Reader Writes In About Single-Payer Article

19 Aug

A regular reader of the blog wrote a comment yesterday about my post on Sweden’s single-payer system and how their costs compare to the costs of health care in the United States. I responded with my own comment, and then figured that the exchange warranted the attention of its own full posting.

You compare healthcare costs in the United States and Sweden against GDP, but do not seem to address the problem of the lack of healthcare choices and availability in Sweden. As Dr. Hogberg points out, many of the county councils there adopted market-oriented reforms during the 1990s to help combat the problem of insufficient care availability.

I might agree with you, based on your data, that a single-payer system has helped Sweden to control rising costs – but as I have before suggested is the case in Canada, only at the expense of readily available quality care.

It’s a fact that 93% of the insured in America are “satisfied” or “very satisfied” with their current care, and 95% of those who suffered chronic illness are satisfied with their health care. Contrast that with the conclusion of the following study conducted at the Nordic School of Public Health in 2002 [Broken link omitted].

Additionally, is it exactly fair to compare “National Health Expenditures” between our two nations? What components comprise these expenditures in each location? After all, Sweden has the Medical Products Agency, the Pharmaceutical Benefits Boards and the National Corporation of Swedish Pharmacies. Does it not stand to reason that many of the cutting edge surgical treatments and pharmaceuticals available here (to those that can pay, of course) simply don’t fit into the global budget there? How many of the costs factored into our NHE are of the R&D variety borne by firms researching new practices and medicines, which might benefit Swedish citizens one day if they are determined to be cost effective enough to fit into their budget?

The numbers here are incomplete and unconvincing. One might surmise from a graph depicting my “Ferrari expenses” to Richard Branson’s that I am getting a much, much better deal on them. In reality, I’m driving a slightly different car.

My reponse….

I assume you’re referring an article by Rosen and Karlberg (not sure, because the link doesn’t work). While you are correct that the article does seem to conclude that there is a gap between what patients expect and what doctors think should be provided, I don’t think that that’s the main point of the study, nor do I think you’d find much difference if you did a rigorous study in this country.

First, I think the main point of the study is that the docs in Sweden want government to make more decisions about what to cover, while government officials want doctors to make the call about what is needed.

Second, even in the U.S., I think you’d find that given the freedom to choose it, most people would want more than their doctors would want to provide. The thing is, patients’ choices are already quite limited. Asking them if they are happy with their own coverage is fine, and you correctly cite that most people are content with what they have. At the same time, an overwhelming majority agree that major health reform is needed in the U.S. It’s a paradox….they love what “they” have, but they think the system needs to be changed for “everyone else.”

To clarify, National Health Expenditures are the same in both countries, only including actual cost of care–that would include cost of prescription drugs, but not the cost of R&D (well, only to the extent that those costs are passed on to the consumer). But don’t think all that happens in the U.S. Yes, we have Pfizer and Merck, but AstraZeneca is the result of a merger between a Swedish company and a UK firm. GlaxoSmithKline is a UK firm. Sanofi Aventis is French. If anything, Pharma is an international force.

As for the Ferrari expenses, I view that as a bit of a canard. But to use your example, there is enough waste built into our system so that with some restructuring and regulation, everyone could at least have access to a car, while those with more resources would still be able to buy a Ferrari if they wish. Every country in the world that can be said to have a “health care system” (i.e., industrialized nations) still has another system that permits the wealthy to “top up” their coverage. That’s true in places like Canada, England, and Sweden.

We’re not talking about putting a ceiling on what people with the means to do so may get, we’re talking about installing a benefit floor that ensures a decent set of essential services as part of a compassionate and humane society. I fear, however, that until people confront some of the more harsh realities of inadequate access to care, they will not grasp the needs that exist here. There are places in this country–impoverished pockets of people– with health outcomes that are actually worse than some places in sub-Saharan Africa. My grandmother, for example, is dependent on both Medicare AND Medicaid. You can’t tell me she didn’t work hard her entire life, and you can’t tell me she doesn’t need the help. I know both to be true.

Why can’t we agree that there should be a basic level of support in this country for the least well off? Again, not a big handout, but a hand up. Because if, after all, a society is to be measured by how well it treats the least among its people, I hate to say it, but the U.S. falls woefully short of a decent society.

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Posted by on August 19, 2009 in Uncategorized


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