Healthcare in the United States is sick, or depending on what you read or hear these days, it is at least not feeling very well (pun intended). The issue of healthcare in the United States has become not only a corporate burden, but also a problem for our society and, due to this, a political hot topic that has been set aside in recent months due to other, more pressing issues (e.g., Iraq, Katrina and the Gulf Coast region). In the United States, according to recent estimates, approximately $1,200 of each new American-made car sold is covering that automaker’s healthcare costs for its current employee and pension healthcare programs. Is there a “cure” for the American healthcare system?

I questioned whether I should even consider this topic, as I have no experience in the medical or insurance industries, I do not hold a degree in finance, nor am I running for political office.  My role, and therefore the perspective I take for this article, is as a consumer (i.e., recipient) of healthcare in two countries with two completely different healthcare systems: the United States and Sweden. Whereas in the United States, one usually needs a salaried, full-time job to be covered by health insurance, in a country like Sweden, everyone is covered, regardless of the job one has. In fact, in Sweden, it does not matter if one is employed or not—everyone is covered by a national healthcare system from cradle to grave. I will say upfront; neither system is perfect, nor is it my intention to use this article to land us all in healthcare utopia. Simply put, there is no such place. However, by briefly comparing these two systems, perhaps a little light can be shed on the subject, albeit from this purely consumer perspective.  And remember, it is not about right vs. wrong here; it is about degrees of different and better.

Healthcare in the United States is based on the delicate, always shifting balancing act between the givers and the takers. Let’s make this simple by taking a look at what I refer to as the healthcare value chain—the process of providing healthcare for any individual and the stakeholders involved in that process. It starts with each of us seeking healthcare, be it for preventative healthcare or what I refer to as reactionary medicine (i.e., after a problem arises).  We then go to any number of healthcare providers (doctor’s office, hospital or clinic, the emergency room). From there the insurance companies get billed by these providers and pay the fees associated with the care we have received. Then there are the companies, institutions and organizations (our employers) that pay the insurance premiums that allow the insurance companies to invest large sums of money to be able to pay those healthcare bills, cover their own costs and still turn a profit. For those who are not covered by a “corporate plan,” there is government assistance, but that is not as simple as it sounds either.

Not having everyone covered (i.e., not being very effective) and being inefficient are not the problems—they are the symptoms of a bigger, more holistic problem: Everyone thinks someone else should pay. In the end we have a system focused on each stakeholder “taking,” so maybe the problem is that each stakeholder in the healthcare value chain does not want to “give” enough (or maybe in the right way). What results is a vicious cycle of “you pay while I benefit” thinking that simply leaves corporations overly burdened, a healthcare system spending more time on reactionary medicine (i.e., being of use only after we become ill) instead of preventative, and a population that believes personal accountability for taking care of oneself means one less basket of bread sticks before our super-size meal is served.

In Sweden, healthcare is out of the hands of private business and in the hands of the government. It is not free as is so widely reported; after all, income tax rates start at around 33 percent in Sweden! Through the taxes individuals pay, plus the social tax each company or organization pays on top of the salary for each employee it has, plus the “fees” that are paid each time one visits the doctor or hospital, nothing about socialized medicine is free. On paper, the system is very effective—everyone is covered. Yet the system is not very efficient. In Sweden, the give in this give-and-take formula includes the high taxes for individuals and companies, the increasing fees, and the long waiting times for service (e.g., seeing a specialist, obtaining an operation). Because the system takes our money via taxes and fees, and pays the bills, efficiency means cutting corners, denying service and making people wait.

It seems as though these two different systems are caught in their own healthcare Catch-22. In the United States, many are not covered (i.e., not very effective), so we over burden the system and make it inefficient, which in turn is what helps to make it unaffordable to cover everyone. In Sweden, everyone is covered (i.e., it at least seems effective), but at the risk of waiting in line, lack of specialists, high taxes and increasing fees, it’s not very efficient either. So what’s the cure? If we look at the give and then the take within each healthcare system, perhaps there is a balance—an informal formula if you will—that allows us to take the best of the give with the best of the take and come up with something more functional. When we find some type of balance between giving and taking for each member of the healthcare value chain, a balance focusing on being both effective (i.e., coverage for all) and efficient (using resources such as time, money, competencies) in just the right way, maybe, just maybe, we have found a system that works better tomorrow than it does today.

		Tim Foster is a lifelong resident of East Lansing and has spent a large portion of his adult life obtaining his education and working as a consultant in the United States and Europe. He will soon complete his doctorate in marketing from a Swedish University and hopes to someday return to his alma mater (MSU) to teach. He can be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .