The Dutch Health Insurance Act and the Jordy Zwarts Case - Is it morally justifible for governments to require that citizens buy health insurance from private companies?

Abstract

This thesis delves into a lawsuit regarding the Dutch basic health insurance. In the lawsuit, it is argued that since the compulsory basic health insurance in the Netherlands is regulated by private health insurance companies, the coercive character is impermissible. This thesis will analyze this argument. First, it will examine the moral permissibility of a private health insurance company, by delving into the debate on the commodification of healthcare. Then, it will question whether the coercion of the insurance is morally permissible, by looking at several conceptions of freedom and how they apply to this argument.

It concludes that the norms used in the market sphere of health insurance are not characteristic of a typical market, as described by Elizabeth Anderson. For this reason, the private health insurance company is just as morally permissible, if not more, than a public one. Furthermore, it shows that the arguments in the court case are based around a libertarian conception of freedom. This account on freedom argues for a free choice, but does not realize that one is not free if one does not have access to all the basic liberties. In order to be free, then, this thesis advocates for an relational egalitarian account where health insurance is seen as a basic liberty. This way, a person is only free if she has both the choice to use it, and the duty to provide it for others. This can only be done in a mandatory form.