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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What is the current retirement age in these countries? Betcha it’s under 65
At least with single payer you can try to design something more efficient. The US has a single payer hospice system, or close enough. It is far superior in quality to the Canadian one and saves the US money by rationing while providing extra needed services. I’m in a part of Canada said to have hospice care among the best, but only the inpatient care can compare with what is available to all in the US. And it and doesn’t even exclude any provider from doing any expensive futile care, so is not available to all because it’s just considered an added expense. (But we’re all entitled to euthanasia!)
The real question is how to make rationing palatable. Maybe it’s time for us boomers to give a hoot about the young and their future and accept our mortality.
My humble approach would be to expand the US hospice idea. If you decline all future ICU care you get some of the extra bennies many frail people need, precisely the people who don’t do well in ICU anyway. You could probably also exclude all incidental finding surveillance, drugs and procedures with NNT under X…, I’m sure there’s more. Just put US geriatricians and pall care doctors in charge and I’m sure they’d come up with a good system of details. Maybe people would live longer.
NNT over X that is
LOL yeah Lance, that’s really what I was trying to demonstrate – we are screwed and getting more worser…☘️ I think this is a problem that only Guinness will solve today.
Just a note on this, Pat:
The point being made in the quotes is that it is difficult to fund the medical system because of the increasing numbers of elderly and retired (high-medical-need non-tax-payers) and decreasing number of young and working (low-medical-need taxpayers), but isn’t that exactly what we have now in the US?
We have nearly-free medical care for the older and disabled (Medicare does require a small monthly premium), who, by definition, can’t pay for it, and who are increasing in numbers, while we have no system at all to provide care for those who are both younger and employed, and who are decreasing in numbers.
So we already have what the Finns are dealing with, only without the nicety of providing coverage for the younger employed people who use very little care anyway.
I’m not saying that I have the answer – just pointing out that we’ve already painted ourselves into the corner of having the worst of all of these situations, with the sickest and least able to pay receiving free care, while those easiest to cover are taxed (flat-out taxed: my real estate tax bill breaks down how much (most of it) goes to the state for Medicaid) to pay for it, but receive “un gotz” (actually: “un cazzo,” meaning “Dick.”) in return.