sector. When several activists were arrested, the SP collected donations to pay their legal fees and fines. These experiences paved the way for the ZorgFonds project, the Socialist Party’s most militant campaign to date.

Campaigning for a Public Health Service

In 2014, the party began planning for this campaign by calculating how much a national health-care system would cost. Then, it developed a conceptual proposal designed to abolish the private insurance companies entirely. If successful, the ZorgFonds campaign will see the SP plan implemented.

Seeking to involve as many allies as possible, the SP focused on two objectives: first, to replace private insurance with a public service; second, to eliminate the personal risk charge. A national health-care fund would become the insurer for all citizens, covering basic medical care as well as physical therapy, dentistry, and psychotherapy. The two-tiered health-care system would disappear with the private insurance packages.

The campaign petition quickly garnered over 250,000 signatures. Activists held local informational meetings all across the country and planned a massive demonstration in front of parliament, while regional action committees formed to distribute material and collect contact information from interested voters.

The SP wants to politicize ZorgFonds supporters, so it does more than simply distribute petitions. Three employees at the party office in Amersfoort reach out to new signatories and invite them to help organize informational meetings, to send campaign material to supporters in other regions, or — if they have expert knowledge in the health-care sector — to contribute to the national health fund plan.

The SP also collects supporters’ places of residence and sends them targeted invitations to local events. Many ZorgFonds activists end up joining local SP branches, underlining the deep impact this strategy can have.

The campaign has already enjoyed some success. Two-and-a-half-years ago, it would have been impossible to organize broad public support for any kind of de-privatization measure. Back then, politicians debated every year over how much to raise the personal risk charge, but now all Dutch parties, except the national-liberal People’s Party for Freedom and Democracy (VVD), promise to reduce or even eliminate this fee.

The campaign also triggered debates within the FNV and PvdA. Several local Labour Party branches support the ZorgFonds, including the one in Den Haag. Lodewijk Ascher, the PvdA’s lead candidate, opened his campaign with a speech promising to abolish the user charge and push back against market mechanisms in health care. The FNV has held similar discussions, although the labor movement as a whole has yet to embrace the project. FNV affiliate Zorg en Wilzjin (Care and Health) and its pensioners’ department support the plan, but the membership has yet to vote on the matter.

Critics note that the SP has failed to prioritize immigration and racism in its electoral agenda despite the growth of the PVV. They argue that the SP is reducing itself to a “party of care work.” Indeed, the SP’s positions on migration and international solidarity have come under fire from the Dutch and European left in the past, particularly when it comes to questions of “wage dumping” by foreign workers and state support for guest worker integration programs.

Additionally, the SP has focused primarily on elections so far. They treated this year’s vote as the movement’s preliminary high point but had disappointing results. It remains to be seen how much pressure the Socialists can put on its coalition partners to reach its goals. Could the party turn the network it built in the health-care sector into a larger social movement? Time will tell, but planning has been put on hold until after the election.

Despite these criticisms, the ZorgFonds campaign deserves our attention. The Socialist Party successfully used a broad organizing campaign to transform the debate over health care. The movement has real strategic implications, as a victory in health care could trigger de-privatization initiatives in other sectors, not to mention raise hopes and expectations across the continent.

“This article originally appeared in LuXemburg (http://www.zeitschrift-luxemburg.de/) and was translated into English for the Brussels Office of the Rosa Luxemburg Stiftung.