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...The issue about what to do with the health-care system is sometimes presented as a technical argument about the merits of one kind of coverage over another or as an ideological argument about socialized versus private medicine. It is, instead, about a few very simple questions. Do you think that this kind of redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes? In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem".
The Moral Hazard Myth by Malcolm Gladwell, The New Yorker, 29 August
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In Finland's Footsteps
If We're So Rich and Smart, Why Aren't We More Like Them?
By Robert G. Kaiser
Washington Post
Sunday, August 7, 2005; B01
Life in Finland, one of the world's best functioning welfare states and least known success stories, can be complicated. Consider the dilemma confronting parents looking for day care for a 4-year-old daughter in Kuhmo, a town of 10,000 near the middle of the country.
Should they put their child into the town nursery school, where she could spend her weekdays from 6:30 a.m. until 5 p.m. with about 40 other children, cared for by a 47-year-old principal with 20 years' experience, Mirsa Pussinen, as well as four teachers with master's degrees in preschool education, two teacher's aides and one cook? The girl would hear books read aloud every day, play games with numbers and the alphabet, learn some English, dig in the indoor sandbox or run around outside, sing and perform music, dress up for theatrical games, paint pictures, eat a hot lunch, take a nap if she wanted one, learn to play and work with others.
Or should that 4-year-old spend her days in home care? Most parents in Kuhmo choose this option, and put their children into the care of women such as Anneli Vaisanen, who has three or four kids in her home for the day. The 49-year-old Vaisanen doesn't have a master's, but she has received extensive training, has provided day care for two decades and has two grown children of her own. The kids in her charge do most of the things those at the center do, but with less order and organization. They also bake bread and make cakes.
How to decide? There's no financial difference; both forms of day care cost the parents nothing. There's no difference in the schooling that will follow day care -- all the kids in Kuhmo (and throughout Finland) will have essentially identical opportunities in Finnish schools, Europe's best. There is no "elite" choice, no working-class choice; everyone is treated equally.
It's a dilemma that American parents don't have a chance to confront. And it's a vivid example of the difference between what the Finns call a social democracyand our society. Finland is a leading example of the northern European view that a successful, competitive society should provide basic social services to all its citizens at affordable prices or at no cost at all. This isn't controversial in Finland; it is taken for granted. For a patriotic American like me, the Finns present a difficult challenge: If we Americans are so rich and so smart, why can't we treat our citizens as well as the Finns do?
Finns have one of the world's most generous systems of state-funded educational, medical and welfare services, from pregnancy to the end of life. They pay nothing for education at any level, including medical school or law school. Their medical care, which contributes to an infant mortality rate that is half of ours and a life expectancy greater than ours, costs relatively little. (Finns devote 7 percent of gross domestic product to health care; we spend 15 percent.) Finnish senior citizens are well cared for. Unemployment benefits are good and last, in one form or another, indefinitely.
On the other hand, Finns live in smaller homes than Americans and consume a lot less. They spend relatively little on national defense, though they still have universal male conscription, and it is popular. Their per capita national income is about 30 percent lower than ours. Private consumption of goods and services represents about 52 percent of Finland's economy, and 71 percent of the United States'. Finns pay considerably higher taxes -- nearly half their national income is taken in taxes, while Americans pay about 30 percent on average to federal, state and local governments.
Should we be learning from Finland?
The question occurred to me repeatedly as I traveled around Finland this summer. Americans could easily get used to the sense of well-being that Finns get from their welfare state, which has effectively removed many of the tangible sources of anxiety that beset our society.
But the United States could not simply turn itself into another Finland. Too much of Finnish reality depends on uniquely Finnish circumstances. Finland is as big as two Missouris, but with just 5.2 million residents -- fewer than metropolitan Washington. It is ethnically and religiously homogeneous. A strong Lutheran work ethic, combined with a powerful sense of probity, dominates the society. Homogeneity has led to consensus: Every significant Finnish political party supports the welfare state and, broadly speaking, the high taxation that makes it possible. And Finns have extraordinary confidence in their political class and public officials. Corruption is extremely rare.
For all of that, Finland doesn't feel like an entirely foreign place -- I thought I was on familiar ground. Finns obviously enjoy things we enjoy, from a good concert (rock, jazz or classical) and a good ice cream cone to a brisk walk on the beach. They are practical-minded experimenters and problem solvers.
One fundamental Finnish value sounds a lot like an American principle -- "to provide equal opportunities in life for everyone," as Pekka Himanen, a 31-year-old intellectual wunderkind in Helsinki, put it. Himanen, a product of Finnish schools who got his PhD in philosophy at 21, argues that Finland now does this much better than the United States, where he lived for several years while associated with the University of California in Berkeley.
In Finland, Himanen said, opportunity does not depend on "an accident of birth." All Finns have an equal shot at life, liberty and happiness. Yes, this is supposed to be an American thing, but many well-traveled younger Finns, who all seem to speak English, have a Finnish take on American realities. Miapetra Kumpula, a 32-year-old member of Parliament, volunteered this on the American dream: "Sure, anyone can get rich -- but most won't."
Finns are enormously proud of their egalitarian tradition. They are the only country in Europe that has never had a king or a home-grown aristocracy. Finland has no private schools or universities, no snooty clubs, no gated communities or compounds where the rich can cut themselves off from everyday life. I repeatedly saw signs of a class structure based on economics and educational attainment, but was also impressed by the life stories of Finns I met in prominent positions, or who had made a lot of money.
