Holland - An Alternative Health Care System

[ScreamingEagle]

We still run against those who dont fall below the "poverty line", we keep the beurocracy and we just end up with more uninsured and underinsured which is the problem we are facing now.

If we didn't depend on employers for health care things would be a lot better.

Cars arent really a neccessity, and for areas that it is because of the way we HAVE set our community up can be fixed to deal with that problem and I think we should. We arent having a problem with those issues like we are with health care. We should definitely provide those things (except autos) for people who truly cant provide them for themselves. Those issues arent in crisis either as health care is.

You really are quite the little social engineer, aren't you? Who are you or anybody to determine whether a car is a necessity or not for other people?

Well in many ways I already do. I live in a socialized nation and one that pays some of the highest taxes in the world.
Secondly my property tax is paid directly to a local "commune" and its called a "rent". My kommun (commune is just like a sub-division really) and we all determine how the money is spent. We decide what power company we will use, what garbage collection, what cable company, what internet providers etc. We even allocate the money for the beautification (planting flowers, trees, people to go around and keep the litter cleaned up, landscaping etc). We have a gym even! We also have a big laundry room people can sign up for so for those that done have machines can use and also they are good for large items like coats and comforters etc. You just sign up for 2 hour blocks.
I find it has given me MORE say and control over my money, not less.

Commune? That sounds kinda like communism. Actually it sounds like is you live in a typical condo/townhouse development that has common areas to maintain. Except for the electrical - do you have separate meters or not? I used to rent an apartment where I had to go to the laundry room - hated it. Most condos/townhomes you buy here have their own washer/dryer hookups.

Well its importance is it our tool to keep our societies running smoothly and in a way that improves life for all those who live in the society.

I wouldn't count on socialism to improve life in the long run….and there are certainly plenty of problems with socialized medicine. America is not based on socialism. That's why it is such a success despite it problems.

The US is spending more yet isnt covering everyone. Much of that problem is DUE to private markets. You cant really have a "free market" in health care and expect it to work like it would on many other commodities. Health care demand is not dictated by its price or availability...its dicated by your bodies health needs. If a person has a child who is sick and needs an anti-biotic.....they will pay whatever it takes and with whatever they have really.

One reason the US pays more is that the govt isnt putting any sort of price caps in place, they allow it to go pretty "free". The US is overcharged for almost EVERYTHING associated with health care and due to the system...its also quite heavy with beurocracy. None of that is cost effective.

The US has no obligation to "cover everyone". Much of the overspending problem in the U.S. is due to government interference in the health care system. Our original free market system has been changed so the provider and the patient both are not directly responsible for payment. Thus crooked doctors and hypochondriac patients abused the system and costs went up. Government regulations that require this and require that have also induced skyrocking prices. Bureacracy, both government and insurance, also contribute to the increased costs. If people had the responsibilty to pay for their own health care, costs would come down. If "price caps" were to be put in place, providers would go broke unless taxes were levied to pick up the slack. A free market is the only way to go.

Because the PEOPLE will demonize the poor and not want to spend much money on them...its works like that. Programs like welfare, food stamps and free health care are demonized and as people are upset about the waste of their tax money and politicians needs to cut in areas...they choose programs for the poor who DONT fund their campaigns over cutting in areas that will affect big business that WILL fund their campaigns and careers.

Many people "demonize" the poor because many do not like forced charity through forced taxation and because many poor abuse the system. It probably would be better to move charity to the private sector except for maybe a small core group of the most needy and get rid of the "entitlement" attitude and political footballs. Socialism is an immoral answer to the problems.

When we all pay and all participate...then we create good quality. When politicians talk of cutting health care they wont just affect the poor, they affect US ALL and therefore cant pull it off very well. The goal then becomes to be EFFICIENT and get the most you can for every penny.

Who says we are not ALL paying right now? Except for the poor of course. Why should politicians have any say in our personal health care? Nevertheless, that's what happens with socialized medicine or universal health care or whatever you want to call it - as costs go up (and they will), services will get rationed.

No you cant, when you are sick you are not in a strong position to negotiate anything. You are competing against people with more money who will pay more when they are sick as well....no one is going to lower the price for YOU when they can make more by selling at higher rates to those who can afford and many who cant but MAKE it happen by making some other serious sacrafices and go into debt trying. *some people have lost homes, college funds etc*

Yes you can, when you control your own health care, you or your family can choose which clinic or doctor you wish to help you. If there is competition in a free market you can shop around and choose the best price and services. Or if it is a catastrophic event your insurance coverage would kick in to cover the big costs. Health care is basically like any other service you pay for. The better clinics and doctors are going to charge more, of course, because they provide better services and are in more demand. You get what you pay for - in a free market. If we revamped our system properly, there would be no good reason for anyone to lose their home or whatever. We don't need the government and the insurance companies telling us what to do.

You arent going to have a clinic down the street ready to give you better rates and pharm companies arent all that easy for a small guy to start. Health care isnt driven by demand and supply rules as other things are. Health care is more unique than that and has its own elements that take it out of that realm. You dont go to the doctor because its cheap, you go because you are sick.

Health care is driven by supply and demand just as any other service. Many would choose to use their money for alternative health care doctors to prevent getting sick. When you are sick you will go to the doctor who will give you the best value for your money. If it is catastrophic you would have your insurance to cover bigger costs, so I don't see the problem.

Yes many poor people are irresponsible, so are many middle class people and so are many rich people. Its a bit ridiculous to punish only poorer folks for a human nature that we ALL have at times and to varying degrees. Also, most wealth is inherited, not earned. That means that those with more wealth are not inherently more deserving because they are more responsible...its the luck of birth.

An open market on health care is not going to bring rates down, as I already said...its not subject to the same supply and demand rules and effects many other industries are. It has unique features that make that a fact.

I also grew up with the manta that free markets are the answer to everything. It is the answer for many things, but not all things. We go to extreme with it just as communism goes to extreme with socialism.

Most wealthy people in America do not get their wealth from inheritance. Most get it by being industrious and making it on their own. We all have the right to life, liberty, and the pursuit of happiness in America. That does not mean, however, we have a right to a trip to Disneyland or a right to health care. If Americans must provide for a plethora of "rights" that socialists want, we will become serfs to the requirement to provide those things. It is not a right to impose a duty on others. In America you only have the right to pursue happiness, not to receive it.

An open market will bring down the cost of health care. In fact it is even happening in your own adopted country of Sweden. Their old socialized system failed. As more and more of their health system is privatized, costs are coming down and quality of care is better.

That is somthing that can be rectified. We can certainly have busses, trains, subways and bike routes etc. Its better for the environment, its relieves some dependence on oil, it helps people get more active (walking to bus stops, from stop to home or work, bikes etc)....and its cheaper!

You dont have to be a small country either. You just break it down into the managable sizes (zones) and create the mass transit system. It provides jobs as well! Not just to build it, but also to maintain it and run it.

There is no way Americans are going to give up their cars. Believe me.

Yes, well I am advocating a socialist program here. Its not a dirty word as you seem to imply...just as capitalism, privatization, or free markets are not dirty words. We need a mix of all those concepts in the right places.

Separating the govt from big business would entail more than a socialist program, on that I agree. It would have to be done with reforms on elections and donations to elections....rules on private investment for politicians as well as conflicts of interest and rules limiting the possibility for them to go in and out of the public to private sector (they join the public sector to do favors for private corps for promises of a job in the private sector and do so numerous times creating a revolving door that gives them influence they shouldnt have and that they use for those private business interests).

You don't seem to understand socialism. It's government controlling big business, not separating the two.

Well I certainly dont need or want the govt to provide everything. You are now dealing in extremes...the ALL one way of ALL the other way. Its a false premise.

Not a false premise at all. We already provide food stamps and government housing to the poor. If they control our health care, who's to say what is next? The food industry is a big business - why not socialize it too? I'm sure many socialists would agree.

I am well aware that socialization means more tax money, I pay those higher taxes. But then I also look at expenditures I dont HAVE because they are provided from the me and other tax payers and I am happy about it. For instance, college here is free. Its merit based, you must have the grades each program requires to get in. I dont have to save for my sons college, (or my own should I choose to go)...he must earn it on his own.

Day care is subsidized, I didnt live here when I had need but it would have been nice and I am glad to see families have that available. My son will hopefully one day have his own family and I am glad that he will have this. We also pay for parents to have 1 full year at home with a new baby (to be split between them). Its support of families..a new family dosent have to worry about the health care aspect nor day care AND can be at home with the baby for the first year as well without losing their job and also have their income. It makes for a less stressful society and it gives kids a GREAT start in life. My taxes on this are well spent.

