Freedom and Security in Denmark

...And it must be conceded that some other organizations, such as trade unions, require their members to join the sick clubs...

...But beyond that there is a maximum of local autonomy and grass-roots direction...

...All this is not to say that every Dane is completely satisfied with the measure of freedom and welfare he enjoys—or with the balance between the two...

...A fourth article, a first-hand survey of Soviet medicine in action, will appear in an early issue__The Editors At a recent national congress of the Danish Social Democratic Party, a portion of which I attended, a large banner proclaimed: "The People's Freedom and Welfare...

...And the doctor, instead of bitterly accusing an alien society of conspiring against him in the guise of "socialized medicine," recognized that he himself was a part of that society and did his best to fulfill his role in it...

...In the period 1930-34, a total of 39 per cent of those called up for military service were rejected as physically unfit...

...There is of course a strong Conservative Party, which wants more free enterprise in the Danish economy —though not at the expense of too many of the social services...

...Within six months we had no less than four occasions to use our insurance benefits...

...And doctors have learned how to deal with the rare chronic complainer...

...Of the five, Denmark and Sweden have undoubtedly made the greatest advances toward the goal...

...In the final analysis, it is clear that the attitude of Danish doctors is the result of the social climate that has been built up over the years by the people themselves...

...The article below by Max Awner, American author and editor who spent a year in Denmark on a Fulbright Fellowship, examines the workings of the Danish system...

...Thus an example of the "welfare" side of /the Danish social coin...

...It is in this area that the greatest hue and cry have gone up in the United States, with "socialized medicine" as the bugaboo...

...Anyone with an income not exceeding the normal maximum for a skilled worker (under a flexible scale based on number of dependents) is eligible for membership...

...However, he is assigned to one designated doctor, always in his immediate neighborhood...

...But malingering is remarkably uncommon...

...it would be extremely difficult to find a Dane eligible for membership who would take seriously the notion that some obscure "principle" stands in the way of his helping himself to better health...

...They have designated one month in each year during which members may change doctors if for any good reason they are dissatisfied with the care they are receiving...

...The first, "Health Insurance for All," by Senator James E. Murray argued the case for a national health insurance program for America...

...Denmark, for example, has the lowest death rate in the world from tuberculosis—14 per 100,000 population in 1950...

...But not so fast...

...It may be assumed that Danes make greater per capita use of medical services than do people in countries where the doctor's bill is as inevitable and inexorable as death and taxes, though I could find no figures on this score...

...It is true that the individual doctor's patient load is a little heavier than in the United States—though lower than in most countries of a comparable character...

...For those with higher incomes (about 15 per cent of the population) there are non-subsidized health insurance associations which operate on a principle similar to our Blue Cross...

...But the Danes are conscientiously trying to lighten this load through stepped up medical training, with women assuming an ever more important place in the medical profession...

...The universal pension enacted recently (superseding a more or less limited national pension which had been in force for many years) provides that every Dane will be entitled to a generous monthly benefit when he reaches the age of 67 (62 for single women...

...The Danish Medical Association itself plays a direct part in the activities of the National Health Service, being represented on several working committees...

...The Swedes have coined a term for the kind of community envisaged by such programs...

...Freedom from ill-health and from the fear of ill-health is an important freedom too...

...that there be "a justifiable division of the proceeds" and no compromise with the principle whose goal remains the achievement of "new social and cultural progress...

...Johannes Frandsen, recently stated: "One inevitable consequence of our entire disease treatment system is the position of our physicians, with incomes mostly deriving from the national sickness insurance and from the hospitals...

...Energy and initiative are encouraged by providing a 10 per cent higher pension benefit to those who wait until they are 70 before applying for it, and 15 per cent to those who postpone application until 72...

...Despite their arduous labors, few doctors seem unhappy with their lot...

...Today they embrace about 85 per cent of the population in an amazingly comprehensive, efficient, and inexpensive health insurance system...

...in all four we would have derived no benefit at all from any standard American health insurance scheme...

...He said people, knowing their neighbor cannot suffer real economic distress with all the welfare programs available, "mind their own business too much...

...Neither in its origin, with the medical profession voluntarily helping to establish our sickness insurance, nor in its subsequent development, has this had any relation to political ideologies...

...One policy alone has been pursued through the years during which this system has been evolved under changing governments and changing political majorities in Parliament: to build up a system for patient treatment that would provide everybody with unhindered access to the best treatment, and to establish the most effective prevention of disease...

...Despite repeated and diligent questioning, I have been unable to discover a concrete theory for this phenomenon...

...The second, by Dr...

...That is a slogan of the Social Democratic Party, but it also sums up the social philosophy of the Danish people and of the Scandinavian countries generally...

...This same official denies that there is a direct connection...

...This includes doctors' home and office calls, unlimited hospitalization and surgery, midwife assistance, milk allowances for pregnant and nursing mothers, and, literally carrying out the "cradle-to-grave" idea, a modest funeral upon death...

