Finland's health care, new bills in Congress, residents' views explored at local Health Care Forum

By Michele Bourdieu

HOUGHTON -- Finlandia University faculty members who recently observed Finland's health care system say it offers a model the U.S. could do well to imitate.

Barbara McLean, Finlandia visiting assistant professor of psychology, and Debbie Karstu, Finlandia nursing professor and nurse practitioner, described their impressions of Finnish health care at a recent Health Care Forum, "Finding Solutions to the Health Care Crisis," at the Keweenaw Unitarian Universalist Fellowship (KUUF) in Houghton.

State Rep. Mike Lahti (D-Hancock) addresses panel members, residents and visitors at the June 13 Health Care Forum held at the Keweenaw Unitarian Universalist Fellowship in Houghton. Finlandia University faculty members Debbie Karstu, second from right at front table, and Barbara McLean, third from right, spoke about the Finnish health care system. On the wall are a map of Finland and photos they brought from Finland representing the Finnish philosophy that health care is for all people. Click on photo for larger version. (Photos by Keweenaw Now)

"It was so wonderful to see what they're doing there," McLean said. "First of all their costs are lower, much lower."

She mentioned Finland's low infant mortality rate -- one of the lowest in the world -- and the fact that health care begins "before the womb" and the excellent maternity care includes after-care and support for families.

"They did not put their programs on a pedestal," McLean noted. "They have problems and they have challenges."*

However, she added, she was impressed by many aspects of the system.

The two professors accompanied a group of Finlandia nursing students on a three-week trip to Finland this spring. The trip included visits to health systems, education systems, elder care, playschool and university systems.

Finnish philosophy: Everyone deserves health care

McLean and Karstu both emphasized the basic philosophy in Finland -- that every person has a right to be treated as human and, regardless of his or her choices in life, is deserving of health care.

McLean gave an example of how people with schizophrenia were released under supervision and cared for in Finland so that they would not become homeless.

"It was so impressive," said McLean. "I would encourage you to find out more about Finland's health care system so we can join this century."**

Karstu, who organized this trip as well as previous trips to Finland for Finlandia students and faculty, also works in the local community as a nurse practitioner in family planning at the Health Department and helps at the Aspirus clinic at Shopko.

"I would like to be an advocate for a basic level of health care for all people -- not just if you're working and pay for your health insurance, but just because you're a human living in a civilized society in America," Karstu said. "I think we have somehow a humane, ethical responsibility to take care of the people in our society."

Karstu noted the health care provided in Finnish schools is a good example of prevention and wellness. She said she would like to see more benefits in the U.S. for living a healthy life style.

Dr. Fredi de Yampert, president, League of Women Voters of the Copper Country and chair of Finlandia University's nursing program, also spoke at the Forum.

Dr. Fredi de Yampert -- president, League of Women Voters of the Copper Country, and chair of Finlandia University's nursing program -- is pictured, third from left, with other panel members, from left, Dr. Richard Imm, president, Western UP Healthcare Access Coalition, Rev. Robert White, United Methodist Church Keweenaw Parish, and Finlandia University faculty members Barbara McLean and Debbie Karstu. They listen to a presentation by Sarida Ross (standing), United Auto Workers Region 1 Representative for Child Care Providers Together, Michigan. At far right is KUUF Pastor, Rev. Sydney Morris, and, in foreground, State Rep. Mike Lahti, taking notes.

Dr. de Yampert said the League of Women Voters' position on health care -- a national plan of affordable, quality health care for all Americans -- was publicized in 1993 -- 15 years ago.

Nursing, she said, can help by bringing in the nurse practitioners and physician's assistants, who are more cost-effective than physicians. Nurses in the schools will also save having to take children out of school to go to the doctor.

Dr. de Yampert noted education of a new generation of nurses requires funding for nursing faculty.

"It's not just nursing where we have a shortage; it's across the health care spectrum," she said.

