To bring some diverse experience into the discussion on health care reform here in the USA, I’ve asked my friends in Europe to share how health care works in their lives. In this four-part series, we’ll start with the most highly taxed and socialistic part of Europe: Scandinavia.
From Hakan in Sweden:
In Sweden, we have free choice in health care. It means that patients can choose a hospital anywhere in the country.
In 2005, the cost of the health and medical care sector amounted to 8.4 percent of GDP (in the US, it was over 15 percent). This amount includes the cost of pharmaceutical products, dental care, eyeglasses, and patient fees paid by households.
We employ a “high-cost protection scheme” that means that no patient ever needs to pay more than a total of 900 SEK (about $125) over a 12-month period. For pharmaceutical costs, no patient has to pay more than SEK 1,800 (about $250) over a 12-month period for prescription drugs. This way, no citizen will be put into poverty because of health problems.
The fee for visiting a doctor or hospital varies from 100-300 SEK (about $14-32), but once you have paid 900 SEK in a 12-month period, the rest of the care is totally free — no matter what kind of treatment you need. Private-care providers are also “clients” of the government. A patient can choose a private doctor or hospital, pay the small fee, and the government pays the difference.
The health and medical services have an obligation to strengthen the situation of the patient, for example, by providing individually tailored information, freedom to choose between treatment options, and the right to a second opinion in cases of life-threatening or other particularly serious diseases or injuries.
Having lived here all my life and raised my family here in Stockholm, I honestly do not see anything bad with our health care system.
From Richard in Demark:
I have lived and worked in Denmark for 24 years and have had numerous encounters with the health care system. In all cases I was satisfied or impressed with the quality of service and the low cost (apart from the tax system — more about that later).
The health care system in Denmark is free to all who live here. Even visiting tourists will be treated free of charge in case of an emergency. A non-Danish friend of mine who sprained her ankle during a recent visit was X-rayed, bandaged, treated by a doctor, and even given a pair of crutches to use — and was not charged anything. She was only asked to return the crutches when she left Denmark.
The quality of Danish health care — which is not run on a profit motive — is very good, though there is a waiting time for some non-life-threatening operations like a hip replacement. But everyone will eventually get the operation they need. Hospitals are free, doctor visits are free, and medicine is highly subsidized so that those who need a lot of medicine get it at a greatly reduced charge. Dentistry is subsidized.
This is paid for through our tax system, which — at 52 percent — is perhaps the highest in the world. None of the 10 political parties in Denmark has ever wanted to change that, because they know that they would not get any votes. The vast majority of Danes are agreeable to pay these high taxes; they know that they get about 50 percent of the money back each year in a vast array of benefits. Seven out of 10 Danes are willing to pay even more taxes, if necessary, to maintain the health care system we expect.
Danes have the mature and realistic understanding that you cannot give everyone a quality health care system, good schools, and the elements that help to make for a good quality of life, without paying for it. Freedom does not mean not paying taxes. For us, freedom is paying taxes. By taking care of each other, and the weaker elements in our society, we all have a better quality of life with very low crime rates, few prisons, and a sense of security that it is not “me against the world.” That is part of what it means to be Danish.
From Hanne and Trond in Norway:
In Norway, everyone has, in principle, equal rights to health care. Norwegian hospitals are “free” for patients (being financed with taxes) and everyone is entitled to treatment, irrespective of income and insurance. However, many things are not always working well here.
When hospitalized, no one asks for insurance coverage. You can stay for as long as it takes without having to worry about costs. At the hospital, every part of the treatment is free, indefinitely. At home, people with chronic illnesses get medicine and necessary medical equipment almost for free, save for a limited, annual base payment.
But some parts of the system don’t function well. Depending on the illness, you could wait a long time for necessary hospital treatment (typically non-emergency surgery). For instance, you have to go through your family doctor in order to be referred to a specialist. When the family doctors have way too many patients and limited opening hours (and limited telephone hours!), this is often an obstacle. Of course, any emergency treatment is exempt from “queuing.”