...In the final analysis, it is because freedom and welfare are the goals, the inseparable goals, for all the people, that 4!/2 million Danes are willing to spend 10 per cent of the total national income and 38 per cent of the entire national budget for these purposes...

...It is perhaps a tribute to the high medical and ethical standards of the Danish medical profession, rather than a symptom of lack of discrimination or energy on the part of members, that few avail themselves of this privilege...

...A high official in the government—and an extremely intelligent one—has expressed himself strongly (though privately) that there is not enough person-to-person contact in all the welfare programs, that the human touch is lacking...

...Doctors have been brought up on the idea that public service and not private profit is the paramount consideration...

...Growing out of the pre-industrial revolution guilds, the Danish "sick clubs" were given legal standing by a national law passed in 1892...

...With or without the private patients, their income is considered generous by Danish standards, and they do not feel themselves debased by the form in which it comes...

...Suppose we turn the coin over...

...In addition, the insurance pays roughly half the cost of most dental treatment and, at optional extra cost, a small daily allowance while the patient is incapacitated...

...But little prodding is needed...

...A. Talbot Rogers, prominent London physician, analyzed the British program in action...

...Virtually all the major epidemic, infectious, and venereal diseases have been brought to the point where they no longer constitute a serious health problem...

...premiums are considerably higher than in the "clubs" and benefits not so generous...

...For total annual dues of about $12 for each family member above age 15 (children under 15 are covered when their parents are), one receives practically all ordinary medical services at no further cost...

...The result, he argues, is too many lonely people, especially among the older age groups...

...In the first place, the health insurance system is voluntary—though it is true that it is so universally applied that many people have come to accept it as practically obligatory...

...Each local society is run by its own members through duly elected representatives, and the day-to-day administration is the job of local people with little or no dictation from higher up...

...Actually, no doctor is forced to participate in the health insurance program, but practically all do—voluntarily and even eagerly...

...This, of course, should be the cue for the foes of "socialized medicine" to start their screaming...

...In the fall of 1955 the figure was 16.1 per cent...

...There are high-minded individuals within most of the parties who maintain that not enough attention is paid to the causes of social distress in all the programs to eradicate its effects...

...Moreover, most find time to minister to a few private patients on the side...

...Here too, the Danes are mindful of the "freedom" side of the social coin...

...The director-general of the Danish National Health Service, Dr...

...When my family and I arrived in Denmark, one of the first things we did was to join one of the 1600 syge-kasser (local health insurance societies) distributed throughout the country...

...Or does he allow himself, for the sake of a little security, to be regimented and bureaucratized all over the place...

...Under the Danish system, each member is furnished with a list of general practitioners in his district...

...But with all due allowance for the fact that Denmark is still far from its goal of welding freedom and welfare into a perfect union, the marriage is about as happy a one as can be hoped for in this imperfect world...

...The Danes, with their customary moderation and good sense, have provided a safety valve...

...Can a Dane reap the benefits of such a system and still enjoy freedom...

...As with medicine, so with other social activities in Denmark—unemployment insurance, workmen's compensation, family welfare programs, housing activities, special services to school children, and many more...

...Life expectancy has increased by about 17 years in the past half-century, and now, at about 68 for men and 71 for women, ranks among the highest in the world...

...And this regardless of whether he chooses to continue working after that age—though of course the payment is scaled down according to other earned income, but never to less than about one-fifth of the maximum allowance...

...Can this be an explanation of the curious fact that the Danes, especially among older elements, have one of the highest suicide rates in the world...

...And even the dominant Social Democratic Party has expressed concern over certain cracks in the social and economic structure, and has been working to encourage more private initiative and investment, but with this important proviso...

...In roughly parallel activities, beginning well before the turn of the century in some cases, Denmark, Norway, Sweden, Iceland, and Finland have been striving to achieve a synthesis of the two terms that in so many quarters are held to be antithetical—that so many Americans are prone to link with a "versus" rather than an "and" when they must refer to them in the same breath...

...From the start, the medical profession strongly supported the sick clubs...

...What's more, the DMA arranges continuation courses for its members in what the association itself calls social medicine...

...It is true that the basic legislation behind the clubs is national, and that rates and essential regulations must be more or less uniform...

...A crucial question, of course, revolves around the relationship between doctor and patient...

...It is "A Home for the People...

...Though the following applies in principle to all five countries, the specific references are to Denmark, many of whose people and customs I came to know intimately...

...The societies are about 70 per cent financed by members' dues, 30 per cent by state subsidies...

...But what about the "inevitable" bureaucratization and resulting waste and inefficency of such welfare schemes...

...It may or may not have any connection with the social atmosphere in the country or the social outlook of the Danish medical profession, but statistics show a marked improvement in the national health level since the turn of the century...

...Who can calculate how many serious illnesses have been checked at the outset, how many deaths prevented, because the patient felt no qualms about visiting his doctor at the first symptom instead of waiting until the ailment was far advanced...