Liberal Solidarity. Guaranteeing Access to Dutch Health Care Under the Banner of Private Initiative, 1848-2015 Roland Bertens 2 Liberal Solidarity. Guaranteeing Access to Dutch Health Care Under the Banner of Private Initiative, 1848-2015 Liberale solidariteit. Toegang tot gezondheidszorg in Nederland onder het vaandel van particulier initiatief, 1848-2015 (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof.dr. H.R.B.M. Kummeling, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op donderdag 7 januari 2021 des middags te 2.30 uur door Roland Marnix Bertens geboren op 4 oktober 1989 te Zeist 3 4 Promotoren: Prof. dr. F.G. Huisman Prof. dr. J.G. Sijmons Copromotor: Dr. R.A.A. Vonk 5 6 Table of Contents Tables and figures ........................................................................................................................................................ 12 Introduction.................................................................................................................................................................... 13 The Longue Durée of Dutch Health Care: Culture, Ideology and Legislation 1848-2015 ................. 13 Research Questions ................................................................................................................................................ 16 The Analytical Toolkit of Governmentality/Governance ........................................................................... 20 Bringing Back the Longue Durée: Periodizing Dutch Health Care......................................................... 25 Historiography, Methodology, and ‘Identity’ of this Dissertation ........................................................ 28 Part I: Liberal Governmentality, 1848-1912 ........................................................................................................ 33 Introduction ............................................................................................................................................................... 34 The State of Dutch Health Care ......................................................................................................................... 35 Medical Care and The Medical ‘Profession’ in the Early 19th Century ................................................. 37 Bringing Doctors under One Banner ................................................................................................................ 40 A Liberal Blueprint: the 1848 Constitution ..................................................................................................... 42 Health Care: A Concern for the State? ............................................................................................................. 44 Setting the Boundaries: The Laws of 1865 ..................................................................................................... 45 A New Governmentality for Health Care ........................................................................................................ 48 Programmatic Laws, Stubborn Realities ......................................................................................................... 49 Case Study: The State Inspectorate and the Fostering of Individual Care ............................................. 51 A Marginal Role for Government: Poor Relief and Health Care ............................................................ 54 Civil Society in Action ............................................................................................................................................. 56 A Changing Political Landscape and a Society on the Move .................................................................. 58 The ‘Social Question’ and Limited State Intervention ............................................................................... 60 Conclusion .................................................................................................................................................................. 63 Part II: Hybrid Governmentality, 1912-1968 ...................................................................................................... 65 Introduction ............................................................................................................................................................... 66 Medicine and Health Care in Transition ......................................................................................................... 67 7 New Promises of Medicine .................................................................................................................................. 68 Great Expectations .................................................................................................................................................. 70 Shifting Care: New Locations .............................................................................................................................. 72 Social Ideals, Faltering Politics ............................................................................................................................ 74 The Limits of the Legislature ............................................................................................................................... 76 Limits of the Legislature, Act Two: Health Insurance ................................................................................. 79 The Trials of the State Inspectorate .................................................................................................................. 80 The Achilles’ Heel of a ‘Local’ Governmentality ........................................................................................... 82 From Arbitrariness to Accessibility .................................................................................................................... 85 Sickness Funds: The Bedrock of Dutch Health Insurance ......................................................................... 86 Private Health Insurance: Lucrative or Lurid? ................................................................................................ 89 State Intervention Through the Back Door .................................................................................................... 92 Local Government Steps In .................................................................................................................................. 94 Hospital Care: Convergence Between Private and Public Financing.................................................... 96 Health Care Financing: Rhetoric vs Reality .................................................................................................... 98 Private Initiative, Publicly Backed .................................................................................................................... 101 The Netherlands under German Control ...................................................................................................... 103 Cutting the Gordian Knot: The Introduction of Mandatory Health Insurance ............................... 104 The Great Equalizer ............................................................................................................................................... 106 New Patients and a New Role for Sickness Funds .................................................................................... 108 Dreams in Exile: The Van Rhijn-Committee ................................................................................................. 110 Reinventing the Social Contract: The Beveridge Report ......................................................................... 112 Beveridge Abroad .................................................................................................................................................. 114 A Silent Death for Big Ambitions ..................................................................................................................... 116 A Return to Pre-War Thinking .......................................................................................................................... 118 Catholics and Social-Democrats: A Recipe for Gradual Reform .......................................................... 121 New Times, New Health Care Politics? .......................................................................................................... 123 Public Guarantees, Private Governance ........................................................................................................ 126 War, Reconstruction, Reorganization ............................................................................................................ 128 Van Rhijn: A Rallying Cry for Private Initiative ............................................................................................ 130 8 A Political Matter Best Left to Parties in the Field ..................................................................................... 132 Case Study: The Elusive Matter of Hospital Planning ................................................................................... 135 The Health Act of 1956 ........................................................................................................................................ 139 Private Initiative Unfettered ..............................................................................................................................