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http://news.yahoo.com/nordic-welfare...052604736.html
One line from the article "In Sweden, visitors are sometimes surprised to learn about year-long waiting times for cancer patients, rioting in low-income suburbs and train derailments amid lagging infrastructure investment."
I thought that this article would be interesting after all the discussion we have had here about welfare, right to healthcare etc. from an area that has been held up as a model of cradle to grave care by many here.
I'm glad our trains only blow up and don't derail or anything, derailing would be bad. Only seriously, do trains in Sweden derail more often (taking into account number of trains, milage etc.) than trains in the U.S. and elsewhere? I don't know. You hear stories of trains derailing sometimes here. Because the article doesn't say so it reads like sensationalism: "and what is more a train derailed!"
As for riots that's neither here nor there, it doesn't tell you anything about how bad things are. Avoid rioting by having the largest prison population in the world maybe that's a better model ....
I don't think you're likely to learn much about Sweden from a yahoo news article which reads as very biased. How would you learn? Basically Swedish papers and the like I guess. Possibly following Swedish commentators especially on Twitter and so on. Unless your able to visit Sweden for awhile I guess.
Aren't some of these countries moving forward fairly rapidly in green power? (despite their "lagging infrastructure investment").
Seeing no data or sources cited behind the any of claims at the link, I don't believe the "year long waiting period for cancer patients" (actually, I don't believe any of what's written there). I am a cancer patient, and every single practitioner I spoke with urged me to move forward on treatment, even when I was considering waiting due to lousy insurance. I do not believe there's a physician on the planet who would tolerate this kind of wait, nor do I believe that there is a health care system that would do so, because of the exponential increases in treatment costs with waiting.
Don't believe everything you read on the Interwebs.
I think you're right, there is no year long wait in Sweden......not anymore. According to a report by the British Columbia Medical Association, in 2003, as an effort to deal with the long waits, a national guarantee of no longer than 6 months was instituted.Quote:
Originally Posted by redfox
See the linked report for info on wait times in various countries: http://www.bcma.org/files/waiting_too_long.pdf
Quote:
In 1996 a revised guarantee was introduced that focused on setting maximum wait times for first contact with GPs and outpatient visits to specialists. Then in 2003, a new national treatment guarantee was agreed to. The guarantee is based on the “0-7-90-90” rule, meaning instant contact with the health care system, seeing a GP within 7 days, consulting a specialist within 90 days and waiting no more than 90 days after being diagnosed to get treatment.
When DW was diagnosed the surgery to remove her melanoma was scheduled for two days after the lab results came back. Here in the USA. That is an acceptable waiting period.
what is interesting is that it is very difficult to find up to date Statistics from reliable sources. Alan, your link was to a report from 2006, with the research done years before, and a lot has happened since then globally. One thing I learned was that even in many countries people that can afford it buy private health insurance too and wait times were often cited. Current wait times were difficult to find. There is a lot of unrest all around the world, with article after article of the worker bees questioning the money that is going to benefits even in the most generous countries, just like here, as well as more money going to the few at the top.
Despite the money that we have to pay for insurance, I for one know that my experience has been like Gregg's. DH had his melanoma surgery a few days after detection and has subsequent surgeries very timely. I had some odd symptoms last friday, x-ray on my MD visit Monday showed something suspicious and I am scheduled for further testing tomorrow. the MD even called me at home about some results from blood work that are already back. I feel very lucky I was able to get in and there was no hesitation about ordering the testing which my insurance company immediately approved.I can't imagine how agonizing it would be to wait even weeks to get testing and diagnosis.
I think most developed countries are suffering from the same general things. People are living longer, requiring more years of pensions, social security and healthcare. Many countries have had lower wages with jobs outsourced and also more unemployment. Many countries have a low birthrate with fewer young to support the aging population. When times are good, you have to keep up your infrastructure, work on things like energy and save for the bad times so you can meet your obligations to your citizens. that is not always the case.
In the U.S., 49 million people do not have insurance, and many more that had not great insurance could not afford $20K in deductibles for elective surgery, so I would think that would cut down the competition and wait times for doctors.
In the U.S. because of the high cost of medical care, unnecessary surgeries are more of an issue for the well insured rather than long wait times. One of my kids got multiple opinions on a foot injury. One doctor wanted to to major surgery when a different doctor showed him simply how to wrap it to prevent further injury. I had a dentist tell me I needed to have surgery to rebuild my jaw followed by years of braces for a chipped tooth because it was a sign my bite was off. I went to a different dentist, who put some bonding thingie on my tooth. It looks perfect and I have had no issues for over a decade.
