Affordable Care Act and Universal Healthcare in Sweden

Health care is one of the most controversial topics in American society, today. Countries have opted to form their own health care from being single-payer, two tiered or insurance mandated. Who can say which one is better than the other? In this research paper, I will be doing an in-depth comparison between Sweden's single payer health care plan and the United States' individual mandated plan through the Affordable Care Act. Specifically, this paper will discuss the differences between Sweden and America's health care system, statistics, quality of the care given, and their policies and procedures when it comes to their health care.

Why does the United States not have universal health care? How does Sweden perform with their current health care plan? Is Sweden healthier than the United States? How do the two countries differ in policy? What does the taxation look like for residents in Sweden versus residents in America? What is the overall cost of operation for each system? Which system offers the most coverage to patients? These are just a few of the topics that are needed to fully discuss the differences between these two health care systems.

Sweden has had single-payer, universal health care for sixty-three years, since 1955 (Kanopiadmin, 2013). Meaning that for sixty-three years Sweden has found a way to pay for its nation's health care through resident's taxes and ensure access to quality health care to all who need it (Sampson, 2015). Their residents pay for their own health care and assist those who may not be able to afford health care of their own (Sampson, 2015). Sweden provides health care for a wide range of needs including but not limited to maternal care for expecting mothers, midwives, mental health care, and specific medical specialists (Sampson, 2015). The nation divides the weight of responsibility over three regions of their combined municipalities (Kanopiadmin, 2013). They have a system that seems like it works well but does it really? What do residents think of it?

Swedish Healthcare- Facts

Healthcare in Sweden is idolized by many American people who claim that it is the best system in the world, but is it really? Sweden is a country that is built upon capitalism, much like the United States, but is influenced greatly by socialistic welfare, the idea that the community has a whole should be responsible for itself and others financially (Sampson, 2015). In 2018, Swedish taxpayers paid an average of 61.85% of their personal income to their collecting municipality while the United States only paid 37% of their personal income (Sweden Personal Income Tax Rate, 2018).

This means that due to their high taxation, Sweden's people are paying over half of their income to cover taxes while the United States is only paying 1/3rd of their income. Is this the price for universal healthcare coverage? While Sweden is recognized as having one of the best healthcare systems in the world, it does have a few flaws regardless of cost. While Swedes can afford their healthcare, politicians have yet to figure out how to help residents gain access to healthcare facilities. With a population over 9.07 million, Sweden has a high demand for healthcare but their hospitals have actually reduced the number of beds in their facilities (Sk??l©n, Nordgren,& Annerb?¤ck, 2016). Not only are Swedes now facing the second highest income tax but they are now facing the troubles that come with not having enough room for patients who need to be hospitalized meaning longer waiting lines. How does this compare to the problems America is facing with the Affordable Care Act?

The Affordable Care Act & America- Facts

Healthcare in America is, in my opinion a controversial topic. Everyone has their own opinion of the Affordable Care Act in the American health care system. It is clear that our statistics necessitated a change but has the ACA actually affected our statistics? As with every new concept or idea implemented within the United States government, the Affordable Care Act presented a few mechanical, economic, and social issues (ACA Overview, 2017). The Affordable Care Act (ACA) was implemented by President Barack Obama in 2010 (ACA Overview, 2017). According to the ACA Health Care website, the Affordable Care Act provides more affordable healthcare to more Americans. The Affordable Care Act brought more focus to the Iron Triangle of healthcare which consists of cost, quality and access (ACA Overview, 2017). The ACA also brought more awareness to the problems of the current healthcare system. Yet, America still has fewer physicians per person than in most other OECD countries and a lower average of hospital beds per population than almost thirty other countries. In January of 2017 VOX reported that 17 states opted out of expanding their Medicaid coverage under the Affordable Care Act. When the act was first written, it was required that all states must enact the Affordable Care Act, but that was quickly changed due to Medicaid being managed differently in each state (Staff, 2017). Each state has made the decision to enact or refuse ACA for various reasons (Garfield, R., Damico, A., & Orgera, K., 2018) . The ACA has certain provisions that make it required for certain individuals and employers. If those who are required to have coverage under the ACA opt to not file for coverage, they may face certain tax penalties (Garfield, R., Damico, A., & Orgera, K., 2018). A big concern that remained hovering over the ACA change was the national spending and its effect on future spending. It was projected that healthcare spending would reduce but at a slow rate.