As for the cost, the hospitals operate with a combined budget of approximately NOK 75 billion ($13 billion). Our health care is not free — we pay for it in our taxes: Our corporations pay a flat tax rate of 28 percent on their profits. Wage income is taxed under a progressive structure, from almost zero (very low, part-time wages) to a maximum marginal tax rate of 54 percent. The average “industrial worker” has a tax rate of 30 to 35 percent.
Good post, can’t wait for the rest! Whether you pay privately or through taxes, you still pay. I think it comes down to caring about your fellow citizens and from a Canadian perspective I do not mind paying taxes for universal health care. BTW There are no “Death Panels” in Canada.
Interesting information from other parts of the world. Troy makes a good point – you will pay. Whether it be out of pocket, taxes, or corporate taxes people do pay for their health care. It’s just a matter of whether they want the money on the front end or the back end. The benefits of Scandinavia seem to be that everyone has coverage while that is not the case in the US. Changing the system in the US is not just a change in policy but in culture. We are more of an individualistic culture and mindset. This means people willing to give up their income to taxes, corporations being taxed more, and the health care industry changing the way they operate. Can ALL of this be done in one fell swoop here in the US? Can we overhaul a system and a culture and raise taxes while people are struggling financially? While European govts do a good job of managing their money are required to stay within budget based on EU policy, the US is by far the worst nation in the world in terms of govt spending and overspending. So on top of all these other issues, can health care legislation keep the govt from mismanaging another program or increasing our debt? This sounds like a great idea but this is a cultural shift, an economic issue, and a shift to more govt control in an era of rising debt. This is not as easy as just passing legislation for healthcare.
How about legalizing marijuana and taxing it to pay for healthcare. It’s long overdue. Just think all the money, that would come from that.
Surprisingly, Corporate Income Tax is actually higher in the USA than it is pretty much everywhere else (with the exception of Japan) http://en.wikipedia.org/wiki/Corporate_tax_in_the_United_States
The problem I see with this is, they get a lot of things for free with that high tax base. We would then still have to pay for all those other things in this country. It would be impossible to only have healthcare and not other things that we have to pay for here and then add that high tax rate.
Here’s a controversial thought, but one that could free up funds to pay for health care for ALL Americans without requiring additonal taxes: Let’s withdraw our troops from Iraq and Afghanistan, invest in a few more drones in case we need to do some spot cleaning, and then use the BILLIONS of dollars saved to fund health care costs for OUR citizens. Then, anyone who still strongly feels that we need to have a military presence in these two countries can go fight the insurgents and Taliban as a mercenary for the Al-Malaki and Karzai governments, respectively.
I aqree with Rob to a point. i dont think we can withdraw ALL of our troops for geopolitical reasons. BUT why cant we reduce our presence to a level that saves enough to overcome the “it costs too much” argument. And while we’re atg it, ehy not build 5% fewer multi-billion dollar tanks,ships,planes. 5% savings for these weapons of war would surely “reduce” the cost even further!
Well Rick, it looks like your back on the propaganda train again! I’m sure you’d be more than happy to give up 45% of your income to the Fed’s to support government run health care. Funny how people overlook the fact that our government contributes to the high cost of health care in this country through their meddling in the free market. Before we spend trillions that we don’t have, (of course we could just print it) perhaps the government should get out the of way and let the market work. But of course we ‘know’ that couldn’t happen because ALL corporations are ‘greedy’ and ‘corrupt’! Why that sounds like our representatives in Washington, doesn’t it? As for me, I’m perfectly happy taking care of myself and NOT paying higher taxes!