EVERYONE can participate, these programs are not reserved for the poor...even the RICHEST citizens also use these same programs. They arent income based. That is my point about a social program, its for EVERYONE.

My husband is swedish and grew up here, his family are well off and he used the same health care systems, the same day care systems, the same schools etc as lower incomed people in sweden do. The biggest difference for my husband is that he could have more luxuries because his family had more disposable income than some others.

The owners of H&M are swedish and they all live here. They use the same health care I do, their kids also have to have the grades to get into college here and if my son has better grades he would get the spot before their kid would....they would use the same daycares we all do and pay the same rates we all do. It dosent matter that they are very rich....all those services are there for them just as they are for me and even the person who makes less than me.

Oh wow, "free" health care and "free" day care and "free" college….nirvana on earth (sarcasm). Frankly, I'm not impressed nor interested.

Well you are incorrect as the evidence shows. It is the US system that is choking and in crisis. Sweden pays less than the US does for health care. I have choice in my doctors, I am not limited there. I can choose whatever health facility I want and I am not restricted to ONLY go there nor am I restricted to a specific hospital either.

There isnt a competitive market in medical care in the US, there is a corrupt and predatory one. I must repeat that "free market principles" dont apply to the health care industry due to the fact that it is not a market that is dictated by supply demand formula.

I never said the U.S. didn't have problems. We need to get rid of government and insurance interference. I'n afraid I must repeat that Sweden is adopting the free private market principles because they do work and they do apply to the health care industry.

Welfare programs like medicare and medicaid arent failed socialized medicine...if they were socialized then they would be servicing ALL citizens (and not JUST poor ones).

As I have stated and your examples illustrate rather well....programs that are designed specifically for the poor tend to be underfunded and the first thing we want to cut to save tax money. The poor are the most unheard group of all with the least amount of power as well. It is better to create programs that they have equal access to, so that they can also benefit from the quality systems we create for ourselves.

*btw, there are numerous parts of the swedish socialized system that are privatized but they are paid for their services by the govt and must adhere to the price schedules and standards of practice. A mixture between socialization and privatization is a good thing. This socialist nation is a mixture of both in many areas.

Medicare is not for the poor but for everyone over age 65. Medicaid is for the poor. Both programs are going broke.

From what I understand the Swedish government is probably going to issue health vouchers next. That is better than most socialized medicine programs but you are still under the thumb of government control. You first pay the govt. money for your health care and then they "give" you your "free" health care. Right. That may be the system Sweden wants but in America it is not a moral solution.

If we get rid of excessive govt regulation and insurance company managed health care and go with HSAs, people can keep their own money and spend it for the health care of their choice. If you take good care of yourself so you don't need to use a lot of health care you could possibly build up hundreds of thousands in your pre-tax HSAs over the years if you invested well. Later in life it would easily pay for your catastrophic premiums and any routine care you had. And then you get to keep the rest and spend it anyway you choose or even pass it on to your kids.

 

[Ruby]

If we didn't depend on employers for health care things would be a lot better.

Well people (even many middle class) simply cant afford to pay as they do and need some kind of system that will help equalize it out. You may have many stretches of time with no health care costs and then a stretch with high costs.

You really are quite the little social engineer, aren't you? Who are you or anybody to determine whether a car is a necessity or not for other people?

Its a luxury, its not an inherent need such as health care is.

Commune? That sounds kinda like communism. Actually it sounds like is you live in a typical condo/townhouse development that has common areas to maintain. Except for the electrical - do you have separate meters or not? I used to rent an apartment where I had to go to the laundry room - hated it. Most condos/townhomes you buy here have their own washer/dryer hookups.

I have a washer and dryer and the homes here all do BUT we like to provide one for all in our area for larger items as well as for use for those who dont have the washer and dryer. Strictly our choice. Yes we all have our own meters and pay our own power...we just voted on which company we would use.

I wouldn't count on socialism to improve life in the long run….and there are certainly plenty of problems with socialized medicine. America is not based on socialism. That's why it is such a success despite it problems.

This dosent make sense really. Most developed countries currently run on a mixture of socialism and free markets.

The US has no obligation to "cover everyone". Much of the overspending problem in the U.S. is due to government interference in the health care system. Our original free market system has been changed so the provider and the patient both are not directly responsible for payment. Thus crooked doctors and hypochondriac patients abused the system and costs went up. Government regulations that require this and require that have also induced skyrocking prices. Bureacracy, both government and insurance, also contribute to the increased costs. If people had the responsibilty to pay for their own health care, costs would come down. If "price caps" were to be put in place, providers would go broke unless taxes were levied to pick up the slack. A free market is the only way to go.

I see health care as a human right and govt is the perfect place to make sure that we are able to distribute that right to all people. Thats why we have govt, to centralize and streamline many issues for the society it serves.

If you leave it as a pay as you go, you will just have many that wont get any and you will have a 3rd world situation on health care.

Many people "demonize" the poor because many do not like forced charity through forced taxation and because many poor abuse the system. It probably would be better to move charity to the private sector except for maybe a small core group of the most needy and get rid of the "entitlement" attitude and political footballs. Socialism is an immoral answer to the problems.

NO mostly they do it cause its easier than taking the hard steps it would require to fix the corruption that is in our own govt and its also easier than taking responsiblity for the fact that its our fault that the govt became so corrupt in the first place.

Calling socialism immoral is odd and only a shows that there is a propaganda that you are buying into. Its no more immoral that a "free market". Each have their place and its a just a matter of placing them where they do the best and most good.

Who says we are not ALL paying right now? Except for the poor of course. Why should politicians have any say in our personal health care? Nevertheless, that's what happens with socialized medicine or universal health care or whatever you want to call it - as costs go up (and they will), services will get rationed.

Its not politicians who get a say in your health care. Its just the fact that we all pay for it on a national level. Its still the medical doctors and personal who determine care with the patient.

You keep saying costs will go up, yet all the other developed nations with socialized health care pay LESS per capita than the US does now.

Yes you can, when you control your own health care, you or your family can choose which clinic or doctor you wish to help you. If there is competition in a free market you can shop around and choose the best price and services. Or if it is a catastrophic event your insurance coverage would kick in to cover the big costs. Health care is basically like any other service you pay for. The better clinics and doctors are going to charge more, of course, because they provide better services and are in more demand. You get what you pay for - in a free market. If we revamped our system properly, there would be no good reason for anyone to lose their home or whatever. We don't need the government and the insurance companies telling us what to do.

Thats a fantasy that people can control costs with their "free market" choices.

Its not driven by demand, its driven by need only.

Sick people are not in a powerful position either.

Health care is driven by supply and demand just as any other service. Many would choose to use their money for alternative health care doctors to prevent getting sick. When you are sick you will go to the doctor who will give you the best value for your money. If it is catastrophic you would have your insurance to cover bigger costs, so I don't see the problem.

No you will choose from the ones in your area and you will find they arent that different nor are costs all that different.

The fact that you cling to the "supply and demand" argument for health care shows you have a hard time understanding its not the answer for everything nor what drives EVERYTHING. Health care is unique in that it is driven by a need, not supply.

Most wealthy people in America do not get their wealth from inheritance. Most get it by being industrious and making it on their own. We all have the right to life, liberty, and the pursuit of happiness in America. That does not mean, however, we have a right to a trip to Disneyland or a right to health care. If Americans must provide for a plethora of "rights" that socialists want, we will become serfs to the requirement to provide those things. It is not a right to impose a duty on others. In America you only have the right to pursue happiness, not to receive it.

Ok now you dont even understand where the majority of wealth comes from, its inherited. There are some who do make their own wealth, but the majority get it just like the current president did...by inheriting it.

The fact that you equate a trip to disney with health care only illustrates your complete lack of understanding of the health care issue.

An open market will bring down the cost of health care. In fact it is even happening in your own adopted country of Sweden. Their old socialized system failed. As more and more of their health system is privatized, costs are coming down and quality of care is better.

Already addressed this. I have told you that Swedens system is a mixture of both BUT its PAID for with tax money. If a person wants to open a private doctors office, they can! The money they recieve for giving services will come from the SAME source though...the govt. They are paid for as they deliver the same way a GOVT facility.

It hasnt changed anything in the realm of whats paid or the quality of service though...you seem to making huge leaps that show a misunderstanding of the system.

There is no way Americans are going to give up their cars. Believe me.

Well my point is that it can be done differently and make more options available. Just because you have mass transit dosent mean anyone is REQUIRED to give up their cars. It helps alleviate costs and helps those who cant afford or would rather spend elsewhere. Of course it also helps environment and our dependency on oil...all beneficial.

You don't seem to understand socialism. It's government controlling big business, not separating the two.