Millions of Americans remain uninsured today despite the insurance provided by the Affordable Care Act. Three years after fully implementing ACA, in 2016 it was reported that 27.6 million nonelderly Americans remained uninsured (Kaiser).

The ACA has reduced the number of noninsured Americans but it has not eliminated the group in its entirety. According to the CDC, the uninsured rate has fallen below 10 percent. According to the US Census Bureau, the number of Americans with health insurance was up further to 91.2%.

Some Americans feel that ACA insurance is too expensive so they would rather go uninsured and pay out of pocket. Family Affordable Care Plans vary in pricing depending on many factors. Family size, age of members, location, and income are all factors in the pricing and allocation of ACA. In my opinion, pricing for affordable care is very difficult to understand. One source reports, that the average individual premium is $393 for an individual not receiving subsidies (government funds). The average family premium is $1,021 for a family not receiving subsidies. It is difficult to understand how much of a tax penalty will be given to those who opt out of affordable care. Certain procedures cost more in the United States than any other country, including Sweden (SWE) (Kane, 2012).
In my opinion, these numbers strongly reinforce America's need for better healthcare coverage for all people. To detail the exact coverage of ACA, the act had to undergo a few revisions and was divided into ten titles which draft out the laws of the act. The Affordable Care Act can be difficult to understand but how does the law compare and reflect upon Sweden's universal healthcare system?

Legislation for Sweden's Healthcare and Affordable Care Act

Both countries have heavy legislation concerning healthcare. Ranging from laws concerning pharmaceuticals and overall patient coverage. The major difference between the two countries is the division of coverage. America uses Affordable Care, Medicare, Medicaid and private insurance to insure the American people. Sweden's legislation manly covers patient safety. According to Socialstyrelsen, a Swedish Healthcare Website, all healthcare providers are personally responsible and have legal responsibility for achieving compliance with patient safety regulations and for monitoring their own work between patients and hospitals (Healthcare complaints, n.d.). Socialstyrelsen also states that the Health and Social Care Inspectorate' is the organization which monitors healthcare activities and professionals to ensure that they comply with applicable laws and regulations (Healthcare complaints, n.d.). The Health and Social Care Inspectorate is majorly responsible for health care, public health, social insurance and social issues (Healthcare complaints, n.d.). In 2011, Sweden introduced the Patient Safety Act (2010) which states that health care workers are personally responsible for their own actions (Hjortsberg & Ghatnekar, 2017). For example, this act would help protect individuals who are harmed or made ill by work related situations which would then be reported to the proper government department which will then determine the course of action to resolve the situation to protect other employees (Hjortsberg & Ghatnekar, 2017).