"Advocating for funding for education in health-care disciplines is critical."

Along with de Yampert, McLean and Karstu, the panel of Upper Peninsula speakers included Dr. Richard Imm, president, Western UP Healthcare Access Coalition, and Rev. Robert White, United Methodist Church Keweenaw Parish.

Dr. Imm described his earlier rural practice as a family practitioner in the 1970s, when medicine was simpler, with fewer tests and x-rays and the cost of care was quite inexpensive compared to today's costs. After that he worked in the Air Force for over 20 years (in a large HMO) and earned a regular salary. More recently he returned to family practice in Houghton.

"It's a mess," he said. "Things are very expensive. There are maybe 100 lab tests I could order instead of 5 or 10 of 30 years ago, etc."

Imm said he works for the Western Upper Peninsula Access Coalition, which coordinates donated care from physicians in the area for uninsurable people under 200 percent of poverty level.

Imm gave these statistics:

• Over 50 percent of doctors are now in favor of universal health care.
• Over 50 percent of U.S. bankruptcies are due to inability to pay medical bills.
  
• The top-paid health insurance company CEO was paid $24 million for 2008.

"Just about every medical journal I get now has at least one health care reform article -- and maybe two or three," Imm said.

Rev. White first asked the audience to have a moment of silence for those who died as a result of having no health care (650 in one year in Michigan alone).

White called attention to the fact that many U.S. hospitals were started by faith-based communities.

"One of the primary things right now that a lot of our churches are stressing is the individual responsibility we all have in our own health care," he said. "The faith community would like to see access in health care available to all, as some of these (congressional) bills are pointing out."

State, federal legislators represented at Forum

The 60 or more local residents who attended the Forum were evidence that health care reform is an issue people care enough about to communicate directly with their state and federal government representatives.***

"It was really heartening to see so many people come out to address this desperate need for health care in our country," said KUUF Pastor Sydney Morris.

Present at the forum to listen to constituents' concerns were State Representative Mike Lahti (D-Hancock) and representatives of other key legislators: Amy Wisti for Congressman Bart Stupak (D-Menominee), Sherri Davies for U.S. Sen. Debbie Stabenow (D-Lansing) and Paul Tesanovich for Michigan Sen. Mike Prusi (D-Ishpeming).

Paul Tesanovich, former Michigan legislator, speaks on behalf of State Sen. Mike Prusi(D-Ishpeming), who was unable to attend.

Davies spoke about Sen. Stabenow's People's Health Care Lobby on her Web site which allows constituents to share their personal stories with her so she can share them with other legislators.****

Wisti and Tesanovich said they were interested in hearing people's comments and would convey them to Congressman Stupak and State Senator Prusi, who were unable to attend because of other commitments.

Guests at the Forum, from the Detroit area, included Sarida Ross, United Auto Workers Region 1 Representative for Child Care Providers Together, Michigan; Randy Block, Michigan Unitarian Universalist Social Justice Network (MUUSJN); and Valerie Przywara, Michigan Universal Health Care Action Network (MichUHCAN).

Ross said her new union was for home-based child care providers in Michigan. Close to 87 percent of the approximately 40,000 home-based child providers in the state of Michigan are without health care, she noted. There are about 400-500 of these providers in the U.P.

Rev. Sydney Morris, KUUF pastor, introduces guest speaker Sarida Ross of Detroit, second from left, United Auto Workers Region 1 Representative for Child Care Providers Together, Michigan.

"The average pay for a child care provider is $1.80 an hour," Ross noted, "and we're advocating with the representatives not only for health care but for a higher living wage."

She also mentioned the following statistics:

• Presently over 75 million Americans are without health care.
• More than 900,000 Mich. residents were without health care in 2008.
• Michigan is 13th in the nation for residents without health care.
• In 2007 Michigan had 984 infant deaths -- 83 percent could have been avoided if those children had had some kind of health care.
• 80 asthma-related deaths among uninsured Michigan children between 2 and 17 could have been prevented.
  

