If Finland Can’t Get It Done …? by Pat Conrad MD

Often the rationale for universal, state-run health care is that of course it can be done because so many developed countries provide it.  Opponents counter this might be due to a number of those European nations having smaller, more homogenized populations.  We often regard those Scandinavian states as such, and so completely different from ours as to make the comparison unworkable.

Well not so fast.  In fact, we might learn from a Scandinavian experience that has been running into some of our same challenges in the west.  “Finland’s coalition government resigned on Friday a month ahead of a general election, saying it could not deliver on a healthcare reform package that is widely seen as crucial to securing long-term government finances.”  The Finns are encountering those same intractable problems of increasing longevity and rising costs, the math that has been pulling the rug out from under such systems for some time.  Their prime minister noted in his resignation that, “We need reforms, there is no other way for Finland to succeed.”  Those reforms? 

The coalition government put forward a plan to reduce health care spending by 15% over the next decade. They hoped to do so by consolidating the number of health care districts from 295 municipalities to “18 elected regional authorities.”  The prime minister also hoped to make available a greater array of public and private options, whatever that may mean.  It might be a real trick, given that Finnish doctors were already paid on the lower end when the system appeared to be working well.  So if real austerity measures must be taken, it’s tough to put the crosshairs there.

“As an increasing number of people live longer in retirement, the cost of providing pension and healthcare benefits can rise. Those increased costs are paid for by taxes collected from of the working-age population – who make up a smaller percentage of the population than in decades past.”  Sweden is trying to raise the retirement age and further privatize some parts of their system.  Denmark also seeks to raise its retirement age, as well as cutting taxes and reducing unemployment benefits in order to encourage more people to work.  As they are here, these will be tough political sells.

Some of this site’s regular readers are sincere supporters of single-payer care.  So without harangue, I ask you honestly:  how would you construct a single-payer system that could avoid these twin pitfalls of rising longevity and rising costs?  If it no longer works in Scandinavia, why will it work here?

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