What the U.S. should learn from Sweden

so says professor Per Bylund in today’s WSJ:

shutterstock_161022188The overall quality of medical services delivered by Sweden’s universal public health care consistently ranks among the world’s very best. … Sweden’s problem is access to care. According to the Euro Health Consumer Index 2013, Swedish patients suffer from inordinately long wait times to get an appointment with a doctor, specialist treatment or even emergency care. Wait times are Europe’s longest, and Swedes dependent on the public-health system have to wait months or even years for certain procedures, or are denied treatment.

For example, Sweden’s National Board of Health and Welfare reports that as of 2013, the average wait time (from referral to start of treatment) for “intermediary and high risk” prostate cancer is 220 days. In the case of lung cancer, the wait between an appointment with a specialist and a treatment decision is 37 days.

This waiting is what economists call rationing—the delay or even failure to provide care due to government budgetary decisions. So the number of people seeking care far outweighs the capabilities of providers, translating into insurance in name but not in practice. This is likely to be a result of ObamaCare as well.

The data that claim costs are lower in nations with some form of single-payer systems do not account for the “costs” of waiting in line:  suffering, loss productivity, and sometimes even death:

Stories of people in Sweden suffering stroke, heart failure and other serious medical conditions who were denied or unable to receive urgent care are frequently reported in Swedish media. Recent examples include a one-month-old infant with cerebral hemorrhage for whom no ambulance was made available, and an 80-year-old woman with suspected stroke who had to wait four hours for an ambulance.

Other stories include people waiting many hours before a nurse or anyone talked to them after they arrived in emergency rooms and then suffering for long periods of time before receiving needed care. A 42-year-old woman in Karlstad seeking care for meningitis died in the ER after a three-hour wait. A woman with colon cancer spent 12 years contesting a money-saving decision to deny an abdominal scan that would have found the cancer earlier. The denial-of-care decision was not made by an insurance company, but by the government health-care system and its policies.

The end point is a two-tiered system in which those who can afford to buy private insurance on top of the higher taxes they’re already paying for free healthcare.

This is why Swedes over the past two decades have been rushing to purchase medical coverage through private insurance, which guarantees and delivers timely and qualitative care. Insurance Sweden, the country’s national insurance company trade organization, reports that in 2013 12% of working adults had private insurance even though they are already “guaranteed” public health care. The number of private policyholders has increased by 67% over the last five years, despite the fact that an average Swedish family already pays nearly $20,000 annually in taxes toward health care and elderly care, including what Americans call Medicare.

I lived in Sweden most of my life and have firsthand experience of the rapid expansion of the public sector in the 1970s and ’80s—followed by the welfare state’s decline and failed promise. The outcome of a government-run and controlled health-care system in the U.S., such as that in Sweden, is as predictable as it is frightening. But it is avoidable.

Sweden has started to self-correct, choosing a more sustainable path: private health-care options that allow for competition, customer choice and better overall care for Swedes. America should learn from Sweden’s experience and follow the Nordic country’s recent example, turning away from government-controlled health care to embrace a free-market solution.

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Libertarian flavor of civil disobedience

The more I read (and hear) him the more I like him:  Kevin D. Williamson on Bundy’s Libertarian flavor of civil disobedience.  I agree this will likely end badly – prison – for Bundy but I hope it brings attention to the issues.  Williamson does a nice job of briefly summarizing those issues below, but only hints at the corruption worth exploring around the Majority Leader and the solar farm.

(A)n individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law.

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Why bold ideas backfire in politics

Ramesh Ponnuru has a theory for why bold ideas backfire in politics:

Americans say they want politicians to tackle the big issues and get things done…  Yet almost every time elected officials have tried bold problem-solving in the past 20 years, it has produced a backlash against them. The more ambitious the attempt, the worse the political repercussions have been.

The pattern has persisted now through three administrations.

There has been, however, the rare success:

The successful cases are instructive. In both, a president was playing on the other side’s turf: scaling back an entitlement in the Democrat’s case and expanding one in the Republican’s. And in both cases some of the political benefit was merely the avoidance of pain

The British politician Enoch Powell once remarked that “in the welfare state not to take away is more blessed than to give.” In the 1960s, it may have been possible for a politician to offer voters benefits, seemingly for free, and rise in the polls as a result. But the sense that our government is now overextended may have made such expansion seem less feasible without making retrenchment appealing. People are markedly unhappy with the status quo, but they’re even more fearful of what might take its place.

