Swedish Style Healthcare in America:
The Good, the Bad and the Ugly

America has a very large decision ahead of it – to remain the only first-world nation without a socialized medical system or to move toward a comprehensive healthcare delivery and payment system. The era of a medical all-you-can-eat buffet appears to be drawing to a close whether we like it or not. We can fight it kicking and screaming, but it is all but assured as we simply have too much expensive technology to sustain with our current economy.
I am not condoning a socialized system, however. As an American surgeon and part-time Swede I have been given insight into the differences between the two systems and what Vermonters may be expected to expect with a Scandinavian-style delivery system.
First the good. Sweden has a very highly respected healthcare system with cutting edge technology and internationally respected physicians. Swedes tend to be healthy and have incentive to remain healthy (more on that in the next paragraph). Swedes who fit inclusion criteria for care can expect first-class treatment similar to that in the United States. Care is “free” and is “cradle to grave.” Physicians are well trained, well rested and on average twice as likely as American physicians to recommend a career in medicine to a child. Despite near universal coverage, the cost per capita for the delivery of care is below that of the United States. Swedish insurance covers bills incurred in other nations.
Now for the bad. Costs are contained by algorithm-based rationing of care. There are certainly no “Death Squads;” however, not everyone gets the care they may need paid for by the government. There are several private hospitals that take Visa for those who so desire. Algorithms mandate certain ages above which one does not qualify for much but basic government-funded care. My grandmother traveled to Vermont for her cataract operation as she was considered too old for the elective surgery in Sweden – not exactly care to the grave. Certain behaviors, smoking being the most common, preclude access to procedures such as bypass. My great uncle Anders became a double amputee for this reason; he could not give up smoking despite debilitating vascular disease and was denied bypass surgery. This harsh reality of consequences for actions is well known to Swedes and does act as a strong motivator to a healthy lifestyle. The care is certainly not free but rather subsidized by some of the highest tax rates on the planet. Bureauocratic waste is part of the equation much as it is in our nation. Lines and hurdles are commonplace.
And now the ugly. Like it or not, our medical system is running out of money, and many Americans are uninsured and even more underinsured. We can either induce our economy to flourish to the point where we can afford our current spending style, or we can shift to a system of algorithm-based rationing. Particularly in Vermont with a steadfastly anti-business stance, the former is unlikely and the latter is all but assured. This will necessitate a potentially very painful transition where Vermonters and Americans will need to accept limitations in delivery of care or be willing to pay for it out of pocket. I have personally experienced both significant benefits as well as shortcomings in both systems. I fear the longer we delay some type of transition, the uglier the transition will be. I believe with an open-minded approach and rational decisions we in America can improve upon the Swedish model and continue to provide top-quality care while acknowledging the financial constraints of our current economic condition. The waiter is here with the check.

Anders Holm M.D., Otolaryngologist
Charlotte, VT/ Sigtuna, Sweden