Socialized healthcare – a nightmare?

I regularly watch political shows, and often in US media the term “socialized healthcare” is used to refer to something negative and something that US consumers should be afraid of.  Remember the "Death panel" discussions that Sarah Palin started several years back in the US? Having lived in Finland for more than 3 years with my family, I now have some experiences within a socialized healthcare system and perhaps it is time to address the big question – is it a nightmare?  In my experience, not so.  Once we moved to Finland, everyone in my family received a Finnish social security card (Kela), which entitles us to the benefits in the public healthcare system.  Of importance, the Finnish system is not entirely reliant on the public system, as there are several large private health providers, who are typically sponsored by employers.  Both me and my wife have the supplemental employer sponsored private health care, so we have also used that for our healthcare needs, especially for quick health check-ups, e.g. for cold and flu symptoms etc.  In essence, we have a choice between the private and the public system, however, the private system does have limitations so that e.g. all surgeries are referred by the private doctors to the public system.

How does the system work?  Our kids are school-aged so they receive regular health check-ups either by a nurse or a doctor through their school.  The cost for regular check-ups for kids?  None.  :)  Recently one of my kid had a regular check-up and during the visit we discussed the need to have her tested for certain allergies.  The original appointment with the doctor at the school premises was on Tuesday afternoon and on Friday we received a letter in the mail indicating that she had been scheduled for an allergy test at a hospital approx. three weeks later.  We did not get to choose the date and time for the test as in the Finnish system typically the providers will do the scheduling without input from you (yes, I can see how that would be considered inconvenient to many), but this was certainly quick and efficient. 

Dental care is free for all until age 23.  Our kids receive letters in the mail for their dental check-ups.  Again, we do not get to choose the time and date, but the system makes sure every child gets their appointments at certain grades/ages.  Cost for kids’ dental care?  None.  Adults pay for dental services, however, the Finnish social security administration (Kela) still subsidizes a portion of the costs.  I have done e.g. dental cleanings via the public system.  Perhaps a bit inconvenient is that it usually will take about 2 months for an appointment, but then again dental cleanings can be planned ahead of time.  Dental care in the public side in our experience has been just fine.  Of course, Finns in general are not very emphatic, or at least they do not hold your hand at every juncture, so I don’t have a warm or close relationship with my dentist, but rather I receive the care and they provide it.  Cost for adult dental care?  Yes, there is some depending on what you need.  Dental cleaning at the public side costs about 30 euros.   My wife has done dental cleanings as well as other procedures at the private providers and paid a bit as well, again with partial Kela subsidies.  Nevertheless, to our surprise the cost of dental care even with private providers in Finland is no more expensive than dental care in US with (good) employer sponsored dental plans. 

Surgeries in Finland are typically handled by the public side.  Even if you visit a private doctor who determines the need for a surgery they will give you a referral to the public hospitals for the actual surgery.  I know some friends who have had surgeries in Finland and my wife recently had one as well.  As far as I have been told, all of them have been happy about the quality of the care they received.  Again, they did not get to pick the date for the surgery, although certainly if the original date does not work you can reschedule it, in which case it will be rescheduled for the next available time the hospital has.  For my wife, the wait time for the surgery, which was not time-sensitive, was approx. 2-3 months.  Cost for surgeries?  Yes, there is some, but they are ridiculously low.  Surgeries involve a day-charge for the use of hospital beds, and that is all that is charged from the patient.  So, if your surgery requires you to stay overnight in the hospital, you would pay 2 x approx. 30 euros ($40, i.e. $80 in total).  For my wife, she did not get to choose the surgeon (or the date), but she had a meeting with one of the two operating surgeons prior to the surgery and as a result had no concerns about not knowing the surgeon or what would happen during the surgery.   Another friend we know had cancer while in Finland, and many of her friends asked if she would have rather been in US to receive care there.  My impression was that she felt that she received timely and appropriate care, and most importantly, she fully recovered from cancer.  So, from our experiences, there are no delays, long lines or other inefficiencies, at least not with respect to serious illnesses or procedures. 

The idea of having to wait for long lines is often portrayed as something that certainly happens in socialized healthcare systems.  We tested this recently as well.  Few weeks ago on a Saturday afternoon my wife suddenly lost hearing in one of her ears (due to what turned out to be an ear infection).  With no private health care providers open late on weekends, she went to the on-call (päivystys) at a local hospital.  She provided her social security card and explained her issue at the front desk.  They logged her in and told her to go to the waiting room to be called.  This is where the long wait times come in, right?  It was a large room with lots of chairs, tables, magazines and TV-screens, and it was after all Saturday evening almost 9 pm.  The patients are called in to see the doctor based on priority.  So, the more urgent your matter the quicker you are seen.  Given that her symptom was merely inability to hear and pain in her ear, she pulled out a bunch of magazines and prepared for the wait.  Long?  No, in about 10 minutes she was called to see a doctor, and within another 10 minutes she was done equipped with an antibiotic prescription.  Since pharmacies were not open, she was given the first two antibiotic pills free of charge by the doctor to get going before the pharmacies would open the next morning.  Cost for urgent on-call appointment?  Yes, approx. 30 euros ($40).   This was certainly just one experience and I am sure there are more busier times than others when patients with less urgent matters have to wait. 

We have had few urgent check-up needs (for our kids) over the years as well.  In each case, we have received an appointment for the same day.  With an appointment we are seen when the appointment is scheduled for, so there are no lines or extensive wait times.  Cost for urgent or same day appointments for children?  None.   My son recently fell at school at recess at approx. 11:15 am.  The teacher called us when my son complained about his teeth hurting.  My wife called the urgent same-day (public) dental care, and received an appointment for 1 pm, which really was the earliest she could do after picking him up from school and driving to the dentist.  Efficient and no waiting.

Filling out form after form.  That is one thing I recall from US health care visits.  Most every time you visit a doctor’s office you have to fill out few forms about your health history and few disclosures as well.  The amount of paperwork required at doctor’s offices in Finland seems to be quite minimal in comparison.  I think the reason for that is a centralized system where all of one’s health information is stored.  Typical doctor’s examination rooms in Finland include a computer, and the doctor always enters some information into the computer during the visit.   Prescriptions are entered by the doctor into the computer system as well and during the visit they will print a copy to you which you can present at the pharmacy.  However, only on few occasions have we been asked to fill out extensive forms about health history. 

Medicine and pharmacies are closely related to health care.  Medicine costs are subsidized by the social security administration.  The costs vary depending on the medication, and the cost is often described particularly by the elderly as being expensive.  Finland in general is an expensive country.  By way of an example, we have seen e.g. antibiotic prescriptions cost anywhere from 10-25 euros (13-35 USD).  I am sure there are more expensive medicines in Finland, but our experiences are quite limited.  Getting a prescription filled in a pharmacy in Finland is in itself one of the most efficient operations I have seen.  Some prescriptions nowadays are electronic, but regardless of the format, you show up at the pharmacy and wait few minutes to be seen by the next available pharmacist.  You proceed to the counter, present your prescription and social security card.  The pharmacist types in the information on the computer and while she/he is still typing, the medicine you need is either dropped off at the counter by another clerk or dropped from an automatic tubing system (think of those systems used e.g. in Costco by cashiers to send a stack of bills via the tubing system into some office).  I have never seen them handling individual pills and counting how many to place in a bottle to be prepared for the patient.  Instead the clerk finds the packaged drug from behind-the-counter shelves etc., and it is brought to you.  I remember having to wait in US in Safeway or Longs for 10-15 minutes even without anyone else being there so that they can confirm the prescription and then prepare it by getting the actual pills, sorting the quantity etc.  The total process for getting medicine in a pharmacy in Finland is finished within few minutes. 

So, in response to the overall question – is socialized healthcare something to be afraid of and would it be the end of the world?  Based on our experiences of over 3 years in the Finnish health care system, I think the words socialized healthcare and nightmare should be used in the same sentence only in late night entertainment shows.  Regardless of the system, some people will always complain.  I know some Finns who complain about the Finnish system as well.  However, based on the experiences we have had, I think (Finnish) socialized health care system works quite efficiently and well, especially considering that it is universal and almost free.  And those Finns who complain, have not really given me any specifics as to what in particular is worth complaining about.  Seems like those who I know who have needed care have received it in a timely manner and with sufficient quality.

Are the high taxes in Finland worth it?

A short film from Finland was recently nominated for an Academy award.  Just the other day I heard on the Finnish news that the Finnish candidates who were nominated and attending the Oscar Gala for best short film would be taxed on their gift (swag) bag that was valued at 60k euros and which all of the candidates received for attending the event. The Finnish tax authorities were quoted in a news article opining that the Finnish candidates would need to pay approximately 20k euros in taxes to the Finnish government!  Hmm.  In case you didn't already know, Finland is not Hollywood.  :)  I highly doubt these short film producers earn much more cash than a typical private sector employee in Finland. However, it is interesting to note how quickly the tax authorities are to jump in and take their "share".  

The real question is whether Finns and foreigners living in Finland get a value for their tax dollars.  I am sure we could debate this back and forth for days.  Finland isn't the highest taxed country in Europe, but it is apparently near the top 5.  It also ranks up with the highest tax rates anywhere in the world.  Finland currently has a corporate tax rate of 20%, a maximum individual marginal tax rate of 53% and VAT (Value added Tax) of 24%.  It is a progressive taxation system, so as your salary increases the tax rate increases as well.  There also seems to be less of a range of incomes, with a larger median as opposed to folks all over the place like in the United States.

The question is a bit more complicated than meets the eye.  There are social services like efficient bus services, free education, including university tuition, disability benefits, health care for everyone, long maternity and paternity leaves and other benefits, etc.  Many people do benefit from the system.

Lets take e.g. health care.  In Finland there is universal health care which means that everyone is covered. There are some fees, e.g. if you need surgery you pay a fee of approximately 30 Euros per each day at the hospital.  The surgery itself was free. Dental care is free for kids and adults up to 23 years of age, including braces and everything else.  After age 23 you pay some fees however they are not very much.  For example, a dental cleaning cost me around 30 Euros, so there is still some subsidies by the government.  In the United States at least until recently most people get their health care from their employer sponsored plans.  Someone out of work with a pre-existing condition may pay an arm and a leg for health care or might be outright rejected from the plan.  There also have been horror stories of those folks falling through the cracks between jobs.  I even had a friend who was between jobs and diagnosed with cancer so he paid for everything from his pocket (i.e. large loans).  This kind of scenario would never happen in Finland because everyone is paying into the system and everyone has coverage.

However, is the public health care system in Finland good considering the high taxes in the country? Some people living in Finland have had negative experiences with the public sector.  They have experienced long waits, talking only to nurses, and some rudeness. On the private side, it seemed that most of the people I spoke to were very happy with the health care they are receiving.  I am also fortunate to receive private health care from my employer.  I do like them (Diacor), but I have to admit it seems a bit odd to me that there are several private health care corporations in a social democracy like Finland.  My thoughts before moving here was that health care was optimal in this system and there really wasn't a need for private sector health care providers.  Interestingly enough, the private and public sectors work together.  If you go to a private doctor and it turns out you need surgery, they will refer you to the public sector.  All babies are delivered in the public sector and so on.  I think the system works perfectly for those diagnosed with serious illness or with pre-existing conditions, however for those looking for care for minor issues the system is not functioning so well.

