An American Epidemiologist in Swedish "Socialized" Medicine (part 1 of x)

I have been in Sweden for ten months now, enough time for things to come up where I have explored the facets of the health care system here.  It’s not a new topic, as you may recall, I am a bit accident prone from time to time.  But that’s not the topic of this post. 

Perhaps because of the big discussions and ongoing debates about health care reform in the United States, I have been asked about my experience with socialized medicine.  At dinner the other night with a couple of Swedes, they noted that having just watched Michael Moore’s “Sicko” that they were surprised Sweden wasn’t one of the countries highlighted.  And, as many other non-Americans have asked, they asked us what we thought that the problem was in the States.

I won’t pretend to know what the solution is.  But, I will say what I have been saying for some time over pints at the pub or over steaming noodles at the local tasty Japanese restaurant.  I am not unbiased.  I work in Public Health, for goodness sake, spending six years on my master’s and doctorate because I think public health, epidemiology, and specifically autoimmune diseases are important.  I do believe that everyone should have access to health care.  I won’t engage in the semantic ping-pong about whether it be deemed a “right” or a “privilege” but will simply say that I don’t believe that it should be a privilege.   I make my position quite clear that I am, like many others (though I don’t speak for everyone), very happy with the care that I get here in Sweden.  If something is wrong and I need to see a doctor, I go in the morning to open hours, get in the queue and see the doctor that day.  If there is something urgent, I call urgent care, they give me an appointment, and I come in (so far, always the same day).  Seeing a specialist is a lot like it was in the states on an HMO – the doctor submits a referral and I wait until it gets processed.  There are queues to wait in, which the Swedes do quite patiently.  And, in the case of something more urgent, I have found the offices receptive, helpful, and quite flexible to accommodate urgent situations.

Are there flaws in the system?  Probably.  Are there ways in which it could be more efficient?  Perhaps.  It’s not perfect, but so far I am pretty impressed.  Are there other issues with Sweden?  Sure.  No place is perfect.

How will it be funded? The first thing that comes to mind for people is taxes.  Either they want them increased to cover this, or they think that that is a terrible idea.  I don’t know what the answer is.  I know that Americans pay quite a bit of money in taxes, though many places think that they are among the few paying much in the way of taxes.   “The National Bureau of Economic Research has concluded that the combined federal, state, and local government average marginal tax rate for most workers to be about 40% of income.” (REF)

Taxation is not uncharted territory for people in the US. The issue is that unlike high taxes in Sweden, few people in the US see much for their tax dollars.   Tell people that you are going to increase their taxes and in the US people think that someone is just taking their money and that they will see nothing for it.  In Sweden, taxes go up and people wonder what they are going to get.  In Sweden taxes get you a lot: 12 months maternity leave, 6 months paternity leave, medical care, pharmacy assistance, housing allowances, free education including university (read: no student loans), over a month of vacation per year, and retirement.  In the States there are ongoing discussions about whether social security benefits will be around in a few decades, and the rest, well, you all know.

So, if people don’t feel like they get much for their taxes because they don’t see what they are getting, then promising something by increasing taxes feels a bit like a raw deal.  What do US taxpayers see?  Public education is going down the tubes, we have millions uninsured, not sure what the retirement situation is, two weeks vacation, little maternity leave…plenty of you know better. 

What does this mean for the future US health care system?  I don’t know.  But maybe it’s not about figuring out how to take what exists now and reorganizing it into a new package, maybe it’s about wiping the board clean and starting over completely.  Perceptions about what such a system entails are being manipulated and exaggerated to make points, probably from both sides to some degree.  Whether we call it universal care, state health care, or socialized medicine doesn't much matter to me.  I don't find the semantics as important as what we see in the end; But, not everyone agrees with that.  Using the word socialized to draw on peoples' fears and hatred of socialism, communism, and fascism is just another way to distract from the issue at hand. 

Comments

[rommy]

you raise a lot of good points, Jules.

the issue of taxes is a true one. Americans since the founding of the country have hated the concept of taxes. it's why the country sought its independence in the first place. now we have it ingrained in our heads that taxes are the result of a monarchy that poaches our money to support an aristocracy and nowadays we have no clear idea where it all goes. so sadly, americans have a right to be concerned and fed up with the tax situation.

i mean, the transparency is so amazing here that if we wanted to, we could check out the Swedish government records and could trace what every single tax dollar goes to support. if you did that in the US, i bet people would have heart attacks (and no healthcare to survive them).

it's a big problem with no clear solution. you're right, the only thing the US could do, is turn back to isolationism, wipe the slate completely clean and start over.

[Julia]

Aside from transparency, which is pretty great here, do you have any other thoughts about the taxes here in Sweden? Any impressions from talking with Swedes and other non-Americans about it?

[Peter A]

Interesting comment about Americans not seeing what they get from their tax dollars. Our defense budget is massive ($500bln-$750bln, depending on what you consider defense related items), but we don't tend to see concrete results that affect our lives, at least not the way a property tax could be tied to the local school or waste-water treatment facility. You rarely see any American complain about the size of the military budget, although it's impossible to ignore the fact that it's the reason we have limited resources for other government services.

[Julia]

Well said, Peter. I completely agree.

[Mimi]

Here's one Swedish Healthcare flaw: If you were to have surgery in Sweden, do you know if your surgeon is a resident, or, more importantly, what does Sweden require for a surgeon to be qualified to do surgery? I do know,in fact,that some US surgeons who do not have hospital priveleges in the USA, can fly to Sweden, fill a week performing multiple surgeries, and return to the US at the end of the week. (Where is the ethical responsibility to your patients under these circumstances?) Check it out, Jules.

[ClubPenguinCheats]

You rarely see any American complain about the size of the military budget, although it's impossible to ignore the fact that it's the reason we have limited resources for other government services.

[Mens True Religion 5]

a 6th or even a 7th QB user in your organization, doesn't mean you'll *ever* need a 9th or 10th. Just seems...greedy?...but self-defeating as you point out. Small businesses who

[MaribelConner]

Set your own life more simple take the home loans and all you need.