HEALTH CARE/Joan Retsinas

One Import Scandinavians Don't Want: American Health Insurance

At the foot of a centuries-old square in Stockholm, people-watchers crowd onto small cafe tables, sipping wine, beer, coffee, whatever (Swedes' kidneys are hardy). The scene is postcard-perfect: the bright summer light, the laughter mingled with chatter, the garden fountain. The cafe is a TGIF franchise.

In my whirlwind Scandinavian holiday, I stumbled upon lots of Americana. Where 19th-century Americans did the grand tour of European capitals to soak up foreign (i.e., better, or older, or maybe just more effete) culture, today that old world has soaked up America. A Hard Rock Cafe draws crowds in Copenhagen's Tivoli Gardens. In barely-accented English, singers belt the lyrics to American music, from hard rock to soft rock, from jazz to Cajun. The movies, which you can rent from Blockbuster (after you buy snacks at the Seven-Eleven), feature Julia Roberts, Harrison Ford and Robert DeNiro. The ubiquitous popularity of American food is not surprising. (I expect to find Coca-Cola sticking a few machines in the Sinai when and if peace happens.) But in the battle between fish roe sandwiches and cheeseburgers, the latter have won. Only the tourists seem to lust after lingonberries and herring. English, moreover, is close to a national tongue. Rushing to make a once-a-day "English-language" tour of a historic house in Stockholm, I discovered that most of the other tourees hailed from Germany, Sweden, Denmark, or France. The timing of the tour was convenient, so they switched their neurons to English.

Culturally, "we" have invaded "them," infusing their culture with our icons. A week left me sympathetic to the anti-globalization protesters picketing the IMF and World Bank conferences. A "one world" of capitalist hegemony may not be desirable, at least from the vantage of those who wake up to find that TGIF runs their city's trendiest cafe. (Do the Swedes, long accustomed to month-long vacations and generous leaves, feel the longing behind the TGIF acronym?)

Yet we Americans have one institution nobody in Scandinavia envies, let alone understands: health insurance.

In Western Europe, governments consider health insurance a public responsibility, much like schools. Every citizen, by virtue of citizenhood, is insured. No means tests. No qualifying physicals. No pre-existing conditions. No mega-premiums. Scandinavians still get illnesses and maladies and syndromes. Even in this land where life expectancy exceeds 80 years, people get sick. The trek-to-treatment, though, does not start with a trek-to-the-insurer, to discover who will pay for what. So the 35-year-old waitress diagnosed with lupus, the 60-year-old writer diagnosed with Parkinson's, the 21-year-old student diagnosed with leukemia -- all can discuss with physicians their treatment options, without first starting the payment-discussions that mark stage one for sick Americans.

The tradeoff for universal coverage is a steep tax bill, one that our conservative politicians lambast as onerous. Swedes routinely pay half their incomes to their Uncle Sven, and VAT taxes are embedded into commerce. We lucky Americans can keep much more of what we make.

Of course, this coming year, as health insurance premiums rise, more Americans will find that they don't have insurance: either our employers won't be able to foot the bill, or we won't be able to foot our share of the premiums. Unemployment too may inch up -- thereby plunging even more of us into the ranks of the uninsured. Furthermore, some of us will discover that our "product" has shrunk, that our health insurance covers fewer services, with higher co-payments and deductibles.

It isn't surprising that Scandinavian countries haven't imported our irrational, even cruel system. What is surprising is that we haven't imported theirs.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I.

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