Another example is the high cost of fuel, food and drinks in Finland.  These are partially related to the 24% (13% on foods) VAT (Value added Tax)    I was a bit shocked after arriving in Finland and noticing the high costs of food, drinks and everything related to automobiles (gas, parts, repair).  It's not like prices are dirt cheap in  US, but in Finland the prices seem just insane.  Do you want to drink a fancy beer with your dinner?  You are going to pay for it.  For example, in the States one Sierra Nevada beer purchased at the grocery store is around $1 per bottle, here in Finland it is around $5 per bottle, so 5 x the cost.  Want to fill up your gas tank on your car, it is about $8.50 per gallon here in Finland.  The proponents of the system will say that the taxes are high on alcohol in order to pay for the social programs cost by alcohol and we shouldn't tax everyone else, just those who drink.  I understand this way of thinking, but why does it have to be so high then?  It is currently the highest alcohol tax in Europe according to a recent study.  Let's take a close look at the fuel taxes.  The fuel argument made by some Europeans is that we are getting much cleaner fuel and trying to get people to take public transportation to help "save" the environment   Is the double price really justified in Finland (and most of Europe) in order to help the environment.  I don't actually think gasoline prices being double in Finland is actually such a bad thing. I think one actual consequence of the high fuel cost is that generally speaking Europeans drive smaller more fuel-efficient cars. The Europeans place a much higher burden on gasoline taxes and "use" that extra cash to clean up the environment and place the extra money into other social services.  For example, Norway is an oil rich country, but they still choose to heavily tax gasoline and use the extra funds for education and other services.   To me it actually makes sense to get more people out of their cars to use the public transportation system and use the extra funds to help with other social services.  I think if some Americans looked at the bigger picture then they might understand the reason for the high taxes, but I seriously doubt the US lobbyists would accept such a large increase in fuel costs.

Other things that taxes in Finland provide for, include education from toddlers to University students.  For example, pre-school cost around few hundred euros per month per child.  Elementary, middle, and high schools are free an provide free hot lunches.  University students also provide free education, aside from approximately 100 Euro annual student union fee.  Moreover, students at higher education schools are also provided with some free allowance each month since their focus is supposed to be  on studying.  Education is free, but is it good? It is quite good indeed according to recent statistics.  Finland has consistently ranked at the top of the world in PISA scores for primary education.  The one negative about higher education is the difficulty in getting admitted the acceptance percentages to many universities are quite low, e.g. someone wanting to become a teacher will need to be in the top 100% of applicants for the 5-year Master's program.

Another field that in most countries is paid for and managed by governments is infrastructure, that is roads, public transportation, etc.  There seems to be quite wide network of trains, buses. etc. and they are typically clean and on time.  It seems like there is always some construction going on in the roads, but generally they are in good shape, snow is plowed timely during the winter, etc. There are also many public sports fields, and areas from ice rinks at most school yards or soccer fields during the winter to many trails, swimming halls, etc. that are also used by Finns often.

Many more topics and comparisons could be covered, but the ultimate question is, does the taxation system really benefit those people who live here in Finland?   The topic could be answered each way.  For me being an American who has moved over here to Finland 2.5 years ago, I have struggled a bit accepting the high taxes.  I wonder if my tax money is really being wisely spent?  Is the health care system optimal enough to justify costs?  Are the social benefits offered here worth it for most folks?  Coming from States I can appreciate the social benefits as I think it overall makes a more trusting and egalitarian system.  It is definitely not a "dog eat dog" world out there and everyone is given a fair chance. However, I also feel like sometimes the taxes are a bit excessive for what I am really getting out of the system.  I think the answer lies in what you value as a person and society.  Are you someone who would rather go about things alone without much government assistance or someone who appreciates social services and is OK paying for them in order to benefit the entire society? I think people in Finland are definitely paying a high premium to live in this society, but then they can sleep at night knowing that they will never have to worry about losing health care coverage and can send their young children to school by themselves because of the overall security and safety of the society here. At the same time we can't build roads and train tracks with private money.  So some things have to be paid by taxes. Is the USA still a good place to live and raise a family?  I am personally fairly neutral on this.  I actually like a little of both systems.  We might not often realize what services and programs we use. It is really a tough issue with no real right or wrong answer and it really comes down to which society you prefer living in.  However, I suggest that one looks more deeply into the question of how taxes affect society as a whole and not just their own personal income.  There are repercussions in a society that has wealth spread too wide and one that has all the wealth in the middle.  Bottom line is that there is no perfect utopia tax heaven.  I think Finland's system works for some and America's system works for some.  What is your opinion?