You're right, I didn't find any up-to-date stats although I found it interesting in the material I did find that wait times were so long in some countries, and specifically in the country you were challenged on, that the government took great pains over a period of years to bring wait times down to a maximum of 6 months.Quote:
Originally Posted by flowerseverywhere
Now, I haven't had any personal experience with cancer, although 2 years ago an abnormal EKG suggested that I was on the verge of heart failure. This was discovered at 5pm in the afternoon, I was seen by a cardiologist at 8am the next morning and had a stent installed in the left, descending, anterior artery, commonly known as the "widowmaker" at 2pm. In less than 24 hours I was seen, referred, diagnosed and repaired. I'm not at all sure I could have survived Sweden's 0-7-90-90 guarantee. When I hear folks rave about the "superior", state run medical systems in other countries I can't help but thank goodness for the inferior care we've traditionally been stuck with in our free market system.
I think most international reports on health care look at a wide variety of metrics such as overall costs, percent of GDP spent on health care, infant mortality, life span and percent of population insured, not just wait times for elective surgeries for a particular segment of the population that has above average group health insurance coverage.Quote:
Originally Posted by Alan
I think if you factor in the wait time for the uninsured and the preACA underinsured who had a wait time of basically "forever" for elective surgery, the U.S. numbers wouldn't look so hot.
If you want to look for isolated areas where U.S. health care is superior to some other countries, I am sure there are more to be found. What counts are the big, overall metrics. On those counts our health care system overall sucks. Check out this chart on our health care costs per capita compared to other countries, and that is with 49 million uninsured:
http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries
In all sincerity, those metrics mean nothing to a person who dies while waiting.Quote:
Originally Posted by try2bfrugal
This according to this official Swedish website:
http://sweden.se/society/healthcare-in-sweden/
Waiting times for preplanned care, such as cataract or hip-replacement surgery, have long been a cause of dissatisfaction. As a result, Sweden introduced a health care guarantee in 2005.
This means no patient should have to wait more than seven days for an appointment at a community health care center, 90 days for an appointment with a specialist and 90 days for an operation or treatment, once it has been determined what care is needed. If the waiting time is exceeded, patients are offered care elsewhere; the cost, including any travel costs, is then paid by their county council.
Statistics from December 2010 indicate that about nine out of ten patients see a specialist within 90 days and receive treatment or are operated on within a further 90 days [a total wait of 6 months]. Roughly 80 per cent today feel they receive the care they need. In 2006, the figure was 74 per cent.
Also emergencies are seen immediately and urgent care cases are given an appointment date in under a week.
From Wikipedia:
Waiting times
Urgent cases are always prioritized and emergency cases are treated immediately. In urgent cases, the national guarantee of care states that a patient should be able to get an appointment with a primary care physician within 3 days of contacting the clinic.
Sweden also has private medical insurance a person can buy themselves and use just like we do in the US.
Your personal experience also does nothing for the 49 million uninsured plus all the underinsured in the U.S., unless their suffering is not important to you. Except for possibly some ER care, their wait times are basically forever.Quote:
Originally Posted by Alan
I'd be happy with the Swedish wait times Spartana posted, if it meant affordable coverage for all.
From an article in the New England Journal of Medicine -
"It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.3 These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?"
http://www.nejm.org/doi/full/10.1056/NEJMp0910064F
All suffering is important to me, but survival ranks up there pretty high too. I'm glad we had a free market system which enabled me to do so. Those strangely familiar wait times Spartana posted probably wouldn't have done the trick for me.Quote:
Originally Posted by try2bfrugal
It sound like you had an emergency - "Also emergencies are seen immediately and urgent care cases are given an appointment date in under a week."Quote:
Originally Posted by Alan
and Spartana wrote "Sweden also has private medical insurance a person can buy themselves and use just like we do in the US."
Free market and government care for those that cannot afford private insurance? Sounds like a winning system.
In the U.S., "For three decades, Americans, particularly men, have had either the lowest or near the lowest likelihood of surviving to age 50. The most powerful reasons found for that were homicide, car accidents, other kinds of accidents, non-communicable diseases, and perinatal problems like low birth weight and premature birth, which contribute to high infant mortality."
