Health Care in Sweden, part 2

Do you think we should all “foot” our own bills when it comes to medicine? Or do you think some kind of actuarial tables or taxes or general fund can be used in order to provide “security” when it comes to medicinal costs? What role does your Christian faith play in this? What are the main themes that you “tap into” when this discussion occurs? Compassion or justice or personal responsibility? Now I’m going to ask you to think about the above questions when you respond… and to think of Jodi’s questions below… and about the italicized words. Friends, this is an important conversation to have.

Again, from Jodi Fondell:

On January 25th I posted a blog about our experience with health care in Sweden.  It was titled, “Enjoying the Benefits of Higher Taxation.”  Scot McKnight “retweeted” it onto his Jesus Creed blog and because a large number of people read and comment on his blog, I started a rather lively conversation about health care and social security in the US.  If you click onto Jesus Creed, you’ll get to the original article along with all of the comments.  After also getting many responses on my Facebook page, where the blog was also posted, and reading through the Jesus Creed comments, I feel compelled to respond.

What is staggering to me is how defensive and heated this conversation becomes immediately, and it is often driven by misinformation and assumptions.  So for instance, the first comment begins, “Well, it may cost $0.00 but make no mistake, they are all paying for it out of higher taxes.”  I never, ever said that the health care was free and the title of my piece indicated that high taxes were a part of the deal.  I know that we are paying for our health care through our taxes but the main point of my blog was to reveal that we got good, decent, emergency care and weren’t going into a financial hole because our tax structure required that we be prepared for such a emergency.  I think that’s a good use of tax dollars, helping everyone be prepared for crises and disasters over which they have no control.I have never claimed that Sweden’s system is perfect or even superior to the US’s.  I also admitted that the two countries are vastly different so it is difficult to compare them.  In fact, here’s a direct quote from the first blog:  “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.”  Again, what surprised me about the comments is how many people started, angrily, it felt, with you can’t compare the two countries.  I know that.  I admitted that.  My main point was that I’ve grown weary of the criticism launched at European systems that are run by the government through taxation.  It’s not all good, but it’s not all bad.

What staggers me about the defensive commentary that inevitably emerges is how protectionist people sound.  I will be the first to admit that there is government incompetence and that turning our health care over to the government has many issues related to it.  But our system is far from perfect and much incompetency can also be found and not just in Social Security and Medicare.  The bottom line for me is that most people in the US cannot reasonably afford health care so in the end, it matters very little how great our care is.  If you cannot access it, what’s the point?  And my driving question is this: Who should be able to access and afford health care?  Should it be only the right of the privileged or can we do better? (I consider myself part of the privileged.)

To be fair, a good friend who has a chronically ill boy (Crohns disease from a very young age) commented extensively on Facebook that they had a really rough time in Sweden trying to get consistent, aggressive care.   I hear her pain and I will concede that if your health issues fall into straightforward categories, you can count on decent access and health care in Sweden.  If your condition is chronic, acute, or a bit out of the ordinary, you can have a rough time trying to get the level of care and attention you will feel satisfied with.  I feel deeply for my friend who is having an easier time with treating her child in Switzerland and I am thankful she feels better about her care.  But here’s something we must all face.  All of our perspective is driven by privilege.  Most who read this blog or Scot’s come from a place of economic means and choice.  The fact that I can even consider getting health care in more than once place is a staggering point of privilege and wealth.  Those critical of other countries are accessing and paying for the high level of care that it requires to attain such benefits in the US.  Most who think government run health care systems are creations of the devil have never had to consider Cook County Hospital as a place to find care.  Yes, there are levels of care in Sweden and again, we’ve been privileged to access some of the more private, elite places where medicine is practiced and for this I am grateful.  But I am utterly thankful that should we fall on hard times, we could still go to the Dr. that lives down our street and get what we need to get healthy.  And we go to her most of the time and Doug’s leg care was not through the private hospital, but through the system that anyone and everyone could access.

My main issue with this conversation is that we need to stop to consider how to help people get the care they need, regardless of economic statusTax based systems level the playing field because they aren’t relying on profit driven insurance companies to pay the bills and people who are unemployed can still get care.  I don’t mind paying higher taxes because I see the benefit of my contribution spread across society and I feel that contributing to a healthy society raises the quality of my life.  In the US, we have a real problem with how our tax dollars are spent and that creates one of the problems with going to a universal health care system.  But for those of you who are critical of a universal, tax based system, help me understand how we can get to a place where you don’t have to have money, job, prestige, or connections to get health care in the US.  I have never said that Sweden is the Nirvana of health care.  There are issues. I’ve seen things I don’t care for.  But please don’t attack Sweden without at least looking at the flaws in the US system.  And remember the place of privilege and power from which most of us are forming our opinions.

Finally, comment 40 from Scot’s blog took a shot at me.  Here’s the comment in full: “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.”

First of all, I have never intimated that I grew up expecting that anyone else should be responsible for paying my bills and the Swedes don’t think that either.  But, in my limited experience (12.5 years living there), I have seen that as a society they don’t mind thinking more collectively about providing for the whole of society through taxation.  The concept isn’t really based an expectation that others will pay your bills, it’s just a mentality that says no one should have more access to care based on financial resources.  She also used ‘free” again, which I have never used and then says that it comes from people who work and sweat and keep the midnight oil going.  I work.  I sweat.  And I am super lucky to be able to do so.  I hope this person never loses her job, or gets a debilitating illness and can’t work, or has a sick child that requires most of your attention because then she’d have to rely on the kindness of others and generosity and perhaps even some government aid.  She thinks that people who pay taxes can’t close up their businesses and take a month off.  Well, she’s obviously never been to Sweden in July because that’s exactly what a vast majority of society does.  And guess what…it creates a much healthier society.  Swedes are more interested in time off than more money and so they live differently in order to take the time off during the year that helps them enjoy a better life.  It’s just a totally different way of looking at life.  I have not closed up my shop…we worked hard before our holiday to ensure that our church would remain strong in our absence and I will return to my job as a senior pastor of this church refreshed, renewed and ready to give my all to my congregation.  Taking time off to care for yourself, visit family and get some perspective is a valuable gift that most Americans have no opportunity to enjoy.  I think this is sad.  I just don’t fully understand why she thinks that my paying higher taxes to ensure that everyone in my society gets health care and then proceed to take my time off is such a disconnect.

Sweden and America are totally different places.  My perfect world would be a blend of the best of the two nations.  My quest in writing these things is rooted in helping people understand that another system isn’t always as dark as it seems and also to help us all realize that for those of us who have means and access, all of our commentary comes from a place of privilege that affords us choice.  What are we doing in the US for those who do not have choices, means, or access?