No I understand how its actually PRACTICED and am not so bogged down in labels and various peoples definitions. Nor am I so bogged down in the propaganda that pretends its evil for a society to determine to provide some things for itself on a national basis.

Not a false premise at all. We already provide food stamps and government housing to the poor. If they control our health care, who's to say what is next? The food industry is a big business - why not socialize it too? I'm sure many socialists would agree.

I have to repeat this again...anytime we design strictly for the poor we do a bad job and demonize it. Socializing medicine is not the same thing AT ALL. Health care as a business opens up huge problems and means that those with less money will get less and sometimes NO CARE and thats a pretty inhumane thing to endorse.

Oh wow, "free" health care and "free" day care and "free" college….nirvana on earth (sarcasm). Frankly, I'm not impressed nor interested.

They arent free, we pay for them as a nation. Its not nirvana, its a just a good way to do things and its helping the society on a whole which is why the society as a whole pays for it.

I never said the U.S. didn't have problems. We need to get rid of government and insurance interference. I'n afraid I must repeat that Sweden is adopting the free private market principles because they do work and they do apply to the health care industry.

No Sweden has always been a mixture of socialized and private. Its not new. The socialized side means its govt funded. Health care is govt funded. Its pretty easy to see that private clinics or offices can open and make a profit while abiding to the payment schedule (and regulations) of the govt just fine.

Medicare is not for the poor but for everyone over age 65. Medicaid is for the poor. Both programs are going broke.

Both have been subjected to a corrupt govt that pays corps tax money for the cash the corps pay our individiual govt representatives. Its the american people who lose there. It seems to me that the govt is MORE involved and tied to business than any socialized nation is. The difference being that the corps CONTROL the govt...not a good situation to have.

From what I understand the Swedish government is probably going to issue health vouchers next. That is better than most socialized medicine programs but you are still under the thumb of government control. You first pay the govt. money for your health care and then they "give" you your "free" health care. Right. That may be the system Sweden wants but in America it is not a moral solution.

NO health vouchers here and dont see any on the horizon. If you want elective surgery you would have to go and pay yourself (which you can). No need to "issue" anything, that would just be an extra cost. We are all covered for health care needs and its tracked through your personal number.

If we get rid of excessive govt regulation and insurance company managed health care and go with HSAs, people can keep their own money and spend it for the health care of their choice. If you take good care of yourself so you don't need to use a lot of health care you could possibly build up hundreds of thousands in your pre-tax HSAs over the years if you invested well. Later in life it would easily pay for your catastrophic premiums and any routine care you had. And then you get to keep the rest and spend it anyway you choose or even pass it on to your kids.

Uhm you need govt regulation so that people are not harmed or lied to...so that we can try to be safe from toxic products etc. Paying as you go is just not possible as I already stated, its just not a workable solution.

 

[ScreamingEagle]

Well people (even many middle class) simply cant afford to pay as they do and need some kind of system that will help equalize it out. You may have many stretches of time with no health care costs and then a stretch with high costs.

What you are really saying is that people are not capable of managing their health care costs on their own. I disagree. Today health costs are managed by other people than the individuals themselves and see where that got them. Costs can be managed well by individuals starting with HSAs when young and regularly putting money aside into their HSAs accounts plus by maintaining a catastrophic insurance plan. When people shop on their own they get choosy about what they buy and look for value. This will help eliminate a lot of the waste and padding in our system.

Its a luxury, its not an inherent need such as health care is.

Realistically cars are not a luxury in this day and age. For many, they have become an absolute necessity to function in today's world…at least here in the U.S.

I have a washer and dryer and the homes here all do BUT we like to provide one for all in our area for larger items as well as for use for those who dont have the washer and dryer. Strictly our choice. Yes we all have our own meters and pay our own power...we just voted on which company we would use.

I thought as much. Your situation is not any different than most condo complexes here in the U.S. Some have more involved management while others are less involved.

This dosent make sense really. Most developed countries currently run on a mixture of socialism and free markets.

Look at the results of the socialism "mix". I'd say there's a whole lot of orange and red there (high unemployment) where there is more socialism. The U.S. rate today is only about 4.5%. http://www.euractiv.com/29/images/Regional_Unemployment_2004_tcm29-146509.png

I see health care as a human right and govt is the perfect place to make sure that we are able to distribute that right to all people. Thats why we have govt, to centralize and streamline many issues for the society it serves.

"Human Rights" is a false battle cry of socialists. The real cry should be "Human Mass Control". Socialists have a whole list of supposed "rights" that they claim democracies are not providing, totally overlooking the fact that democracies are about the only form of government that actually support basic individual human rights in the first place. Socialism might sound all righteous, fair, and "equalizing" but in actuality it is a very destructive force because it forces everybody into becoming a serf to the system.

Our rights in America are very simply the right to life, liberty, and the pursuit of happiness (as well as the right to own property). There is no special right to health care. There is no right in our Constitution to take from one person to give to another (even though our bastardized tax and spend system does exactly that). Every person has the right to freely pursue his own life and to provide for himself. The entitlement mentality of socialism would destroy the principles of America. People would become serfs to the government as larger and larger amounts are taken from their paychecks. That is why it would be immoral to establish socialism in America - it flies in the face of our freedoms. We are taxed more than enough already. The more you become shackled with taxes, the less free you become and it lessens your ability to pursue your rights to life, liberty, and happiness.

Another reason socialized health care would be immoral is that it would destroy doctors and patients alike. As Ayn Rand wrote, doctors are not servants of their patients. They are "traders, like everyone else in a free society, and they should bear that title proudly, considering the crucial importance of the services they offer." Patients would suffer as doctors fled the socialized system for better jobs and as services were curtailed in an effort to prevent the inevitable overblown costs.

If you leave it as a pay as you go, you will just have many that wont get any and you will have a 3rd world situation on health care.

A person must begin when he starts working to save funds in his HSA account in order to "pay as you go". Part of his income must also be dedicated to buying catastrophic health insurance to prevent from going bankrupt if there was a major problem. People can manage to buy their houses and cars. There is no reason why they cannot manage their own health care. And nobody is going to look out for a person's health care better than oneself. Your health care in the control of government, employers, and insurance companies just does not make sense. As I mentioned before, Health Savings Accounts could become quite fat and more than adequate to cover routine health costs over one's lifetime as well as pay for the premiums for catastrophic insurance.

NO mostly they do it cause its easier than taking the hard steps it would require to fix the corruption that is in our own govt and its also easier than taking responsiblity for the fact that its our fault that the govt became so corrupt in the first place.

And so then you think MORE government and therefore MORE corruption is the answer?

Calling socialism immoral is odd and only a shows that there is a propaganda that you are buying into. Its no more immoral that a "free market". Each have their place and its a just a matter of placing them where they do the best and most good.

I already gave you my reasons for calling socialism immoral. It is not propaganda. Nowhere in our Constitution is it written that health care is a right. Both doctors and patients from countries with socialized medicine will tell you of the inherent problems. It's immoral to choose a system that not only destroys our freedom but also will not deliver the best medicine for the best price.

Its not politicians who get a say in your health care. Its just the fact that we all pay for it on a national level. Its still the medical doctors and personal who determine care with the patient.

When your health care is on a "national level" that definitely means politicians are in control. Control of your health care should be on the "individual level". Power to the people!

You keep saying costs will go up, yet all the other developed nations with socialized health care pay LESS per capita than the US does now.

That's because we have a corrupt system right now that has had a very negative effect on our free market. We need to get government and insurance companies and employers out of the business of running our health care. The control of health care needs to go back into the hands of patients(buyers) and their doctors/clinics(sellers).

Thats a fantasy that people can control costs with their "free market" choices.

Its not driven by demand, its driven by need only.

Sick people are not in a powerful position either.

It's more of a fantasy to think that the government is going to control costs.

Need creates demand. You need food too. That also creates a demand.

When you get sick you should already be in a powerful position to receive health care if you have been responsible.

No you will choose from the ones in your area and you will find they aren't that different nor are costs all that different.

For routine costs in a free market you could always shop around and change doctors/clinics anytime you wanted. You wouldn't have to belong to some HMO or limited "group" defined by your insurance company. For catastrophic events you would go probably to the hospital closest to you or one that you preferred.

The fact that you cling to the "supply and demand" argument for health care shows you have a hard time understanding its not the answer for everything nor what drives EVERYTHING. Health care is unique in that it is driven by a need, not supply.

Once again, health care is not unique in that it is a service just as any other service. More critical, yes, but still a service. Just because it is more critical does not mean it needs to be socialized. You need food too. And shelter. And clothing. Those things are all critical too and you pay for those things by yourself.

Ok now you dont even understand where the majority of wealth comes from, its inherited. There are some who do make their own wealth, but the majority get it just like the current president did...by inheriting it.