It doesn’t surprise me a bit that Europeans like their health care system and don’t feel bad about high taxes because that is the only experience they know. For instance, some folks may grow up and hate their mothers’ cooking, but I bet most have a fondness for that good old home cooking because that’s what they grew up with. However, that does not mean everyone else will like your mother’s cooking. It’s great that the woman in Denmark got free care when she twisted her ankle…what’s not to like about that. I wonder if she would like it as much if she needed to pay 52% taxes to get free wrapping and crutches. As a person who does consumer research for a living, it is not accurate to make conclusions about anything based on the opinions of persons who know only that scenario…for instance, what insight does a man’s opinion about his Volkswagen (the only car he has ever driven) give others about whether their Toyota is better or worse? While there may be some interesting things to compare, the reality is that you can’t draw any conclusions. Net, I’m happy that folks in Europe are happy with their health care…just be careful when you make that leap to assume that you will like it just because they seem to.
Very interesting points by Mike and Bryan. Go back and reread the quote from Richard of Denmark “for us, freedom is paying taxes”. That illustrates the totally different mind set in Europe as compared to here in the US. Personally, I cannot ever see myself equating freedom with paying taxes, and I doubt very seriously that anything approaching a majority of my fellow citizens would either.
Europeans seem to have a sense of community that we are falling further and further from in the US. They do many more things on an honor system that just wouldn’t work in this country. There are so many tangible and intangible aspects that cause universal health care to work in those countries. I would be all for paying the higher taxes to fund universal health care if there was a shred of hope that it would work here. I just haven’t seen our government be able to run any program half as well as the private sector. There has to be a better answer. The “Europe can do universal health care, so can the US” argument just doesn’t hold water anymore.
I agree with April. The idea of universal health care is of course an admirable one. The idea of the U.S. government beauracracy mediating such a system keeps me awake at night. The U.S. Postal Service, for instance seems to do nothing but lose money. What makes us believe the government can do a better job with health care than they do with the postal service? It is bad when things get lost in the mail…how bad will it be when the government agency (or more likely many government agencies) running health care creates a mess of red tape that an army of master scientists and engineers couldn’t unravel? And by the way, yes, attitudes in Europe are different than what we see here in America. However, despite the apparent public willingness to pay higher taxes to get government programs and entitlements you will find many mounting problems amongst European governments trying to figure out how to pay for those programs–pretty troubling when tax rates are above 50% in some places already. I recall past blog posts from Rick talking about this very topic. The most common options at their disposal to remedy this are 1) cut programs and entitlements or 2) raise taxes. Also, most of these European countries don’t have huge armed forces, so for everyone who thinks the answer is just eliminate the military and all the federal deficit problems go away, think again. Of course we can cut spending on the military, but if you look at the relatively small amounts many European governments spend on the military already, it is clearly not a panacea.
Of those 3 I would say that Sweden’s plan seems the best to me. No offence to Troy but I lived in Canada for a while I had quite terrible health care experiences because it was free. I had to wait for hours every time I went to the doctor and most of other the patients not very sick at all but went to the doctor just because it was free. (a fact confirmed by my canadian friends who admitted that they go the doc for pretty much everything ‘because its free, so why not’) When I finally got in the doctors would rush through the meeting to try and get through the crowds; resulting in several mis-diagnoses meaning I had to go back several times; and the last error when the doctor wouldn’t listen to me has caused me a year of complications after leaving Canada. Perhaps my experiences were the exception but the point is that have people pay even a nominal amount will cut down on overcrowded doctors offices and burnt out doctors which is one of the biggest problems with universal health care.
No offense taken at all. No system in the world will ever be perfect and you always pay whether by taxes or privately. I agree with having small services charges but I am in the minority in Canada. I have had nothing but great experience our with our system up here but some do not. I have also had good experience in the States. I will never preach to my American friends on which system to choose. I do think that having so many people uninsured in your country is not right. It is a hard subject and I think the USA has to find a solution unique to it’s culture, no system from outside the US will work for the USA. I do get a little tired of some of the mis-information that gets reported about us in Canada. If you believe the news reports we would be revolting on mass up here if everything reported about our Health care system were true. Bottom line is as much as we Canadians complain about our system not too many would change it, in fact when anyone mentions privatization large portions of our population get really upset.
