Socialized medicine in Sweden: a tragedy? DANIELLE RACETTE Socialized medicine in Sweden, ac- in a bitter and unceasing struggle new doctors, positions were multi- cording to Dr. Philip Sandblom, a with the Socialists. plied, hours of work were cut and first-hand observer of its evolution, A detailed and meticulously craft- salaries were lowered. Many older is a ghost story with an unhappy ed strategy, which Dr. Sandblom and more experienced doctors were ending. "It's a subject I don't enjoy said smacked of communism, seems assigned to outpatient clinics, thus talking about", he says. "It's truly to have guided the evolution of so- depriving young doctors of their sad - a tragedy - what has hap- cialism in Sweden. "The first step leaders. "At the present time", said pened, and Sweden's doctors have the Socialists took toward their goal Dr. Sandblom, "everything is run by been unable to do anything about it, was to encourage a proliferation of a bureaucracy gone mad." despite their fight." doctors, in order to weaken the In the surgical unit where Dr. Dr. Sandblom said that 25 years cohesion of the medical profession Sandblom worked there were origi- ago he was proud to speak about the and make them incapable of putting nally 26 doctors. There are now 80. Swedish health care system. Even up a united front during negotia- When one of them works a weekend, then it was a type of socialized tions." The number of students in he gets a week off. Patients rarely medicine. Anyone, whatever his in- the various faculties of medicine see the same doctor twice. come level, wherever he lived, had quadrupled. Because there are not enough access to the best of medical care. It was decided to accept appli- patients for all these doctors, there This system, according to Dr. cants with experience in the social are not enough opportunities for Sandblom, reached its peak around field: teachers (including music them to operate, and surgical skills 1955, the year health insurance leg- teachers), social workers, and so on. get rusty. Dr. Sandblom feels that islation was passed. The insurance Eighty percent of the students se- the tragic consequences of this de- scheme was financed to a great lected were already in the labour velopment will only become truly extent through taxation, and covered hospital costs and a major portion of physicians' fees and prescription drug bills. Doctors received both a salary and professional fees on the basis of the quality of their work "It's truly sad - a tragedy - what has happened, and and their training. Sweden's doctors have been unable to do anything about "Why did we have to get in- volved?", asks Dr. Sandblom. Be- it, despite their fight." cause, he said, the socialist ideology was seeking to advance at any cost. Dr. Philip Sandblom "It's an ideology based on a mixture of envy and distrust of private enter- prise", he explained, "plus, on the force; only 20% had the traditional apparent in the next generation. other hand, confidence in anything educational background; the average A free and competitive medical run by the state." age of medical students shot abrupt- market still exists. However, said A decisive step was taken in 1950 ly from 19 to 31. There were even Dr. Sandblom, government authori- when Sweden's doctors decided to some successful applicants to medi- ties regard it as a constant threat. conduct a partial strike during their cal school who were over 50 years of "They have done everything they fee negotiations. The public, very age, while young matriculants with could to wipe it out", he said. "They satisfied with the private care, sup- excellent marks found themselves did away with private hospital ported them. The government re- being turned down. "It's not hard to rooms, with the free choice of doc- treated. And from that time the understand why a doctor like myself tor, with the choice of a hospital for country's doctors found themselves would despair a bit", says Dr. Sand- the patient, with direct payment by blom. How could solid traditional the patient of his doctor's fees. The training be provided for this mass of most anyone pays for a visit to the Ms. Racette is a freelance writer living in doctors-to-be? hospital is $3." Montreal. To make room for this horde of All Swedish doctors are now corn- pletely on salary. Salaries are based younger generation admire", said on a 40-hour week with allowance Dr. Sandblom. "They are often ide- for overtime. Ability and knowledge alists, but they are interested in have no bearing on remuneration. It other values in the light of their would appear that young doctors are rigid perspective on current world no longer interested in a large in- problems. The new generation of come that will be three-quarters de- Swedish doctors doesn't know what it voured by progressive taxation. The means to live in a liberal society trend is thus toward shorter working with freedom of choice in one's hours, with leisure activities taking work. Personally, I think that the on greater importance. great tragedy of our contemporary What happens to private practi- history is this transformation in the tioners in this system? Can they philosophy of the young." compete with such cheap public Dr. Sandblom believes that doc- health care? According to Dr. Sand- tors must work with administrators blom, they are increasingly seeing and politicians to make the decisions patients who want a more personal that affect medicine. "That way and continuing relationship with they will be able to help avert what their doctor. But in an effort to is happening now in Sweden." force private practitioners into the Sweden's elite react as negatively system, ceilings for fees have been as Sweden's doctors to the direction proposed and patients have found their country's health care system is themselves refused any reimburse- taking. But the great mass of ment at all, even through their pri- Swedes have no way of understand- vate insurance plans. ing what is going on, said Dr. Sand- One major consequence of the blom. "When a phenomenon occurs socialization of the system has been gradually", he says, "it isn't per- the increase in administrative per- ceived. People don't realize what sonnel at all levels. "Medical care is they're losing little by little." . being made systematically less effi- cient", said Dr. Sandblom. "The administrators imagine that a hospi- Dr. Philip Sandblom was born in tal can be run like a factory. The Chicago in 1903. He received his burgeoning bureaucracy blocks all medical training in Sweden, where initiatives. The medical profession he became a professor of surgery. has grown to loathe the army of For 10 years he was president of the young bureaucrats sitting in their University of Lund. His links with offices in Stockholm." He adds: American medicine are close. He "The civil servants don't know what held a research chair in the depart- it's really like to practise medicine ment of physiology at Northwestern these days, they think up preposter- University for a year and then ous ideas and force the doctors to taught surgery at a number of cen- act on them. tres throughout the United States, The method invented by the bu- notably at the University of San reaucrats to determine the number Diego in California. Dr. Sandblom's of doctors necessary for any clinical work has been recognized by the department is to Dr. Sandblom an University of Paris and a number of astounding monument to total ab- other universities, which have surdity. "It's not surprising", says awarded him honorary degrees. He Dr. Sandblom, "that clinicians who is also an honorary member of have never before refused to play an many medical associations, includ- active part in running Swedish hos- ing the American Surgical Associa- pitals are turning away from 'the tion and the Royal College of Sur- mad house' in consternation." geons of Edinburgh and of Ireland. Politically, most of Sweden's doc- He has just completed a book enti- tors are either Conservatives or Lib- tled "Creativity and Illness ", in erals, according to Dr. Sandblom. which he traces the lives of world- But an appreciable group of younger famous painters, authors and musi- doctors are now more or less ex- cians with reference to the medical treme leftists. "Freedom of intellect, conditions that may have influenced the integrity of the person, respect their work. He spoke recently to for the individual, no longer neces- doctors at H&pital H&tel-Dieu in sarily represent values that the Montreal..