Can A Geneticist Save Iceland’s Healthcare?

After weeks of treatment, targeted zapping of cancerous cells, and immune crushing medicine, you need verify the status of your cancer. Has it shrunk? Have the cells been eradicated—leaving only scar tissue behind? Has the treatment been effective or do you need to discuss another approach with your oncologist?

Don’t worry. The answer is only a short flight away to Copenhagen. There are no PET scanners in Iceland. In the near future, you will be able to get your PET scan done here in Iceland. Kári Stefánsson, Icelandic neurologist and CEO of DeCode, raised the funds and donated one to Landispitalin, the national hospital.

On January 22, 2016, Kári started an online petition to make the government agree to allocate 11% of the GDP for healthcare. According to the OECD, in 2013, the total amount allocated for healthcare was about 8.7% of the GDP—putting Iceland below average in comparison to the rest of the nordic countries (with Finland also falling below average). Within five days, Kári’s petition had more than 50,000 signatures.

“Why did I personally have to raise money to buy a PET Scanner for the national hospital?”

“Why did I personally have to raise money to buy a PET Scanner for the national hospital?” says Kári sitting across from me at his desk in deCODE. “This is an instrument that has been in use in hospitals all over the world for 20 years. It’s simple: we haven’t been funding healthcare and it is unacceptable, completely.

In my mind, if you ask ‘what are the minimum requirements that you make with a group of people with whom you want to live together and call yourselves a society?’, the least you can do is attend to the sick and the wounded. That should be an absolute priority. You shouldn’t be spending money on drilling holes through mountains before you make sure that you have reasonable ways of attending to the sick and the wounded”

It’s clearly a budget. It’s got a lot of numbers in it.

In 2014, a doctors’ strike lead to an agreement to raise the salaries of doctors over three years. This was not only about compensation, but also about keeping doctors and specialists in Iceland. When interviewed that year, Dr. Íris Ösp Vésteinsdóttir, then head of the Icelandic Association of Junior Doctors, worried about attracting young specialists to Iceland, with the prospect of 35% of Iceland’s specialists slated to retire in the next decade.

“My view on this is simple: before you begin to divvy the budget up for various projects, you should make sure you have a healthcare system. Our healthcare system is not on par with the healthcare systems in the neighbouring countries. There is no question about that,” says Kári, straightening up in his chair. “Unbeknown to me, I was copying the policy of the government from 2014. Why is the government opposing this now? Well, it’s because they never meant what they said. This is so common amongst politicians, to make promises they never intended to keep. That is the reason direct democracy is necessary. You can look at my petition as an exercise in direct democracy: where you go to the people and ask them to support a cause.

“I started to lobby, forcefully, and I got some allies amongst the members of parliament. It was the view of those who were running the national hospital that it would need about an additional 2.5 billion ISK to be able to run the hospital at the same level as 2015. That was taken to the government and everyone agreed to allocate this additional 2.5 billion ISK—except the minister of finance, he cut it in half. The hospital got an additional 1.25 billion ISK, which is not sufficient to run the hospital at the same level as the previous year. Then a few days later he announced there would be a 300 billion ISK surplus in the government budget next year. So despite a 300 billion ISK surplus, they could not afford an additional 1.25 billion for the national hospital.”

An honest politician stays bought

Kári’s petition has been met with criticism from the government and a few outside consultants. Recently, Pawel Bartoszek debated Kári’s petition—concluding that Kári’s 11% of the GDP was unreasonable and that the 8.7% of the GDP being reported by the OECD was misleading. Kári was using the total expenditure of the GDP on healthcare, which includes public and private expenses on healthcare. If you were to look at only the public expenditure Iceland uses about 7.1% of the GDP; whereas, Sweden, Kári’s go to example, used about 9.2% of its GDP on public healthcare.

“I like Pawel, but he’s a numbers guy,” Kári says with a smile. “He insisted that I was basing my petition on false numbers on false arguments. I was trying to explain to him that the 11% number was not an argument. The 11% number is a goal. There is a difference between your goal and your argument. He’s written many interesting pieces for the newspapers, but he is entirely incorrect if he thinks we have been funding the National Hospital well. Walk through the hospital and see the people in the corridors. Go check out the waiting lists for the various operations and procedures. The waiting lists are long and they are not becoming shorter.”

Kári has been known to make a scene. Watching him on television, anyone can see he doesn’t shy away from conflict. When Pawel attempted to bring up his concerns and criticisms,he didn’t really have the same testicular fortitude and showmanship as Kári, which could be a reason for people being sceptical of Kári’s motivations.

“The healthcare system is a concern for the majority of people in this country. I don’t think it would have mattered who initiated this. This isn’t a controversial issue. Who is against better healthcare?”