That’s a coherent set of attitudes built on distrust for the political class in Washington. If voters think politicians have made a lot of messes, they may presume that their solutions will only make things worse. That kind of skepticism is recognizably conservative, but it isn’t ideologically conservative. It creates a high hurdle for ambitious free-market and limited-government reforms just as much as for liberal ones.

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Unpleasant necessities will be someone else’s problem

In Bait-and-Switch Liberalism William Voegeli uses the essential dishonesty employed to pass Obamacare to make a broader point about the growth of government in general:

In order to get Americans to institute — little by little, but ultimately in its entirety — a Scandinavian safety net, one must assure them every step of the way that its benefits won’t require anything resembling Scandinavian taxes or regulations

The hope is that civil and respectful policy debates, ones that tell Americans what they need to hear instead of what they want to hear, will leave voters ever more favorably disposed to assigning new responsibilities to government, confining the arguments to technical details about delivery and financing. But the category of what people need to hear seems to include nothing that would alert them to the prospect that implementing the liberal agenda might incur significant difficulties, costs, and dangers. Rather, what people need to hear includes everything — but only as much as — liberal politicians and publicists want to tell them.

So, throughout the 2008 campaign, Obama made a “firm pledge”: “No family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital-gains taxes, not any of your taxes.” The problem with exempting 97 percent of American households from any federal tax increase is that it makes it impossible to pay for: 1) the expensive obligations baked in the cake when Obama took office in 2009; 2) the expensive obligations government has taken on since then, Obamacare chief among them; and 3) the expensive obligations sure to be added to existing ones the next time Democrats have the power to enact them…

Liberals rely on bait-and-switch tactics because they fear the results of describing their agenda clearly and candidly to voters, who can’t handle the truth. Even an elementary truth, such as the proposition that improving health care will cost money rather than save money, must be denied over and over, lest don’t-tread-on-me rubes start asking awkward questions about how much improving health care is going to cost and where the money will come from. Once a policy such as Obamacare is enacted and implemented, making the switch means admitting the obvious, and then claiming it’s so obvious — “everyone always knew” it would cost money and disrupt existing health-care arrangements — that it doesn’t really qualify as a switch. The villains in this story are not the liberals who spoke incontestable untruths when political circumstances called for telling people what they wanted to hear. The villains are conservatives who complain about the deceits by commission and omission

This is the basis for New Republic editor Noam Scheiber’s defense of Obamacare against liberals who complain America really needs a Medicare-for-all, single-payer system. Obamacare’s virtue is that it’s a “deceptively sneaky way” to hasten the arrival of single-payer, he says, since its shortcomings will create an “organized constituency” with “a whole set of grievances to get exercised about.” The hysterical, prevaricating tea-party zealots who denounced Obamacare as a step to something much bigger were basically right, in other words.  People can be relied on to demand more government benefits without prodding, but not to demand the taxes those benefits will require. What the people most need to hear is also what liberal opinion- and lawmakers need to avoid telling them: Benefits correspond to burdens, so higher benefits will require heavier burdens…

The keys to bait-and-switch liberalism are: a) serial responsibility, so that the people who do the baiting are not the ones who do the switching; and b) plausible deniability, so that those still on the scene who did the baiting can claim, if anyone asks, that they never anticipated or intended the subsequent switching. Either the welfare state will need to be scaled back, or taxes will need to be raised on Americans making less — much less — than $250,000, but those unpleasant necessities will be confronted on some future president’s watch.

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Astronomy pictures of the fortnight, LXII

This edition includes a few extreme close-ups that you’ll find interesting.

Video of the sun rotating.  It takes about an earth month to complete one rotation.

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Astronomy pictures of the fortnight, LXI

Catching up on a few fortnights…

715 new exoplanets discovered, bringing the total to just under 1700.  A dozen or so are potentially in their star’s habitable zone.  But there’s a long way to go from “habitable” to “inhabited.”  Cool nonetheless.

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Astronomy pictures of the fortnight, LX

This edition could be considered “Gravity” and The Milky Way.

Waves of gravity that rippled through space right after the Big Bang have been discovered - the first detection of cosmic inflation.

Plus this interactive “scale of the universe” tool that takes you from Quantum Foam to the furthest reach of the observable universe.

Gallery with more detailed explanations below the jump.

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