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  • Christine

    Jodi, not sure why my statement “”Well, it may cost $0.00. . .” (referenced in your second paragraph) bothers you?

    Yes, I said, “$0.00,” but I was quoting YOU when you said, “The cost for that was $0.00.” That’s why I wrote it exactly as you did – i.e., “$0.00.” My own writing style would have said “cost you nothing” or “at zero cost to you.” And we both acknowledged that Swedes pay higher taxes for this. So where’s your quibble with my comment?

    I’m not sure why my sentence was used as an example of being driven by “misinformation and assumptions” when it couldn’t be further from the truth. Doesn’t seem fair.

    FYI, comment #40 was not me, though it sounds as though you might have the two of us confused because you say that she ‘again’ uses the word ‘free.’

    I do agree with you that when medical issues are straightforward, care is good. That’s what I experienced in England for ordinary medical issues. It’s when ongoing, serious, chronic issues arise that wrinkles occur. And as I said the first go-round, I’d LOVE that much paid vacation. 🙂 Seems very healthy.

  • David Himes

    Tax based systems are not inherently better than profit based systems, because tax based systems are run by bureaucracies, which have no incentive to be efficient.

    That is the fundamental flaw in Jodi’s argument.

    Also, while I’m empathetic with the idea of helping people get the care they need, tax-based systems also deny people the right to be jerks. Do Christians have the right to impose their views on others?

    If so, how is that different from Muslims to threaten non-believers with death, if they don’t convert? The consequences may be more severe, but the concept is essentially the same — forcing someone to do something against their will.

  • Susan N.

    I do not think that we should all “foot” our own bills for medical costs, but rather, as I have heard others speak of it in a more positive way, health care should be part of a basic “social contract” (the word “entitlements” is used pejoratively, it seems) that ensures “justice for all.”

    Especially in a capitalist system, the health care industry (doctors, hospitals, pharmaceutical companies, insurance companies) — absent strict regulation — has gotten completely out of control. Costs are rising beyond even the working class’s ability to bear, let alone the poor.

    Faith-based groups have a part to play in caring for the poor, but health care is a systemic problem, too big for churches to make a dent in, that I believe requires government involvement to reform for a “healthier” society.

    My sense of compassion and justice and mercy are central to my position on this issue. In light of these convictions of my Christian faith, battling tooth and nail for my personal rights and my money to be used to benefit me and my own (exclusively chosen recipients) causes a tremendous conflict.

    Of course we can’t compare the U.S. with another country; it will be an apples to oranges contrast in many ways. But, I believe especially as Christians, we can be humble and teachable and look to other ways of approaching our gigantic health care problem. Some great, creative minds should (theoretically) have the ability to analyze other systems to separate out the parts that might be applied with success in our own system.

    I won’t ramble on about my personal experiences, except to say briefly that I am in a position of privilege now, but have been poor — and helpless at the time to effect any change in my economic condition. No one in this country should do without basic health care for lack of ability to pay. My husband and I debate this issue. He fears too heavy a financial burden will result. I say it is a sacrifice that we will just have to make. We will adjust, and I have faith that God will provide “enough” for our material needs.

    Thank you, Scot and Jodi for having the courage to bring this dialogue forward for discussion.

  • Jodi

    Christine…my apologies for intimating that my response was based on your comment by using again…it’s was more of a general again, I think people have misinformation. When referencing the cost to us issues I should’ve reworded it and stated, extra out of pocket cost to us $0.00. My point was that once we pay our “premiums” (though taxation) the added out of pockets costs are very low. My experience in the US has been that on top of high premiums, the out of pocket costs continue to be debilitating for people. I hope that clarifies. thanks for your engagement. And to be fair, I have another friend who has a child with lymphoma and she is very pleased with the ongoing care and attention her son is getting.
    David, if you think America’s profit, incentive driven system is not full of bureaucracies and inefficiency then you are experiencing something very different than many Americans. And while I think we need to address issues when things don’t go well, one of the reasons medical costs have soared in America is because of the need most doctors feel to carry malpractice insurance because they live under the threat of being sued. They order unnecessary tests and perform procedures just to ensure that in the end they won’t get attacked for missing something. A litigious society hurts a lot of people. Nothing is being forced on anyone in Sweden. Society has voted for this system to be in place. Susan’s use of a social contract is spot on.
    Thank you all for at least taking time to consider where America could do better.

  • Diane

    I believe all people have a right to access to decent health care, even if they are poor. As a Christian, I believe we are to love our neighbor and to help the sick and injured, whether they “deserve” it or not. Further, as a pragmatist, I believe a universal, single payer government system would be the most efficient way to do this. People in the health care industry constantly complain about the inefficiency of private insurance, such as having to hire extra people to fill out health claim forms and problems with certain insurers paying at a slow rate, trouble getting necessary treatments approved, doctors being demeaned as “health care providers” rather than professionals and hence second guessed, etc. Despite the current brainwashing that says “government is always inefficient,” government does do many things well. Finally, there are certain parts of the economy that are not well served by for-profit industry if you care about people–health care costs are out of control, in part, because people with life-threatening conditions can’t very well turn down care, no matter how expensive, so companies can charge what they want. For-profit works best for items people can rationally walk away from. Finally, and this is the crucial issue to me, we would do well to stop pitting ourselves against each other. We are in this together, one country, and we rise and fall together. A nation with a sizable number of people who can’t afford health care is an unhealthy nation for everyone. I too write from a position of privilege.

  • @David Himes, #2, wrote: Tax based systems are not inherently better than profit based systems, because tax based systems are run by bureaucracies, which have no incentive to be efficient.

    The empirical evidence states otherwise: those European nations, like Sweden, and Japan provide health care for all at almost half the cost per capita compared to the U.S., yet the U.S. trails all these nations on metrics such as life expectancy, infant mortality, etc.… Worse, people die in the U.S. for treatable conditions because they do not have health insurance and/or cannot afford the treatment.

    In the U.S., 20-30% of cost (or more) is devoted to bureaucratic, non-administrative activity — far greater than most other nations where it is a fraction of that.

    Also, examine social security administrative costs in comparison to 401K plans — social security administrative costs are, I believe, around 2-3%, compared to 20-30% administrative (and fee) allotment for private 401K plans.

    There are inefficiencies inherent in any large organization, be it government or corporation. And “profit based system” is not a panacea — most large corporations are totally dependent and interlocked with the public sphere just as government outsources functions to private entities, so making a cut and dry distinction based on imagined delineation is folly.

