(I wanted to let the Burton post “soak” a bit before putting this on the front page… – promoted by mataliandy)
The following is a pseudo liveblog from last night’s public meeting in Montpelier, featuring Bernie Sanders and Friis Petersen, the US Ambassador from Denmark, to discuss the difference in health care and education policy in our two countries.
EVERYTHING below is paraphrased. I tried to capture the gist of what was said, but I can’t type as quickly as humans speak (especially Bernie). Any inaccuracies or misspellings are mine. Feel free to correct.
US Senator Bernie Sanders and Friis Petersen, Denmark’s Ambassador to the United States, Sunday, March 21, 2010
Introduction, Bernie Sanders:
I get a little bit tired of hearing some of my colleagues in Congress and people in the media dismiss the European model and Scandinavian model, because, you know, we’ve solved all social problems … [much laughter]
We were driving in from Burlington earlier and I asked the Ambassador how much vacation time the average Dane has. Some people here have 0 vacation in the us, and many, if they’re lucky, get 2 weeks after a few months and maybe 3 weeks or more if they hang onto the same job for a number of years.
It is 6 weeks for ALL workers in Denmark. [gasps in audience – literally]
Now is not the time for us to be arrogant. It’s time to open our eyes and ears.
One of the issues that bothers me – we have the highest rate of childhood poverty of almost every nation on earth. Not coincidentally, we also he have the most people in jail. An embarrassingly high percentage of our children are dropping out of high school. College costs are out of control at 40-, 50-, 100-thousand a year. We live in a country where people feel lucky to have a job that makes them work 50 – 60 hrs a week.
[In Denmark] They look at the world a little differently than we do. They are a country that invests in their children. Imagine what it would mean if you knew your kids could go to college. If you knew that your out of pocket for health care wouldn’t bankrupt you.
Recently Mitch McConnell, when talking about health care said “our goal is to make sure we don’t do what Europe did.”
[Introduces Ambassador Petersen – remarks and Q&A below the jump]
Ambassador Friis Petersen:
We Danes are very proud that we are one of the countries in the world with the longest unbroken diplomatic ties with the US.
We call it activist foreign policy – through cold war the policy was “don’t rock the boat” but since the end of the cold war, we have been very close in daring to do things with the US, when others won’t.
We cherish human rights, democracy, rule of law – we try to spearhead those kinds of policies. We do not do just the hard parts (like military – such as in Afghanistan). That’s been a big priority for me – to be w/the administration on these issues. Another issue, energy and climate. We didn’t get to where we hoped in the Copenhagen accord, but we are happy with the help from Obama that moved the process forward.
How our welfare society is organized:
Dealing with health education, welfare, and social security. The things that you know: we have few natural resources (a little oil and gas in the North Sea, but nothing more, just our heads and hands), so we have to organize ourselves very cleverly to have a high standard of living.
The private sector and the public sector: when we try to look at our private sector, we’ve been able to grow some companies to be very large. We have one rich man in Denmark [laughter]…
We have Vestas wind turbine producer – the largest in the world, some of the largest most successful biofuel companies that create the enzymes that convert biomass (including switchgrass in 2010 and 2011). These successes were created by government policies. We have a lot of medical and pharma companies that combine their production w/corporate social responsibility. When it comes to the business environment, we are ranked as number 1 in the world. You can’t do enough to ensure that your companies are healthful, strong, and sustainable companies.
When it comes to education and health – we have decided to have a very public run, govt financed free for all system. If you want to study to become a doctor, lawyer, etc. in college, you do it because you are interested and because you have the grades – not because you want to make the money.
People do what they have a strong interest in doing – not because they will make the most money at it. It’s not because we don’t want to have strong business, but because it gives us flexibility and freedom. Our freedom is maximized by offering education free for everyone if they have the desire to work to get the grades that will get them into the program.
When it comes to health, we have universal coverage. Who could not be part of universal coverage? Who would you exclude from health? How would you make the decision? So we had a competition in how to provide the BEST govt run health system.
US pays 19% of GDP to health care. We pay 9%. When it comes to those comparisons of health output – we do a little better, but have half the cost.
No Dane would know what malpractice litigation is – we simply don’t have that. No Dane would know what pre-existing conditions are – we don’t have that. It gives us an increased freedom – enables us to live freely without worrying about health care.
We are not magicians – we just let the private sector do what they do best: create global companies, but at the same time admitting that there are things done best by the public sector. Schools, health care, etc. By that division between private sector and public sector, we get the most freedom. Security that our society needs and wants.
