Health Care in Sweden

This post is from Jodi Fondell, former chaplain at NPU and now co-pastor with her husband, Doug, who is one fine golfer (and so is Jodi). [A big question: Did Doug have to eat lutefisk in the hospital stay?]

I know that many people in the US are scared out of their wits that the US is “going the way of Sweden” and turning into a socialist society.  I almost laugh out loud every time I hear that.  For starters…the US is so FAAAAARRRR from being a socialist nation it’s not even possible.  Secondly, going the way of Sweden wouldn’t really be so bad if you consider some of the facts.

We have finalized Doug’s hospitals bills from when he broke his leg.  He had to be picked up from the street by ambulance and rushed to the emergency room for x-rays and treatment.  This part of his medical journey cost us $53.00.

Then we found out that he was going to be admitted and have emergency surgery the next morning.  He was given a temporary cast, drugs for pain and a shared room with 3 other guys and no TV.  So, not the luxury and amenities of a private US hospital but he received good care and ended up staying two nights in the hospital.  This part of his medical journey cost us $27.00.

Then he came home and two days later he got his cast wet and so we had to go back and have it re-cast.  The cost for that was $0.00.  Three weeks later, he went in and got the plaster cast off, saw a Dr., got the boot.  This part of the journey cost $0.00.  Three weeks later, he went in, got the boot off, stitches taken out, saw the Dr. and the physical therapist.  This cost $48.00.  Finally, he had the last surgery to take out the pin and get a final clearance.  He also saw the physical therapist.  This cost $27.00.  Total cost of Doug’s emergency broken leg: $155.00 plus the cost of the pain medication, which was actually a bit high…about $100.00, but included morphine so I guess it was OK.  The crutches were free.  We returned them. 

But now, Doug has paid the maximum a person can pay out of pocket for a certain time period so he has totally free health care until September.  I’m pushing him to get the torn cartilage fixed in his knee before then!  Yes, he still has a torn cartilage.  Poor guy. But the point is this:  His injury did not put us in peril.

We are not going to pay medical bills for the next several years because of an emergency.  Yes, we’ve done our bit by paying our taxes, but the great thing about paying taxes as we do is that you are automatically forced to “save for an emergency” which most people do not.  So when something catastrophic happens, it often really sets people back.

Now, I’m not saying that we can compare the US to Sweden because the issues are complex and complicated, but I am saying that people really need to quit saying that countries like Sweden are really messed up.  This is not messed up. It is a way of providing for your population and making sure that people don’t become destitute when an emergency medical situation presents itself.  We have been quite happy with the care that Doug has received and we feel very lucky that we have gotten through this whole ordeal without having to worry about paying for it.

Additionally, we are now about to embark on our annual winter hiatus.  We will leave on Thursday, take a long weekend in New York, attend a pastors’ conference in Chicago next week and then take a 4 week (paid) holiday.  This is totally normal for Swedes, except most of them do it in the month of July.  We are odd in that we prefer a winter holiday since we have the chance to attend the conference and see family all at once, and an added bonus is that my parents are in a warm, resorty place: Palm Springs, California. Yes, it’s sickening that we don’t even have to cash out all of our days.  Once you turn 50, you get 35 days plus the public holidays.  Starting to understand how our 3 year contract turned into 12.5?  Of course, these aren’t the only reasons, but the long holidays certainly make living here much easier as we have the privilege of getting back to the US to visit family regularly and still have time to refresh ourselves with some other kinds of travel.
So, when the conversation about universal health care or ensuring that all are covered, instead of totally panicking that you will be forced into that “Swedish way of doing things” just stop for a minute and consider that higher taxes, put to use in the right way, could be a life saver for you or your neighbor when you slip on an icy street and break your leg in two places.

About Scot McKnight

Scot McKnight is a recognized authority on the New Testament, early Christianity, and the historical Jesus. McKnight, author of more than forty books, is the Professor of New Testament at Northern Seminary in Lombard, IL.

  • Christine

    Well sure, the cost may be “$0,” but make no mistake, they’re paying for it out of very high taxes. Almost sorry we’re embarking, again, on Jesuscreed about the wonderful European way of doing things when it comes to health care.

    I spent six weeks in an orthopedic hospital in England – cost me nothing as well. But did I receive good care? Well, I only saw the doctor once/week and if he didn’t discharge me then, it automatically meant I’d have another week of hospital care. My neurosurgeon in the U.S. was shocked that I’d been hospitalized for SIX WEEKS! Any idea of the true cost of that? Sure, I didn’t pay, but LOTS of folks paid taxes to ensure that I had coverage as a foreigner.