    I recommend giving T.R. Reid “The Healing of America” a read — he examines various health care systems of other nations, and the picture is far from “socialized” vs. private system medicine that simplistic bromides portend. It is Comparative Health Economics 101 — and an excellent antidote to the fear mongering and corporate propaganda blitzes.

  • DRT

    I think there are a couple of classic issues at work in the health care debates.

    First, the health industry has to deal with a free rider problem with regard to the people who do not purchase insurance but benefit from mandatory care if they go to a hospital when sick. These people are not paying their share. One of the most common solutions to a free rider problem is to mandate payment.

    Second, I think there is another Free rider problem from the affluent. In the declaration of independence, it concludes with “we mutually pledge to each other our lives, our fortunes and our sacred honor.” The affluent have established a mechanism to get health insurance that is inherently discriminatory, that is, based on employment in a “good” job. They have not pledged to each other honor. They have only pledged their liberty. If there was a way for the rich to have the poor not benefit from the common defense then I think they would.

    I must admit, there is more ignorance out there than is easily imagined. I know people who honestly believe that the only reason someone would be poor or get into big financial trouble is because they somehow did not work hard enough or did something bad. These people look at themselves and don’t see how fortune has played in their lives. Being part of a discriminated against population is difficult to conceive (for many) if you have not been a member or had it done to you first hand.

    We are going to have more unrest in this country as the class differences increase, which they will. If there is merely an economic class distinction then that is bad enough. But to have a health class distinction is evil.

  • Linda

    US government is deep, deep, deep in debt – there is no way Obamacare is going to help relieve that enormous debt, it will only add to it.

    Any country that takes on enormous debt is asking for serious trouble.

  • I’ll jump into this coversation shortly but I’m in the dentist chair awaiting some health care. 😉

  • “most people in the US cannot reasonably afford health care”

    That’s simply not true. There are lots of people who don’t have insurance. They still get care. (Lots of them at my hospital.)

    Moving on…

    This subject is all too often approached with a false dilemma: status quo or European socialism. Neither are sustainable in the long run.

    “Free” health care is impossibly expensive. In the US is comes in the form of employer-provided health insurance. We go to the doctor for whatever we want, pay our $20, and someone else pays for all the rest. We don’t know or care how much that rest cost. So costs keep going up up up. Those few who don’t have employer-provided health insurance have to deal with incredible prices because there is NO DOWNWARD PRESSURE on costs. Insurance companies have to make money to stay in business, so the cost of insurance to get this ever-more-expensive free medical care keeps going up as well.

    In the European form, is exactly like the above except there is downward pressure by faceless bureaucrats. If costs get too high, they just stop paying. Or raise taxes. So either taxes go up or care goes down. As long as you’re essentially healthy, you won’t really notice, but if you get sick, you’re going to notice real quick. (This is true of Medicare, too.)

    We have to do away with “free” health care. Car insurance provides the model. Stop requiring health insurance to cover every conceivable procedure; provide catastrophic insurance coverage only. Set up a way for savings from now lower health insurance premiums to go to cash that people can use for their normal health care needs. People who have to pay for their care will be cost-conscious. They won’t go to the doctor for every little thing. They won’t tolerate “defensive medicine” on their own dime. Downward pressure on costs will be provided.

    Now you can provide assistance to people who cannot meet those normal costs and/or don’t have access to that catastrophic coverage.

    I know it sounds extreme, but nothing less than a complete overhaul of how we pay for health care is going to solve our problems.

  • Adam

    In the US, the general attitude is that people who can’t afford medical help should get help from private individuals and institutions. As David(#2) points out, Americans fear bureaucracies.

    But the flip side is, Americans are selfish. Yes, it is a great ideal that everyone who needs help would get help from generous individuals surrounding those people, but reality is that it doesn’t happen.

    My question: is bureaucracy better than selfishness?

    What does a belief in resurrection say to this?

  • For any who are interested, I’ve written a great deal on this issue. Begging Scot’s indulgence, here are a few examples:

    Health Care Reform in Other Countries
    One Place Feds Contain Health Care Costs
    Eye Care Reveals Secret to Health Care Reform

  • Robin

    The simpler issue to me is the cost of providing care. The cost of all healthcare spending in the US is approximately $7,500 per resident. Using an average household size of 2.5 this comes out to $18,750 per household. If you take reduce the administriative costs from 7% to 3% (the amount reform proponents claim for Medicare) you still have total costs of $18,000 per household.

    Average household income in the US is $50,000. So, if you wanted to fund the entire healthcare system through taxation you are looking at a 36% tax (average) on all income, either through the income tax system or through a special tax, like we currently do for Medicare.

    This is a tax that must be added on top of the rest of the income tax, as well as state and local taxation, property, sales, etc.

    That is what it would cost to fund a healthcare system, identical to what we have now, through the individual income tax. You could, and likely would, also fund it through the corporate income tax, but that is dicier to calculate.

    There is no getting below these numbers, at least not in our political system, with the preferences of our citizenry. If you decide to decrease the number of hospitals, reduce doctor or nurse pay, defund research, prohibit experimental treatments or discontinue the use of expensive drugs, then you will face unprecedented political backlash.

    Americans will continue to demand the level of care they currently receive, our politicians would be forced to aquiesce (mostly by borrowing from China) and that 36% tax would only go up in the future as healthcare inflation outpaces wage inflation.

  • Debbie

    Jodi and Scot….. Thank you for this discussion.

    I believe Jodi has asked a question…What are we doing in the US for those who do not have choices, means, or access?

    My answer…. Not enough. There is much to be done in this area.

    Equal access to good health care should be shared by all, regardless of income, location, ethnicity or residency status. I believe universal health care should be a right for everyone living in the United States.

  • Barb

    thanks for bringing this dicussion back in such a clear way. I see things from here very much like you see them. I wonder why Christians, who are saved by grace alone, have such a sense of “I earned it so I should get it” when it comes to health care. I pretty sure that many low wage earners sweat FAR MORE than I ever did at my good paying job with benefits.
    NOW, I’m retired and do not have health care provided for me by ANYONE. Luckily we do have the means to have an HSA account and a $5,000 deductible policy for our family of three. But what that means is that we see the cost of every doctor visit, every test, x-ray, and pill.
    ChrisB–I’m totally with you–your experience is now mine. One pill that I take daily cost me about $4.50 each when I started them three years ago–BUT the cost has gone UP and they are now close to $6.00 each!!!! This med is widely advertised on TV, but no poor person could afford it. We do need a radical solution–.

  • Robin

    To further clarify, Some European countries are able to do more in healthcare, for a comparative bargain, because they have cultures, or political system, or personal values that let them get away with it.

    My mom went to the ER last week with Chest pain. They did an EKG that day, a heart-cath 2 days later, and told her that if she needed it, they would have done bypass surgery the next day.