New Health Rankings: Of 17 Nations, U.S. is Dead Last
http://www.theatlantic.com/health/ar...d-last/267045/
While I agree that the Swedish system is far better than no medical care options at all - like we have for those low income and unemployed people who are uninsured in the US and can't afford the costs to buy insurance - but I think that the Swedish model of a 3 month wait to be seen by a specialist and 6 month wait for treatment or surgery is not something I'd be happy with at all. Especially if I was paying 50% or more of my income in taxes to support that care level. That small lump on your breast can metastasize to untreatable deadly cancer in much less time than that. So it's not a healthcare model I would cheer for. It seem Sweden could easily remedy those long waits by de-funding many of it's other very generous, but certainly not life or death situations, social programs to offer better and speedier medical care for it's citizens.Quote:
Originally Posted by try2bfrugal
Exactly why I find the claims of such waits for treatment of a serious medical issue & medical emergencies, which is what cancer & cardiac symptoms often are, to be non-credible. Some cancers are slow growing and can wait for treatment. Some are not, and cannot wait. Where are the facts?Quote:
Originally Posted by Spartana
Of course, we too have a lengthy waiting system in the US. Those who are uninsured do not seek attention until they are in a medical emergency, then access the ER, to great expense. Waiting periods are enforced socially through shame, and economically, via the reality of financial disasters if one is not adequately covered. Let us not presume that our system of punishing the poor by denying access to timely and effective care at an affordable price doesn't not exist. This very underbelly makes our class stratified system wholly unethical.
Quote:
Originally Posted by redfox
When I have a patient with a serious cardiac issue, once we have stabilized them, we have them in the cath lab, or wherever else they need to be, from here, in minutes. We keep a helicopter and some fixed-wing aircraft on-deck on the mainland to evac them, generally it is at the LZ here by the time we transport the patient to the site. Weather is bad, they may get stuck on a boat, which can be problematic.
We never ask about their insurance situation or paw through their wallet looking for $20 bills, we just get them to treatment.
Sometimes there *is* a delay, if all the aircraft are committed, or the patient is too sick to be airlifted.
We have a >80% rate of spontaneous return to circulation here, which I suspect beats Rob's Mexican paradise. And we have great post-treatment outcomes.
If Alan had been vacationing here and complaining of the same symptoms, we would have probably had him in surgery earlier than he experienced in his run-through.
Cannot speak for the Swedish system but the Canadian system had my DH in full care for lung cancer in no time flat, tested for all the possibilities that might also be present and was fully insured under universal care.
A close relative had a stroke and was treated immediately with good follow-up therapy as well under universal coverage.
One can make an argument for both but the fact remains that the expectations are simply not sustainable indefinitely. I don't have a solution but do find that universal care does give peace of mind when it is critical.
So I guess the question is how would Americans feel about having a substantial raise in taxes to fund a system like this? From the link spartana provided there also is an amount you pay each year when you access care. So it sounds like we are talking close to a 50% tax rate! give or take. So emergency care is assumed to be covered. Then people that want it pay for private insurance. This is a very different system than what we are used to.
Of course, with the ACA I would be very surprised if our taxes don't rise. Expanded medicaid and subsidies have to come from somewhere. It is just a big shift in thinking. I have a hard time believing Americans would swallow a 40 or 50 % tax rate. What do you think?
I think part of the problem is in defining what "emergency" means in Sweden. Say I have a wacked out lab test at my annual physical and my primary care person wants to send me to a specialist. That wait may take 3 months because the wacked out lab test really isn't considered an emergency or even urgent. Same with that strange lump or rash. So by the time I actually do see someone, my wacked out lab test or lump or rash is now something that is untreatable. Or, if it's treatable but not considered an emergency, then I may have to wait another 3 months to have a needed surgery (although not an emergency surgery). That wait can mean a lot of changes happen that can potentially be deadly. I'm dealing with this situation at the VA hospital now (wacked out lab tests and looonnnngggg waits for specialists and between further testing) and I imagine the experience is the same with any other public health system. I have opted to buy n expensive (to me) private insurance policy because the wait times are just too long if it is something serious. I have no way to make it go faster so going to a private doctor is the only option if I want speedier care. Or at least speedier diagnosis of what could potentially be something bad.Quote:
Originally Posted by redfox
Not too long ago I looked up the tax rates of various countries, including Sweden. If I remember correctly Sweden had a personal income tax rate starting at 30% (USA's bottom is 0%) for lower earner and going up to 68% (USA's is around 38%) for higher earners. Can't remember what their corporate rate was but there are other taxes like local taxes, VAT (sales tax), etc... that were pretty high. I think VAT was around 25%. Some other countries I looked at that had universal health care had lower tax rates because they had less social services overall than Sweden. Some countries also had a separate healthcare tax besides personal income tax that was at a set rate - kind of like our Medicare and Social Security tax is. I'll try to find the link as it was pretty interesting.Quote:
Originally Posted by flowerseverywhere
As for how much I think we should all pay towards universal healthcare? Hmmm.... not sure. I kind of like the idea of expanding Medicare to allow all people to buy insurance at a more affordable contracted fixed rate. I also like the idea of a separate flat tax rate based on gross income that everyone pays (again like we do for Medicare and SS) and not just the wealthy. Also a matching % flat rate corporate tax that businesses pays/employee instead of providing health insurance for them (although they still can provide private health insurance to their employees as a benefit if they want). Lower income/asset people could have government aid to pay for health insurance. Probably wouldn't be enough moolah from those taxes to pay for it all though so may have to have some personal income tax increases as well. 10% on top of what we already pay? Too much? Not enough?