A high percentage of Michigan's population is at or below poverty level and not receiving preventive health care, Ross added, showing a strong need for national health care.

Ross said her purpose in attending the forum was to challenge Michigan residents to speak to legislators (both national and local) and community members to impress upon them the urgency for national health care.

Michigan health reform bills now being proposed

Block and Przywara took up this same challenge, pointed out the need to become familiar with the bills for health reform now being proposed in the Michigan House and Senate. In their Power Point presentation titled "Michigan Health Reform Legislation; National Health Care for All Principles," they summarized key points in two Michigan House and Senate health reform bill packages. These are House Bills 4934-4943, introduced in 2009 by Rep. Marc Corriveau (D) Northville, and Senate Bills 579-582, introduced in 2009 by Sen. Tom George (R) Kalamazoo. According to the presenters, both legislative packages provide greater access to health care; make health care more affordable for Michigan residents; and hold insurers accountable for certain consumer protections, rate setting practices and subsidizing the costs of coverage.

State Rep. Mike Lahti commented that this plan would require every insurance company -- not just Blue Cross / Blue Shield (the insurance company of "last resort") -- to make insurance accessible to all.

"The more you have insurance companies that have to insure everybody" Lahti explained, "competition should drive costs down."

Przywara, speaking for MichUHCAN, which is part of a broad coalition working for health care reform, said the coalition is looking for outcomes based on principles.

"We want to see comprehensive quality health care for everyone," Przywara said. "We want health care that's affordable."

Przywara added other principles include patient provider choice, public accountability for coverage of services, equal access to all and mental health parity.

Block discussed national health reform principles and the fact that it's quite possible that a national health plan could be referred to the states to carry it out.

"The state could very well be forward-thinking by trying to tap into these new federal dollars to bring more health care to people in Michigan," Block said.

One important principle on the national level, he noted, is that government should act as a watchdog, setting and enforcing rules so private insurance companies can't deny coverage or raise rates based on health history, age or gender. Health care also needs to be comprehensive (not just catastrophic coverage) and accessible to all, without discrimination against minority or low-income groups.

"The Obama approach to health care," Block said, "is to give a choice."

If you have your own private insurance policy that you're comfortable with, you can keep it or you can join a new public insurance plan -- which would be a backup to ensure quality, affordable health care coverage for anyone, Block explained.*****

Block and Przywara urged the audience to become informed about emerging health care bills and to call members of Congress and express their opinions.

Some residents call for single-payer system

Panel members and guests took several questions from the audience.

Visiting presenter Randy Block, Michigan Unitarian Universalist Social Justice Network (MUUSJN), standing, left, and State Rep. Mike Lahti comment during the question - answer session of the Health Forum.

"Can we afford health care for all?" was one of the questions.

"I think we can," Mike Lahti replied to this question. "It's up to us," he added. "I think this is a critical year, and we have to keep on it."

Karstu said it's not a question of "Can we afford to do it" but "We can't afford not to do it."

To a question on whether health professionals should be salaried to save on costs, Dr. Imm mentioned the Mayo Clinic system where doctors are salaried and charges are very low.

"They're not worried about the income; they're worried about the medical care," Imm explained.

White asked whether it would be more effective to try to get health care done on a national or on a state level.

Lahti answered that it's happening on both levels.

"It's not either or," he said.

Tesanovich, a former Michigan legislator, pointed out the importance of bipartisanship and letting legislators know what you want.

Dr. de Yampert noted educational outreach programs such as those available locally for diabetes are one way for people to take responsibility for health.

Oren Tikkanen of Calumet noted his disappointment at the fact that President Obama "accepts the idea that a single-payer program is politically impossible in the United States."

Tikkanen said he believes the health care costs in this country are brought about by the insurance companies, who lobby Congress so they can keep their very lucrative positions, while governments in Finland and many other countries "step in and cut costs by providing things on a rational basis."