“On this issue, I don’t think my public persona has much impact,” says Karí. “The healthcare system is a concern for the majority of people in this country. I don’t think it would have mattered who initiated this. This isn’t a controversial issue. Who is against better healthcare? How large is the group of people here in Iceland who would not put healthcare at the top of the government’s priorities? This is so uncontroversial that I doubt my person has much impact on it. I think the only people really opposed to this are blind loyalists to the government parties and I don’t think they are a very large number of people. I think it’s a small group of people. If you were in a position to get everyone in this country’s opinion, the people opposed would be less than 5% of country.”

Heavy lies the crown

On January 1, Ólafur Ragnar Grímsson, President of Iceland, announced he would not be running for another term in office. Kári’s petition coincides with this new available seat of power and the use of populism and direct democracy is in tune with other politicians and parties—most notably, The Pirate Party of Iceland.

“This is one way the Prime Minister [Sigmundur Davíð] tried discredit my petition by suggesting I was doing this because I was planning to run for office. That is absolutely untrue.”

“This is one way the Prime Minister [Sigmundur Davíð] tried discredit my petition by suggesting I was doing this because I was planning to run for office. That is absolutely untrue,” says Kári without pausing. “We are doing fascinating work here at deCODE. It’s a scientist’s dream to be in the position I’m in.

“I have no interest in running for political office. I’m a nearly 67-year-old geneticist. I love to do human genetics. I run the best human genetics operation in the world. Why should I want to become a president. I don’t understand how anyone could think it would be more suitable for me. I’m a somewhat uninhibited, forceful, opinionated asshole. Why would I become a president?”

Davið and Goliath

The Prime Minister, Sigmundur Davíð, wrote a response to Kári’s lobbying for more healthcare funding titled Toppari Íslands, which basically translates to “Iceland’s One-Upper.” In his response, Sigmundur Davíð compares Kári to those people in coversations who always have to one-up the last speaker—everything they do is better, more exciting, more intelligent. The fact that a Prime Minister is responding directly to Kári, and hurling insults, has created what appears to be a rivalry between the two.

“I have no rivalry with the prime minister,” said Kári before breaking into a smirk “Why should I have a rivalry with this obese two-year-old little boy?”

“I have no rivalry with the prime minister,” says Kári before breaking into a smirk “Why should I have a rivalry with this obese two-year-old little boy? He’s just answered my criticism with juvenile insults. There is no rivalry there. It looks like he’s surrounded himself with really bad advisors. It isn’t to the interest of a Prime Minister to write pieces like he has done in this debate.

“I can write whatever I want. I’m a private citizen, but we have a Prime Minister who basically every time I say something he begins to throw shit. I’m used to shit like that—actually, I’ve taken the majority of my calories in the form of shit like that—but for a Prime Minister to be doing it, it doesn’t make much sense. He just seems very insecure. He becomes defensive almost instantaneously.

“My petition for the improvement of the healthcare system he [Sigmundur Davíð] looks at as a criticism of his government. I went out of my way to say that I did not think this was a criticism of his government. I thought this was a criticism of a succession of governments, a string of governments and, therefore, it was the responsibility of the people of this country, the voters who have voted these governments into office. But He took this as a criticism of his government, and by doing this he is claims possession of the mess. He makes the mess his, which is politically and rhetorically stupid. It’s unbelievably stupid for a Prime Minister to pull himself into something like that.”

Keep The Ball Rolling

“There is absolutely no way we can take these politicians seriously,” Kári leans back in his chair and raises his hands over his head. “They simply don’t mean what they are saying. Therefore, I believe, because this has been the experience for the last 20 years or so, that we have to, we the people of this country, seize control of this issue and demand that a specific percentage of the GDP should be allocated for healthcare.”

Kári continues to lobby and plead in newspapers and online for more support from the people of Iceland. If the rate at which the signatures keep coming in continues, it appears to be working. Meanwhile, officials haven’t decided where to build a facility to store, let alone run, the PET Scan Kári donated.

“We will make it there. I think an overwhelming majority of the people in this country are in support of this.”

“We are up to 55 thousand signatures. This has been a one month effort. I am probably going to recruit some people to help me with this. See whether we can keep revitalizing this initiative. We will make it there. I think an overwhelming majority of the people in this country are in support of this.

“This is a very interesting experiment in direct democracy. In addition to being useful because it improves healthcare, and timely because of how bad of shape the healthcare system is in, it’s also interesting to find out if we, the people of this country, can use this method to influence the decision making by the politicians. If not, we are in deep shit.”

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If you are interested in reading or signing the petition, check it out online at www.endurreisn.is.

See Also:

I had met Dave Eggers the night before he gave a talk at the Reykjavík Literary Festival. He was having a drink at Reykjavík’s oldest coffeeshop/unofficial Icelandic hip-hop HQ, Prikið. At Prikið, Dave was friendly. He told me that after his talk, he would be meeting for lunch with Kári Stefánsson at the offices of deCODE Genetics, and that members of the press were welcome. He invited me to come along—actually, he signed my copy of ‘The Circle’: “See you Tomorrow, Dave Eggers.”

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