Not everybody - although I will admit a lot of wealthy people got started with help from their well-off parents. However many parlay that help into even more wealth. For instance, Bill Gates parents were well off professionals with probably less than a million and Bill went to private school and then to Harvard which he quit to become worth more than 55 billion. Not bad for starting a business in a garage. There are more millionaires being made in America all the time and many start with very little. America is still the land of opportunity because of our Constitutional freedoms.

The fact that you equate a trip to disney with health care only illustrates your complete lack of understanding of the health care issue.

You don't get it. There is no "right" to your health care. There is no "right" to your food. There is no "right" to your house. You must go out and work for it. No free rides in America, not even in Disneyland. If these things were "rights" and the government was supposed to supply them to everybody, why would anybody want to even work?

Already addressed this. I have told you that Swedens system is a mixture of both BUT its PAID for with tax money. If a person wants to open a private doctors office, they can! The money they recieve for giving services will come from the SAME source though...the govt. They are paid for as they deliver the same way a GOVT facility.

So Sweden now has a two-tier system, both government and private practice. The private sector however is providing better care at less cost. That is not the "same" way a GOVT. facility is delivering.

It hasnt changed anything in the realm of whats paid or the quality of service though...you seem to making huge leaps that show a misunderstanding of the system.

Well then fill me in. My understanding is the whole reason Sweden has been experimenting with privatization of health care is because socialized medicine costs are increasing and they want better performance such as shorter waiting periods. Privatization has been successful because costs have come down and waits are less. For example the average wait for heart surgery in the private sector is only 2 weeks compared with 15-25 weeks in the public sector. Stockholm’s experiment with privatization has proven the ability of the private sector to dramatically outperform the public sector by reducing costs, improving care and saving lives.

Well my point is that it can be done differently and make more options available. Just because you have mass transit dosent mean anyone is REQUIRED to give up their cars. It helps alleviate costs and helps those who cant afford or would rather spend elsewhere. Of course it also helps environment and our dependency on oil...all beneficial.

In my liberal city they keep pushing for mass transit trains and monorail systems that would be very expensive to build. And yet they keep pushing for them despite the fact that studies show that only a tiny percentage of the public would even use them - much like the buses. Very few Americans will give up their cars if they don't have to. Attempting to force mass transit usage would probably be the next step for these socialists. I guarantee there would be instant rebellion. Americans love their cars and trucks. Of course if gas becomes too expensive and people have to convert to those tiny two-seater European tin can death traps that get 60mpg maybe people would be willing to take mass transit instead...maybe

No I understand how its actually PRACTICED and am not so bogged down in labels and various peoples definitions. Nor am I so bogged down in the propaganda that pretends its evil for a society to determine to provide some things for itself on a national basis.

Sweden is moving toward privatization - that is why their health care is getting better. Not the other way around. And I am not bogged down in labels nor propaganda that is "pretending" it is evil to socialize medicine. It's been proven true time and again. In Sweden, in England, in Canada, in Russia, in Cuba, etc. Both doctors and patients suffer under socialized medicine. Sweden is actually proving the case for free market health care.

I have to repeat this again...anytime we design strictly for the poor we do a bad job and demonize it. Socializing medicine is not the same thing AT ALL. Health care as a business opens up huge problems and means that those with less money will get less and sometimes NO CARE and thats a pretty inhumane thing to endorse.

I think "demonize" is a bit much but whatever. Face it. Helping the poor with anything is a form of CHARITY…not some rational reason to reorganize the system for everybody else to include them. They would still be getting charity.

Why is it so hard for the government to dispense charity? For health or food or whatever, all they need to do is give out vouchers for what the poor person needs. Pretty simple really. The truth of the matter is that politicians do not really want to dispense government funds unless they get some kind of reward in return. Socialized anything is definitely a power trip for politicians.

They arent free, we pay for them as a nation. Its not nirvana, its a just a good way to do things and its helping the society on a whole which is why the society as a whole pays for it.

Will you choose to go to the public health care facilities in Sweden fifteen years from now? My money bets not.

No Sweden has always been a mixture of socialized and private. Its not new. The socialized side means its govt funded. Health care is govt funded. Its pretty easy to see that private clinics or offices can open and make a profit while abiding to the payment schedule (and regulations) of the govt just fine.

When the unemployment rates are high I can see clinics keeping to payment schedules. However if the economy improves and true competition kicks in some will want to raise their prices due to increased demand for their better services. If prices are artificially kept down then problems will develop. Problems always develop when a government tries to run the market.

Both have been subjected to a corrupt govt that pays corps tax money for the cash the corps pay our individiual govt representatives. Its the american people who lose there. It seems to me that the govt is MORE involved and tied to business than any socialized nation is. The difference being that the corps CONTROL the govt...not a good situation to have.

I agree. The government, employers, and insurance companies are all in bed together.

NO health vouchers here and dont see any on the horizon. If you want elective surgery you would have to go and pay yourself (which you can). No need to "issue" anything, that would just be an extra cost. We are all covered for health care needs and its tracked through your personal number.

Who determines whether a surgery is elective or not? Your doctor or the government?

Uhm you need govt regulation so that people are not harmed or lied to...so that we can try to be safe from toxic products etc. Paying as you go is just not possible as I already stated, its just not a workable solution.

Agreed, there is need for some, but not excessive government regulation. You keep saying pay as you go (for routine care) is not possible but I don't see any valid reason why that could not be a workable solution. We already pay for our health care one way or another, just not very efficiently. Putting our money into the government's hands would make things even more inefficient. Hillary recently unveiled her health plan - more of an insurance plan - that will cost the government $110 billion dollars a year - just for starters.

“If you liked Michael Moore’s ‘Sicko,’ you’re going to love HillaryCare 2.0,” said Katie Levinson, communications director for Republican presidential candidate Rudy Giuliani. “Sen. Clinton’s health care scheme includes more government mandates, expensive federal subsidies and more big bureaucracy — in short, a prescription for an increase in wait times, a decrease in patient care and tax hikes to pay for it all.”
http://www.cqpolitics.com/2007/09/hillary_rodham_clinton_unveils_1.html

 

[Ruby]

A few points.

First you are confused about private and public care in sweden. Private only means the health care facility is privately owned, the money they recieve still comes from the Swedish govt and is paid according to who they treat and with what (they get paid a set amount for each thing they do and they bill the govt for each patient). Private isnt working any better then the govt owned...they both operate and get paid the same way. The govt owned are still RUN BY HEALTH CARE PROFESSIONALS.

There is no reason to NOT allow private facilities, they are under the same scrutinization, get paid according to the same payment schedules and are subject to the same laws and regulations.

Second, your point that socialized medicine destroys doctors and patienst is false and this has BEEN proven with experience. Socialized systems have as many doctors to patient ratios as the US. The health situation in socialized systems is as good and better in some areas than in the US. If it were true that socialized medicine destroys doctors and patients this would be reflected in a shortage of doctors, in a less healthy populace (who are the patients sopposedly getting destroyed).

Third, you think govt automatically equals corruption. WRONG. It is a populace who determines how corrupt it will ALLOW its govt to be. Finland and the scandanavia region have done fairly well, far from perfect but you will not find the same high levels of corruption you find in the US or in some other nations. This says it CAN be done. I think Finland had one of the MOST honest in the world in fact. They are also pretty socialized in most areas, not just medical. It is not like some mathematical equation that more govt means more corruption...thats a very cynical and defeatist view of govt and EXACTLY what a corrupt govt would LOVE for you to believe...that way you wont bother to change what you think is IMPOSSIBLE to change.

And yes I will still be going to public health care facilities in Sweden.....You wouldnt be able to see a difference from the private to the public ones here nor would your process be any different...

The only health care any person would pay out of pocket for would be ELECTIVE surgeries such as cosmetic. Why would anyone PAY for it when they have already PAID for it in their taxes? Its not the nightmare you imagine nor are there such long horrendous waits as you portray. Nothing is perfect and I hope we keep seeking ways to improve and rural care needs improvements in all aspects but that isnt related to socialized care as much as its related to no one (not private or govt) wanting to spend the amount of money it takes to serve the few that live in rural areas.

In the US I waited 5 months for a simple surgery.....that was WITH good insurance. Lets not pretend those waits dont occur in the US, that would just be a lie.

 

[ScreamingEagle]

First you are confused about private and public care in sweden. Private only means the health care facility is privately owned, the money they recieve still comes from the Swedish govt and is paid according to who they treat and with what (they get paid a set amount for each thing they do and they bill the govt for each patient). Private isnt working any better then the govt owned...they both operate and get paid the same way. The govt owned are still RUN BY HEALTH CARE PROFESSIONALS.