For me it is a moral as well as a financial issue. I’m uncomfortable with the idea that I will receive a life-saving operation on the 3rd floor of a U.S. hospital while another American citizen (someone’s mother, brother, wife, husband) is being denied the same operation on the 2nd floor –solely because he/she can’t aford insurance or was denied a treatment by some insurance company paper-pusher. My job has taken me to Austria. I like being in a society where the social compact is that everyone has health coverage. In addition to being “more fair” it contributes to social peace and stability. Austria has a two tier system: meaning that if you can afford the more expensive private coverage, you frequently get bumped to the front of the line. It’s far better than the U.S. form of rationing: we simply deny coverage to millions of poor people. An African American living in New Orleans has a shorter life expectancy than the average person in Vietnam or Honduras. In Austria, at least, everyone has coverage and no one is denied. A coworker of mine has gone through not one, but two, fights with leukemia. She is on the plain vanilla Austrian public health coverage. She has nothing but praise for the system –it has saved her life twice. It is true, however, that no system is perfect. For more comparisons of different systems, I recommend reading the article below in which Nicholas Kristof apologizes to Slovenia for insulting them: http://www.nytimes.com/2009/11/05/opinion/05kristof.html?_r=1
Being in the Physician Recruiting business I see the good, bad, and the ugly of the American health system. I believe a hybrid system that incorporates private insurance and a public option/expansion of medicaid/care will help patients and Physicians bring costs down. I also think some sort of opening of the state borders on insurance plans must happen, much like a 529 plan you can buy for you kids. There are so many complex issues in this area it is difficult to sort them all out. There must be an easier way.
I think it might be helpful to hear from the medical community in Scandinavia. Are there sacrifices, such as mandatory hours, amounts of patients seen, salary, modern equiptment, etc. on that side of their program. Also,the high price of drugs in the U.S. is always justified by research costs. Assuming they do, how do these countries keep the cost of drugs down? Thanks, Ceil
I note that you have not included any comments from the UK or other areas of Europe out side of Scandinavia. We have three close friends in the UK and their experience is very negative. Not only is the cost extremely high (one of the reasons why their taxes are 40% of their income) but most have to carry private insurance or they wait months and years to get on the list for surgery. Those that are senior citizens (over 55) cannot get surgeries such as joint replacements until they have suffered years of pain being on a list. Scandinavia is the true exception and what they are talking about here is very different. It is only fair to show both sides of the issue, where it works and where it doesn’t.
@Pat S.: Considering the title of this post is “Part 1: Scandinavia,” one might reasonably assume that Parts 2 etc. would cover other geographical areas of “The European Health Care Experience.” You might want to get that jerking knee looked at with yo
Rick, this is the perfect place for your political (and other) views. It is your blog and you have the right to post what you want with out apologies. To refer to Europe including Scandinavia as socialist is not really true. Germany for example has a VAT of 19%. This is like a national sales tax at that same rate. Many Americans would consider that regressive. While ~40% of Americans pay no income tax, all Europeans pay the VAT. In contrast the US income tax encourages spending and not saving as the VAT. American income tax does a much better job of redistributing wealth. Except for health care, we are the socialists. As a physician I see health care from a different perspective. Most people make little use of the health care system, so most people are happy with their system. Europeans do not know what it costs them but when they get a cold it is “free.” Consider that ~60% of Medicare dollars are spent in the last 6 months of life. Since 20% use 80% of the dollars, naturally 80% have no problem with the system because they use it little. American health care is more aggressive. It is what both doctors and patients expect in America. As to quality, don’t believe the “statistics.” It is impossible to compare costs in the different systems. You can select data to show anything. US life expectancy would be higher than in Europe if we did not average in the age of death of trauma (murder) victims.
