EZRA KLEIN wonders whether Democrats haven't made a mistake by selling the health-insurance reform bill as, at bottom, an effort to contain runaway health-care inflation, rather than as an effort to guarantee decent health care for all. He cites a passage from T.R. Reid's new book "The Healing  of America: A Global Quest for Better, Cheaper, and Fairer Health Care" that notes that in Sweden and Taiwan, successful moves to universal health care were couched in terms of social justice, not cost-cutting. But just how interested are Americans in the egalitarianism of foreign health systems, as opposed to their cost savings?

Certainly, those cost savings are pretty juicy. Ten years ago, when I moved from New York City to Amsterdam, my health insurance premiums dropped by about 75%. In both countries, I was on fairly low-benefit private individual insurance plans, but in the Netherlands, that plan cost, as I recall, somewhat over 1000 guilders (alas for Europe's vanished national currencies!) per year—about $500, at contemporary exchange rates. I experienced reverse sticker shock. It was hard to believe it could be worth the time of the office staff to process my payments. And that was on the private market.

But as it turns out, if a young American moved to the Netherlands today, he might not get as good a deal as I did. The reason my premiums were so low was that I was young and healthy. But the fact that young and healthy people paid less for insurance than old or sick people was, in the context of Dutch politics, viewed as a problem. Over the past ten years, the Netherlands has steadily made its insurance market more egalitarian, and in 2006 the country passed a major systemic reform under which all health insurers must offer everyone in the country the same individual rate, regardless of age or prior medical condition. This paper in Health Affairs by two Dutch experts explains the details. As of 2007, the average Dutch premium was about €1100, rather than the roughly €500 I was paying back in 1999. On the other hand, each Dutch taxpayer now gets an income-related subsidy from the government to help reimburse premiums, up to a €1,464 maximum. There's also a 7.2% payroll tax to fund the government-run Risk Equalisation Fund (more on that below), but employers reimburse employees fully for that.

So young healthy people in Holland now have to pay the same rates as the people who are actually likely to, as it were, get sick. But wait—how can an insurer offer everyone the same exact rate, regardless of age or health? That's where the Risk Equalisation Fund comes in. The fund compensates insurers based on the risk profiles of the individuals they cover. (Germany has a similar system.) In theory, insurance companies won't compete with each other to get the youngest, healthiest customers; if their customers are old and sickness-prone, the government will compensate them accordingly. Instead, insurers compete on price and efficiency. And buying insurance is mandatory, preventing the "adverse selection" phenomenon, in which the young and healthy drop out of the system, driving up costs for everyone else.

And so, in its quest for social justice, the Netherlands has rendered its health insurance slightly less of a great deal for aimless 20-something bachelors from America than it was ten years ago. (Though, still, pretty great. €1100 is about $1560. The Robert Wood Johnson Foundation says the average cost of an individual policy in America was $4,118 in 2006, though other estimates are lower.) But with respect to Mr Klein's idea, the Dutch story raises some doubts. Is this kind of political dynamic plausible in the US? Do American voters really embrace the idea that it is unfair for a young person to pay less for insurance than an old person does?

Perhaps that kind of commitment to complete equality isn't necessary. The bill currently in the House limits price discrimination by age to a 2-to-1 ratio. It prevents insurers from rejecting anyone on the basis of their health, or from charging unhealthy clients more than healthy ones. And to counter adverse selection, it mandates that nearly everyone in the country buy insurance.

That, in itself, would be a momentous change. On my last visit to Amsterdam, I found myself wondering how a friend, a terrific artist from New York who has lived there for years, makes ends meet. "I wonder whether he has health insurance," I mused. It was a mental slip, and my wife gave me a baffled look. "He lives in Holland," she said. "He has to."