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Near the end of the 2015, Ron Meyer, newly elected as leader of the Socialist Party of the Netherlands (SP), informed his comrades that they “have to do things differently . . . Not a little bit differently, but completely different.” With his experience as a campaigner for the country’s largest trade union federation, Federatie Nederlandse Vakbeweging (FNV), and as an organizer for a youth movement to raise the minimum wage, Meyer wanted to launch a militant, SP-led campaign to de-privatize the Dutch health-care system. Rallying around the slogan “Nationaal ZorgFonds” (National Health Care Funds), the party’s initiative kicked off six months after Meyer’s speech. Some quarter-million supporters allied with political parties, unions, and social movements to release a common appeal: the state must take over all health-care costs. Ten thousand protesters marched through the capital in mid-February to back up the demand. The left-leaning Party for the Animals (PvdD), the 50PLUS pensioners’ party, and the Pirate Party announced their support for the campaign, while the Labour Party (PvdA) and the FNV debated it internally. The SP began planning the campaign in 2014, and it marks a major shift in party strategy. In years prior, the Socialists ran several smaller campaigns that met with limited success. Its base had stagnated, and it claimed only about 9 percent of the vote, down from a high of 16 percent in 2006. SP members now wanted to focus on a large, nationwide campaign, arguing that it made more sense to pick a fight they could win than to limit themselves to resisting neoliberal reforms. Party activists hoped that a successful campaign focused on improving voters’ quality of life would begin chipping away at the dominance of neoliberal ideas in Dutch society. Fighting for public health played to the Socialists’ strengths. Lilian Marijnissen, the third candidate on the party’s 2017 parliamentary list, led the FNV’s first organizing campaign around health care after the system was restructured in the 2000s. Although the system has become one of the most intensively neoliberalized sectors in the country, these changes are relatively new. Most people remember the old system, making de-privatization seem both plausible and attractive. Indeed, a 2016 survey conducted by nu.nl found that 63 percent of respondents ranked health care as the most important election issue, even above immigration, which so dominated the right-populist Party for Freedom’s (PVV) campaign. Although the SP failed to profit from the country’s recent political earthquake — winning just 9.1 percent in the March elections and losing one parliamentary seat — the ZorgFonds campaign shows how a party can build a broad base of support around a single issue. The party allied with trade unions, health-care experts, and ordinary citizens to deliver a powerful message to the government, radically changing the terms of the health-care debate.

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.