There is no reason to NOT allow private facilities, they are under the same scrutinization, get paid according to the same payment schedules and are subject to the same laws and regulations.

First, despite what you claim, the private sector in Sweden IS doing things differently - they are working better and are having better results than the public sector in Sweden. Please look at the facts before you make baseless claims. Costs are less and wait times are shorter with the private services. Sweden has not made a complete changeover to private health care but certainly is moving in that direction.

A study conducted for the Stockholm government compared the costs of services in six medical specialties between physicians in 40 private practices and 20 public hospital outpatient clinics, and found the cost per consultation to be lower in private practice. For example:
--In ophthalmology, costs in the public sector were 28 percent higher.
--Among ear, nose and throat specialists, costs were 17 percent higher.
--In general surgery, internal medicine and dermatology, costs averaged 13 percent higher.

In addition, private nursing home costs have fallen 30 percent, and the costs of care among private specialists have been cut by 40 percent. Savings have been even more dramatic in the hospital sector. At St. Göran’s, costs for lab and X-ray services, for example, have fallen by 50 percent, and overall costs are down 30 percent. For many types of treatment, doctors in the private sector have reduced expenses to levels 15 percent lower than the same procedures would cost in the public sector.

One result of decentralizing and divorcing health care providers from bureaucratic control in Stockholm has been that private sector companies have been able to introduce simple, professional management structures that enable doctors to spend less time on paperwork and more time with patients. This change has, in turn, increased productivity in several key areas. Most importantly, it has drastically reduced waiting times for treatment by increasing the number of patients being served. For example, as the figure shows, at St. Göran’s:

--The average wait for heart surgery is two weeks, compared to 15 - 25 weeks in Sweden’s average public sector hospital.
--The average wait for hip replacement surgery is 10 weeks, compared to more than a year in the average public hospital.

No longer hampered by public system restraints, St. Göran’s is now treating an average of 100,000 more patients each year than it did as a public hospital - but using fewer resources. As a result of St. Göran’s success, the Council now has formal plans to sell all seven remaining public emergency hospitals in Stockholm to private investors.

Today in Stockholm, the trend toward privatization of all health services is accelerating. Emboldened by the experiment’s success, in 2000 the Council licensed 150 additional health care contractors to leave public ownership. By that same year, over 60 percent of the Council’s planned privatization of primary care had been completed. Altogether, when the second wave of privatization is complete, private general practitioners and other contractors will provide more than 40 percent of all health care services and 100 percent of primary care.

http://www.ncpa.org/pub/ba/ba369/

Second, your point that socialized medicine destroys doctors and patienst is false and this has BEEN proven with experience. Socialized systems have as many doctors to patient ratios as the US. The health situation in socialized systems is as good and better in some areas than in the US. If it were true that socialized medicine destroys doctors and patients this would be reflected in a shortage of doctors, in a less healthy populace (who are the patients supposedly getting destroyed).

Second, let's look at some more facts which prove the opposite of what you are saying.

Thousands of extra surgeons are going to be needed over the next few years to meet demand, a report warns. The Royal College of Surgeons (RCS) said there would be a 2,760 shortfall by 2010 because of early retirement and new working practices. The figure amounts to 50% of the current number of surgeons and takes into account surgeons who will graduate from training in the coming years. The study said action was needed now as it takes 10 years to train a surgeon. ... However, the government missed its target of increasing consultants [medical specialists which includes surgeons] by 7,500 by 2004. A Department of Health spokeswoman said the government was looking to increase the number of surgeons. "It is something we are working towards. We know we have more work to do here.
"It is extremely difficult to see how the government can meet its proposed 'patient journey' waiting list target of no more than 18 weeks if the NHS does not have enough surgeons to carry out operations.
http://news.bbc.co.uk/1/low/health/4265559.stm

"There are 17,000 deaths from the cancer in Britain each year and the five year survival rate for sufferers is just 40%, compared to 60% in America." Dr Lesley Walker, head of scientific information at the Cancer Research Campaign (CRC), said: "We're delighted that more lives are being saved from bowel cancer - thanks to better reporting and treatment of the disease. "But UK survival rates are still lagging behind those in the US and this shameful situation can only be changed with a greater investment in our health service." Earlier reporting by patients, along with better screening programmes and greater access to new treatments, are thought to account for the discrepancy.
http://news.bbc.co.uk/1/hi/health/546846.stm

Patients who have major surgery in Britain are four times more likely to die than those in America, according to a major new study.
The comparison of care, which reveals a sevenfold difference in mortality rates in one set of patients, concludes that hospital waiting lists, a shortage of specialists and competition for intensive care beds are to blame.
Fresh evidence of a stark contrast between the fate of patients on either side of the Atlantic will re-open the debate over whether NHS reforms are having any impact on survival rates.
http://observer.guardian.co.uk/nhs/story/0,1480,1036970,00.html

Third, you think govt automatically equals corruption. WRONG. It is a populace who determines how corrupt it will ALLOW its govt to be. Finland and the scandanavia region have done fairly well, far from perfect but you will not find the same high levels of corruption you find in the US or in some other nations. This says it CAN be done. I think Finland had one of the MOST honest in the world in fact. They are also pretty socialized in most areas, not just medical. It is not like some mathematical equation that more govt means more corruption...thats a very cynical and defeatist view of govt and EXACTLY what a corrupt govt would LOVE for you to believe...that way you wont bother to change what you think is IMPOSSIBLE to change.

Third, there is corruption in all systems. I think the American system is quite corrupt today. However I think government health care is for idiots. Government has never run anything well. Under a private system there is much better oversight that contains costs and maintains better delivery systems. We certainly need to improve our corrupted system here in America by reducing government and 3rd party involvement but as the FACTS prove, we definitely should NOT convert to socialized medicine which is demonstrably even worse than our broken system.

Let’s face it, the American system is rotten. It is not even a system. It is a hotch-potch. Most hospital provision is by not-for-profit, private hospitals. But the biggest buyer of medical care is the US government. Through Medicaid (for the poor) and Medicare (for the old) and other schemes, the government pays for 45 per cent of all healthcare. (The British assumption that American healthcare consists of an unfettered free market could not be more wrong.)

Most British people do not realise that the non-private hospitals in America are not run by the federal government. They are local government hospitals. The San Francisco General is run by the City of San Francisco. And another unexpected thing for Brits is that even in such local government hospitals treatment is not free to those who can afford it. (Incidentally, all sorts of American hospitals — especially the not-for-profit ones — receive large sums of cash from charitable benefactors.) And if you think all the above is confusing, that is hardly even the beginning of the bewildering diversity and contradictions of American healthcare. It is a muddle.

The British system was a muddle, too, until Aneurin Bevan came along in 1945. As minister of health, he set about unmuddling it. We, too, used to have local government (‘municipal&#8217 hospitals until he took them over. He took over the charitable hospitals too, like St Mary’s and Moorfields and many other famous ones. He made it not confusing at all. What could be simpler than the central government being in charge of everything? Over time, the government put itself in charge of all the doctors, too. So all was made simple and clear.

But the curious thing is that the new, improved, simple state system of Britain does not work as well as the American muddle. You have a better chance of living to see another day in the American mishmash non-system with its sweet pills of charity, its dose of municipal care and large injection of rampant capitalist supply (even despite the blanket of over-regulation) than in the British system where the state does everything. It is not that America is good at running healthcare. It is just that British state-run healthcare is so amazingly, achingly, miserably and mortally incompetent.

http://www.spectator.co.uk/archive/features/13221/die-in-britain-survive-in-the-us.thtml

 

[Ruby]

Two things on Swedens care.

You still fail to understand the mix of private and public. The private is not that people PAY FOR IT OUT OF THEIR POCKETS, the care is still paid for with tax money. It only means a private corp or private person can own and operate the facility and to do so at a profit (which can be done) they will have to run it efficiently because they are getting the same pay as public facilities do and its per service and per patient.

Secondly, how come the article you site dosent link to the actual swedish study. It seems to think I should just trust that the study says what they claim it does....why not also a include a link to the study directly since its using it as a source?

Now you are trying to say that "PROJECTED" facts are actual facts? I dont see that as a valid argument at all.

I think all systems need improvements BUT when socialized medicine is looked at in its overall sense and in the various nations its practiced in...it outperforms the US system and thats not PROJECTED facts, those are established facts in evidence.

I wonder how the US counts the cancer patients that dont even GET treatment...does it count them at all or does it only count the ones that are actually TREATED?

 

[ScreamingEagle]

Now you are trying to say that "PROJECTED" facts are actual facts? I dont see that as a valid argument at all.

What kind of nonsense statement is this? Projections are typically based on current findings. Specifically, what exactly is it you are freaking about?