Peter Ekstrom of Houghton said he agreed with Tikkanen on the single-payer system and questioned "why we have to think so small." Ekstrom said he believes Obama is being practical.

"He wants to get the best that he can at this time," Ekstrom noted. "I'd like to know why we as a country find this a difficult idea to wrap our minds around, whereas a very large number of people in the world see this as a logical choice."

Barry Pegg of Houghton also said he agreed with Tikkanen on the need for a single-payer system.

"I also think a lot of politicians are waiting to see if there's enough support for a single payer," Pegg said.

Carol Kurz of Calumet noted present CHIP (Children's Health Insurance Programs) differ from state to state and are not as effective as the home and school visits by nurses that began during the Depression and still existed in the 1950s -- to keep children healthy.

Joanne Thomas of Ahmeek said she learned, when she was sick, to advocate for herself in asking for a discount since she is without health insurance.

"I asked if I could get the same discount as insurance companies get," Thomas said.

Thomas said in talking to the billing person at the hospital she not only received a discount but pointed out what she believed was an unnecessary double charge and had it removed from her bill.

Editor's Notes:

* Keweenaw Now emailed one of our Finnish readers, Annukka Vepsäläinen of Turku, with a question on her satisfaction with the health care system and received this reply: "I'm quite satisfied with our health care system, but it used to be much better. It has been downsized since the depression in the early 90s. Yes, it's paid by our taxes. People trust and count on our system. Often you have to wait for quite some time, though, if you go to a public doctor; but a private doctor you can see much quicker, of course, if you are willing to pay (much) more money. The system in many other European countries is better than in Finland nowadays even though we tend to be very proud of our system and not aware of the former fact."

** See the article, "Health Care Systems in Transition: Finland," published in 1996 by the World Health Organization Regional Office for Europe, Copenhagen. Here's an excerpt from the article: "Everyone in Finland has the right to health services regardless of ability to pay or place of residence.

"The 1972 Primary Health Care Act obliges Municipalities to provide health counselling, medical care, rehabilitation (when it is not provided by the National State Sickness Insurance) and dental care for children and young adults. It also obliges Municipalities to provide school, student and occupational health care, screening (cervical and breast screening), mental health care appropriate to a health centre and patient transportation. The statutory services are to be provided in health centres: either the Municipality's own, or together with other Municipalities. They can also buy these obligatory services from the private sector.

"The health care system in Finland is mainly tax-financed. Both the state and the Municipalities have the right to levy taxes. In 1994 about 33% of total health care costs were financed by the Municipal income tax, about 29% by the state, 13% by the compulsory National State Sickness Insurance (N.S.S.I.) and about 25% by private sources. About two-thirds of total health care expenditure is spent on health services provided by Municipalities. Most of the remaining one third is spent on medicines and other pharmaceutical products, private health care, medical aids and prosthesis and occupational health care. This third is largely financed from the N.S.S.I., outof-pocket payments and employers."

*** According to standupforhealthcare.org, July 7 and 8 are National Call-In Days for health care. You can call 866-210-3678 and ask to speak to your Representatives.
See http://www.standupforhealthcare.org/CallCongress for details.

**** Visit Sen. Stabenow's Health Care Reform Resource Center to learn more.

***** President Obama explained this policy last week during a virtual Town Hall Meeting in Virginia, saying, "There's no doubt that we have to preserve what's best in the health care system, and that means allowing Americans who like their doctor and their health care plan to keep their plan. And that's going to be a priority for us. (Applause.) But we also have to fix what's broken about the system, and that means permanently bringing down costs and giving more choice for everyone." You can read the transcript of this event held on July 1 at Northern Virginia Community College, Annandale, VA, on the White House Web site. The Video is also available.

This is the first in a series of articles on health care reform. Please send us your comments or let us know if you want to contribute an article or letter to the editor. Email us at andersm@pasty.com.