    By contrast, peer-reviewed research has found consistently longer wait times in countries with universal care. One study in particular showed that in Canada and the UK 46.7% and 88.9% respectively waited more than 3 months for cardiac diagnostic procedures (like the one my mom had done the same day) and 6.7% and 16.7% had to wait more than 9 months for a test (cardiac angiography) use to tell doctors whether or not the patient needed bypass surgery.

    Don’t get me wrong, there are probably some patients who can wait 3 and 9 months for such tests with very little risk, but our population won’t tolerate that kind of wait. They won’t tolerate the means which unviersal care countries utilize in order to keep their costs under control…which means any universal care system in this country could not hope to contain such costs.

  • Robin

    As far as what a Christian should support. I could see myself, conservative and libertarian as I am, supporting a tax that was used to fund a universal care system. I would prefer sliding scale Medicaid, but I would be up for other instruments.

    The problem with this approach is that it would require a 36% tax to duplicate our current system, and that tax level would never get levied. Any taxation level short of approximately 36% would entail drastic changes to the way healthcare is delivered in this country.

    So the key question is what changes would a Christian make to the current healthcare delivery system in order to balance the books, and any progressive Christian that doesn’t address this issue is not being intellectually honest. Even under ACA they addressed it, somewhat, by admitting they would have to slash some Medicare payments.

    So, how would you change our current system to make it work under a universalist framework? Would you increase wait times, decrease the number of beds, decrease physician and nurse compensation, eliminate funding for experimental procedures or medications, etc.?

    Life, and economics, is all about tradeoffs. And if we are seriously considering universal coverage, financed through taxation, there are going to be costs associated with that benefit. I just don’t think we have the stomach for the costs.

  • For me the challenge is not how this comports with America’s value system, but how it comports with the value system of God’s kingdom come in Jesus. To me that means one thing in regard to this: basic and decent affordable health care available to all, including the unemployed.

    But before that, I know it’s an issue of whether or not we in Jesus should be concerned about a government’s policy, or a nation’s policy, indeed our own nation’s policy in regard to health care, or anything else. We need to live out the values of God’s kingdom in a way that is reflective of the light that is in Jesus. And then the question becomes, can nation-states learn and do better by that light. And surely without a doubt the answer is yes. Which means we do need to speak, but above all live out the love and will of God in Jesus. But we are more or less too much a part of the system ourselves: we’ve bought into it, so that we are not about to have that disrupted.

  • Robin

    Last clarification.

    We currently ration care as well. We provide excellent care to (1) the rich (2) lots of people with employer-sponsored care and (3) people on Medicaid.

    I work with Medicaid on a daily basis and there is no private insurance I could purchase in Kentucky which would provide benefits comparable to Medicaid.

    We provide good care to (1) everyone else with employer-sponsored insurance 2) most people with private insurance and (3) Medicare recipients.

    And we provide either emergency only, or poor care to (1) the uninsured and (2) people with cut-rate private insurance.

    Universal Care would move us from our current rationing system to a system which provides poor to good care (depending on the funding level and taxation rate) for all citizens.

  • Jason Lee

    Why do people with jobs that provide them with health care think that its all their own effort and hard work that got them there? This looks like a kind of ideology of individualism (admittedly a sacred ideology among Americans). The problem is that people are born in situations of advantage and grow up with more advantages and connections than others. This plays a big role in who gets humane work or any work at all. And in America all of this is connected to who gets health care. To restate, I don’t understand why people think their money and good jobs are 100% because of their hard work and other people’s lack of money, skills, and jobs is 100% because of their laziness. Why this simplistic way of looking at it?

  • Debbie

    Robin at #17….
    Very good point… we must be intellectually honest about the cost/benefit of universal health care. And I agree with you that currently most Americans do not have the stomach for the potential costs. You are wise to bring the subject of taxes and overall cost to the discussion.

    One earlier post made mention of how selfish we are in this country when it comes to our money and health care. I believe that is true… the majority of Americans do not want to wait for tests, do not want to share hospital rooms, insist on the latest medications at low prices, and are not willing to make proactive lifestyle changes (diet, exercise) to improve our health. I too am a selfish American.

    Before Americans can begin to wrap their brains around the costs, we need to wrap our hearts around the need. Social changes are often advanced when voice and image are given to issues.

    As a follower of Jesus I want to help bring these issues to both the heart and minds of other Americans. I believe Christians can, and should lead on this human rights issue. This is part of kingdom living and it isn’t easy.

  • The economic issue of externalities is important here … sometimes called “spillovers.” Negative spillovers occur when a factory dumps chemicals in the river upstream from my land and pollutes my environment. I end up bearing part of the costs the factory owner and his customers create for making and using the product.

    There are also positive externalities. It greatly benefits business and society for people to be able to read, write, do math, know basic health issues, know about civics, and know how to learn new things. If we left it to everyone to decide whether they want to get an education, then some would opt out and others would feel they couldn’t afford it. We have public education because the positive spillovers of everyone having a basic level of education are so great.

    Similarly, I think there is a strong public policy argument to be made for a basic minimal level of care. There are very positive economic and societal spillovers from having a healthy population.

    But with education we fund through grade 12. Some can prove chooses a private route but the still have to help support the public option. However, education beyond this basic level is not provided free of cost to students and families. College costs more and cost vary between institutions like Harvard or a really good school like Kansas State. 😉 If you want beyond the basics you have to prioritize your own life to get it. I think something similar should be the case in health care.

    A big piece of the beyond the basics coverage, needs to be market competition which will drive the costs of these services down. I couldn’t disagree more with someone above who said the problem is not enough regulation. Health care is one of the most heavily regulated industries we have and the end user, the patient, has absolutely no way to make financially informed decisions about medical care.

  • Robin

    As soon as I saw someone mention externalities (I couldn’t see who posted it yet) I knew that Michael Kruse was done with his dentist’s appointment 🙂

  • I agree that there is a right to health care (no one should be blocked from pursing care) but that is different from saying someone has a right to have health care provided for them at someone else’s expense. The latter is how I understand those above to be talking about “right.”

    If something is a right, then there can be no qualification of it. No one can deny it because I can’t pay for it and no government entity can ration it for me. If you are going to allow that costs must somehow be factored into the equation, then we are talking about something other than a right.

    The “rights” approach has led to some serious unintended consequences. In some African nations, health care has been enshrined as a right. But it is the wealthy who have the ability press their case for elective procedures because they have the right to health care. So health care dollars get funneled to elective procedures and away from AIDS medication because the poor cant’ press their case for their rights in the courts as effectively. If it is a right, you have no right to ration care away from the wealthy.