From: http://www.taxrates.cc/html/sweden-tax-rates.html
Individuals pay both national income tax and municipal income tax. In 2010, individual income tax rates in Sweden change between 54% and 61%, 57.77% being the average tax rate, Corporate tax rate is 26.3% and VAT is 25%, Dividend and interest income are taxed at a flat rate of 30%. Capital income is taxed separately from income from employment at a rate of 30%. Social security contributions – Contributions by the self employed amount to 29.71% (for 2010), plus a pension insurance fee of 7%, Social security contributions – The general aggregate contribution by an employer on behalf of an employee is 31.42% (for 2010).
Your post has really made me think. I myself would be willing to pay 50% more in taxes easily - but the kicker with me is on my income my taxes are quite low so 50% more to me is not that big a deal. It would mean fewer books and/or fewer secondhand clothes. Not all that big a sacrifice. However, OTOH, those who have somehow managed to maintain what would be considered a middle class income - for those people a 50% hike would be a much bigger deal and I'm afraid to say would have economic consequences - less consumer spending which comprises around 2/3 of the economy in the US. Less consumer spending means more layoffs and fewer jobs, up and down the income spectrum. So the answer - I don't know.Quote:
Originally Posted by flowerseverywhere
Advice I can give is this - if at all possible, have some liquid money saved in case you get sick for transportation costs and health care costs in another country with reasonable medical costs. I read this advice online on another forum and I couldn't agree more with this. I am even starting to think of having this readily available cash to run to another country for reasonably priced health care as a cost of holding US citizenship.....I also think a by product of higher co pays and deductibles under ObamaCare plans is going to be more medical tourism, and if anyone considers the above advice out there at all - I'm thinking in another five to ten years it will be standard everyday advice given to all. Pretty sad is my opinion. Rob
Medical tourism is actually a booming industry. Even some employers are (voluntarily) offering to send their employees overseas to have surgeries because the cost is so much lower - even including the airfare and "medical" recovery hotel stays. The employers even offer a big bonus to the employees who choose this. India seems like a common choice and is the lowest cost.Quote:
Originally Posted by gimmethesimplelife
Here's one cool site amongst many many more :
http://www.business-in-asia.com/asia...l_tourism.html
http://news.health.com/2009/04/08/traveling-treatment/
The problem of course is that while it's cheaper, you are paying the full amount. So it might end up being much much more expensive overall than just buying insurance here. Especially if you can increase your income by just a few thousand dollars a year and get the ACA subsidies.
The program is already fully funded, according to the nonpartisan Congressional Budget Office. It is expected to lower the deficit by $100 billion over the next decade, not add to it, and there are no plans to raise taxes on the middle class to pay for it -Quote:
Originally Posted by flowerseverywhere
"MIT economist Jonathan Gruber, who helped develop the law, says about half the costs are offset by projected savings in Medicare payments to insurers and hospitals. Another quarter is offset by added taxes on medical-device makers and drug companies.
"The other source of revenue is a tax increase on the wealthiest Americans," he says. "Those families with incomes above $250,000 a year will now have to pay more in Medicare payroll taxes."
Those provisions actually make the bill a net positive for the federal budget, according to the nonpartisan Congressional Budget Office. By the CBO's accounting, Obamacare will produce a surplus. Gruber says the law will "actually lower the deficit by about $100 billion over the next decade and by $1 trillion in the decade after."