We probably have some of the highest tax rates in the world (50% or more), but that social contract is an attractive contract. We like the services govt provides to us, so we really don’t have a discussion about cutting taxes. It’s not likely to be a factor in next elections. The issues we will see are things like: can our education become even better? We want smarter youngsters securing our long term viability in competition with other countries….
Bernie:
Q: Please explain average life of a Dane. Say I’m a young father. We have a baby. In this country, the mom gets 12 weeks off without pay, if she can afford it. In Denmark how much time do you get off?
A: We had 6 months paid leave when I got married, now it’s 1 year.
Q: Finding good quality child care is enormously difficult in this country.
A: We pay a very high price for child care. There is less expensive care, but my family pays $600/month. We have such a high price, because we want people to consider staying home with their young children, which is why we also provide paid leave.
(Q: to the audience, asking how much does it cost for child care around here? A woman from Montpelier said it’s $45/day which works out to $900/mo).
Q:I lived in Denmark many years ago and never saw anyone complain about health care. They complained about taxes, just because they have to complain about something, but said they would NEVER switch to our system. Real Q: does Denmark provide free health care and education to immigrants?
A: Yes. It’s one of the biggest issues, politically. You have people who come in and live up to the social contract, but others who don’t. It’s a big political problem. They come and enjoy the benefits, but don’t want to partake of society. There has been some change in immigration policy – requiring that you do certain things to become fully integrated into the society to get access to many of the benefits.
We used to have little crime. We have 68 citizens in prison per 100,000, the US has 10 times as much. The cost of this in the US must is very high.
Q: What did it take to get the nation to accept this kind of social policy, this kind of allocation of $$ resources?
A: It’s a historical evolution from the emergence out of the second world war. We were in VERY bad shape – many would not understand how troubled it was all across Europe at the time. Out of that time came great a production revolution and associated affluence. Out of that grew a prominent role for government to have a dual-component society that would support companies while also providing the services that support society. We didn’t finance it – we accrued a huge debt until the 1980s, when we changed fiscal policy to reduce our debt through high taxes. We had the social policies in place first.
We also had a philosophy to build a strong, vibrant society that had public-private partnership. We have a slower GDP growth rate per year than the US. We want to increase it with more productivity w/more advanced technologies and better education to be more competitive.
Bernie: When we say “conservative” we mean “would privatize all social programs.” When you say conservative, do you mean the same thing?
Petersen: Well, when people complained about issues (like waiting times of a few weeks for things like knee surgery) we liberalized the system to allow a private health care choice. Conservatives support a socialized system. Our health secretary came to see where US health system (which is the best and worst in the world) can provide ways for us to be better – looking for things like technologies we can adopt. (audience comment: don’t do what we do!)
Q: What is the general tax rate? Isn’t Denmark the country where people bike everyplace, saving resources and being healthier?
A: 35% of transit in Copenhagen is by bike. It’s healthy, but also practical and much smarter than sitting in queue’s being in smog, frustrated, wasting fuel. It’s easier.
Tax rates in the %0% range. We have energy taxes. $9 – 10/gal for gasoline. We’ve decoupled growth from energy consumption. We saved a lot of dollars and increased economic competitiveness that way. By incentivizing people to save energy, and increasing taxes on carbon based energy, we’ve given people incentive to use alternatives – growing those industries, making the success of companies like Vesta possible. We can then reduce income taxes by the amount gathered in carbon taxes. Waste costs extra.
Q: Tell us about your retirement system?
A: Universal people’s pension system for everyone. If you have a little wealth, you get a slight reduction. My Dad retired in 1991, and still enjoys it, and saves from his pension.
Q: How much in American dollars:
A: My Dad makes $1200/mo after taxes (but he doesn’t have to pay for health care, medications, etc.)
Q: Fixed budget for health care?
A: Yes. We keep our total expenditures at 9% by having a system in which the hospitals decide what they can afford in services for a given patient. If it was health suppliers or politics making the decisions, then, like here, the providers would try to provide the most possible care, while health insurers would try to deny the most. It’s an unhealthy system.
An example of the difference: with my children, because their births were diagnosed as normal, they were born in the hospital without a doctor or midwife present in the room, though a doctor is on-call the whole time, just in case. In the US, you have multiple nurses, doctors, etc. in the room constantly, at an extraordinary cost, even for a normal birth. If you use the $$ for the things that don’t need the $$, like a normal healthy birth, then you are depriving yourself of the bang for the buck in the places where it’s really needed, like cancer treatment.
We know where the money is needed to get the best outcomes, so that’s where we use it.
