Waiting to board the plane that would move me to Iceland several years ago, I had plenty of second thoughts. Hesitations. Reservations. It will be cold and windy, I thought. And dark. I am close with my family; the notion of leaving them behind put a lump in my throat. The language sounded made up and/or alien, like Elfish. I was petrified—had I made horrible decision, a huge mistake?
I powered through, though, and I’m still here. Throughout the transition period, when in doubt or discouraged, one mantra in particular proved especially helpful. I would repeat to myself, over and over: “You are choosing to live in a place that used tax money to pay for education and health care, not killing people.” It felt good. Back in the US I had left behind, Dubya was still in charge. Like many, I had actually followed through on all those threats to “jump ship if the country re-elects that backwards, gun-loving, women-hating, war-mongering, beady-eyed ignoramus.”
It felt good. Breathe in, breathe out. Step on plane. Education and health care. A government that actively invests in making society better for regular people. A compassionate, humane government that recognizes the benefits of providing affordable, quality education on every level, from pre-school to grad school. A community that opted for paying a significant amount of their monthly earnings to their government, in turn tasking that government with helping everyone live lives as long, healthy and productive as possible. Liberal chick dreamland. Wheels up. Girl gone.
Getting sick changes your perspective. So does being foreign.
There’s nothing like getting sick to make you appreciate feeling healthy, just like there’s nothing like moving from the US to Iceland to make you appreciate a strong, publicly run health sector. Healthcare economics are insanely complicated, and I cannot claim any knowledge beyond what my own lived experience has granted. However, as someone who grew up within the US healthcare environment before transplanting, I can confidently say: I like it waaay better here.
When describing Iceland’s healthcare system to Americans, there are a few examples I find particularly useful. For instance, the parking ticket I found on my car the day after my son was born was more expensive than his delivery and our overnight stay in the hospital. According to the International Federation of Health Plans’ Comparative Price Report (2012), total hospital and physician cost for a normal delivery in the US typically ranges from $7,000 to $16,000. That’s a typical vaginal birth, with no complications. As soon as your body starts doing the “wrong” thing, requiring more intense medical attention, the price tag on your bundle of joy shoots up even higher. The same 2012 report indicates that C-Sections range from $10,000 to $26,000 (1.3 to 3.4 million ISK). So, I giggled, paid my parking ticket, and took my son home. Then we got a home visit from a midwife over the next several days. Free of charge. Because, you know… Scandinavia.
I also talk about the time that my then-eleven-month-old daughter was found to need surgery. Looking into her frightened eyes, assuring her that everything was going to be okay as the anaesthesia took hold and and her body went limp was one of the hardest moments I have experienced as a parent. The operation was a basic one, but it still scared the living shit out of me. When it was all over and I was checking out, ready to take my healthy, whole girl home, the receptionist was profusely apologetic. So sorry. There were in fact two bills we would need to pay, one for the anaesthesiologist and one for the surgeon. The total damage was 3,000 ISK—a little over $20. So sorry. I wanted to laugh or cry or scream. While it is difficult to make sweeping statements about the cost of various medical procedures in the US, factoring in regulations and insurance options in different states, a brief online search, with conservative estimates, reveals that my daughter’s routine surgery costs around $4,000 to $6,000 (530,000 to 790,000 ISK).
I have more stories, if people need convincing. Like that time my infant son developed a nasty cough. I took him to our neighbourhood health centre, and the doctor there referred us to the children’s hospital. It’s upsetting to watch a baby cough until he starts to turn blue, particularly when you’re his mom and there is nothing you can do to help him. But the doctors and nurses took exceptional care of him. Monitored him. Listened to his cough, checked his oxygen. Moreover, they took good care of me. They answered all of my questions (even the over-worrying mom ones) and imparted good advice. After hours of attention from excellent medical professionals, we left the hospital with a wave and a smile to the receptionist. No bill.