    Now, seven weeks of paid vacation, PLUS government holidays . . . yeah, I
    could get used to that!! :-)

  • Kenny Johnson

    Christine,

    No one was claiming this was truly “free” care. Jodi even admits that their taxes pay for this. Why she doesn’t mind that though is that she doesn’t have to worry about going bankrupt because of a medical emergency or a life threatening illness. Or worry about getting kicked of her insurance. A coworker of mine was told, after his wife had a complicated birth (they have non-group insurance, he’s a contractor) that she’d either have to get her tubes tied or they’d drop them from the policy. My brother in law and sister in law looked for months and months for insurance about a year or so ago because every company kept denying them due to my sister-in-law’s previous use of anti-anxiety medication.

    She also didn’t say it was perfect. She just said it’s not scary or “messed-up” like so many fear. I’ve heard bad things about Britain. I don’t think their system is very good, but that doesn’t mean all government-provided or subsidized health care would be like Britain’s.

  • James Petticrew

    Christine we certainly do pay for our NHS, in our taxes, we as a nation choose to do so for the maximum good of our population, so that the poorest and most vulnerable people in our society do not suffer because of inability to pay for healthcare. Does that produce a perfect system? no. Do I think its better than the system I experienced in the States where many people were excluded from health care because of finance? absolutely I do.

    So your health care here in the UK was not free, I helped pay for it. Could I politely suggest that instead of making snide remarks about our healthcare system, a thanks to those of us who paid for your stay would be nice, i.e. the British tax payer. If you were a visitor to our country and not a resident in possession of a national insurance number you or insurance company should have paid for your treatment. I hope that is what happened.

    We have lived in the States and I received treatment which cost outlandish amounts of money. On my return here my clinical specialist was equally shocked by my treatment and could only conclude that many of the tests and treatments I received were unnecessary and were little more than revenue raisers for the hospital. So it cuts both ways.

    Can I please ask Americans to stop listening to scare stories about our NHS and discover the facts? We have a world leading health service in many areas, our primary healthcare and health prevention system are outstanding. We have seen the biggest drop in deaths from heart disease, breast cancer and lung cancer any where in Europe over the last 20 years.

    My wife as a nurse works with terminally patients and I simply cannot see how there could be better treatment anywhere in the world with the combination of specialist hospital units, specialist nurses in the community and hospice care.

    We do have our problems in our system but when I hear some Americans speak they describe our NHS like the health care of some third world country. I have frequently used the NHS over my whole life and only ever had outstanding, care and treatment from my local GP, accident and emergency departments, and consultants in our hospitals. The care my wife had when having our children was equally good as is the management of her chronic illness. Here in Scotland we do not pay for prescribed medicines further ensuring no one is excluded from the care they need.

    Do I care I don’t get a single room in hospital? do I care I wait a couple of weeks for an appointment for non-urgent treatment? No, not if it means that we can afford to treat everyone regardless of ability to pay because I judge the morality of my nation by the treatment of its most vulnerable and poor. I like to think there is something of the Kingdom of God in that.

  • Mike Bird

    Scot,
    I had a similar experience when I got viral meningitis in Scotland. Doctor visited me at home after hours and diagnosed me, sent out ambulance to get me, in hospital I had lumper puncture (hurt like a mother), saw specialist the next morning and he told me it was thankfully viral not bacterial, I went home for rest, few days later another home visit from doctor when I felt bad, then recovered after two weeks. I don’t mind paying taxes as long as I get something for my taxes. I’m also very happy that this type of care is available to everyone in the UK, not just white middle class types! And even better, no one once told me that we are doing this because it is the Marxist model.

  • Mike Bird

    Scot,
    I forgot to mention that I’ve been unsuccessfully trying to get ETS to have a session on universal health care. Maybe one day!

  • Robin

    I think a larger issue that people who do not support universal coverage might have is the sustainability of the system. Medicaid went from a small program that covered a modest amount of people inexpensively, to a program that, in Kentucky, takes up 20-30% of the entire state budget, and this despite the fact that the federal government pays 75 cents out of every dollar. The same could be said of Medicare.

    Regular inflation averages 3%, medicaid and medicare inflation has been more like 10-15% for a decade. So the question becomes (1) if we put 300,000,000 on national health insurance, how long would it take to completely crush the rest of the budget and (2) if we wanted to keep the costs reasonable, and prevent 10-15% inflation, how draconian would we have to be in our rationing.

    I know that recently Great Britain and Canada have contemplated severe cuts/changes to their healthcare systems because the costs have finally become unsustainable. I don’t know what Sweden has done to avoid this problem.

  • James Petticrew

    Misinformation again, the present government has in England/Wales committed to spending the same on the Health Service as the last government during the recession which given inflation will mean a small real terms cut.