You might think of it as a cruel system, where doctors decide things for you, but in our system everyone gets the same care as the Prime Minister. We don’t have people getting worse care just because they have less money.
We have highest income and wealth equality in the world. We could not live with inequality similar to other countries. We want equality as a political goal. It creates what is better than the private solutions. We want the best result – that’s the best of democracy.
Q: I had the privilege of experiencing your system. I went to the hospital at midnight on a Sunday. It cost me $7, including the medicine. How do you ensure quality at every step?
A: Advocating transparency. Hospitals publish treatment records – how well does this hospital work? You have the free choice to go to the hospital with the best treatment. Our standards are high and uniform, so there’s little need to go one place vs the other. But we’ve added private hospitals and private insurance, you pay extra so you don’t have to wait 3 weeks.
The doctors who work in govt hospitals go to the private hospitals after they do their hours in the govt hospitals and make extra $$. We like that, we’re not socialists.
Q: People who want to start a business or are artists, don’t belong to a large pool, and can’t really get insurance. Our system stifles innovation.
A: How do you deal with health care for them? It’s free for everyone. There’s no employer needed to get health care. (Bernie: 25% of people stay on their jobs instead of starting new businesses, so they can get health care. One man joined military when quite old for HC benefits for his wife with cancer.).
Q: You were diplomatic about Copenhagen meeting. Q is for Bernie: I’m sure Denmark doesn’t have the problems we have, global warming will destroy us all, regardless of health care.
A: The dynamic is that I sit on both energy and env. The ranking member of env. committee (Inhofe) does not believe in global warming. Thinks it’s a hoax, not interested in moving forward. Sen Kerry working hard to get 60 votes, which means reaching out to some very, very conservative people. It means we won’t end up with something as strong as it needs to be. We ARE beginning to make some progress in energy efficiency and sustainable energy. We got the most $$ in history of the US to go toward efficiency and sustainable technology.
A: Petersen: What do people in Denmark feel about this. We’ve had more people visit Greenland to witness global warming. I saw this last week, danish produced film, made in Greenland by danish film director “One Degree Matters” – global warming is real
Danes thend to believe in science.
Q: I worked in Copenhagedn in the 1970s. I was paid more than Danish artists because I was a foreigneer. Are there subsidies for the arts in Denmark now?
A: We attract special quality talent with subsidies. We grant subsidies to as many foreigners as possible to come participate – we benefit from the creativity of those people. We want to make sure we get the best of everything.
Q: Web sites where we can keep up with European and scandanavian countries re: health care over there?
A: It’s easier than before to be informed. If you search the Denmark dept of health, and the embassy of denmark in DC, you will find links. Danish pharma companies are used to dealing with a very difficult market (misers) that gives them a competitive advantage. Research and innovation is happening from pooling interests – could be even more streamlined and focuses.
Q: Thanks for letting mothers stay with their young children. I attented discussion w/Dr. Hsaio who discussed the complex system in Hong Kong, Taiwan, etc.. Which is better?
A: I can’t immediately come up with studies (off the top of my head). If you compare the US v Denmark or many European systems, you use almost double the amount of GDP but only get the same health care outcomes (or worse). Life expectancy, infant mortality, deisease outcomes.
Bernie: No debate that ours is the most costly and inefficient system in the world. Exactly which system is the most efficient is not answered.
Q: Danes don’t know what malpractice is, how does the system handle injuries?
A: We don’t have malpractice litigation. We try to treat malpractice with great seriousness, by trying to prevent it via procedures – learn from it when it does happen, and try to provide some compensation to the patients.
Bernie: In this country, if you go into surgery and there’s a mistake, you have to pay 10s of thousands of dollars to be made whole. That’s not the case in Senmark.
Q: Our primary care physicians are least well compensated and specialists most well compensated, which drives students into specialties, leading to shortage of primary care physicians.
A: Doctor’s union negotiates with the finance ministry to deal with the compensation. It’s comparable to lawyer or other professional. it’s not US salaries.
Bernie: 10s of millions of people can’t get a doctor. So they walk into emergency room to get treated for a cold. In addition, since doctors emerge from school $100s of thousands if dollars in debt, they can’t afford to be primary care. We are going to put 12.5 billion into community health centers. 7500 new centers in US, to get health care, dental care, low cost drugs, and increase 17k new doctors, dentists, and nurse practitioners in the next 5 years alone.