We pay these costs, sure. Taxes are really high. But, with them, we buy peace of mind. Everyone gets sick at some point in their lifetime, and everyone benefits from living in a community where you know that if your neighbour gets really ill she won’t have to sell her apartment to pay her medical bills. Each month, I pay into a system, because someday I know I am going to need it. My family members, friends, neighbours, random strangers and even you (yes, you!) will need it, too! Getting sick is part and parcel with the whole “having a body” thing. It gets infected with a thing here, something breaks there, bing, bang, scrape, cancer, migraine, stroke, pneumonia, tonsils… It is inevitable.
Health for sale; very good price for you today, my friend!
This is being written for a reason. Recently, I have felt the tone of Icelanders’ conversation about their healthcare system changing. The nation’s nurses and doctors have been striking, and there is significant brain drain from both professions to countries like Norway, where they are paid significantly better, and work far less gruelling hours. We regularly hear horror stories about the inadequacy of facilities at the National Hospital. The healthcare system is constantly described as “broken.”
Some suspect that the system is being starved on purpose, to ease an intended transition to the private sector. Unfortunately, that doesn’t sound too far-fetched. As Noam Chomsky posited in a 2011 lecture at the University of Toronto, “The State-Corporate Complex: A Threat to Freedom and Survival”: “That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”
I have no idea whether such a scenario is currently playing out. But, I do know that Finance Minister Bjarni Benediktsson has said he wants to “increase the private sector’s role in healthcare.” That very Bjarni, incidentally, is the head of the Independence Party, traditionally a big proponent of privatization efforts and home to almost all of Iceland’s free market cheerleaders, many of whom have benefitted tremendously from prior instances of formerly public goods being divvied up and doled out.
Remember that time in 2001 when Iceland’s banks were deregulated and privatized, and then we all lived happily ever after and never worried about money again? Thanks, Independence Party.
Since Iceland is so small, connections are everywhere. Sometimes these connections are suspicious, sometimes they are not. Small or not, in my opinion, it is okay to raise an eyebrow when you hear that a former Independence Party MP is running a private sector healthcare firm, and looking to expand (her name is Ásdís Halla). Paired with the Finance Minister’s statements, some healthy scepticism about who privatization will actually benefit is surely warranted.
Models of health care? Don’t go West, young man!
And privatization in healthcare is a big problem. Because while free market competition does an excellent job of determining things like how many size 39 blue high heel shoes a store should stock and at what price, it does a total shit job of improving health care efficiency. The evidence speaks for itself. If in doubt, turn your gaze westward, towards my motherland.
The US spends a shit-ton on healthcare, and it hasn’t made the folks there any healthier. A 2014 Bloomberg survey of healthcare efficiency by nation derives its rankings by measuring average life expectancies against government spending on health care. On that list, the US ranks a miserable 44th (eat that, Bulgaria! Sorry, Iceland wasn’t studied). The chart toppers were surprising to me: Singapore, Hong Kong, Italy, Japan, South Korea… As diverse as these places are, the countries at the top of that list have one thing in common: tight governmental control over a universal system of health care.
Good ole’ economic theory crumbles to bits when you try and use it to make healthcare more efficient. I am not a rational actor when I need a tonsillectomy. If chemotherapy becomes 50% more expensive, it doesn’t mean I will purchase half as much if I need it.
It is privatization that leads to rich people accessing better care and middle-class people selling their homes to pay medical bills. A 2007 Harvard study found that 60% of bankruptcies in the US were related to medical bills. Three out of four of those filing for bankruptcy *had* health insurance. Even with the Affordable Care Act, which became law in 2010, unpaid medical bills are still the leading cause of bankruptcy in the US, more than credit card and mortgage debt in 2013. Oh, and forget about the poor. They’re totally screwed. But hey, man…that’s competition.
Take it from an American, please. Don’t go down that path…for that way, darkness lies!
Iceland’s Universal Healthcare (Still) On Thin Ice
One year ago, Iceland’s lauded universal healthcare system seemed to be teetering off the edge. Doctors’ wages had stagnated after the economic crash, and following a bout of failed negotiations, they went on strike for the first time ever. While they coordinated their actions to avoid endangering patients’ lives, the doctors’ message was clear: if demands were not met, they would seek employment elsewhere.