Sunday, November 22, 2009
Affordable, quality health care for all
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Robert Barnes
Barnes is a native of Roanoke and lives in Sweden.
I am a Roanoke native who has been living in Sweden for the past 10 years. Observing the debate over health care in the U.S., I have heard characterizations of reform as potentially turning us into Sweden. I'd never try to talk us into adopting a Swedish-style system in the U.S., but it is important to point out that this is not even close to what is on offer in the reform that is being considered in Congress. However, I would like to dispel some myths and raise some questions for consideration.
The Swedish example
The factors that brought about the public medical system in Sweden and the rest of Europe are as cultural as they are economic. In Sweden, one of the most important concepts in society is security (trygghet in Swedish). Trygghet reaches into schools, the workplace and life in general. Within this idea is the fundamental right of access to affordable, quality health care. No political party, no matter how conservative, would ever consider eliminating guaranteed access to health care. Of course, in each election parties discuss who will ensure the best results, but universal access to health care is here to stay.
Sweden has a single-payer health care system, which is government/taxpayer funded and decentrally administered through provincial governments (landsting). The system works something like an HMO. You have a primary care center in your neighborhood, pay a copayment for a doctor visit of about $20, and there is an out-of-pocket cap of approximately $200 per year for medicine. Further work is based on referrals, and the out-of-pocket costs are minimal. Prevention is a major focus of the system.
As a parent of two teenage boys, we have made extensive use of the system for prenatal and postnatal care, emergency room visits due to accidents and illnesses. My youngest son has a mild case of scoliosis, and we have had regular visits to a specialist clinic since he was 8 with no out-of-pocket expenses. My wife had a scare with a lump in her breast a couple years back. Within hours of discovery she was having a biopsy. The coverage moves with you despite your job or working status. And we will not have to worry that an illness or health condition early in life will be excluded from coverage later.
Of course nothing is free. Last year, I paid tax totaling 40.8 percent of my income (including national and local taxes). However, the tax bill provides for not only universal health care, but also helps fund free universal education from preschool through doctoral programs in university.
Questions for change
Having lived under different types of health care systems allows me to look a bit more objectively on different solutions, and perhaps raise some questions we should consider:
n What are the causes of overspending in the U.S.?
The lawsuit environment is blamed. However, without a guarantee to access later in life, what options exist for future medical bills than a fat up-front settlement? What choice do doctors have than to overtreat or over medicate to avoid potentially catastrophic malpractice suits?
To solve the problem we need to consider the entire landscape.
n Are private-market efficiencies working in the interest of the patients today?
If private insurance companies are going to work on the best interests of the company and the customer, then why is preventive care often excluded? In the wake of the financial meltdown, we can see how goals and targets in financial service companies can get separated from good sense.
n Should health care insurance really be connected to an employer or even employment?
In most of the developed world with whom American firms compete (including in Asia), public health care access keeps health care burdens off employers. Can U.S. firms, particularly smaller firms or start-ups, continue to compete if they have to foot medical bills? Industry associations in the U.S. should be an interested and constructive force in finding major reform that would help create public health care options.
n Would public involvement in the health care system really hinder choice and freedom?
Look at our educational system, which is rightfully the envy of the world. We have public, government-funded options for education from kindergarten up through doctoral degrees in university which exist side-by-side with private options.
Does a system of public and private schools and colleges provide more or less freedom of access and choice in education? If we accept this role for education, then why not health care? Why is health care less important than education to life, liberty and the pursuit of happiness?
n And finally: Are we well served by the current system?
A look at the metrics comparing the results for the U.S. and Sweden will show that despite spending double the resources per person on health care in America as compared to Sweden, the results are not better. In fact, in some areas they are worse.
The status quo is not reasonable. Congress needs to keep the pace moving forward. The result will certainly not be a Swedish-style model. However, it must be a system that offers access for all citizens through either guaranteed insurance access or a public provider option.
Will this diminish our freedom? Before you answer, perhaps you ought to ask someone who cannot get coverage, or perhaps who just lost their job and their insurance at the same time: How free do they feel in the current system?