Q: Did Denmark ever suffer with public sector people mishandling public resources that makes people worry about large amounts being mishandled? Was there ever such a loss of trust in government? I don’t know if you have lobbyists…
A: Even though I am a public employee, I try to stay in touch with the reality of the economy for the private sector. The challenges in a tough competitive environment, I think what we do in Scandinavia can be done in other places. We don’t pretend that we can give the kind of standardized good health sector policies that we use in Denmark. There are income inequalities that make it harder. Second if you run a big bureaucracy, it’s difficult to make big bureaucracies be effective and productive and stay in tune to the current reality. Maybe at the state level is more comparable.
Bernie: there is a crisis in confidence. Does the average Dane feel better about govt than we do in the US? Yes. If we were 60 times bigger, we might have a harder time proving that we are running the system well.
Q: Mental health care in Denmark. Our system is absolutely broken. Psychiatric hospitals excluded from Medicare reimbursement. 1/2 people w/persistent illness never get care and end up in correctional system.
A: Not an expert on mental health care. But we tried to address the fact that modern life creates mental diseases, and it’s an area where we no longer make the distinction.
Q: Cynical that ins. cos, medical equipment manufacturers and other lobbyists have written our health care policy.
A: Our parliament is pretty independent. We have lobbyists, but our legislature is very independent of them.
Bernie follow-up Q: How does the campaign system work in Denmark?
A: There’s very little financing from private sources in our campaigns. Our parties collect a small membership fee ($100/yr). Companies pay little to the parties. The numbers of dollars spend on campaigns in the US are very, very impressive and staggering.
(Bernie: 5 billion in 10 years wad donated in US just to get deregulation in financial system.)
Q: What do you see for cost happening in Denmark with aging population?
A: We have the same problem as other countries in terms of demographics. Big block of retirees needing care, newer generations are smaller. We’ve done a number of things – make healthy lifestyle important. People smoking less and living healthier, which is counteracting the trend of cost increase from more elderly. We ask older people to stay in the workforce longer – also seeking shorter college programs to get people into the workforce earlier.
Q: Private sector relationship between capital and labor. In US it’s “hands off” invisible hand systen. But we continue to reduce the taxes on most wealthy while our capital flies out of the country seeking lower cost markets. Do you keep your capital in the country?
A: Biggest MS facility outside US is in Denmark. CEO said for MS to be the biggest possible, it would go Danish. Tax rate is something, but the overall assessment of the business environment is what matters to companies when they look at Denmark.
Bernie: Their wages are high, taxes are high (50%), and they have 60% unionization, and they’re one of the best environments for business.
Q: How do your companies become successful with high taxes, and high wages?
A: You have many high salary companies in the US, so it’s not that dependent where you locate your production. The salary isn’t what determines success. It’s the whole company, and its whole process and planning that matters. Advanced consumers and research are important.
Q; (for Bernie: Use reconciliation to force taxes of 95% on insurers, oil cos., etc.)
For the Ambassador: Have you ever seen obstruction in any democracy on the level that’s taken place in Washington in the last year?
A: Bernie: The democratic leadership has started to catch on. You’ll see movement toward reconsideration of the filibuster and hold mechanisms. House will pass its bill today. Next week it comes to Senate. Working hard to get second next budget that will continue the process using reconciliation.
Petersen: If you look at US political scene with very limited time span, you get a bleak assessment. I believe it should be judged on long term performance. The constitution is a state of the art constitution. If you look from longer perspective, it has accomplished more than anyone else, and I would therefore be positive about the US. But it seems to be t a crossroad because the world has changed. Globalization has affected us all. Next I will be ambassador to China and we all have to relate to this new flatter world where legislatures have to try to adjust to the project of the nation. We need to be attentive to broader solutions and cooperation. Your 1st 300 years you’ve done quote well.
Q: Energy policies. We have a leaking nuclear power plant, washing waste into the ground. In all likelihood it will close soon. People are trying to pass alt energy legislation. Farmers in the northern part of state want to start wind on their own farms, but there’s local opposition. Do you have local or govt opposition to such in your country? If so, how did you “stomp it out”?
A: We have no opposition on this. We get 24% of our electricity from wind, which has been a major part of our energy infrastructure for the last 30 years. We decoupled our energy from foreign countries and went from 99% dependence on foreign energy in 1970s to a net exporter today. Energy is our most strategic industry.
The US is very creative, it created the NIMBY phenomenon. You apparently want to discuss everything, but we’re practical people. We thought: if we can harvest the wind, we should harvest it.
We have no nuclear, but the Sweden put their nuclear plant as far from their own major cities as possible – right across from us.
\Bernie: We ignore their successes at our own preil.
