Sweden single-payer health care - more cost savings through rationing and waitlists

Chart showing percentage of patients not receving surgery within 3 months in Sweden

By now most people following the debate on reforming the US health care delivery process have heard at least a few horror stories about the quality and availability of health care in Canada and the UK. Those two nations both have known problems with their largely government run and funded systems and many who question the wisdom of having the US adopt many of the changes being proposed like to cite the issues the nations have with waiting lists.

Of course, the proponents of the current HR3200 bill will usually claim that Canada and the UK are poor examples and try to cite other nations successes. It turns out that the other nations are not necessarily better. In some cases it might be just that no one has looked deeply into the conditions. It turns out that Sweden's single payer system, one that many people like to claim is successful was looked at in May 2007 by a senior analyst for the National Center for Public Policy Research. His findings were not positive:

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.

Much of the information matches the complaints we hear about Canada and the UK. Simple procedures and the availability of older drugs is not an issue. Co-pays are very low for a doctor's visit and the government has instituted heavy price controls on drugs. If you stay relatively healthy and do not need surgery, the system is obviously successful, but most American's can say the same about the US system. If you don’t' get sick, the system we have now is fine. Its only when you need surgery or other specialized treatment, that there are major issues with the cost of treatment in the US.

David Hogberg, the writer of this article delves into some attempted reforms that the Swedish government experimented with in the 1990's, although he notes that they quickly abandoned them after allowing so much government interference with the markets during the reforms as to eliminate any possibility of success.

However, it’s the waiting list issue that is most surprising. David notes in his article:

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.

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. Rather, Persson stood out because he was Prime Minister of Sweden at the time.

It’s a bit surprising to find that the Prime Minister waited eight months for hip replacement, although David does point out that Gorann was adamant about not jumping ahead in line using his position to advantage. Still one has to ask if any US senator or representative is willing to participate in the same single payer system many are trying to force on the US people. Currently they have exempted themselves, which suggests that they are very aware of the wait lists, which will quickly appear once the government controls all the money going to hospitals and doctors.

Health Care and its delivery is going to remain a contentious issue, but the economics have never supported a government run system where cost controls are imposed through bureaucratic measures. It has been tried and has limited to no success everywhere it has been tried. In the US system, care is rationed by ability and willingness to pay, although most hospitals do end up performing some procedures for less than their normal fees due to the US laws that forbid them from failing to treat someone who is unable to pay if its an emergency. The single payer systems of the world, claim to avoid this, but all of them have wait list issues, and many are struggling to maintain the level of service as cost pressures on treatments push them to increase the level of rationing.

This is a complex issue. We need to approach it carefully and slowly. Unfortunately, Congress has decided to use a 1000 page shotgun to solve the problem and appears completely unconcerned with the collateral damage they might cause by doing this.