    In Scotland our government will sustain or increase health modestly when spending on new buildings is taken into account. So no severe cuts because the system is unsustainable another horror story of misinformation propagated by I don’t know who in the States.

    There are certainly challenges to keep finances under control and make sure we get efficient delivery of healthcare but the system is not breaking down. In the coming fiscal year we will spend £48 billion on defence and 126 Billion on health. I think that is a good balance, how sad if we spent more weapons than medicines

  • Susan N.

    Robin @ #6 – “I don’t know what Sweden has done to avoid this problem.” I say it’s worth finding out. It would be so wonderful if our lawmakers could really take a careful look at these other systems (Sweden), and discover how it can work.

    My cousin has been living and working in Germany for several years now, and when he had a major health crisis requiring delicate surgery and extended treatment, he insisted on staying in Germany vs. coming home to the U.S. for medical care. He has also loved working in Germany. Their work culture and ethic is to put in reasonable hours, but work hard during that time, and then have lots of vacation time and leisure time on weekends.

    There are other, maybe better, ways of doing things than we Americans have yet devised.

  • http://seguewm.blogspot.com/ Bill

    The naysayers have so thoroughly labeled universal health care systems in other countries as socialism that our law makers are afraid to give any of them a serious look. It is difficult to find objective comparisons of the various health care systems. We have a penchant for merely comparing anecdotal accounts. It seems that we are more interested in protected a particular way of life than in protecting the most helpless among us.

  • Andy W.

    Sweden is not the US. The population is smaller then NYC! Also they have not created an economy that is entangled in private healthcare corps. The untangling of just that in the US is a huge challenge. Universal healthcare sounds great, but the track record of similar existing government programs in the US should have us concerned. Is it not smart to look honestly at how the Gov. has handled similar programs to see if they can be untrusted to healthcare?

    Do a google search of any of these and see what you uncover:

    - Social Security expected to be bankrupt by 2037

    - US budget deficit reaches all time high.

    - Medicare and the budget deficit.

    I know this is an extremely complex issue with agendas on all sides, but the fiscal challenges we already face because of mismanagement and corruption should give serious pause.

  • Mike

    The costs may be a burden to some provinces in Canada, but it is far from being unsustainable enough for anyone to seriously talk about dropping universal coverage, save the odd fringe group. Even talking about ‘two-tier’ health care, that is, keeping universal coverage but allowing people to pay for their own medical bills privately, is considered political suicide here.

    The reason things look so unsustainable to the US is that your healthcare system has allowed the costs to balloon at an alarming rate. You spend 15% of your GDP, or $6700US per capita, and don’t have everyone covered, while we spend 10% or $3700US per capita, and everyone gets what they need. I’ve been told you can buy global medical insurance that covers your bills anywhere you go in the world, save the US – if you want coverage there it’s twice as much. There are a number of factors in this. One is, that preventative care is more readily accessed in Canada, which is far less expensive than emergency room visits when problems get out of control. Since there is only one payer of bills, administrative costs are half of what they are in the States. Hospitals and doctors do not need to pay for marketing. I also imagine a great deal is saved from not having profit margins for insurance companies. If the US changed to single payer, some of the costs would be brought down considerably.

    Is the Canadian system perfect? By no means. But most are grateful for it and very few would seek to dismantle it. Most Canadians are aghast when they hear that their complaints get turned into arguments against universal coverage in the US.

  • http://faithandfood.morizot.net/ Scott Morizot

    Bill (9), it’s also not just about protecting the most helpless among us. Psychologically, we are really bad at estimating these sorts of risks, but the reality is that the odds are overwhelming that each of us or someone we love will be hit with a medical crisis in our lifetime. That’s as true as the reality that we all suffer 100% mortality. Our current system is bad for all us, not just the helpless. In fact, it’s probably worst for the self-employed and small businesses — which most people would not describe as helpless. (That’s not to denigrate how much the poor do suffer under our present system — just to point out that the scope of the problem goes far beyond that one aspect.) Health care reform in the US is not even primarily about charity. Simple self-interest dictates its necessity.

    Personally, I agree with LaVonne Neff. A significant portion of our population, perhaps even a majority, believes in magic. Nothing else explains it.

  • http://faithandfood.morizot.net/ Scott Morizot

    Andy (10), Social security doesn’t have a problem. We probably do need to raise (or eliminate) the annual withholding cap and Congress can’t rely on it anymore to make their budget mess look better than it is. But it doesn’t have any fundamental structural problem. That’s just FUD.

    The only way to control Medicare costs is to continue to actively reform our entire health care system. It’s completely irrational for people to point to the ballooning costs of Medicare or Medicaid in an out of control, fundamentally broken health care system as evidence against reforming that system. The problems in Medicare and Medicaid are actually a huge part of the evidence and argument *for* reform of the system within which they operate, not against it.