    Using subsidiarity, we can look at an issue to determine if a form of collective action on an issue is optimal compared to more decentralized approaches. When that is the case, I think we can argue that there is a “societal obligation” to pursue that course. I think talk of obligations is much better than the individualistic framing of rights.

    Some above have said that American reluctance toward paying more taxes for health care is based in selfishness (I got mine, to hell with you). Yes, there are some selfish people out there, but I don’t think selfishness is the driving feature. In fact, when Americans see there dollars are going to be used effectively and efficiently, they are quite generous. The issue is that we Americans have stronger suspicion (right or wrong) of centralized solutions than most other developed nations. Therefore, there the issue is one of means to end (health care), indifference. To characterize the resistance by many to government health care as selfishness is just the flip side of the other camp who says advocacy of government health care is communism.

  • Robin #23

    You got it! Back from being tortured by the dentist. Now its time to torture Jesus Creeders with economics. 😉

  • Robin

    Especially after Michael Kruse’ comment, this is starting to remind me of the education debate.

    Lots of people, progressive and conservative alike, understand that the government sometimes fails when it comes to educating our children. I’m not getting into the reasons (budget, tenure, parental involvement, etc.) I am just acknowledging that in some locations the government does a good job, and in some places it does a terrible job. This is one reason every president since Carter, including the present one, hasn’t trusted D.C. public schools with their children. This is one reason that even lots of progressive Christians have chosen to put their children into private schools or homeschool them.

    One solution that many of us have favored regarding education, especially those of us who care about poor, inner-city residents, is vouchers.

    Just like Libertarians and conservatives can get behind a voucher (sometimes means-tested) for parents to aid them in selecting the best school for their children…I think some of “my people” would find a universal healthcare tax that had a refundable voucher attached to it a lot less objectionable.

    That way everyone would pay in, and people who were satisfied with public insurance and provision would effectively be in a single payer system, and if you thought you could find better insurance/provision on your own, you could take your voucher down the road just like we advocate for education.

  • Ryan

    There is so much to be said here…

    Comparing Social Security with private 401k (or most other private retirement plans) is crazy. Citing administrative costs to defend something like SSI? It’s commonly known that had that same amount of money (just fill in the blank for what you pay during your entire working life) had been invested in just about any private retirement plan you would be retiring with millions…not $2k a month or so. This should be the caution with ANYTHING the government decides to do.

    Whats more, is these government programs create dependency. People have grown dependent on their SSI and as they approach retirement are trying to figure out how they are going to stretch that meager stipend to cover their costs. This, of course, is going to be the people who do not make enough money to invest 15% in SSI AND more in a private plan. But why would the government/politicians want to create dependency? JOB SECURITY! If you are dependent on the government, and see the government as the provider of your retirement, health care, housing down payment, “cash for clunker”, or whatever other brilliant plan they come up with, they know you’ll vote for them because of what they provided for you.

    So, I don’t see this at all in terms of the good guys, the ones who are really trying to practice God’s kingdom on earth, vs. the selfish bad guys. Politicians are not agents for ushering in God’s Kingdom on earth…they weren’t in Jesus’ day, and they aren’t now. That is the role of Christ followers, not the government (as an institution, not as individuals who make up the government who may be Christ followers in their private lives).

    When it comes to people getting sick and how to afford the care…there is no health care system to solve the fundamental issue: we live in a fallen world suffering the consequences of the curse. When I’ve been sick (or worse my kids) it has been terrible. Sometimes I’ve had insurance, sometimes I haven’t. But it is no ones fault that it happened. It isn’t evil insurance companies fault, or the governments, or the church…we have been cursed and we are dying. I am very thankful that I could go to any hospital in my city and receive care regardless of my insurance situation. Did I have to pay for it? OF COURSE! What else in life do I get to consume without having a bill to pay?

    Things goes back to my original point: I don’t have a problem paying for what I consume because I don’t think I should be dependent on you or anyone else…and I don’t think Jesus wants me to be dependent on any other person either. Please don’t confuse this with spiritual issues like grace and forgiveness. Being forgiven of my sin and brought into God’s family has little to do with someone else paying for my car or my house down-payment or my health care. We all need to do everything we can for one-another IN THE CHURCH (again, not the governments role), and probably need to do more, but creating generations of dependents, IMO, is not the way to do it.

  • #26 Robin

    I think there is merit to a voucher-like component.

    I think there is knee-jerk response that says “profit = evil” and “non-profit/government = compassionate.” Profit is seen as making money off the backs of the poor.

    But to make a profit, a business must persuade buyers to purchase their product and the business must exercise the discipline and innovation to keep its costs below its revenue. They must become directly responsive to their clients.

    Non-profits and government entities are not directly and immediately accountable to their clients. They are accountable to their donors and legislatures, respectively. Their clients almost inevitably become objects of care rather than human clients to whom they are accountable.

    Giving the poor a voucher to select services in a competitive market does two things. One, the competition keeps the cost low. Two, the voucher means the service provider must be responsive to the voucher holder in order to earn the voucher. The poor person gets both lower cost and greater responsiveness.

    So I’m with you about a voucher-like component being a part of the solution.

  • I’ll also add that “health care” isn’t simply a matter of “health insurance.” Above, Naum points to the fact that life expectancy is little lower in the USA than in other developed countries. Our homicide rate is just under 5 per 100,000 people a year. That is the lowest in almost fifty years but it is still double and triple what it is in some European countries. If you lowered the homicide rate, our life expectancy would be on a par with European countries.

    Second, there are millions of people eligible for Medicaid that do not sign up for it and millions more who have it and don’t use it. Economist Robert Fogel points out that a great many of the poor are intimidated by medical professionals. Plus, medical care facilities are frequently located at inconvenient places with inconvenient hours. (The rise of clincs in places like Walgreen’s is doing a lot to help with this problem.) There are some culture issues that impact the health care debate that have nothing to do with insurance. So just like the idea that having democratic elections will create a free society, and then witnessing what happened in Lebanon, we should be cautious about saying we can transport what happens in a homogeneous country like Sweden with 9 million people to a diverse country of 300+ million people, with millions of immigrants every year and with a very different founding narrative. (I don’t hear Jodi saying we can just import another system … it’s just that some seem to make this leap.)

    It was also Fogel who noted that the increase in health care as a percentage of household expenditures is not an entirely negative development. As people have moved up the pyramid of Maslow’s hierarchy of needs, people are spending more on health care. It has become a higher priority. Also, there is now a more expansive range of health care services we can chose from than we ever had before. There is a greater “supply” to stimulate demand.

    I’m not trying dismiss the health insurance question. Just trying to suggest this is an immensely complex issue.

