December 14, 2019

Finland versus the USA

The NYT has a large article up under the heading: "Finland Is Our Capitalist Paradise". Finns pay huge taxes but business activity also thrives there they claim

The argument runs that Finns get most big-ticket items "free" for their taxes. The authors are particularly impressed with the free education and free hospitals.  They claim that both are high quality.

And they write as if there is no free education and no free hospitals in the USA. Yet most Americans go to "free" local schools for their primary and secondary education and can go to government hospitals where they will be treated regardless of ability to pay.  So where's the difference?

We have only the word of the authors that there is a difference in quality but I am prepared to concede that many American public schools are ratshit and that American public hospitals can often afford to provide little more than emergency care. So why is that? Can socialized services be better than private ones?

A big part of the American difficulty is that the population of the USA is so diverse.  Many in that population would not even call themselves Americans.  That contrasts with the small and homogeneous population of Finland.  So the American population is orders of magnitude harder to manage than is Finland. So what works well in Finland might work much less well in the USA.

I cannot with any brevity take on all the claims in the NYT article so I just want to focus on one of the claims -- about the high quality of Finnish public hospitals.  Like most Leftist writing, however, they will only tell you the good bits and ignore the bad bits.

I have no new information about Finnish healthcare but I live amid a similar system in Australia.  We too have universal government health coverage. And the limitations of that are well known. Despite the free government healthcare available, 40% of Australians take out private health insurance.  Now why would they do that?

They do it for two reasons: Access and quality. If you have any serious problems, the difficulty is getting yourself in front of the doctor.  There are waiting lists for almost everything and even waiting lists to get on the waiting list!  You could die while waiting and some do.

And the quality of treatment is public hospitals is poorer, if only because it is the private hospitals that have the latest machines.  Even when the public sector has the machines they may not have the staff to operate them.  There is for instance in Brisbane a public hospital hyperbaric chamber to treat divers with the bends but that hospital will simply refer distressed divers to a private hospital that has one.

Similarly, there are apparently PET scan machines for detecting cancer in the public sector but they are very expensive to use so most patients will be referred to one of the private PET clinics, where patients will pay out of their own pockets for the scan. My last PET scan (in a private hospital) was arranged with only a couple of days notice

So I doubt that Finnish hospitals are much better than that. I would be most surprised if Finns get the "no waiting" experience that is common in Australian private hospitals.  And it is for access to such hospitals that Australians buy private health insurance

So that is a relevant comparison. Australians and Americans both are mainly of British and Northern European heritage and both have trouble coping with large "indigestible" minorities.  If you want to know what free universal healthcare would look like in practice in America, look to Australia, not Finland.

The Australian system is not wholly bad.  The immediate and mostly free access to your family doctor ("bulk billing") is certainly hard to beat.  It is the hospitals that are the problem area.

This whole topic is a huge one so I am not going to go on to talk about American versus Finnish university education.  But it is clear that American university education has gone off the rails in recent years and is getting worse rather than better. Finland might well be better. It might need Mr Trump to take an interest in American university education for it to have any hope of improvement.





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