    As far as deficits go, they are a long-term problem. However, as long as the American people believe they can conduct wars without sacrificing and paying for them and as long as they are willing to believe they can cut revenue (tax cuts) without ever compensating for them, or can get services (from infrastructure to emergency services to the host of other things government provides) without paying for them, there is no solution. On this issue the right is, if anything, even less rational than the left. We’re back to magical thinking across the political spectrum.

    However, as something of a student of history, I’m not sure this is the best time to start to cut back on spending. I’m mindful of the lessons of the Great Depression. Whether it was the best thing to do or not, at least we didn’t sit back and do essentially nothing like Hoover and allow the recession to collapse into a depression. However, I’m also mindful that several years in, Roosevelt gave in to concerns about spending, worked with Congress to reduce spending, and then had to reverse course as the depression worsened again. Recessions on this scale don’t happen often enough for us to actually know what to do. The best we can do is try not to repeat errors that have been made in the past. So my take is that a lot of it is pure guesswork. But I think we do want to move somewhat cautiously at this point. It would be easy still to tip things back into a downward spiral.

  • Robin

    Mike,

    You make an interesting point about preventive care, and I have a sincere question. Preventive care is exceptionally available here in the U.S.. Anyone who has health insurance, VA benefits, medicare, or medicaid has no reason to not have a primary care physician and see them for routine visits.

    However, lots of people in the U.S. use the E.R. or critical care centers as their primary care provider. My wife works in the ICU as a nurse and works once or twice a month in the ER and is constantly regaled by ER nurses with stories of people who came to the ER for a sniffle instead of going to see a real doctor. The story that has been impressed on her the most is of young women on Medicaid who will come to the ER in order to get a pregnancy test (because it’s free to Medicaid recipients) instead of going to the dollar store and buying one for $2. According to the ER nurses this happens multiple times weekly.

    Obviously, Americans have some problems properly utilizing the healthcare system, and I have no doubt this is one reason for our enormous expenditures.

    My question is what keeps Canadians from doing stupid stuff like this? Is it a cultural ethic, are there actually laws in place to prevent this sort of abuse?

  • http://LostCodex.com DRT

    I have been working with the banking industry for about 15 years now and my perspective of those who go bankrupt has changed dramatically. I don’t remember what the exact numbers are, but by far the biggest driver of bankruptcy is health issues. What makes this so devastating is that just when you are down and out (having major health problems) that is exactly when our country lets you down and you add bankruptcy to the situation. It is wrong.

  • Robin

    Scott Morizot,

    There are long-term fiscal problems with social security. This year, for the first time in U.S. history, social security is paying out more in benefits than it collected in revenues. So the program now has an annual budget deficit, whichis fortunately backed up by 60 years of savings. Forecasters knew this day would get here due to the demographic stress of the baby boom, but it got here quicker than they thought. As recently as 2008 government forecasters said we had until 2016 until expenditures exceeded revenues, but the recession has hastened that event.

    By law, social security cannot spend benefits which exceed its “balance” which is measured as historical revenues minus historical outlays. According to the CBO the current balance is $2.5 trillion, and our social security budget deficits are predicted to run through that $2.5 T by 2037. They have also said that if the economy does not improve quickly, it will spend through the balance before 2037.

    So, what does that mean about our “problem.” It means we could literally make no changes to social security and spend down the balance until 2037, at which point we would have to redesign the system so that revenues matched expenditures. This would be a draconian redesign.

    Our alternative is to make changes to the program which either decrease our annual budget deficit and push that 2037 date back a couple of decades, or make larger changes which return us to a budget surplus and guarantee solvency for the foreseeable future.

  • Robin

    Sorry, here is the cite for the social security info.

    http://www.nytimes.com/2010/03/25/business/economy/25social.html

  • Mike

    Robin, overuse of the emergency room can be an issue here too. But the US has over 30 million people with no medical coverage, who will end up going to the emergency room instead of the doctor, because the ER staff are legally obliged to help them.

    In Canada, if you come to the ER and it’s not all that significant, you’ll probably end up sitting around for hours upon hours in triage. Far more worthwhile to visit a family doctor if you have one, or an urgent care clinic. In Ontario, the government has a 1-800 number you can call to talk to a nurse who can advise you on what kind of medical attention you require (though both times I’ve used it they’ve directed me to the ER). When flu season hits, newscasters remind viewers to take their kids to the doctor, not the ER.

  • Andy W.

