Sobering thoughts from Sweden.

Longtime readers of this magazine with especially good memories might have a faint recollection of an article I wrote back in 1999 about Sweden's "almost perfect" long-term care system ("Does Europe Have the Answers?" September 1999, p. 52). I found that the country provided high-quality, well-staffed resident care based on exceptionally generous tax contributions, with tax rates ranging from 30 to 50%. The article cited a statistic that only 1% of Sweden's elders reported having unmet needs, versus 30% of American elders. I concluded that if a country was willing to support its long-term care system in this manner, it would pay off in comparatively excellent services. (Sweden's minimal regulatory approach didn't hurt either.)

I've recently returned from a second visit to Sweden, which was mostly for fun. (I highly recommend Stockholm as a travel destination for anyone.) On one of my walking tours, the guide, while claiming "no political expertise whatsoever," commented that the country's ruling Social Democrats and its all-encompassing social service programs were in some danger in next year's national elections. "People are fed up with the taxes," she said. "It's gotten so that small businesses are having a hard time making money, and people want more of a chance at doing that." It was an explanation that would resonate with many Americans, I thought, although an American woman accompanying us on the tour wondered out loud whether, with nearly 46 million Americans now reported uninsured for healthcare, this was the way Sweden really wanted to go.

And yet the tour guide's observation was one I could understand. A free market economy stifles its entrepreneurial spirit at considerable peril, in my view. I can comprehend the frustration of those who want to see their investments and hard work rewarded with personal wealth and opportunity.

But, as we Americans well know, not everyone is an economic winner. Those who lose at the private economic game risk severely hard times if no general provision is made for their basic welfare. And there is the conundrum: private initiative versus personal security. Where is the balance?

As I write this, Washington, D.C., is preparing for the December White House Conference on Aging (see "Warning Signs for the White House," p. 26). Political debate is just starting to heat up concerning what it will take to finance a decent system of long-term care for the fast-growing population in need. No one expects we could ever have a fully financed system supporting every level of need. Many would argue furthermore that private economic interests are so deeply entrenched in American healthcare that there could never be a program even approximating Sweden's, Canada's, or any other Western country's systems.

But there has to be a better balance than we have now. And, as in Sweden, now is the time to be thinking about where that balance might lie.

BY RICHARD L. PECK, EDITOR-IN-CHIEF

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