One of the richest Finns is 39-year-old Risto Siilasmaa, founder and CEO of F-Secure, an Internet security firm that competes successfully with American giants Symantec and McAfee. Siilasmaa, a teenage nerd turned self-made tycoon, is worth several hundred million dollars. His wife, Kaisu, the mother of their three children, has a decidedly un-tycoonish career: She teaches first and second grade in an ordinary school. Like every Finn I spoke to about money, Siilasmaa would not acknowledge any interest in personal wealth. "I'm a competitive person, I like to win," he said, "but I've had enough money since I was 15."
This too seems to be part of Finnish egalitarianism; most Finns don't boast or conspicuously consume (except perhaps when they buy fancy cars). Finnish authorities know how much everyone earns, and they pro-rate traffic fines depending on the wealth of the malefactor. Last year the 27-year-old heir to a local sausage fortune was fined 170,000 euros, about $204,000 at the time of the fine, for driving at 50 miles per hour in a 25 mph zone in downtown Helsinki.
The Finnish educational system is the key to the country's successes and that, too, is a manifestation of egalitarianism. Surprisingly, it is a new system, created over the last generation by a collective act of will. The individual most responsible for it was Erkki Aho, director general of the National Board of Education from 1972 to 1992. Aho, now 68, was "a little bit of a radical," he told me with a smile -- a Finnish Social Democrat who believed in trying to make his country more fair. The early '70s were a radical time in Finland. Change was in the air.
For reformers, education was the principal arena. The traditional Finnish system was conservative and divisive: Kids were selected for an academic track at the end of fourth grade. Those not chosen had no chance at higher education. Universities were relatively few, and mostly mediocre.
Aho and his colleagues thought schooling should be "comprehensive," keeping all kids together in the same schools for nine years without tracking them by ability. Only for "upper secondary," or high school, would academic students be separated from those with vocational interests. The schools would be administered by municipal governments, but at the outset, the substance of the reform would be controlled by the National Board of Education and the government in Helsinki.
The key to reform, Aho and others believed, was teacher training. Teaching had always been a high-status profession in Finland, but now it would become even more prestigious. (Today there are 10 applicants for every place in the universities that train teachers.) Teachers would be required to complete master's degrees, six years of preparation that combined education courses with substantive work in subject areas. "Of course I faced much criticism," Aho recalled. "Upper secondary school teachers were very skeptical. Many parents were critical. The cultural elite said this would mean catastrophe for Finnish schools. The right thought the comprehensive schools smacked of socialism."
But by the end of the 1980s, the new system was broadly popular. It was strengthened by a reform of higher education that gave Finland numerous new, high-quality universities. A grave economic recession in the early '90s was a key test, Aho said. "It was wonderful to see how strong the consensus was" that even in dire economic straits, Finland had to save this new school system, which had become "so important to the society," he said.
Indeed it had. Finland in the '90s became a high-tech powerhouse, led by Nokia, now the world's largest maker of cell phones. Finnish students have become the best in the world, as measured by an internationally administered exam that assesses the educational progress of 15-year-olds in all the industrial countries.
Aho's time in charge ended in the early '90s, when Finns turned against excessive centralization. After he left the Board of Education in 1992, power over the schools reverted to localities and the schools themselves.
Teachers and headmasters were given the authority to write curricula, choose textbooks and allocate resources. Apart from the Program for International Student Assessment (PISA) tests and final exams at the end of high school, Finnish kids take no standardized tests, a stark contrast to the current test obsession in this country.
I found Finnish society beguiling on many levels, but in the end concluded that it could not serve as a blueprint for the United States. National differences matter. The Finns are special and so are we. Ours is a society driven by money, blessed by huge private philanthropy, cursed by endemic corruption and saddled with deep mistrust of government and other public institutions. Finns have none of those attributes.
Nor do they tune in to American individualism. Groupthink seems to be fine with most Finns; conformity is the norm, risk-taking is avoided -- a problem now, when entrepreneurs are so needed. I was bothered by a sense of entitlement among many Finns, especially younger people.
Sirpa Jalkanen, a distinguished microbiologist and biotech entrepreneur affiliated with Turku University in that ancient Finnish port city, told me she was discouraged by "this new generation we have now who love entertainment, the easy life." She said she wished the government would require every university student to pay a "significant but affordable" part of the cost of their education, "just so they'd appreciate it." Today every Finnish student is assured free tuition and a monthly stipend to live on that they can receive for 55 months, the length of the six-year courses most still take.
But if Finland can't be a blueprint for us, it can be an inspiration. Education struck me as the area where Americans could most profit by learning from Finland. Nothing achieved by Aho's reforms would be beyond the reach of American schools if we really wanted them to become good.
And I think we could learn from Finns' confidence that they can shape their own fate. Finns speak of the Finnish National Project, an effort involving much of the country, and nearly all of its elites, to make the country more educated, more agile and adaptive, more green, more fair and more competitive in a fast-changing global economy. Manuel Castells, the renowned Spanish sociologist who teaches at the University of Southern California and has been writing about Finland for nearly a decade, argues that Finland's ability to remake itself followed from its success in creating a welfare state that made Finns feel secure. "If you provide security and it is felt, then you can make reforms," he said in an interview. Of course you have to agree on what reforms are needed.
The complicated Finnish language includes the word talkoot, which means, roughly, "doing work together." It's a powerful Finnish tradition, and reflects a national sense that "we're all in the same boat," as numerous Finns said to me. This idea has always appealed to Americans, but in this country it has nearly always been an abstraction. Finns seem to make it real.
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