From National Public Radio -
http://www.npr.org/blogs/health/2013...ance-subsidies
Gimme. - I didn't mean 50% more! I meant 50% of your total income at least- per the link spartana provided you would pay 30% of your income in taxes, plus higher taxes across the board. That is more than a few extra books. The average tax per her link is over 57%
trytobe - I would love to believe them but I just don't. The math does not make sense to me. More people accessing care, gbmt paying more and it all a wash? Not buying it. Only about 2% of earners make more than 250,000
http://www.politifact.com/florida/st...s-250000-year/
i can't believe that will pay for all of this, and I am for affordable care for all
I am unclear why you think the program is only funded by increased taxes on the wealthy. Do you have a reference for that assumption?Quote:
Originally Posted by flowerseverywhere
The largest source of funding is Medicare payment cuts. You can see how the ACA is funded from these charts based on an analysis by the Congressional Budget Office:
http://www.washingtonpost.com/blogs/...in-two-charts/
The Congressional Budget Office is not affiliated with either political party:
https://www.cbo.gov/about/overview
"Since its founding in 1974, the Congressional Budget Office (CBO) has produced independent analyses of budgetary and economic issues to support the Congressional budget process. The agency is strictly nonpartisan and conducts objective, impartial analysis, which is evident in each of the dozens of reports and hundreds of cost estimates that its economists and policy analysts produce each year."
Here is a chart that shows where the Medicare payment cuts come from:
http://www.washingtonpost.com/blogs/...ion-heres-how/
If Congress overturned the ACA, spending for Medicare would increase by an estimated $716 billion over the 2013–2022 period, and of course we wouldn't have any of the benefits of the ACA, such as Medicaid expansion for very low income households and insurance subsidies for lower and middle income households.
Try2b. Your article states the medicare advantage plans were projected to save money. They didn't. Imagine that
This very interesting but lengthy article explains some of the problems with this approach. It is well annotated.
http://www.nationalcenter.org/NPA640.html
and another.
http://www.urban.org/UploadedPDF/412...ca-seniors.pdf
both articles are written by MD and PhD types, not columnists.
also I am not saying to turn over the ACA. I am only saying it does not make sense to me, no matter how it is repeated and phrased, how they say it will be paid for with no new taxes. Maybe in two years you will be pointing out what a dummy I was.
To be fair to the Swedes, those high taxes go to pay for a lot more social welfare services than just medical care. Things like a fully paid year off work for either/both parents when they have kids, fully funded childcare once they go back to work, higher level education, unending unemployment benefits, etc... They also heavily subsidize their industries - like Volvo and Saab (didn't Saab die off during the recession? Didn't Volvo go to Ford or some other auto maker?). So I'm not sure exactly how much of their taxes actually are used to fund their medical system. Now that Sweden (and a lot of European countries who offer many social welfare benefits) have a greater influx of immigrants (and who often have large families and lots of kids) they have been struggling with funding their social welfare programs even at those high tax rates.Quote:
Originally Posted by flowerseverywhere
http://blog.gmfus.org/2013/12/18/swe...stem-up-close/
In Sweden, new parents get 480 days of parental leave and a child allowance from the state. There is free day-care offered from age 1, and a free primary and secondary school system that promotes democratic values. School lunches are free for all students. University and post-graduate studies are free. Healthcare and dental coverage is high quality and universal, and patients choose their doctors. A public pension system reserves a portion of your income for retirement. There is an efficient public transportation system of metros, streetcars, buses, and commuter trains
EQuote:
Originally Posted by Spartana
Exactly. I am interested in where things are going since that Nordic mono-culture has been changed to be more diverse. I always roll my eyes when the Scandinavians are compared to the U.S. because culture and attendant values matter especially in health issues.
When we take our state of, say, Idaho or New Hampshire and compare social issues to a Scandinavian country there are many parallels, it is often a match up. Not so much with Mississippi, Alabama, and that cultural mixing bowl California.
Your post that I replied to was that the ACA was unsustainable because it was funded solely by taxes on the wealthy. That assertion was, and remains untrue, and you have not provided any resources to prove that point.Quote:
Originally Posted by flowerseverywhere
The first article is written by a partisan conservative think tank. Surprise! They are against the ACA.
http://en.wikipedia.org/wiki/Nationa...olicy_Research
The second article is a balanced article of the pros and cons to Medicare changes that concludes that most policy analysts think positively of the potential of new delivery and payment approaches to improve care. Maybe I missed it, but I didn't see where this article pointed to future tax increases to lower and middle class families to support the ACA? Can you tell me what part of the article supports that idea? Funding for Medicare and high U.S. health care costs are issues for the U.S., ACA or not. Without the ACA the CBO says Medicare costs would increase by an additional $711 billion over the next ten years, so if anything the ACA appear to reduce, not increase Medicare costs.
Sweden has a population of around 9.6 million so it's hard to use it as an accurate comparison to even a smallish urban city area in the USA let alone the whole nation. I think 9.6 million is about the population of just Los Angeles alone not even counting the urban area metro sprawl. My grandparents are from Sweden and I've spend lots of time there (and absolutely love it!) but it is very culturally and socially insular - although that is changing and not all Swedes are too happy about that.Quote:
Originally Posted by iris lilies