    Scot #13

    SS doesn’t have a problem? The same system is illegal for any non-govenrment enterprise; They call it a Pyramid Scheme and people are in prison for this today. Remember New Era Philanthropy which lost a lot money for Christian orgs. and colleges? This is how SS functions. Now if it functioned as designed, then you’re right, it does not have a problem, but that is my entire point: The US gov. does not act responsibly with what they have been untrusted. They raid SS funds to pay for other things and thusly create a mess of the future viability of SS. I agree that the entire healthcare system needs reform. How do you do that? That’s a very difficult question. Massachusetts has an interesting program, but it has fiscal challenges after 2 years because the cost has been way more then anticipated. I don’t have the answers here, I just see the US not acting fiscally responsible, this includes all parties: Gov, citizens and corporations: The old adage stands and we all know this to be true: “If your outflow exceeds your income, your upkeep will be your downfall”

  • JoeyS

    Our (US) difficulties in maintaining systems like medicare and medicaid can be partly attributed to partisanship. How is a system supposed to work well when one party is bent on dismantling it? Of course SSI, Medicare and Medicaid haven’t worked – our politicians have made sure of it!

    I lived for the better part of a year in Australia and not only did everybody have healthcare, higher education was also way more affordable. If I recall they did not have to begin paying for their education until they made over $35,000 AUD.

  • http://faithandfood.morizot.net/ Scott Morizot

    Yes, we need to apply some actuarial accounting to SS (and I even mentioned removing the current cap as one approach toward that goal) but it’s not a structural problem. In fact, if my generation, GenX, were not such a small generation it wouldn’t even be a problem. Fortunately, the Millenials are, if I recall the numbers correctly, even a larger than the baby boomers. So it will even out over time. However, other than minor tweaking as the population fluctuates, there’s no major structural problem with SS, though a lot of people are trying to spread FUD to make major changes to it in order to use the money elsewhere. Basically they want to dismantle and raid SS rather than fix actual problem areas.

    One of those problem areas, of course, is Medicare. Which brings us back to the need to reform the overarching broken health care system within which Medicare operates. We won’t be able to control Medicare costs unless we continue fixing our whole health system so it stops draining every part of our country to feed its present voracious appetite. The health care reform act was a decent start, but it’s nothing more than a beginning. It was more of a modest (though desperately needed) private, for-profit insurance reform act. That will help, but isn’t sufficient in and of itself.

  • http://faithandfood.morizot.net/ Scott Morizot

    Mass. has problems because they are not an independent government. They are one state operating within the larger context of our health care system. And Andy, SS is not a “pyramid scheme.” That’s just part of the irrational and unproductive rhetoric.

  • http://faithandfood.morizot.net/ Scott Morizot

    Next we’ll get the tried and true line about how the federal income tax is illegal…

  • Gloria

    I see that Representative Paul Ryan has a new proposal for privatizing Medicare for those under age 55. It’s a start anyway.

  • Christine

    James, #3, sorry, as it truly was not meant at all to be snide. It was an indicator to me of tremendous waste and cost in healthcare that y’all ARE paying for. What do I mean? Well, when I only saw the doc 1x/week during a six week stay, it meant that an automatic seven more days of care was instituted. Here, it would have been evaluated daily and the doc seen daily, and discharge would have occurred much earlier. That’s why my neurosurgeon was stunned. Here, I’d have been in hospital no ore than one week, if that, compared to six weeks. My point was that it IS costly. And it wasn’t a ‘horror’ story, but reality. I watched a woman as she consulted with her doctor prior to surgery. She had waited three YEARS since the time her problem was diagnosed to getting the surgery, due to the queue and no supplementary private insurance. She had significantly deteriorated and the surgery was much more extensive. How do I know? Cause I was lying in the bed across from her and heard every word of the discussion with the doc and the patient.

    No system is ideal, obviously. They all have flaws. I was in a rare situation as an American where I experienced NHS first-hand. Not just routine office visits, but hospitalization. And yes, it was nice that it was paid for, but six weeks of hospitalization wasn’t really best practice.

  • Andy W.

    Scot,#22 Let’s hold off on calling folks irrational…that’s not productive rhetoric. Is it legal for any other entity to do the same thing SS does? You know it is not. Madoff did the same thing SS is currently doing, did he not?

  • http://faithandfood.morizot.net/ Scott Morizot

    No Andy. It’s not what Madoff did. SS is most similar to a universal defined benefit pension plan, not a ponzi scheme. Personally, I don’t see much point in conversation with those who can’t tell the difference between the two. And if someone is making irrational statements, I don’t see what’s wrong with calling it that.

    And really Gloria? It’s when we let the health insurance flip from non-profit to for-profit (mostly in the early 90s) that our health care system went from OK with structural weaknesses to absolutely terrible and we began to see the horrible abuses that the recent reform began to address. So you consider placing those who most need consistent, reliable, and affordable health care at the predatory mercies of *that* system a good thing?