Like America, Sweden has legislation that prohibits discrimination based on nationality Sweden also has an equal treatment law which states that all suppliers must have the same access to information (Hjortsberg & Ghatnekar, 2017). Contrarily, Sweden has legislation which requires suppliers to have transparency when providing information, one that requires proportionality between the contacts and their stated requirements as a supplier (Hjortsberg & Ghatnekar, 2017). America by comparison has been attempting to perfect healthcare for many years. Medicare and Medicaid are government funded programs which seek to provide health insurance to those who cannot afford it, Medicaid, and the elderly over 65 years of age, Medicare (Mazie, 2018). America has laws to protect workers, expecting mothers, veterans and health care professionals (Health Care Law, n.d). Both Sweden and America have legislation that reinforces patient's safety and privacy through HIPAA (Woods, 2014). The Affordable Healthcare Act of 2010 is a more recent development in America which seeks to provide insurance to all American citizens had to undergo a few revisions and had ten titles established which outlined the specific requirements for users and providers (ACA Overview, 2017). These ten titles address affordable health care for all Americans though affordable coverage, the roles of public programs which focused on expanding Medicaid and CHIP (Childern Health Insurance Program), improving the quality and efficiency of health care, preventing of chronic disease and improving public health, health care workforce, transparency and program integrity, improving access to innovative medical therapies, community living assistance services and supports, and finally revenue provisions strengthening quality, affordable care (ACA Overview, 2017) . In my opinion the affordable Care Act was written to cover a wide variety of Americans and it does a great job of ensuring that the needs of those Americans are met by law. While Sweden does not have heavy legislation on healthcare like America, they are monitoring their health care professional through government agencies to ensure optimal patient safety and care (OECD, 2013. While legislation is important, how well have these laws affected how each country spends on health care and compare to each other with other costs?

Sweden and America's Spending

As previously stated, America spends more on healthcare than any other country. The graph below illustrates the healthcare spending compared to forty-four other countries in 2016, six years after the Affordable Care Act was implemented. (Source: OECD Health spending Data)

(Source: The U.S. Spends More Public Money On Healthcare Than Sweden Or Canada, 2017)

America spends more than any other country for private healthcare but actually spends less than two other countries do on public healthcare. While America may be spending more than any other country privately, what are they paying for? America pays more per person for pharmaceuticals than any other country. America also pays its doctors, nurses and specialists more than any other country. The U.S. is also spending more on health care administration than any other country to plan, regulate and manage health systems. In my opinion, this spending gap is due to the high cost of healthcare services and medicine. It costs to have quality care.

( Source: Davis, K., Stremikis, K., Squires, D., & Schoen, C., 2014)

Here we see the countries ranked based on various health criteria. America ranks last overall when compared to Sweden who ranks third overall. The U.S only out-ranks Sweden in three categories, overall quality of care, effectiveness of care, and timeliness of care (Davis, K., Stremikis, K., Squires, D., & Schoen, C., 2014). America does rank fifth overall in quality of care which speaks strongly to our spending habits in my opinion; while we are spending more our citizens are receiving great care (Davis, K., Stremikis, K., Squires, D., & Schoen, C., 2014). I raise the question what good is free universal healthcare if it isn't good, quality healthcare?

Health Statistics Compared

After examining the policy, legislation, facts and spending, how do the two countries differ in success after the implementation of the Affordable Care Act? Statistics such as infant mortality rate, percentage of insured, and effective care. The chart entitled effective care measures depicts different care scenarios and ranks each country based on their care. The U.S. ranks third overall while Sweden is ranked ten out of eleven. This chart was provided by commonwealth in 2014, four years after the Affordable Healthcare Act was implemented. In my opinion one could argue that this proves that ACA helped improve the quality of care in America.

( Source: Davis, K., Stremikis, K., Squires, D., & Schoen, C., 2014)
OECD then reported that America has more hospital beds per 1000 in the population than Sweden. In my opinion, this fact also reinforces the effectiveness and quality of America's healthcare.

Conclusion

Sweden may have universal healthcare but residents are taxed heavily and then receive poor quality of care. The Affordable Care Act provides affordable, quality healthcare to those who need it without heavy taxation. There are positive and negative effects to both plans but ultimately health care remains a controversial topic. After observing the facts discussed throughout this paper I, in my opinion, have determined that the taxation is not fair for universal healthcare, the quality of care is poor, policy and procedure is hard to understand, and it is difficult to receive care when you need it. The Affordable Care Act, however, seems to be lowering costs, improving quality of care, heightening the number of citizens insured but healthcare spending is still the highest without the highest of quality. Faults can be found in both parties but overall it is the citizens who inhabit the country who control the system by being an active voter to decide future laws and being educated about current healthcare systems.

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