I think all systems need improvements BUT when socialized medicine is looked at in its overall sense and in the various nations its practiced in...it outperforms the US system and thats not PROJECTED facts, those are established facts in evidence.

Overall socialized medicine results in long waiting lines, reduced care, and higher costs. Those facts are established in evidence.

I wonder how the US counts the cancer patients that dont even GET treatment...does it count them at all or does it only count the ones that are actually TREATED?

Yeah, I wonder too. What does this comment have to do with whether socialized medicine is good or bad? We already know the US system is totally messed up because of too much government, insurance company interference, and other reasons.

 

[ScreamingEagle]

Two things on Swedens care.

You still fail
to understand the mix of private and public. The private is not that people PAY FOR IT OUT OF THEIR POCKETS, the care is still paid for with tax money. It only means a private corp or private person can own and operate the facility and to do so at a profit (which can be done) they will have to run it efficiently because they are getting the same pay as public facilities do and its per service and per patient.

Secondly, how come the article you site dosent link to the actual swedish study. It seems to think I should just trust that the study says what they claim it does....why not also a include a link to the study directly since its using it as a source?

Here is another article on Sweden that is FULLY DOCUMENTED and provides links that you can peruse on your own. It was also written by a Ph.D. who is obviously qualified to write such an article.

It should further your understanding why the Swedish system and single-payer systems are NOT good -- despite the "mix" of private and public that you think makes the Swedish system so wonderful.

Sweden's Single-Payer Health System Provides a Warning to Other Nations
by David Hogberg, Ph.D.
May 2007

Sweden is a country of about 9.1 million people on the Scandinavian Peninsula of Northern Europe. Geographically, it is slightly larger than California. It is by any measure a first world country, with a labor force working primarily in industry or the service area, a GDP per capita of about $31,600 and an unemployment rate of 5.6 percent.1

For much of the 20th century, Sweden had a single-payer system of health care in which the government paid almost all health care costs. Like other nations with a single-payer system, Sweden has had to deal with the problem of ever-growing health care expenses causing a strain on government budgets. It has dealt with this problem by rationing health care - instituting waiting lists for medical appointments and surgery.

Sweden stands not merely as a warning about single-payer systems, but also as an example of what happens when market-based reform of such systems do not go far enough.

In the 1990s, Sweden set about reforming its health care system by introducing aspects of privatization. These reforms were limited, however, and the old problems with waiting lists and rising costs had re-emerged by the beginning of this decade.

The experience of Sweden demonstrates that when a nation adopts market-oriented reform for its health care system, the reforms will fail if the market is not permitted to work.


Structure

For much of the last fifty years Sweden has had a heavily socialized health care system. Almost all of the funding comes from government revenue, and most aspects of the health care system, such as hospitals, primary care centers and prescription drugs, are controlled by the government. Doctors could still have a private practice, although by the 1960s about 80 percent of doctors worked in government-run hospitals.2

The Swedish Parliament first tried to provide comprehensive national health insurance in 1946 with the passage of the National Health Insurance Act. Because of financial restraints, it was not actually implemented until 1955. Since that time, that national government has given increasing authority and responsibility for the health care system over to county governments (commonly known in Sweden as "county councils") to the point where they now have more power over the health care system than either the national or municipal governments. Nevertheless, the national government still plays an important role.

At the national level, the agency with the most authority over the health care system is the Ministry of Health and Social Affairs. It is responsible for ensuring that the health care system runs efficiently and supervises the health care activities of county councils. It also provides research and advice to the Swedish parliament on legislation and policy matters regarding health care. National legislation sets the goals and ground rules for the provision of health care in Sweden.

There are a number of boards and institutes at the national level that focus on health care, but they have little more than advisory or research roles. The three exceptions are the Medical Products Agency, the Pharmaceutical Benefits Boards and the National Corporation of Swedish Pharmacies. The Medical Products Agency regulates the manufacturing and sale of drugs and other medicinal products. Before a drug (including natural remedies) can be sold in Sweden, the Medical Products Agency must approve it. The Medical Products Agency also provides information about medicines and gives permission to conduct clinical trials.

The Pharmaceutical Benefits Boards is charged with deciding whether a drug is included in Sweden's pharmaceutical benefits scheme and setting the price. The primary factor that the Pharmaceutical Benefits Board considers when deciding whether to approve a drug is the drug's cost effectiveness. If the Pharmaceutical Benefits Board does not approve the drug, then people who use it will not be reimbursed by the government.

Also at the national level is a state monopoly known as the National Corporation of Swedish Pharmacies. It owns all of the pharmacies in Sweden, which enables it to maintain a countrywide distribution system. It runs both community and hospital pharmacies. It is responsible for supplying drugs at uniform prices throughout Sweden.

The next level of government in Sweden is the county councils, which are run by elected members.3 County councils are responsible for operating most of the health care delivery system, from primary care to hospital care.

County councils have complete authority over hospital structure in Sweden. Either an executive board or an elected hospital board at the county level determines the management structure of hospitals within its county. County councils have similar authority over primary health care centers, which differ from hospitals in that they are responsible for providing most outpatient care.

While physicians can practice privately in Sweden, county councils heavily regulate the establishments of new private physicians. They regulate the number of patients that private providers can see in a year. Private physicians must also have an agreement with the county council in order to get reimbursed by the government. If a physician does not have an agreement, then the patients will have to pay the full charge of the physician.

County councils also have the responsibility of providing dental care through the Public Dental Service. Dental care is also provided by private dentists.

Municipal governments are left with the responsibility of overseeing patients who have been discharged from a hospital and need public nursing homes or home care.


Financing

In 2004, Sweden spent about 9.1 percent of its gross domestic product (GDP) on health care, which is slightly above the average for nations that belong to the Organization of Economic Cooperation and Development.4 The largest share of funding for the Swedish health care system comes from taxes. Both county and municipal governments have broad authority to levy income taxes. Since 90 percent of county revenues are expended on health care, a breakdown of the sources of county revenue give a roughly accurate picture of the revenue sources for health care provided by county councils.5 In 2003, 72 percent of the revenues for county councils came from taxes, while 18 percent came from grants from the national government, three percent came from user-fees, and the remaining seven percent came from other sources.6 Municipal government generated about 69 percent of their revenues from local taxes in 2003, and 20 percent of their revenues are spent on health care.7

Patients in Sweden pay user fees (similar to co-payments in the United States) that are set by county councils. The fee for seeing a primary care physician varies from 11 to 17 kronas (the Swedish unit of currency; $1 U.S. equals about 6.90 kronas), while the fee for seeing a specialist ranges from 22 to 33 kronas. While county councils have discretion in setting user fees, the national government limits the amount of total user fees paid per patient at 100 kronas annually for physician and specialist visits. The maximum user fee for hospital care is nine kronas per day.

For prescription drugs, patients pay no more than 200 kronas annually. Payment for prescription drugs is set on a sliding scale, in which patients pay 100 percent of the first 100 kronas charged, 50 percent of the next 89 kronas, 25 percent of the next 178 kronas, and 10 percent of the next 111 kronas. After that, the state pays 100 percent of the cost for drugs.

County councils provide dental care without charge for patients under age 20. For the remainder of the population, the national government sets fixed subsidies for dental care, and patients must pay the difference between the subsidy and what the provider charges. Municipalities set the user fees for nursing homes and home health care, although the national government limits such user-fees to no more than 175 kronas per month.8

Private funding, beyond user fees, plays a small role in Swedish health care. Only about 2.3 percent of the population has supplementary health insurance, and the primary benefit of it is the ability to avoid waiting lists for treatment.9


Reform

During the 1990s, many county councils adopted market-oriented reforms of the health care system. This reform wave had its roots in an attempt in the 1980s to control the burgeoning cost of the Swedish health care system.

By the early 1980s, with an aging population and increasingly expensive health care technology, the system had become unsustainable. In a ten-year period from 1972-1982, the health care portion of Sweden's GDP grew from 7.2 percent to 9.3 percent (see Figure 1).10 Until 1985, the national government reimbursed county councils for health care expenses on a fee-for-service basis. The Dagmar Reform of 1985 changed the reimbursement formula to one of "capitation," in which counties were reimbursed for the number of patients served. This led to "global budgets" - a fixed amount that each county could spend annually on health care services.