    Even if you are an ideological believer in the saving power of market forces, I don’t grasp why anyone believes those forces will work in health care. When your child or another loved one is sick, there is no price you won’t pay and nothing you won’t do. Market forces are largely irrelevant when that’s true.

  • Robin

    To clarify about social security/ponzi. Social Security is deifinitely a pay-as-you-go scheme. For the past 60 years our social security checks have not been going into lock-boxes and earning interest, they have been spent. The people who are paying social security in 2010 are not funding their future social security expenditures, they are funding current social security expenditures.

    When you keep in mind that the only way such a system will work is if successive generations continue to pay in more than is withdrawn, and once current earners pay in less than current recipients use in services…well you run a budget deficit and start draining down the “balance” which is a budgetary gimmick anyway…then you can start to see how the system is set up in the same manner as a ponzi scheme.

    There are only a few differences, but they are important. In a ponzi/pyramid scheme people can withdraw their investment or receive payouts at any time. As long as only a few people are demanding the investments plus 10% interest, no big deal, current investors can foot the bill. The scheme only collapses when lots of people get nervous, make a run on the investments, and it becomes apparent that it was a pay as you go system all along.

    Importantly, in social security, we cannot “make a run” on social security. I cannot, as a 30 year old, get nervous about where my SS payments are going, demand to get them back so I can invest them myself, and (if every other 30 year old did the same thing) immediately collapse the system.

    So, social security is set up in the same way that a pyramid/ponzi scheme, but it is protected by federal laws that prevent runs against it.

  • Robin

    Scott,

    SS is not anything like a universal defined benefit plan. Structurally, as I pointed out above, it is designed like any other pay-as-you-go plan which is dependent on having more people currently paying in than are currently receiving benefits. Yes, we normally call these pyramid schemes, and the ONLY difference between SS and typical pyramid schemes is federal retirement ages, etc.

    Defined benefit plans are vastly different. When I make a contribution to my defined benefit plan (which I am mandated by state law to do) it goes into an actual fund, which is actually used to purchase investments, which actually earn interest and dividend income, which is used to pay retirees.

    If (1) the people in charge on the fund did a good job of investing the funds entrusted to them and (2) legislators didn’t over-promise on benefits, then my actual contributions, plus the interest accrued to them, would actually fund my entire pension, and it wouldn’t matter how many workers the state had in the future.

    However, since legislators have always promised benefits dependent on 10-12% annual growth, and since the fund managers have only attained 3-4% returns, then our state pension fund is currently about $40 billion upside down, and is now being managed as though it were a paygo system.

  • James Petticrew

    #25 Christine, clinical practice here is different so the fact you didn’t see a doctor doesn’t mean you weren’t being assessed. I always saw a consultant or house officer every day when in hospital, hard not to as they do daily ward round. So I don’t understand your experience.

    People often do stay longer in hospital for two reasons. Our clinicians don’t want them back in the next week secondly there are no insurance companies pushing for discharge. I don’t know when you were in hospital here, but no one in Scotland is waiting three years for any operation.

    Under the NHS urgent treatment, life threatening treatment is quick and thorough. There are no waiting lists in that sense for potentially fatal illnesses and people don’t get to jump the line in the cancer specialist units just because they have money. The treatment is prioritized on clinical need not ability to pay. To me that is a key value that I will always vote to support. To most British people the National Health Service is the greatest achievement of our nation since world war two.

    My experience of US Healthcare was that I was put off going for consultations because I was worried about the cost and when I did have to access service I discovered I was right to fearful of the costs. I was so glad when I got back to the UK and was able go to my local doctor with my kids or for my own health without worrying not just that it could be something serious but that if it was it could push us to the limit financially.

    I had emergency gall bladder surgery at roughly the same time as an American friend. I had an fantastic standard of care and made a full and quick recovery. My American friend years later is still paying off that bill.

    As I said earlier if you were not a UK resident your treatment should have been paid for by you or your insurance company.

  • Robin

    To further illustrate the vast differences between defined-benefit pension funds and SS. Every single entity that has a defined benefit pension system is required, by law, to produce an annual CAFR. Here is the one I am a part of.

    http://kyret.ky.gov/investments/cafr/2010-cafr.pdf

    These reports don’t just show you how much money came in the door and how much went out. They show you, in great detail, where all of the money in the fund is invested, how much interest it is earning, etc. They show the actual investments, that earn actual returns, because there are actual investments earning actual returns.

    No such (real) report existed for Madoff, because he wasn’t investing the money, and no such report exists for social security, because it isn’t invested either. They have a running record of receipts minus expenditures, but that is it. Structurally, it is hard to imagine SS being much more different from a 401(k) or a DB plan than it currently is.