I think it’s wonderful that such a controversial topic can be debated on this blog without it turning into an ugly argument. I wish our politicians could act as maturely. I spent time in Sweden, Denmark, and Finland last summer. A bartender who was very happy with his high taxes & government-backed benefits made an interesting comment. He said that while he wouldn’t have his system any other way, he didn’t think it would work in the U.S. In his opinion, the U.S. has too much debt, too many incompetent politicians, and too many people already accepting government aid (i.e., not contributing to the tax base) to make this a practical system here. I agree with him—especially about our incompetent politicians. I live in Chicago, where we boast the highest sales tax (10.25%) in the country. Higher taxes, unfortunately, do not translate into a higher standard of living for anyone. Half of the money goes unaccounted for and the other half goes to those who need it the least. I don’t have any confidence that higher taxes at the federal level will make anyone’s life better, except the politicians and their cronies.
Here’s my 2 cents: I’m an American and have received healthcare services in both Norway and France–for a small fee (under $35). The providers were EXCELLENT–professional, caring, and competently treated my illnesses. I thought the care was superior to a lot of what I’ve had to deal with in the US (with the exception of Harvard’s teaching hospitals).
I will start by saying that I am uncomfortable with the trillions of dollars we are planning to spend in the future on the health care overhaul, and I am just as uncomfortable with the government of the United States running anything anymore. That being said, what concerns me more is that for profit corporations, that are responsible to share holders, are in charge of allocating health care funds for me and my family when it is in their financial best interest to do just the opposite. This is a conflict of interest and completely inappropriate. What really needs to be done is the conversion of ALL health insurance companies into non-profits. They can still pay high salaries to their executives and they would still be in competition to make money. They just wouldn’t be looking to make a carry over profit from year to year and they wouldn’t be shackled to the best interest of their shareholders. Then we would really see whether the market can regulate the system. I also think that health insurance companies should be mandated to accept all comers and offer basic plans at affordable rates. In turn everyone should be expected to buy health insurance, thus spreading the risk around and reducing costs. I also want to discuss this annoying myth of choice in this country. The only choice I have is to take the insurance my job provides or go without. I cannot even come close to affording insurance on my own. Until everyone can actually afford the cost of health insurance, there is no real choice in that regard in this country.
There have been some excellent comments on this. And this it what it seems to come down to. Is there enough of a cultural shift in this country where people are willing to pay higher taxes and feel comfortable enough for a govt to run another program into the ground? Congress seems adamant about doing this and ramming this thing through without looking at all the possibilities. It is assumed our current system is broken beyond repair without realizing a system run by the govt, with higher taxes and more govt spending, could actually make things worse and even more inefficient. Everyone having health care is a great idea. And for those in Europe where this is all they know is high taxes and free health care, that is great. It definitely isn’t a perfect system there as many people wait hours or get inadequate care. How do you change American culture to depend on govt and accept higher taxes for a system that does work for a majority of people?
a)Just because you have health insurance, doesn’t mean you’re adequately covered. b)We wouldn’t have to spend the extra trillions of dollars for universal health care if people in Congress had the guts to recalibrate–that is, cut–defense spending. With what we’ve poured into the Iraq/Afghanistan money pit (from taxes paid only by the blood of casualties), we could fund health care for every U.S. citizen for the next three generations….
