What unites figures like J.D. Vance and Bernie Sanders, who both envy Swedish health care, is a tendency to find fault with the American political system.
Republicans inclined toward voguish populism — many of whom have only recently soured on reforming America’s unsustainable entitlement programs, turned away from a foreign policy that checks Moscow’s violent expansionism, become disenchanted with free markets, and even questioned the political utility of pro-life policy prescriptions — are apt to cast a rueful aspersion on their conventionally conservative counterparts within the GOP: “You’ve changed.”
The new Right is forever confronting the old Right with their dewy-eyed discovery of what Republicans of a certain vintage recognize as garden-variety left-wing assumptions and the advocacy that springs from them. Always good for a fresh spin on mid-century liberal banalities, freshman Republican senator J.D. Vance has unearthed what he appears to think is a novel line of inquiry. Why, the Ohio senator wonders, can’t the United States have a health-care system like Sweden’s?
“One tough answer for the American Right,” he notes, is that “the Swedish system—a ‘socialized’ system—is much more skeptical of how the profit motives of the health care industry encourage really gross public health policy.”
It’s usually the disparity of outcomes or the per capita costs of care that prompts left-wing observers to offer this Bernie Sanders–style indictment of the American health-care system, but that wasn’t Vance’s trigger. Rather, the senator seems merely to be capitalizing on a recent decision by Sweden’s national board of health to apply “caution” when evaluating cases of pediatric gender dysphoria — emphasizing psychological care over pharmaceutical and surgical remedies.
“One thing Americans of good sense should try to understand is why public health is so much better in Sweden than our own country,” Vance observed, citing a Swedish government agency study recommending hormone treatment for children only “as part of clinical trials.” Vance adds: “From Covid to masks to dysphoria, there’s much less hysteria and much less group think.”
Vance’s argument isn’t lifted entirely off the left-wing bumper stickers we grew up with. He’s innovated a center-right culture-war twist on a very old argument.
One rejoinder to the senator’s observation is that Sweden didn’t invent anything new here, as is usually the case with — scare quotes — “socialized” systems. The country’s health system is following the trends emerging out of a number of European health-care institutions, which are only just beginning to apply some scientific rigor to the “gender-affirming care” fad.
This is a commendable and long-overdue development. If there’s resistance to a similar development in the U.S., the obstacles are political and social rather than the features of the health-care system itself. As such, they’re hardly as intractable as the senator suggests. Vance’s deeper question, however — why can’t America be more like Nordic nations? — is one he should be able to answer himself had he followed the arguments conservatives have been making for decades.
Take, for example, our own Jim Geraghty, who dismantled Vance’s argument when it was advanced in 2016 by self-described socialist opinion writer Elizabeth Bruenig. Why can’t a continental republic composed of 330 million people with a medical and pharmaceutical sector that leads the world in innovation emulate the health-care model adopted by a culturally monolithic nation of just 10 million? The answer is baked into the question. More consequentially, as Jim notes, Americans would recoil at the consequences resulting from the adoption of something like a Swedish model.
As he notes, the Nordic system is inimical to medical innovation. Indeed, they rely on the advancements made in places like the U.S. The cripplingly confiscatory taxation rates required to ensure that Swedes have lower per capita health-care costs than Americans and the sense of languid entitlement thereby engendered in its citizenry would fundamentally alter the social contract. That might explain why Scandinavians rival Americans in their rates of self-medication. Average household debt relative to disposable income in the Nordic world is far larger than America’s.
Vance is asking the question that Bernie Sanders and Alexandria Ocasio-Cortez asked before him. It’s the question Barack Obama and Hillary Clinton asked before them, which is the same question antique liberals like Ed Muskie were asking even earlier. It’s the same question the New York Times has been asking for generations. The question persists even though it has been answered, and answered again. If the answer fails to satisfy, it’s because the question is a red herring.
What is it that unites seemingly distinct political philosophies like those of Vance and Sanders — one that rejects American individualism such that it allows even self-mutilation, the other that rejects American liberalism such that it abides high health-care costs and suboptimal outcomes? Maybe it’s less about health care per se than that these discrete outlooks find more in the American political economy worthy of criticism than they find worthy of praise.