Politics & Policy

Obamacare in Sweden

Sweden’s small, homogeneous population makes comparisons of it to the U.S. fairly unhelpful.

Supporters of Obamacare typically deny that President Obama’s signature legislation would lead to government-controlled medicine. In Sunday’s New York Times, Cornell professor Robert H. Frank tries a different tack. Because Sweden’s government-run health-care system provides good care, he writes, we have nothing to fear from Obamacare.

At first blush, it might appear ludicrous to say that something will work in America because it works in Sweden, whose population is less than 3 percent that of the United States — and less than that of Benin or Haiti. To put it in a stateside context, Sweden is a bit smaller than North Carolina. And North Carolina is a lot more heterogeneous. Thirty-five percent of the Tar Heel State’s population is either black, Hispanic, Asian, Indian, Alaskan, or Pacific Islander. Not only is almost all of Sweden’s population white, but 87 percent of Swedes who are religiously affiliated are Lutherans.

Forget apples to oranges. This is like comparing a lone grape with a large bowl of mixed fruit. But let’s suspend our skepticism and look at Frank’s evidence. After a short time in Sweden as a visiting economist, he is eager to share his findings about that country’s medical system and to relate those findings to Obamacare.

Frank writes that “males aged 15 to 60 are almost twice as likely to die in any given year in the United States than in Sweden” — a claim that, even on its surface, would seem to have a lot less to do with medicine than with lifestyle, as Frank admits, at least in part: “In fairness, those differences result partly from lifestyle. In Sweden, workers are more likely to commute by bicycle than by car, for example, and obesity is far less common.” But that doesn’t stop him from suggesting that this statistical comparison demonstrates the superiority of Swedish medicine.

Other evidence, however, not cited by Frank, suggests just the opposite. In his new book Priceless, health-care expert John Goodman shows that, if one equalizes fatal injuries (car crashes, murders, etc.) across countries, the U.S. has the highest average life expectancy in the world — Sweden ranks sixth — even though Americans are more likely to be out of shape than Swedes are. In other words, if we Americans don’t die a quick, swift death at the hands of a car, a gun, or a knife, American doctors tend to do an excellent job of keeping us alive.

Frank puts forth a favorite canard of the Left, citing the U.S.’s comparatively high infant-mortality rate. But the measurements on which that claim is based are essentially meaningless, for four reasons, as Scott Atlas, a professor at Stanford University Medical Center, has explained — the measures are unequal; the surveys are unreliable; no allowances are made for premature births; and no allowances are made for more heterogeneous populations. On that last point, Atlas writes that “racial and ethnic minorities have far higher infant mortality, whether in the U.S. or under government-run systems such as Canada’s and the United Kingdom’s.” And “racial-ethnic heterogeneity in the U.S. is four to eight times higher than in countries such as Sweden, Norway, France and the U.K.”

Perhaps even more importantly, Thomas Stellato, a professor of surgery at Case Western Reserve University, explains that

the United States counts all births as live if they show any sign of life, regardless of prematurity, size or weight. In Belgium and France, births fewer than 26 weeks of gestation are considered lifeless. In Switzerland, the fetus must be at least 30 centimeters in length to be considered alive. In Austria and Germany, fetal weight must be at least 500 grams (just over 1 pound) to count as a live birth. These tiny, premature babies born in the United States will undoubtedly have a greater one-year mortality rate than mature, full-size babies. The nations of the European Union eliminate these very high-risk infants in their mortality statistics.

What other statistical facts does Frank provide to make his case for Sweden’s “superbly” (his word) performing health-care system? He offers just one: “More hip-replacement operations are performed per capita in Sweden than in most other countries.” This is a claim that, whatever its relevance, is also true for the U.S. (although Sweden’s rate is a bit higher). Moreover, it’s unlikely that hip-replacement technology originated in Sweden, or even in Europe, where free-riding on American innovation has long been the norm. But in this regard, as in so many others, Obamacare may usher in a new norm.

Indeed, it’s clear that Frank is a fan of the natural alliance between Big Government and Big Health. He praises Sweden’s success in “consolidating services into fewer but larger hospitals” and criticizes America’s “boutique hospitals” — even while admitting that many wealthier Americans, who presumably aren’t voluntarily choosing to get bad care, prefer the latter. Frank, however, has a different vision: “larger hospitals with heavier patient flows.”

What about evidence that Sweden’s quality of care actually lags behind America’s? Here Frank, perhaps unwittingly, provides some striking information:

When I asked my Swedish hosts to describe any downsides to their system, several mentioned the waiting times for certain nonemergency services. One told me that whereas in the United States a wealthy or well-insured patient might schedule a hip replacement with only a week’s notice, in Sweden the wait could be as long as three months.

Frank doesn’t seem at all alarmed by this, blithely observing that one of his Swedish hosts “described such waits as a design feature, noting that they allowed facilities to be used at consistently high capacity, and thus more efficiently.” In other words, when Obamacare makes you wait longer, Swedish-style, then you can at least take solace in the “efficiency” to which you’re involuntarily contributing.

What about cost, another aspect of Swedish health care that Frank praises? He writes of Obamacare that, “at least in its initial stages, it will not be able to match the cost savings achieved in Sweden.”

Frank thus offers no persuasive evidence to support his claim that Swedish medicine is superior, and he even highlights its long wait lines for care. He admits that, so long as most Americans have employer-sponsored health care (which he happily implies Obamacare will help do away with), Obamacare’s long lines won’t yield cost savings proportionate to Sweden’s. And he shows no awareness of the problem in comparing a homogeneous nation of fewer than 10 million people with a heterogeneous nation of more than 310 million. Yet, at the end of his report from abroad, he tells his fellow citizens that they “must abandon their futile efforts to repeal Obamacare” and must embrace “greater government involvement in health care.”

If only American academics spent as much time trying to advance American notions of liberty in Europe as they spend trying to advance European notions of “collective action” (Frank’s term for consolidated power) in America.

— Jeffrey H. Anderson is executive director of the newly formed 2017 Project, which is working to advance a conservative reform agenda.



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