  • alison

    These words keep running through my head: “Would you deny for others what you demand for yourself?” (thank you, Bono). Many people who complaint about this issue complain because they have good health care available to them and they don’t want it to change at the expense of those who don’t have it. This is not “loving your neighbor!” I am pro-life, and I consider access to adequate health care and the ability to pay for it to be a pro-life issue.

  • DRT

    FWIW – After reading Ryan’s post I ran some numbers just to see how they would come out for SS. I simply assumed that you work for 35 years paying the maximum amount into SS and then you withdrew $2,500 per month for 22 years. I then back calculated the implied interest rate and it is 1.2%. Now, this is a real interest rate since I did not index contributions, withdrawels or anything. The interesting part to me is that it works out to about what someone would consider to be the risk free rate of interest you could expect, and I would dare say that the government should be investing our money risk free since we have no choice. Sounds reasonable to me.

  • alison

    And stop calling it Obamacare. Seriously.

  • DRT

    Michael, I agree that making it a right, is wrong. I do like your “societal obligation”. It is more like providing for a common defense in my opinion.

  • @Michael W. Kruse, #29: no, the shibboleth about homicide rate affecting life expectancy is not true — again, I refer you to T.R. Reid who has compiled an excellent report of the economics of our system v. other developed nations. The largest part of the U.S. life expectancy mark is lack of access to health care that could prevent early deaths.

    U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

    The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

    But life expectancy is just one statistic and by itself not very useful. And a great deal of money is expended on extending life span of the elderly. WHO uses a disability/health adjusted life expectancy score, — (HALE/DALE), how many years average citizen expects to live before disabling diseases of old age. U.S., after filtering the homicide rate out, improves (rises from 47 to 24), but still ranks far below other developed nations.

  • Robin


    T.R. Reid isn’t exactly an unbiased, neutral observer on health issues, and to top it all off he has no training in economics or health care.

    His work may or may not be true, but asking us to take it at face value is kind of like asking us to believe everything the NRA says about gun safety.

    Do you have anything from sources that might be considered more objective, or at least more qualified. Health care economists that haven’t worked for administrations perhaps, health care economists that don’t serve as consultants to major insurance or lobbyist groups.

    I’m just not willing to take the word on someone who (1) majored in classics (2) spent 20 years writing about Japan and micro-chips and then (3) went to work for a Healthcare advocacy group and miraculously published a book and documentary advocating for healthcare…as the final word on the subject.

  • @Robin, #35: I do not have the book in front of me, but the stats are sourced from WHO and other organizations — he did not “make them up”…

    …and I really tire of the practice of immediate, knee-jerk discounting (and that goes for both sides, i.e., discounting a CATO study because they’re little L libertarians advancing partisan causes) something just because of the source, regardless of the merit therein.

    Neutrality is not the equivalent of objectivity.

    Reid, whatever his slant, has compiled a great deal of study on the various health care systems.


  • Richard

    @35 so you’ll dismiss the notion of actually engaging with the arguments and data presented in the book because the person isn’t “objective.” Why not actually read it and engage with it instead of writing it off as a matter of principal. Everyone has a bias, at least you can claim to know where that author is coming from on things.

  • Robin

    Sorry, I thought naum stated that Reid was the “definitive source” on the issue. I look back and see that he did not make that actual claim.

    A journalist with no economic or health-specific training cannot be the definitive authority, but yes he can be one reference among many.

    Alas, this is just a blog post, and I don’t have the desire or energy to research every issue Scot brings up, so I’ll just have to take Naum’s word regarding Reid.

  • The last part of my comment is too sweeping and harsh, and for that I’m sorry. Was a general statement which includes myself to some extent, no doubt. Not to mention too hazy.

    I have to admit, this is a troubling issue for me. I take it personally. There just doesn’t seem to be the will present to do what Jesus would call people and nations to do. I say that from what I’ve seen. I am thankful for the exceptions to the rule.

    This is a huge subject, but I strongly agree with the essence of what Jodi Fondell is saying. It is scandalous that basic, decent health care is not a given to all, in this country–one way or another. But that’s my view.

  • Debbie

    Ted at #39
    Agreed, this is a troubling issue and I am saddened that good basic health care is not easily available to everyone in this country. What is particularly baffling to me is why this issue is so politicized. And not just politicized but highly politicized!

    Michael at #24
    You make an excellent point to my post about how selfishness is part of the driving force. I had not thought of the suspicion of centralized institutions.

    Let me put my statement about selfishness in context. I live in Arizona. For the last few months I seem to hear and read more and more about how “they” (read undocumented workers) are taking “our”……. (Insert what you want here.)

    They fill up the emergency rooms. Their children are educated and fed on our dime. They contribute to the drug traffic. They increase the crime rate. They don’t deserve free health care. It all sounds so very selfish. Certainly all this grieves the Holy Spirit.

    All in all this is a very complex issue. I’ve enjoyed today’s discussion; ironically I have taken the day to stay home due to a nasty head cold. Thank you all for an enjoyable day!

  • #34 Naum

    For people who reach 65, the USA has the highest life expectancy of any nation. It is early death that is that skews the life expectancy at birth numbers. But when you control for the issues of homicide and traffic fatalities … both of which are much higher in the USA … the USA moves to the top of the list.

    Over the past couple of years I’ve seen various people look at this issue from a variety of political perspectives. “Angry Bear” is one left of center blog I visit. Here is his post on the topic back in 2009, based on research done by economists and demographers that uses various data sources including WHO.

    There are other factors. The USA has a higher infant mortality rate than other nations. Why? The USA has a higher percentage of low birth-weight babies. This is highly connected with teen pregnancy. Teen pregnancy is significantly higher here than in other countries. I don’t if the difference is that fewer teens get pregnant in other developed countries or if they simply have more liberal abortion policies that allow them to abort babies that otherwise would have been born with low birth weight and died within a year after birth.

    Then we come to the Hispanic anomaly. Hispanics are a poor minority yet their infant mortality rates and life expectancy are nearly identical to whites (see here for example).

    So I come back to my original point. There are significant cultural and demographic differences that affect how we compare and evaluate health care. Health insurance is an important concern but it is only a piece of larger cultural mix. You can quibble at the edges but I stand solidly by this point.

  • Ryan

    DRT 31: again, this argument is not even rational. If someone earns on average $30k year for 35 years, this means they are investing $4,500 per year into SSI. To only receive 22 years of $2,500/mo. on that investment is terrible. I still remember looking at models of investing only $2k/year starting when I was 20 in “safe” retirement earning you into the millions by retirement. This would give you 66 years at $2,500/mo. with less than half of the investment required.