Global budgeting would prove to have serious consequences for Sweden's health care system, most notably expanding waiting lists. Waiting lists for surgery and other procedures had long been a problem in Sweden. Like most government-run systems, the Swedish health care system was already plagued by declining productivity - a consequence of which included delays in care.11 Global budgeting, however, worsened the problem of waiting lists. With county councils now operating with fixed budgets and citizens facing few restraints on demand for health care, county councils needed to ration health care services. An increase in wait times was the result. By 1988 the wait time for an angiogram - a heart X-ray - was up to eleven months. The wait time for bypass surgery could be an additional eight months.12

Although the Dagmar Reform had some success in containing health care costs, the rationing that resulted from it led to public outcry over waiting lists that grew throughout the late 1980s and early 1990s. During the 1990s, the national government shifted responsibility for funding of health care to county councils but also gave counties more freedom to structure health care delivery. This led to a number of market-oriented experiments by county councils. Of all counties, Stockholm County engaged in the most aggressive reform regimen.13 Under this reform, which became known as the "Stockholm Model," the county council still provided the funding, but health care providers could be owned by private individuals or companies. The initial results were impressive. Stockholm County encouraged doctors, nurses and private companies to take over the operation of primary health care centers. Over 60 percent of primary care centers were run privately by 2002. Costs declined, particularly for laboratory services, which dropped by 30 percent. Stockholm also privatized one of its seven hospitals, St. George's. St. George's Hospital began running a profit in 1994, and 90 percent of patients were satisfied with the care they received there.

Other county councils followed suit and initiated a purchaser-provider split, in which the government would continue to pay for health care, but the provider would become a private entity. The county council would contract services out to primary health care centers and other private providers. Providers would be paid on a "per-case" basis, and, thus the provider would be able to make a profit based on his ability to attract patients while also holding down costs. Additional reform at the national level created circumstances in which a patient could go to any hospital of his choice, even one in another county. This reform was the Patient Choice and Guarantee of 1992, which required patients to be treated within three months of diagnosis. According to Swedish economist Ragnar Lofgren, "The logic behind this reform was to let the money follow the patient. This approach would give hospitals and doctors a strong incentive to increase efficiency in order to attract patients from outside their hospital's catchment area and avoid losing patients to other hospitals."14 These reforms at the national and county levels had some early success. Waiting lists dropped by over 20 percent from early 1992 to late 1993. Furthermore, health care expenses did not increase, as health care as a percent of GDP held steady during the 1990s.

Unfortunately, waiting lists began to increase in 1994 and in late 1996 the Patient Choice and Guarantee was abandoned.15 By the early part of this decade, most counties once again faced a problem with waiting lists.16

Worse still, costs have clearly been on the rise again, as demonstrated in Figure 1. Part of the recurrence of these problems stems from the purchaser-provider split, or lack of one. First, a majority of county councils did not implement a provider-purchaser split based on a per-case payment basis or did so only partially.17 Thus, there was not sufficient pressure on providers to attract patients for fear of losing funding. Second, the split was weak to begin with. As one study of the split policy noted, the contracts between purchasers and providers often amounted to little more than "letters of intent," and the "escape route back to traditional planning and management was always open to the central county-council administration."18

Another problem was that although patients were free to choose which hospital in which they could get treatment, there were few penalties on providers that failed to attract patients. For example, in Stockholm, the county council did not permit any emergency hospital - public or private - from shutting down. Additionally, market-reform initiatives were vulnerable to the whims of politicians. In 2004, the left-leaning Social Democratic coalition, which controlled parliament, banned the privatization of hospitals and forbad the practice of private patients buying their way past waiting lists.19

One of the underpinnings of any successful market is that entities that do not adequately satisfy consumers eventually go out off business. The greatest failing of the market- oriented reform of the Swedish health care system is that they did not permit private providers to, in essence, "fail." As a result, one of the hallmarks of single-payer systems, waiting lists, are again plaguing the Swedish patients.


Waiting Lists

Görann Persson had to wait eight months during 2003 and 2004 for a hip replacement operation. Persson was not considered to be a very pleasant person to begin with, and he became even grumpier due to the pain he endured while waiting for his operation. As a result, Persson walked with a limp, reportedly used strong pain medication and had to reduce his workload.20

What made Persson unique was not his wait for hip surgery. Despite the government promise that no one should have to wait more than three months for surgery, 60 percent of hip replacement patients waited longer than three months in 2003 (see Figure 2).21 Rather, Persson stood out because he was Prime Minister of Sweden at the time. Persson could surely have used his position in the government to gain access to private care, essentially jumping the waiting list. Yet Persson stated that he planned on waiting for his surgery like everyone else.

Whether Prime Minister Persson did this out of benevolent motives is an open question. His party, the Social Democrats, have used the phrase "equal access to health care" to attack the center-right parties on the issue of health care for many years. Persson would have greatly undermined the effectiveness of that attack had he jumped the waiting list.

In practice, the political notion of "equal access" actually means "restricted access." Swedes who do not have private insurance must wait, often for months, for treatment. For all Swedes who needed an operation in 2003, slightly more than half waited more than three months (see Figure 2).22 The situation continues. Moreover, patients often wait in great pain and distress.

Researchers studying Swedes waiting for hip or knee replacement concluded that "almost every aspect of daily life is affected by the indeterminate wait for surgery and the related experiences of pain and disability. The respondents express a deep sense of lost dignity, powerlessness and frustration."23 One patient complained that the pain had gotten so bad that she "had no quality of life." "I can't participate in anything," she said. "I can't go for a walk, I can't do anything, so why on earth do I need to wake up in the morning!"24 Depression and hopelessness were other common symptoms. Another patient complained, "I feel as though I've lost my human dignity. You get depressed and fed up with the pain. Still I try to be patient. But you lose the desire (to live)." She further complained of her treatment by the clinic where her surgery was to take place. "I felt so neglected, you get treated, yes, worse than an animal because you can take an animal to the veterinary... I feel so powerless."25

Pain and anxiety are also common problems for Swedish heart patients waiting for surgery. One study found that more than half of patients waiting for heart surgery experience chest pain daily, and longer wait times were associated with increased nervousness.26 Another study found that 88 percent of patients waiting for heart surgery reported chest pains that limited their daily activities. It also found symptoms of anxiety and depression to be strongly associated with the pain.27

While rationing may permit the government to save on costs and thereby restrain health care budgets, putting patients on waiting lists is not cost-free. One study that examined over 1,400 Swedes on a waiting list for cataract surgery found that 5.2 million kronas were spent on hospital stays and home health care for patients waiting for surgery.28 That was the equivalent of what it would have cost to give 800 patients cataract surgery.

A recent study that examined over 5,800 Swedish patients on a wait list for heart surgery found that the long wait has consequences far worse than pain, anxiety or monetary cost.29 In this study, the median wait time was found to be 55 days. While on the waiting list, 77 patients died. The authors' statistical analysis led them to conclude that the "risk of death increases significantly with waiting time."30 Another study found a mean wait time of 55 days for heart surgery in Sweden and a similar rate of mortality for those on the waiting list.31 Finally, a study in the Swedish medical journal Lakartidningen found that reducing waiting times reduced the heart surgery mortality rate from seven percent to just under three percent.32

Sweden is one of several nations whose practices offer proof that single-payer health care systems lead to the proliferation of waiting lists. It also shows that waiting lists have adverse and sometimes tragic consequences for patients.


Conclusion

While Sweden is a first world country, its health care system - at least in regards to access - is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients' anxiety, pain and risk of death.

Sweden's health care system offers two lessons for the policymakers of the United States. The first is that a single-payer system is not the answer to the problems faced as Americans. Sweden's system does not hold down costs and results in rationing of care. The second lesson is that market-oriented reforms must permit the market to work. Specifically, government should not protect health care providers that fail to provide patients with a quality service from going out of business.

When the United States chooses to reform its health care system, reform should lead to improvement. Reforming along the lines of Sweden would only make our system worse.

http://www.nationalcenter.org/NPA555_Sweden_Health_Care.html

 

[Ruby]

Here is another article on Sweden that is FULLY DOCUMENTED and provides links that you can peruse on your own. It was also written by a Ph.D. who is obviously qualified to write such an article.

It should further your understanding why the Swedish system and single-payer systems are NOT good -- despite the "mix" of private and public that you think makes the Swedish system so wonderful.

I think you better go check the sources for that article. It seems the article TRIED in many areas to spin things. For instance if you look at this source it gives...

http://www.socialstyrelsen.se/NR/rdonlyres/1DA644DE-5036-43C5-A186-3DC31171F021/2519/summary.pdf

It actually gives a pretty POSITIVE outlook but also tries to look for areas to improve as well as natural problems ALL nations are facing and how best to set plans to deal with inevitable issues (such as longer lifespans and negative birth rates etc).

A few of the sources, werent available any longer so I couldnt say much about those sources.

