I am writing this letter while in Sweden, a country with a national health service since 1798. Granted, Sweden’s population is 9.5 million, its income tax rates average 50 percent and its sales tax (value-added tax) is 25 percent – all differing greatly from our own. As a percentage of gross domestic product (9.5 percent), Swedish health-care costs are half of our own (18.2 percent). The Swedish system works for citizens through a well-constructed network of primary care providers, preventive care programs, much lower rates of liability litigation and long-standing acceptance by its consumers.
As the ACA attempts to provide an inclusive plan for all Americans, it will not look like the Swedish NHS, nor will it likely achieve the same results. Unlike the Swedish system, the infrastructure of U.S. health care lacks an adequate network of primary care providers or comprehensive preventive services, both of which are essential to cost-effective care.
Once fully launched, the ACA may receive pushback from many private practitioners (50 percent of U.S. physicians) to see these newly “insured” patients whose health exchange policies will not provide the same level of reimbursement as many currently available plans. The anticipated lower fee schedules for Medicare and Medicaid patients also may deter providers from accepting new patients or any patients covered by these plans. The result: overcrowding of emergency rooms with higher costs for non-emergent care will continue, a situation we already have.
Regarding compliance with the requirement that all Americans buy health insurance, business owners and/or younger people may rather pay fines, simply because this is a much cheaper alternative. Businesses that do purchase health insurance for their employees may select less comprehensive basic policies, leaving their workers to fend for themselves for uncovered services.
Americans who currently pay for their own health insurance will bear the brunt of inevitable additional health-care costs to a degree that remains to be determined. Thus, the combination of “affordable” and “health care” may be our latest national oxymoron.
It would seem obvious that simply mandating a new national health plan without attending to the above issues, including tort reform, will not bring the desired results for all Americans: more coverage at lower cost.