  • http://LostCodex.com DRT

    Robin, it seems to me that one has to keep the fact that lawmakers “borrow” from SS outside of the analysis. That is not part of the SS system. At least that is what I thought.

  • Robin

    DRT,

    I think I took that into account. The $2.5 trillion “balance” includes all of the revenues social security has ever taken in, and it subtracts all of the payments it has ever made to beneficiaries. The outcome of that equation is $2.5 trillion. If you accounted for the fact that the $2.5 trillion has already been spent by lawmakers, and it is only a balance on paper, then you would realize that every cent of the annual budget deficit isn’t coming from a pile of $2.5 trillion, it is taken directly from the general fund and a debit is made against the “paper balance” of $2.5 trillion.

    So for 2011 we are supposed to spend $49 billion more on SS than we take in. The paper balance will be decreased by $49 billion, and the $49 billion will actually come out of the general fund. The long-term problem is that once we spend the paper balance down to $0, we are prohibited by current law from taking the excess out of the general fund, our credit is effectively terminated.

    We all know that won’t happen. We’ll either make changes to the program to encourage long-term solvency, or we’ll change that law so that even when the paper balance is $0, we can overdraw it and continue to take money out of the general fund.

    Anyway, my larger point is that structurally, SS has much more in common with a pyramid scheme (pay-as-you-go, current payers cover current recipients, no actual investment of funds, no returns on investments) than it does with a 401(k) or defined benefits plan (current payments invested, actual record of investments and earnings, current payments plus investments (pooled) fund future pensions).

    The one gigantic difference, and it really is the only meaningful difference, is that federal retirement law prevents citizens from making a run on social security, thereby ensuring it cannot fail instantaneously.

    However, if Bernie Madoff had been able to get his investors to sign a statement promising not to request the investments, plus interest, back until they reached age 65, then his scheme would have literally been an exact structural equivalent of SS.

  • Jim H.

    Two weeks ago, I presented at the ER with chest pains/discomfort, pain in my arms and difficulty breathing. I’d been experiencing the symptoms for a couple of weeks. Since I couldn’t seem to pin-point what was wrong and have never experienced those symptoms before, I went in (I wanted to save the ambulance fee). I was admitted at 2 am and stayed until 3:30 am. The ER doc did all the usual stuff and said my blood pressure had spiked – causing the symptoms (maybe some panic on my part too). The bill was just shy of $3,500. Now I’m getting a series of bills for every single procedure done in the hospital – first they charge my insurance carrier for each procedure and then the statement gets forwarded to me. Think of the cost of that overhead.

    I’ve lived in Germany and Holland for 13 years and have experienced health care in Europe. Obamacare does not go far enough. Health care has to be removed from private corporations and interests.

  • K.

    Comparing the US with any European country is like comparing apples and oranges. Our size alone will make any healthcare plan complicated, plus the number below the poverty level, plus the humongous amounts we’re having to pay out in foreign aid (money we could use for healthcare), etc. Anyway, yes, we need to find a solution to the healthcare problem so that we provide good, affordable care to all (and I say this as a Republican). Now, what this looks like, I have no idea. But, as one person pointed out, we’ve got to become untangled with the private insurance companies (and I used to work for CIGNA). So, this is not only a financial change for us, but a cultural one since private healthcare has been the norm for so long.

  • K.

    Oops. Sorry, that should be untangled from the insurance companies.

  • Seamus O

    3 personal experiences have led me to realize the healthcare and insurance system in our country are horribly broken and ready to adopt the tradeoffs inherent in socialized medicine:

    1. I once found myself dreadfully ill in the Hague, Netherlands stuck in a hotel. A local friend called a doctor who showed up in 15 minutes, checked me out, prescribed medicine and then had someone go get it for me. total bill including prescriptions: 50 euros. (obviously benefiting from the higher taxes paid but I’ll take the tradeoff)

    2. Recently had to apply for individual health insurance for myself and family. A staggering process that seems to have no end. May not even get coverage and if we do we will likely be confronted with exclusions that pose big health and financial risk for our family. Scary stuff

    3. Managing doctors/hospital bills and coverage is complex for any family. The waste and silliness in this process is truly mind boggling. Much of the waste in the healthcare system is tied up in this bureaucracy.

  • Cathy

    Talking about the government taking over the health care system in the U.S. to make it affordable for everyone is a waste of time simply because the U.S. government doesn’t run anything well, except for bureaucracy. Not to mention that we are flat broke. With no new manufacturing base or very large scale industry coming anytime soon, who exactly would be able to pay the taxes to keep such a health care program going? The current health care reform in the U.S. is nothing more than a pandering to special interest groups and does nothing to reduce the actual costs of health care…it just tries to force everyone to buy insurance. You shouldn’t have to buy insurance…you should be able to pay an honest dollar for an honest health care service, like we used to before Medicare/Medicaid and the insurance industry came along.

