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The Golden Throne of “Healthcare Inc.”

In early 2023, the Maastricht council faced a packed corridor in front of the council chamber: parents of young children with complex learning disabilities were panicking. Their Medical Day Care Center (MKD) was about to close. To some, the story seemed clear: due to municipal policy, it seemed impossible to keep crucial care for children open. The truth is more nuanced.

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Ryan Wilmes

To better understand the truth, we must start with the organization of Xonar. At this organization, which is responsible for the Medical Day Care Center, an annual loss of one million euros is the norm. Meanwhile, this loss-making companing has, in addition, bought shares in the equally unstable organization of JENS. All this weakens their position so much that the Dutch Youth Care Authority (Jeugd Autoriteit) has rang the alarm bells.

A recovery plan was needed in order to continue offering the necessary care. Xonar assured to spend roughly 750,000 euros on another external agency and 350,000 euros on a new interim director. That recovery plan went into effect at the end of 2022. Before the summer recess of 2023, it was shared with the Maastricht City Council. However, it was shared in secrecy. That is allowed by Dutch law: Xonar is, after all, a private healthcare institution (i.e., a company) and that means that Xonar can enjoy quite some privileges.  

Four main points can be shared (by now, no longer classified as secret information):

Xonar was to divest “unprofitable non-core products” in early 2023. In normal-people English, that means: the Medical Day Care Center was to close.

Xonar will merge with another party during the years 2023 and 2024.

The 16 municipalities that purchase care from Xonar together donate 8 million euros, with the municipality of Maastricht contributing 1.5 million.

Because an overwhelming part of the problems arose from mismanagement at Xonar, a reorganization was to take place.

Xonar, together with the Youth Care Authority, has decided to close the Medical Day Care Center. The municipality has no influence on this whatsoever.

However, the municipality of Maastricht does have the obligation to contribute 1.5 million euros of public money to a recovery plan of Xonar – a recovery plan that the public is not allowed to see because it is under secrecy.  

Volt thought it could still control all sorts of things in this at the beginning of its consideration of this case. Aren't we politicians? Surely we should be able to do something about this? The short answer is negative. We can do nothing but pull the purse strings. But, you are here, of course, for the long answer:

That secrecy of Xonar is regulated by national law. A company, be it Coca-Cola or health care provider Xonar, may keep sensitive company information secret in name of their company privilege. There are a couple of problems with that. First of all, all healthcare here in the Netherlands is performed by companies, and secondly, Limburg is one giant border region. As a result, there is way less competition in the Limburg market than elsewhere – after all, Belgium and Germany do not have such companies to broaden the market. In other words, Limburg society is largely dependent on a number of monopolistic companies, which have to carry out the government's duty of care.

Ronald van den Hoven / RTV Maastricht 2023

In short, although Xonar has the same corporate privileges as a normal company, like Coca Cola, in reality the two are quite different. Dutch municipalities have a legal (and moral) obligation to provide healthcare, for which they depend on a company, like Xonar: a company too big to fail. Xonar knows this: if they go bankrupt, the municipality can no longer offer the healthcare. As a result, Xonar knows they can push the financial limits. This won't happen if Coca Cola goes bankrupt: it may just vaporise your favorite soda. So, whatever you think of Coca Cola's right to keep information secret, it is fundamentally different from Xonar's case. In today's politics, however, the healthcare provider ensures that democracy has its hands tied to the free market. We think that’s a problem.

Specifically, here in the Netherlands, we are in the unique situation that the implementation of care must lie with private companies, but the responsibility of that care lies with the municipality. In practical terms, it means that Maastricht absolutely cannot say “no” to the 1.5 million claimed by Xonar. It cannot put conditions on it either, because Xonar may refuse those conditions. We cannot hold Xonar's board legally liable: no one has ever been sued for being bad at their job. At most, you can be fired. But guess who has absolutely nothing to say about that? Exactly: the municipality.

That is the golden throne of “Healthcare, Inc.”. The municipal duty to provide healthcare means that the municipality is at gunpoint by the Dutch national attorney – after all, this deal with Xonar is legally binding on a national level. Any opposition is enough to spark a legal conflict that benefits no one. Certainly not the children who depend on Xonar's care.  

This bothers me. We are talking about healthcare for vulnerable children. Healthcare that is highly valued by the parents of those children. This fact is used as a sword of Damocles company directors. But then, there comes a time when the care facility runs out of money, and, without a fight, the company starts closing down products that people depend on. Then they come knocking on the municipality's door for more, and then the municipality can do absolutely nothing about it. That will be price for these companies, paid by tax payers. Rinse and repeat.

Xonar will merge with the Mutsaersstichting to form the “Samen Jong Geheel Stichting” (the “Together Young as a Whole Foundation”) during 2023 and 2024. On Sept. 8, Follow the Money wrote about the Mutsaersstichting. Like Xonar, this foundation is not financially healthy and leaves behind a trail of destruction. And yet, the municipality plans to establish a contract with Samen Jong Geheel. That contract is likely to be fixed for 10 years. 

You may wonder: What a dumb thing to do. This is a huge risk, isn't it? But the real question is: Does the municipality have a choice?

The neoliberals of The Hague may be in love with the market forces in healthcare, but they're simply not working. It does not work in the Netherlands as a whole, nor does it work in a border region like Limburg.

Volt calls for a radically new healthcare system across Europe. A healthcare system where people, not the market, comes first. Preferably, this should be a system where people have the freedom to go to care providers across borders in Europe.

But more importantly, our healthcare system needs to be simpler. It must be one where cooperation and shared responsibility are the common thread. The incentive to make profits, combined with the neoliberal sanctity of private enterprise, puts politics out of business. This is why Volt wants to move toward a simpler and more centralized healthcare system, which should eventually create a European Health Union - in which not competition, profit and business are central, but quality is tested based on meeting the desires and needs of patients and clients. Not just from a humane perspective, also from an economic standpoint, this is essential: the neoliberal management of healthcare is so focused on perverse financial incentives that it leads to an unnecessarily expensive healthcare system, which offers no insight to government and citizens. It keeps people at a disadvantage who otherwise, with the right care, could have participated better in our society.

Wondering how we want to shape this? Read our updated (draft) election program here.

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