Thursday, April 22, 2010
Service failure: Part one - "universal healthcare"
I know a lot of people, especially in Finland, will take offense at reading this, because it's been in the government's best interest to promote a picture of the world where the Finnish (or Scandinavian) model of social welfare is the best, and really, the rest of the world are suffering without any medical services. Perhaps I exaggerate a little in saying this, but a little examination of some devil's advocacy I engaged in yesterday would seem to support this claim.
I made a claim, for the sake of taking an extreme argument, that user pays is better.
The general gist of the responses to this claim was that this system doesn't leave behind those with absolutely nothing, and that the system is comprehensive and provides for everyone in need.
True. Those with absolutely nothing (that is, "absolutely nothing" by Finnish standards, which, by a lot of standards, is still a lot, but that's a different topic altogether) don't get absolutely nothing. And it's true that everyone gets emergency medical services.
But by no means is it a comprehensive system, as many claim. Or how much 'in need' do people need to be? Those who need everyday medical attention are not seen. The system should stop being hypocritical and just admit that all they provide is severe malady and accident insurance. I mean, if, even after three days of being sick, people are still advised to stay home and see what happens, it sure isn't covering everything.
Basically, it's a medical system with a big sign on the outside that reads: "Do not enter unless your life is at risk."
Before many Scandinavians will (again) make the point that "At least we get medical attention when we need it - user pays means people are dying without healthcare," let me first and foremost say that I am the last to believe in a totally user pays system. I believe in universal and accessible health care. But the system here is not universal and accessible. People in Finland do die because they are sent home to 'wait it out', and stories like that are often reported in the media here. My problem with the system is that those running it have brainwashed people into believing it is such an awesome system. And on top of that, many people believe it's free!
I've heard many say "we have free healthcare". Free? People are paying around 20 - 60% of their money in taxes for this and other state provided services. No problem with that - the state should provide those services to everyone equally. What is ludicrous is this: Those paying the most for it often have a sense of 'guilt' at using the system - a sense of "I can afford private healthcare, so I better leave the public system for the poor and truly in need." So not only are they paying for healthcare they never use - they then go to private clinics that are far more expensive and get only a fraction of their costs back from the state. Even the cheapest of private clinics are far more expensive than public services, and according to some sources, of lower quality, too. And yet, people feel guilty for using public services.
So, instead of a system where everyone benefits equally from public healthcare, you end up with a situation where only those who are in the 0 (no income) - very low percentage tax brackets feel that they are entitled to public health services in situations that don't constitute an emergency.
There is also the question of cultural appropriateness. A discussion with most middle-aged Finns will reveal that there is "Finland" and there are "others". Finland is populated by Finns and an increasing amount of "foreigners". Incidentally, these "foreigners" have Finnish passports, but so long as they belong to different cultural, ethnic and language minorities, they are "foreigners".
This situation is not unique to Finland. Many countries suffer from similar delusions of mono-ethnicity and mono-lingualism. And as such, these countries often provide services accordingly. Since we are on the topic of medical services, I shall provide an example in that thread. Finnish healthcare is intended for Finns who find the concept of 'modesty' fairly difficult. To a Finn who goes to public saunas and undresses in front of all sorts of strangers, it is no big deal to undress as doctors and nurses watch. To people who are not from a 'sauna culture', this is incredibly humiliating and dehumanising.
So - a universal healthcare system? I think not. It's a very Finno-ethnic healthcare system, suited to those who have been born and raised here, and generally only of benefit to those in the lowest earnings brackets. To a "foreigner" who doesn't understand how the system and it's bureaucratic machinery works (and also won't be told), it's frustrating, infuriating and humiliating.
fon @ 6:52 PM link to post * *