For instance, the claim that we have such long waits for surgery gives a source of the washington post! Its not available and I have NO IDEA what source that paper used nor if its credible. Surely if that were the case, an in depth swedish study like the PDF file given above would have identified that as a problem. In fact in this source says that the shortest wait times were for cardiac care which is in OPPOSITION to what you article is trying to state. I guess we are cherry picking info out of various sources and all the sudden the more in depth study information is ignored in favor of a newspaper article we dont have the source for.....gee no spin there! ROFL!

The average wait was 3 months for surgery, *shorter for cardiace* and this is in direct conflict with what your own article states..odd that huh?

In fact according to this source, there is ongoing improvement in health care despite gloomy economic projections *since gloomy economic projections should impact health care delivery in a negative way it is NOT HAPPENING".

Sorry your spin article was easily easily DEBUNKED, YOU should have checked the sources a bit more thoroughly and you would have seen this rather quickly. My guess is YOU ASSUMED that since there were sources that it would automatically be all believed and the spin would be harder to detect....you were wrong to assume that.

BTW, the author is also wrong about what is paid out to see a doctor. We dont pay 11 to 17 kronor...we pay 140 kronor so in the first paragraphs there was some faulty info. Specialist also dont cost more...more faulty info. It may be a small detail but when the article starts out with incorrect info it is pretty telling.

There were more than one source that is no longer available as well...but again it dosent matter, it was easy to see the spin job applied with the ones that were available.

It was also a VERY ridiculous statement to say that Swedens health care third world...that was SO OVER THE TOP its just ridiculous. Its overall care was rated ahead of the US and still spends less per capita than the US...those are facts. I also know because I am in the system and use it, its not even CLOSE to third world medical care.

 

[Ruby]

BTW, your link....its a think tank who is devoted to a particular outcome and are designed to spin things in that direction. From your link...

The National Center for Public Policy Research is a communications and research foundation supportive of a strong national defense and dedicated to providing free market solutions to today's public policy problems. We believe that the principles of a free market, individual liberty and personal responsibility provide the greatest hope for meeting the challenges facing America in the 21st century.

No matter what, their conclusions are going to coincide with the above...FREE MARKETS and they would NEVER advocate for socialized medicine...which of course explains why they ignored information that didnt fit in with their agenda and sited some washington post article without naming the source the post used. Its odd though, cause they already had a credible in depth study they were using as a source that REFUTED the information sopposedly found in the washington post.

 

[Ruby]

BTW, some interesting info on your thinktank (which is a townhall member btw)

http://www.sourcewatch.org/index.php?title=National_Center_for_Public_Policy_Research

NCPPR's projects include Project 21, a conservative African American organization that opposes affirmative action and the minimum wage and has issued news releases in support of genetically modified foods. Project 21 has been funded by R.J. Reynolds, and it has lobbied in support of tobacco industry interests, opposing FDA regulation of the industry, excise taxes and other government policies to reduce tobacco use.

These are not people who are concerned about our health or our health care! No wonder they played so fast and loose with facts and spin!!!

If this is the best you can do, you really should just give up, its just getting humorous now.

and this...

http://sfgate.com/cgi-bin/article.cgi?f=/examiner/a/1998/02/08/NEWS3642.dtl

Amy Moritz Ridenour, president of the National Center for Public Policy Research, says that emotional pitches get results, and insists that would-be donors don't want the details.

Thats what the spokesman for your thinktank said! LOL!! Precious, really it is.

 

[ScreamingEagle]

I think you better go check the sources for that article. It seems the article TRIED in many areas to spin things. For instance if you look at this source it gives...

http://www.socialstyrelsen.se/NR/rdonlyres/1DA644DE-5036-43C5-A186-3DC31171F021/2519/summary.pdf

It actually gives a pretty POSITIVE outlook but also tries to look for areas to improve as well as natural problems ALL nations are facing and how best to set plans to deal with inevitable issues (such as longer lifespans and negative birth rates etc).

A few of the sources, werent available any longer so I couldnt say much about those sources.

For instance, the claim that we have such long waits for surgery gives a source of the washington post! Its not available and I have NO IDEA what source that paper used nor if its credible. Surely if that were the case, an in depth swedish study like the PDF file given above would have identified that as a problem. In fact in this source says that the shortest wait times were for cardiac care which is in OPPOSITION to what you article is trying to state. I guess we are cherry picking info out of various sources and all the sudden the more in depth study information is ignored in favor of a newspaper article we dont have the source for.....gee no spin there! ROFL!

The average wait was 3 months for surgery, *shorter for cardiace* and this is in direct conflict with what your own article states..odd that huh?

In fact according to this source, there is ongoing improvement in health care despite gloomy economic projections *since gloomy economic projections should impact health care delivery in a negative way it is NOT HAPPENING".

Sorry your spin article was easily easily DEBUNKED, YOU should have checked the sources a bit more thoroughly and you would have seen this rather quickly. My guess is YOU ASSUMED that since there were sources that it would automatically be all believed and the spin would be harder to detect....you were wrong to assume that.

BTW, the author is also wrong about what is paid out to see a doctor. We dont pay 11 to 17 kronor...we pay 140 kronor so in the first paragraphs there was some faulty info. Specialist also dont cost more...more faulty info. It may be a small detail but when the article starts out with incorrect info it is pretty telling.

There were more than one source that is no longer available as well...but again it dosent matter, it was easy to see the spin job applied with the ones that were available.

It was also a VERY ridiculous statement to say that Swedens health care third world...that was SO OVER THE TOP its just ridiculous. Its overall care was rated ahead of the US and still spends less per capita than the US...those are facts. I also know because I am in the system and use it, its not even CLOSE to third world medical care.

I'm afraid you've been reduced to kicking the tires (no, the spare tire) of my argument.

You claim you've "debunked" my argument based upon 1)a positive outlook despite the economic slowdown of Sweden 2) that long waits were not mentioned in a particular article 3) you claim one study says that cardiac waits are shorter than other surgeries (duh! that's obvious) as if that is the issue, when actually the article was saying the mean wait in Sweden is 55 days for heart surgery and that speeding up that time frame would save lives - that is hardly "spin" as you claim 4) If the study said the "average wait was 3 months for surgery, *shorter for cardiace*" then how could the article be in "direct conflict" when it said the mean wait for heart surgery was 55 days? I believe 55 days is shorter than 90 days? 5) you're squeamish about one report on long waits written by the Washington Post

And those are your big reasons for "debunking" my article? LOL

And yes, IMO (and obviously the doctor's) compared to US health care, if you got to wait two months to get heart surgery when you might otherwise die, your health care in Sweden could certainly be considered "third world" in that respect.

Also, just because you don't like the political stances of a sub-organization project does not mean the argument itself is incorrect. If anything was humorous, that particular reason for "debunking" the article certainly was.

 

[Ruby]

I'm afraid you've been reduced to kicking the tires (no, the spare tire) of my argument.

You claim you've "debunked" my argument based upon 1)a positive outlook despite the economic slowdown of Sweden 2) that long waits were not mentioned in a particular article 3) you claim one study says that cardiac waits are shorter than other surgeries (duh! that's obvious) as if that is the issue, when actually the article was saying the mean wait in Sweden is 55 days for heart surgery and that speeding up that time frame would save lives - that is hardly "spin" as you claim 4) If the study said the "average wait was 3 months for surgery, *shorter for cardiace*" then how could the article be in "direct conflict" when it said the mean wait for heart surgery was 55 days? I believe 55 days is shorter than 90 days? 5) you're squeamish about one report on long waits written by the Washington Post

And those are your big reasons for "debunking" my article? LOL

And yes, IMO (and obviously the doctor's) compared to US health care, if you got to wait two months to get heart surgery when you might otherwise die, your health care in Sweden could certainly be considered "third world" in that respect.

Also, just because you don't like the political stances of a sub-organization project does not mean the argument itself is incorrect. If anything was humorous, that particular reason for "debunking" the article certainly was.

No it was debunked because it tried to use information from one source while another source (the better one) contradicted the info they chose to use...its called cherry picking and NOT bothering to care which info is actually more accurate.

Secondly, you chose a source who has a POSITION before it even starts. Its not a fact finding mission, its on a political mission and only ONE outcome is acceptable and information will be used or discarded on that basis.

Its not the positions of the sub-organization either, its them themselves! They directly used very immoral tactics to get money from the elderly and were quick to say that people didnt WANT facts...secondly it is their own mission statement that says they are DEDICATED to free markets and private markets which means they wont EVER take an objective look at an issue...they will simply spin in whatever ways they need to to arrive at the conclusions that meet their PRE-DETERMINED agenda.

Its also pretty over the top to say that Sweden has 3rd world heallth care dont ya think? I mean thats pretty stupid right there and shoots their credibility in the ass, then they seemed to have trouble getting BASIC information correct such as what people pay to see a doctor or specialist. That cant possibly be hard information to get, yet they couldnt get it right.