By James McCusker Herald Columnist
Robert Frank believes that when it comes to health care systems we could learn a lot from Sweden. He is probably right, but exactly what we should learn isn’t immediately clear.
Professor Frank is an economist who teaches at Cornell University’s Johnson Graduate School of Management in Ithaca, N.Y. (and no relation of Herald City Editor Robert Frank). He is also the author of “The Winner-Take-All Society,” far and away the best and most readable analysis of how income distribution got so lopsided in our country.
In a recent essay he described the Swedish health care system as more efficient — and, of course, it is. Based on measureable outcomes such as life expectancy and infant mortality the system in Sweden outperforms ours. Moreover, its annual cost per person less than half of what it is in our country.
Based on Frank’s accurate description, we wouldn’t need a free chicken dinner and a compulsory sales presentation to buy in. Our first reaction is, “Where do we sign?” How could we possibly pass up a chance to get a better system at half the cost?
The truth is that he might be right, and the Swedish system might work here — but as the line in the Randy Newman song goes, “I don’t think so.”
We cannot simply import and install the Swedish system transmitting it to everyone’s computer like the latest Windows software update. Somebody would have to sit down and design a U.S. system that had all of the key characteristics of the Swedish model. We’ve already seen what a bull-headed, read-it-later, majority political party can do with health care design, but let’s assume that we won’t do it that way again.
The first problem for a designer involves “scalability.” taking a prototype or small system and expanding it into a big one.
As so many private businesses, government agencies, and the U.S. military have found out, expanding a small, successful operation into a large, successful one isn’t as easy as it is on a spread sheet. And, compared with our needs, the Swedish system is quite small. Their total population is less than half the size of the TV audience in the New York City metropolitan area.
Our two populations have some very different characteristics, also. Until recent changes in immigration policies, for example, Sweden had a textbook example of a homogeneous population where everyone was native-born and shared a common culture, language and economic system. By comparison, in most American cities an average classroom looks like a U.N. General Assembly photo-op.
Swedes are, on average, healthier than we are, too. Our self-indulgent ways have all too visibly affected our diet, our shape and our health.
We are a nation of immigrants and take pride in that, despite the problems that come with it. We are also, though, a nation of complainers, protesters, and litigants and each of these characteristics has shaped our current medical system and its costs. More importantly, they are likely to continue to influence any system we adopt, including Obamacare.
Our characteristic lack of acceptance of things as they are has been a major factor in our nation’s founding and is a continuing influence on our inventiveness, entrepreneurial spirit, and economic growth. Fitting this into a Swedish-style health care system, though, won’t be easy.
One thing that we have gotten used to, also, is leadership in health care. The U.S. system, with all of its excesses, has been responsible for the lion’s share of medical discoveries and developments that have transformed miraculous cures into everyday occurrences.
It is much more difficult for a single-payer system — what used to be called socialized medicine — to develop, harness and focus the resources that nourish productivity and innovation. These things need the inquiring and unaccepting minds that government bureaucracies actively or passively discourage.
Whether Americans will accept the surrender of our leadership role and a much slower pace of medical progress in exchange for a health care system that promises lower costs is a question that only the future can answer. Given our past behavior, though, it doesn’t seem likely.
Frank has certainly identified a key element in the economic success of the Swedish system: Virtually all doctors are hospital employees. As employees in the U.S. then, physicians would presumably be just like the workers surveyed in the recent Gallup poll, in which 70 percent are either “going through the motions” or “actively disengaged” at work. Now, there’s something to look forward to the next time you’re sick.
Despite all the problems with importing the Swedish health care system to the U.S., Frank is still right. We can learn a lot from them about medical services delivery and shouldn’t simply accept either our current system or Obamacare as they are.
James McCusker is a Bothell economist, educator and consultant. He also writes a monthly column for the Herald Business Journal.