(reprinted from the Calgary Herald, June 28, 2003)
The recent column by Naomi Lakritz (The trouble with think-tanks: they don't think, the Herald, June 19) is about as close to reality as an edition of Flash Gordon or Batman.
In a crackerjack, usually astute mind, Lakritz has a disconnect shared by millions of other Canadians when it comes to any mention of privatizing Medicare.
Here's what happened: The Frontier Centre, a Winnipeg think-tank, sponsored a western Canadian tour by Johann Hjertqvist, a smart Swedish health policy specialist who's worked for years in the thick of Stockholm's health care reforms. After a visit with the Herald's editorial board, during which Hjertqvist let it slip that the mother of the welfare state had privatized a large part of its medical provider pool, Lakritz wrote, "It was no surprise privatization was all the talk" because, in her opinion, all those crazy right-wingers are predictable and can't think.
Hjertqvist recalls cautioning that privatization was not an accurate description of what happened in Sweden. Access and funding remained universal and public; only some facilities and worker pools had moved out of public ownership and were competing for contracts. The efficiency and increased productivity induced by those changes give the public framework a chance to survive.
Lakritz also wrote: "Bring in private health care alongside the public system so those with money can buy their way back to health. . . . Tough luck for the poor saps forced by financial circumstances to wait in the public queue." Guess what? In Stockholm, waiting lists have been shredded and people from unreformed parts of the country are flocking there for quicker service, in sharp contrast with our lengthening lines. Everybody is getting better service, the poor, the middle-class, God forbid, even the rich.
Lakritz also said, "[In] the Swedish model . . . patients must pay about $220 a year in fees before government funding kicks in, and about 200,000 Swedes buy themselves faster health care through private insurance." This statement is the most dangerous kind, one that's only partly true, redolent of demagoguery. The fees and insurance are real enough, but they have nothing to do with Stockholm's new purchaser-provider split, they predated it by decades, brought in by the socialists in 1970 to be exact. More importantly, in Sweden nobody is refused access if you are on welfare the authorities pay the fee for you.
The column also mentions Daniel Cohn from the Canadian Centre for Policy Alternatives, "whose position on Swedish health care is backed by facts." Cohn's first factoid is that the Swedes booted out the health care reformers last fall and elected Social Democrats sworn to reverse them. Okay, so far. But the untold denouement is ironic. Once in office, the Social Democrats changed their tune. Nothing is being reversed, and the privatized St. Goran's operates so well they are talking about selling more hospitals. The Socials Democrats are also raising user fees.
Cohn's next expert witness is "a leading heart specialist who says privatization has jeopardized cardiac care." This man operates at the unprivatized Karolinska Hospital, in competition with private bidders, and he faces a situation where the public hospital has to upgrade its services and efficiency or lose its budget share. We sure hope the CCPA shared its expertise with the good doctor, perhaps sections from its ground-breaking study of the correlation between capitalism, heart disease and cancer. "Cancer and heart disease know no class boundaries," Lakritz writes. Except, that is, in Canada, where the rich fly south and the rest of us wait until we are half dead before we get service.
She also labels Hjertqvist, the nicest person you can imagine, as an avatar of "repulsive Social Darwinism." Please, please. Is Swedish Prime Minister Göran Persson, who's keeping Stockholm's private hospital private, thank you very much, also in league with the devil? Is Britain's Tony Blair, who wants to do the same thing in Britain, a henchman of the evil profit-mongers? Are the authorities in Spanish Catalonia's highly respected health-care system, 70 percent of which is private, in need of re-education?
The world is not composed of black and white, and doctors and nurses in Stockholm did not stop looking after people in their pursuit of filthy profit. They're doing better than they ever did and faster, with better pay and lower costs, sharing the efficiencies generated in a publicly funded system that now has a bias to some innovation and customer service courtesy of the competitive delivery model.
It's all about incentives. Nobody wants to cancel Medicare. Canadians just want it to work.