  • Andy W.

    Robin # 33 Thank you for saying much more clearly what I was trying to say in my “irrational” comments above. The point I keep trying to make is that the way SS functions is illegal for any other entity. This in itself says something about the SS system.

    I agree completely that the healthcare system (healthcare, insurance, hospital admin., Dr. pay-per-service, etc) is messed up and needs to be fixed. How we do that is the billion dollar question and I don’t have a clue. My entire point is that the Gov. has proven fiscally irresponsible with the largest social programs that it has implemented: SS and Medicare being prime examples. Are they completely worthless, or course not. Do they perform a needed function, sure. But does Gov. have a record or good management of these? I have to say no.

  • Cathy

    I just want to add that I find the tone of this article troubling. I just didn’t grow up thinking that anyone else should be responsible for paying my bills or that I’m entitled to 35 days of paid vacation time just because I turn 50. People who are in need should definitely be helped, but there is a cost to all of this “free” stuff and it comes from people who work and sweat and keep the midnight oil going. People who pay taxes. People who can’t just close up their business in order to take a month vacation. I find it perplexing to hear someone say we might like higher taxes if it means it could help others…and then she jets off to travel for the winter. Just saying.

  • Edward Vos

    Thanks for the post. It is high time that the church gets involved with the debt on healthcare. Healthcare issues are to the poor like the Egyptians were the Israelites. The Bible speaks often of not oppressing the poor yet when it comes to healthcare as Christians we buy into the profit margin issues of the insurance companies and listen to the fear factor of potentially bad healthcare. It cant’t be worse then what the poor have now, which is no healthcare insurance whatsoever.

    As for the privatizing of Medicare it is an other form of healthcare rationing where those with money will be able to get the care not covered with the voucher you would get, otherwise known as supplemental insurance.

    I find it odd that we with our capitalistic system have subsidizes for farmers, and tax incentives for the rich, but when it comes to healthcare for the middle class and those out of work we act like the older brother in the prodigal son story and question why our taxes should support universal healthcare.

    Great post I wish the universal church at a national level had this issue front and center like the abortion issue, but sadly politics steps in the way and we can’t talk about it without all the baggage and false testimony.

  • Edward Vos

    It is high time that the church gets involved with the debate on healthcare.

    Sorry about the last post, my mind said debate and my fingers said debt. Go figure we have a lot to think about between healthcare and the national debt.

  • nathan

    My take away from this article confirms my view that anyone committed to speaking the truth (i.e. all Christians) should refrain from describing the current healthcare proposals/developments in the USA as “socialism”.

    We can disagree about the substance of the proposals, but that rhetoric is misleading at best, and lying at worst.

    Considering the source of such rhetoric makes the claim of “socialism” even more problematic and self-defeating.

  • Alan Wilkerson

    Question from those in Sweden or the UK. How does the health establishment handle malpractice and tort law? A driving force behind medical costs in the U.S. is simply the insurance a medical professional needs to carry to do the job.

    We were in rural Nevada and not one of the three doctors were able to see OB/Gyn patients because the malpractice insurance was about 40k per year for that specialty in that location. That’s about equal to what they grossed.

    Alan

  • Christine

    James, #30, the woman I spoke of who DID wait three years for surgery was not an isolated incident. Over half the people on the ward had similar stories. There was one tier of care for those who could afford private insurance on top of NHS, and another tier for those who only had NHS. The queues for surgery have long been documented in the UK.

    I stand by my statement: Six weeks of hospitalization for something that would have warranted one week in the US was excessive and expensive. Sure, ‘assessment’ occurs during the week when one doesn’t see a doc, but when he only comes once/week and is the only one who can discharge, there’s a problem.

    James, I wasn’t derelict in my responsibilities. My hospitalization was paid for because I was covered under NHS.

  • Tony

    I have lived in the US for 14 years and have had to battle with what is labelled as the “best” healthcare system in the world. I have also lived under the universal healthcare systems of Sweden, UK, Canada and Australia for a total of more than 29 years so have a lot of experience with these. Sure you pay for “it” in increased tax -in Australia, my healthcare tax was 1.5% of my gross earnings and my “top up” insurance to get private coverage was $200/ month which made a total of $3,900 year in “tax”. I currently pay $12,000 per year for Private Insurance not much better coverage in the US (+ my SS tax)

    I say bring on universal health care. The private system in the US is screwed up


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