Having had close to two decades working in the private sector, and an additional nearly two decades in the public sector, my own experience was that the public sector was generally more efficient, more customer-centric, and vastly more concerned with the general welfare of the community. The private sector worked hard to maximize short-term profits, often ignored long-term costs (someone else’s problem), and did its best to suck the government teat dry whenever it had the opportunity. People are frightened about government run programs because… 44 cents seems too high a price to pay to send an envelope from Jeb Bush-country to Sarah Palin-land? Because… Medicare and Social Security have not been godsends to our parents and grandparents? Because… the American military is a mess? And the private sector hasn’t done their best to game the system and, in the process, impoverished millions and nearly destroyed the global economy? Again (Enron wasn’t that long ago, folks)… and again (S&L Crisis, people)… and forever back to long before the Great Depression… Sorry, I just don’t get it. And all of the recent crises brought about in substantial part by deregulation – that is, getting the government out of the way so that the private sector can flourish. Yeah, that worked out well… We pay far more than anyone else in the world for health care and don’t get anything near a reasonable return on that investment precisely because it is a largely private system with incredible profits being scooped off the top. A better system need not cost more. (And 47 million get nothing at all, which is nothing short of shameful.) Again I don’t get it. Where does this crazy faith in the private sector to take care of our health come from? It’s not what they are designed to do, and they’ve proven incapable of doing it well. Let the private sector make golf clubs, and laundry soap, and reality TV shows, and let the government “provide for the general welfare.”
dprat, a huge factor in the high cost of health care is the anti-trust exemption insurance companies receive. Essentially, the market isn’t open to competition. You say the our system isn’t working. The health insurance industry doesn’t function like the rest of the market. It’s like pointing to MLB, their high salaries, and the number of teams in financial trouble, and trying to use that as an example of why our economy is flawed and struggling. Sorry, it’s comparing apples to oranges. Take away the anti-trust exemption for insurance companies, open up the market to true competition, and I GUARANTEE you costs will come down. If not, many insurance companies will either merge or go out of business because their security blanket is gone. With the way things are now, we don’t know how insurance truly works in the private sector.
open up the market to true competition, and I GUARANTEE you costs will come down….. and the sad thing is this COSTS THE TAXPAYER NOTHING, yet our government won’t even try it! They’d rather just steal from us as they’re conditioned to do.
I think whats needed for any “discussion” on health care reform to be most informative is a clear understanding of the writer’s perspective. particularly whether or not the writier currently enjoys the “privilige” of group benefits. I would be very interested to see how many of all the “market-based” believers in a system that has been broken for over 6 decades enjoys the security of such coverage. After all, it is very easy to say no to others while you enjoy the benefits. As do all of the repugs in Congress.
I agree with cwiakan. Those of you who think health care is just fine and dandy as it is now better hope you keep group coverage. If you lose your job and find a lump in your breast, there is no one in America who will insure you at any price. Geez,I thought people who spend so much time in Europe would be open to considering another way of doing things. If the people on this blog are not in favor of universal coverage, it stands little chance of ever becoming a reality.
Our country was founded on liberty and freedom, and it’s the last, best hope on earth. I for one am not ready to give that up. Government is like a cancer and I’m all for slowing it’s intrusion into our lives, as it’s already gone too far IMHO! The health care debate will play itself out…. some will be happy, others disappointed. For those so eager to cede their God given rights to the government, I offer some suggested enlightenment….http://www.serendipity.li/jsmill/welch.html
The black vs white nature of the discussion makes me think of a line from Billy Joel’s song, Shades of Grey: ….”Now with the wisdom of years I try to reason things out…. And the only people I fear are those who never have doubts”…. http://www.youtube.com/watch?v=wyVcHuV2MHQ
To all who say if the market is open to competition costs will come down. How well has this worked where tried? My understanding is that Minnesota allows hundreds od insurance companies to sell health insurance in the state. Companies must prove they are financially sound and meet minimum levels for reserves, etc. and then they are able to sell health insurance in Minnesota. How do insurance costs compare in Minnesota to other states? Are Minnesotans saving money and getting better coverage for their insurance dollars?
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American income tax does a much better job of redistributing wealth. Except for health care, we are the socialists. As a physician I see health care from a different perspective. Most people make little use of the health care system, so most people are happy with their system. Europeans do not know what it costs them but when they get a cold it is “free.” Consider that ~60% of Medicare dollars are spent in the last 6 months of life. Since 20% use 80% of the dollars, naturally 80% have no problem with the system because they use it little. American health care is more aggressive. http://www.onlineuniversalwork.com
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