I need a medication that I don’t want to take and am too cheap to buy. I just avoid certain foods.
My son wants me to eat with abandon like him.
“Dad, aren’t your drugs free?”
“No,” I said. “Only kids’ meds are covered.”
“Well, why don’t you just get it under my name?”
“Because that would be lying.”
“Oh, good point,” he said. His shy smirk reassured me.
Johan Norberg created a documentary called Sweden — Lessons for America. Most of us picture Sweden as a socialist utopia. Norberg says, No.
Reforms in the 1990s created a radical, new welfare state. I sensed that during a half a day with the Swedish Medical Association this spring. They sounded far less socialist than Canada.
The Welfare State
Norberg interviewed Dr. Tom G. Palmer, an expert on international history and politics.
Palmer said, (46:47)
“So, high degrees of social trust allows a welfare state to persist for a very long time because people don’t cheat. They don’t cheat on taxes and they don’t cheat on benefits.
However, over the long term, institutions can erode those levels of social trust. So the World Values Survey asked the question about getting government benefits for which you are not qualified.
And the most recent survey, only 55% of Swedes said you shouldn’t apply for those benefits: 80% [down] to 50%. So there’s a greater willingness to game the system over time.”
Norberg responded,
“We learned that the hard way in Sweden. When we had the most generous government sick leave benefits, it suddenly happened that the, objectively speaking, most healthy population on the planet were off sick from work more than any other population on the planet.”
In 1988, Swedish workers claimed sick days one out of every 8 days worked. Since the reforms, rates have dropped.
Dr. Palmer goes on to say that long-term permanent disability qualifications have been rising in the US, as the population gets healthier.
“Why are more and more people qualifying for permanent disability? It’s because of the erosion of this sense that: You shouldn’t do that.”
Moral Hazard
Economists write about moral hazard. People engage in risky behaviour more often when they do not have to bear the consequences.
The welfare state creates its own moral hazard. When we consume at no cost to ourselves, we consume more .
Patients request massages they could live without.
Politicians promise projects that voters don’t really need.
And physicians offer tests to avoid complaints and lawsuits.
Moral hazard makes us do things that we might not otherwise.
My son and I talked about collision insurance versus wiper blade insurance. I change my blades once a year. With insurance, I might change them twice or more.
“But Canada’s going down,” he said. “You can’t stop a train going down a hill.”
I lost, again. My homily on character felt weak, puny to his runaway train.
Doctors work at the front lines. Clear evidence makes Choosing Wisely easy. Anyone can say, No, to nonsense.
But most things are not clear. Do we dare say, No? Who protects us when we do? Who can stop the train?
********
Here’s the full video:
Photo modified from NY Post
Finland initiated a radical social experiment guaranteeing income in the war on poverty (as a part of reforming its welfare system) ….it selected 2000 unemployed people between the ages of 25 and 58…the theory was that it would free them to meaningfully contribute to Finnish society etc. etc., …it would ”reduce poverty and inequality and increase individual liberty”.
There was no requirement to either seek or accept employment, although the social justice theorist planners had anticipated , predicted and hoped that many of the participants would flood back into the work force.
They didn’t.
It seems that humans are human after all.
So after 2 years ,after it was recognized that the guaranteed income plan simply punished work whilst subsidizing sloth, it was decided to roll the plan up and so it will close in 2019.
Finnish tax payers , amongst the most educated people on our planet, decided that the idea of them working and paying taxes so that others could do nothing even as the government bureaucracy overseeing it grew larger and larger, was simply crazy and harmful to all, including the participants themselves, over the long term.
“ What you subsidize you get more of…what you tax you get less of”.
The Finns stopped this particular ideologically correct train before it ran off the tracks …many pot headed Canadians , one suspects, incapable of learning from the evidence of history would like to hop onto such a train and do so in droves….and they may still get the chance… ”party today , pain and panic tomorrow”…happily not in Ontario however , at least for the time being .
Andris – I remember reading about the initiation of this program as it began. In hindsight, people will say the outcome was predictable but I would maintain we likely need a persistent flow of evidence to remind us of what DOESN’T work. Thanks for the update. It is a warning for Canadians.
As our family travels around the world we now find ourselves in a particularly interesting place: Bulgaria. Under Communist rule until 1989, Bulgaria is still struggling to establish a stable democracy. After feudalism, capitalism and socialism, communism is the epitome of developed society . . . at least according to Karl Marx. Of course, due to its fundamental flaws – namely not taking human nature into account – it fails every time. And still so many societies like Canada’s seem to be sliding in that direction. It’s like the rhythm method for birth control – sounds great in theory, but human beings are not so good at pulling it off.
I’m not trying to be alarmist or sensational, but I see a country like Bulgaria with wonderful people and resources limping into the 21st century thirty years later and communism is no longer some damaging alien ideology that happens in other places. I worry deeply about Canada’s future as so much of its population is seduced by these unsustainable socialist ideas untempered by reality. We need to learn from our neighbours like Bulgaria and Finland before we become the next failed experiment.
We took on full time traveling as a family for a lot of reasons – family time, adventure, education . . . but we also felt increasingly uncomfortable with our kids growing up in a society that seems to have adopted the belief that everyone is entitled to everything regardless of their contribution.
Wow. Powerful, articulate comments from both of you. Thanks Andris and Matt!
I cannot help thinking (and worrying) about Polybius’ Anacyclosis, or cycle of government. He thought that all governments go through the following cycle: Monarchy, Tyranny, Aristocracy, Oligarchy, Democracy, Ochlocracy and back to Monarchy and around again.
Alexander Fraser Tytler said, Once people realize that they can vote themselves gifts from the public treasury, democracy ends. With screaming mobs of social justice warriors, I think we’ve already come to ochlocracy (rule by mob). I fear we might see a new supreme ruler/King to offer peace (at a cost).
Thanks again to both of you for reading and posting comments!
Cheers
There are winners and there are losers in this world. Sometimes people cannot change their circumstances through no fault of their own. They need a helping hand. As Physicians, we choose to be that helping hand.
Well said, Chris.
I agree entirely. Many people need help. We can offer it. It creates moral distress when we know that there is more we could do that the system does not allow.
Thanks for posting a comment!
Cheers
“Life is like a sewer: what you get out of it depends very much upon what you put into it.”
Tom Lehrer.
I eat the butter tarts, and told my doctor to “just give me the Crestor without the guilt trip”.
Ha! Mike, you always make me smile, which makes your wisdom sink in more than it might have otherwise.
I agree with your comment about statins. I am sure you would also agree that it is probably different than third opinions and skipped MRI appointments.
Great to hear from you!
Cheers