    Ted Gossard #39: you said “It is scandalous that basic, decent health care is not a given to all, in this country–one way or another.” Not just to pick on your comment, but on all the same sentiments so-far expressed: EVERYONE HAS THE ABILITY TO RECEIVE BASIC, DECENT HEALTH CARE. You cannot be turned away based on any form of discrimination. The question is how does it get paid for. It is my opinion (see my comment above) that people should pay for what they consume. This seems pretty obvious to me in every area of life. If you don’t like the cost, hey I get it and am dealing with it personally…but my child has received care and has been brought back to health! The same could not be said in many countries around the world.

  • The basic principle remains: Many have access to health care that others can’t afford. Quality of life as well as quantity is affected. And people who do have insurance are a job loss and illness away from catastrophic loss. Is that good, or right?

  • Ryan #42
    Of course there is discrimination. Pre-existing conditions. Everyone should pay, because everyone may end up needing more than they could pay on their own. And no, sorry to say there are plenty of people who can’t afford health care insurance.

  • …glad for your child, Ryan!!! 🙂

  • @Ryan

    No, everyone doesn’t have the ability to receive basic, decent, health care. While you cannot be denied emergency (life threatening) care, most doctor require payment or insurance up front. Hence, unless you’re in pretty bad shape,you really don’t get decent health care.

  • Theo

    No, not everyone has the ability to receive decent health care. Try getting, say, a protrate exam, baby vitamins or an ultrasound at the emergency room.

    In these snowstorms, the people at my church are working at warming centers for the homeless, and one of the big surprises are how many families are homeless — homeless!! — because of medical bills.

  • Theo

    Since this is an anonymous forum, I’ll share that I’ve been very suicidal in my life, with lots of therapy, etc., but I’m currently off my medication for the simple reason I can’t afford it. But, hey, if I blow my brains out, that’s one less person you people with good jobs with insurance have to worry about somehow stealing your great health care.

  • Ryan

    Hey all…I didn’t say it was cheap, and I didn’t say everyone can have Health Insurance…but that is not the same as being able to go to the hospital, have a doctor see you/diagnose you and help you get better. Sure, it’s not preventative, but other lifestyle choices (diet/exercise being just among those) can aid a great deal w/ prevention…but we all want our triple whopper, xlarge fries, 44 oz coke and choc. milk shake for lunch!

    If you are sick, if you are in labor, you can go to the hospital and be treated/deliver your baby. I believe the argument should center on cost, not the emotional untruth that people cannot get health “care”.

    Ted Gossard #43: “The basic principle remains: Many have access to health care that others can’t afford.” This is true in just about every area of life: homes, cars, vacations, restaurant choices…why stop at equal health-insurance for all. Why not the next logical step: equal houses for all. If it’s a human right to have equal health insurance, then how bout a human right for an equal house…then you need equal cars to park in the garages…Jesus said you will always have the poor with you. I just don’t seen any way that everyone can have equal everything.

  • There are several factors why US health care costs are higher than most other countries. There is an article in The
    New Yorker magazine by Atul Gawande.

    This article is really quite informative. It steers clear of political arguments, yet points out some of systemic weaknesses. Example: increasing co pays actually increases costs while decreasing usage. Patients don’t use their Primary Care Physicians, may not be able to afford the prescription co-pays and wind up in the ER which is more costly to the insurer than if the patient followed the correct regimen.

  • Ryan

    Theo: I’m assuming you’re not referencing my post…or you didn’t read it. I don’t have a good job with insurance provided…but I’m choosing not to play some emotional card and blame society.

  • @Ryan
    “I believe the argument should center on cost, not the emotional untruth that people cannot get health “care”.”

    What you are talking about is much more expensive than you realize.

  • Ryan

    “but I’m choosing not to play some emotional card and blame society.”

    If I didn’t have insurance, I would be dead. Five years ago, i started going into liver failure. No drugs, no alcohol but due to an auto immune problem called PSC. Thank God, I received a liver and kidney transplant. At the time of the transplant, my wife was told that I had less than 1 month to live. Before I was even seen by the surgeon or any of the doctors, my insurance was checked to see if they would pay for it. No insurance, no way to pay, no transplant. The costs for the transplant and all of the hospitalization was around $400,000.

    This is not playing some sort of emotional card. There are people who will die simply because they don’t have the money to get treated. Good people who just simply cannot afford insurance or treatment. The United States is The richest country in the world. Yet, we allow people to die for lack of money. As a Christian I find that appalling. God has blessed us beyond other countries and we don’t take care of our own.

  • Robin

    Steve D,

    If you have children, then in any state of the union you can get a “spend down” that will cover the entire cost of the operation, minus your monthly income in the month you have the operation. Just because you are not aware of the types of care that are presently available doesn’t mean that care is unavailable.

    I have personally helped a farmer and his wife get their entire neo-natal care covered for a baby that was 1 month premature. They had 4 kids, owned 300 or 400 acres of land, and didn’t carry health insurance because they thought it was a bad investment. The spend down paid for everything except about $2,000. I’m pretty sure they put the remainder on a payment plan.

  • Robin

    If you do not have children then your eligibility would indeed depend on the state in which you reside. Several states have received 1115 Waivers from HHS to cover child-less adults. Those states also provide the spend-downs I mentioned above. My state, Kentucky, does not provide benefits for childless adults. I know Utah and Maine do.

    Also, spend downs are not dependent on income, but on the combination of monthly income and monthly medical bills.

    For example, in Kentucky if a couple with children had an annual income of $240,000 ($20,000 per month) and no health insurance, or a procedure that wasn’t covered by their health insurance. And the procedure cost $500,000, then the state would expect the couple to pay roughly $20,000 towards the procedure, and the state would pick up the remaining $480,000. Obviously any procedures which cost less than their monthly income ($20,000) the state would cover nothing.

    I sincerely recommend that you look into the spend-down laws for your state (local Medicaid workers should have them) and familiarize yourself with them, if not for you, for the next couple that thinks they are ineligible for any assistance in a time of crisis.

  • pam w

    We have really messed up how we define the wealth of a nation. In God’s economy, the health of our neighbor would be considered part of our measure of success. The ability to use our God given gifts to participate in an economy where all have equal access to health. some of us were given gifts and blessings to lead organizations, attend institutions of higher education and be able to discuss these things on a blog. I believe those of us with these kinds of blessings and privileges have a responsibility to help create systems where all life can flourish.

    The health of our neighbor should not be dependent on a for-profit industry that is built on incentives to get you to take more tests and spend more more rather than on making you well. The system is incredibly broken as insurance company execs have been making million dollar bonuses during a recession and two wars. Their bonuses are based on not caring for the sick!!

    There are amazing ways to create hybrid organizations that are inside government, so not ‘for-profit’, but competitive and incentivized to keep people healthy – everyone!!! Real dialogue hasn’t made public (I know it has happened) with all of the options on the table because the people with the power and money in for-profit health care won’t come to the table to create a system that has just as much competitive advantage, rewards and incentives for efficiency and effectiveness (measures for a better national health record!), a LOT of money saved due to not having insurance agencies running the show, and everyone covered.

  • Our resistance with increased taxation to provide accessible care for all seems to fit within the same American mentality that we would rather struggle to keep our noses barely above the water economically as long as we can cling to the hope that one day we might just make it to the health and wealth promised land rather than change the way our economy is run.

  • Susan N.

    I’ve been pondering on a few points:

    Capitalism — the idea that working hard profits both oneself and the whole community/country. I’m not sure there are very many on the far left of this issue who are against profiting from our labors? The “evil” in profiting comes in with greed. Relating this to the health care industry, injustices occur because the individuals and corporations (hospitals, pharmaceutical companies) within the “system” are a little too invested in making a big profit on a service that isn’t a luxury but rather a necessity to all people.

    The distrust of government — I would agree that much of the resistance to change stems from a cynicism and fear of corruption in politics. I admit to sinking into despair over the state of affairs at times! We may wonder, whose side are our elected officials on: ours, the people, their constituents, or the corporations that fund their campaigns and “reward” them for voting a certain way on issues near and dear to their hearts (regulations, or lack thereof)? To add to the chaos, every 4 or 8 years, the likelihood of all that’s been done during one administration is dismantled and the direction is reversed. Difficult realities of our existing political process.

    So, I’ve been wondering — we know of other countries which have successfully provided universal health care. Are there any countries that have operated like ours and then transitioned to universal health care? In other words, how could we, as a nation and a people which are extremely invested in our current system, smoothly transition to universal health care?

    Naum @ #6 (and Richard @37) – thank you for suggesting the book ‘The Healing of America’ by T.R. Reid. I can definitely stand to become more educated about this issue.

    Theo @ #37 and #38 — my heart goes out to you. My mother was poor and suffered from clinical depression. Her health care was erratic, which over time resulted in a severe decline in her general health and a shortened life. There are people who do care that you receive the health care that you need, and who understand at least some of your struggles. May God protect you and sustain you, and bring people and resources into your life to minister to your needs. You’re not alone.

  • Susan N.

    That’s Theo at #47 and #48, sorry for the typos.

  • @Michael W. Kruse, #41: Again, life expectancy is not the end-all of the debate, and is why I alluded to the HALE/DALE score, but sure, your point about once American reaches 65 is valid — but also, does that not make a case for universal health care? Once you reach 65, you qualify for “socialized” health care AKA Medicare.

    Another benchmark for national medical system is “avoidable mortality” — how well a country does at curing diseases that are curable. In 2008, the Commonwealth Fund report concluded that the U.S. was the worst of developed countries on this measure.

  • Ryan
    Thanks for the information. However, I would not have qualified since I am married with no kids. My state doesn’t support families with no kids.

    A couple of thoughts about Medicaid programs and health care.

    1- State funded programs are subject to the vagaries of state budgets and the political process. Witness Arizona where some 90 people who needed transplants had their approvals reversed because the state legislature and the governor decided that transplants were too risky and “experimental”. One person has already died.

    2-Programs such as this tend to fund the big expensive medical problems while leaving the chronic unfunded. Preventative medical is also unfunded as well. Studies have shown that regular checkups do really save money in the long run.

    I believe that we really need to re-think health care from stem to stern. We emphasize fixing illness instead of preventing illness.

  • Robin

    Steve D,

    The problems in Arizona are no different than the problems facing universalist systems in Canada and the UK. We both have budgets that we have to live within. Arizona chose one particular method of dealing with their budget shortfall that has resulted in highly visible, immediate consequences. Canada and the UK chose to decrease funding/facilities/staff for cardiac diagnostic services so that it took, on average, more than 3 months to get diagnostic tests done on patients presenting with chest pain and possible heart attacks.

    I also wouldn’t be overly critical of Arizona and the decision they made. I work intimately with Medicaid in my state and I notice that their elimination of transplants occurred at the same time that the federal government, under President Obama, lowered the Medicaid match rate. I know that in Kentucky this sent us from having a balanced budget, to having a $600 million budget shortfall. Because of the decreased match rate we now have to cut $600 million from our budget. It will either come from Medicaid or from draconian cuts elsewhere. We have already discussed the possibility of eliminating things like…prescriptions for all medicaid patients.

    The decisions are not easy, but they are necessary in this time of recession. I am sorry for the transplant patients, but I don’t know how to adequately decide if transplants for 100-200 people are more or less valuable than pharmaceutical benefits for 500,000 people.

    Medicaid currently takes up 20% of the entire state budget as well, so it is difficult to cut $600 million if youd don’t at least consider cuts to that program.

  • RobS

    Lots of good idea flying around.. I’m especially interested in the fact that health care costs dramatically rise and few try to control or contain them. The government solution is too often to just throw more money after it to buy a few votes.

    Sweden does have that 25% value added tax which I’m not a big fan of. I can’t imagine people liking paying that and it seems to be regressive (maybe other incentives compensate the poor people that pay 25% more for many things).

    I aaw a 2009 article suggesting 47% of GDP goes to taxes in Sweden. That’s a lot — and funds a giant bureaucracy just as much as it ‘helps’ people. It’s hard not to create bureaucratic waste and do the most good at the same time it seems to me…

  • Robin

    I think that the whole transplant issue in Az. was poorly handled. During the hearings about the cuts, there was a lot of misinformation and misinterpretation of data. Decisions about health care priorities need to be made intelligently based on accurate data,not on political sloganeering.

    I also understand that none of these decisions are easy. However, all of what you have been talking about indicates that we really need to reevaluate our health care system.

  • Harald Solheim

    Coming from Norway which are very similar to Sweden in the aspects discussed here, I find this discussion quite fascinating.

    I just want to clarify on the vacation part. Paid vacation in Scandinavia is not paid by taxes although some of the comments seem to assume this. Vacation is paid by the employer based on regulation that has been established on the basis of collaboration/discussions between labor unions, employer organisations and the government. My employer has to give me five weeks paid vacation every year. Basically I am paying for my own vacation since it is part of the benefits my employer has to give me (but I can’t opt out of it to earn more money a given year). If I ran a private business with no employees I wouldn’t have to take vacation unless I wanted to, and I would not have to pay for anyone elses vacation either.