[ExI] Why is “cost of living” such a big problem?

Thu Nov 5 17:41:45 UTC 2026

Actually, spike, the reason healthcare is expensive in the us is your shite
ability to make deals. Trumpia mismanages capitalism in a horrible way.
I work in health care in Sweden.  Socialist state, almost commies, no?
Everything is Socialist pipedreams and fiat moonies from the state and
taxes right?
Fuck no. But I can't be arsed to spend the time to write all that so
mistral has done that. Appended at the end.
What is interesting for you is that costs are highly and competitively
minmaxed.
My prime example is my bread and butter, hip replacement.
At Lindesbergs lasarett we take all comers, basically if you are alive and
can argue enough with the surgeon, then you are welcome to hip replacement
at our hospital,  we are a part of the Örebro University hospital and take
everything.
The majority of our patients go home the day after. Not day surgery but
basically 24h surgery.
Price point for this?
$8.900
That is the price any organisation who do hips get for a normal hip
replacement for a normal patient.  We have no problem keeping that price.
We as a university hospital do not make any useful profit since we take all
sick patients but we are not going bankrupt either.
The private providers have some sanity checks on patients and make a
healthy profit at this price.
What, pray tell do you pay in the US of trump?
And why?

We do not extort any medical companies for anything,  they make a healthy
living profit too.
/Henrik

Here's the piece, rewritten as an open letter in American English for a
Republican reader:

---

**An Open Letter to My Republican Friends: How Sweden's Health Care
Actually Works**

You've probably heard Sweden described as a socialist medical dystopia —
government death panels, rationed care, no choices. Having lived with both
systems in view, let me tell you what it actually looks like, because the
reality doesn't fit either party's talking points.

**First, it's not the VA.** The biggest misconception is that Swedish
health care is run like a government monopoly. The better comparison:
**Medicare for everyone — but run at the state level, with private doctors
and clinics competing for patients.** The government doesn't own your care;
it funds it. Roughly half of Sweden's primary care clinics are run by
private companies or foundations, and they're allowed to make a profit.

**How it's paid for: taxes, not premiums.** There are no employer-sponsored
insurance plans to negotiate, no in-network/out-of-network, no deductibles,
no open enrollment windows. Care is funded by an income tax that partially
goes to the regions — think of it as each state running its own Medicare.

**And it's decentralized.** Sweden's 21 regions (think: states) set their
own tax rates and decide how to organize their own care. That's federalism
and local control in practice — values you hold in high regard.

**What the patient pays:** a maximum of about **$140 per year** for all
outpatient visits combined — after that, everything is free nationwide,
including at private clinics ([SKR](
https://skr.se/halsaochsjukvard/ekonomiochavgiftersjukvard/patientavgifteriallaregioner.7874.html)).
A hospital day costs at most about $12. Prescription drugs have their own
similar cap. No Swede has ever faced a medical bill that led to personal
bankruptcy — a phenomenon that pushes hundreds of thousands of American
families into bankruptcy every year.

**What it costs the country:** about **11.2% of GDP** in 2024, with 86%
publicly financed and 13% from patient fees and private pay ([Statistics
Sweden](
https://www.scb.se/hitta-statistik/statistik-efter-amne/nationalrakenskaper/nationalrakenskaper/halsorakenskaper/)).
The U.S. spends about **18% of GDP** — dramatically more per person,
without covering everyone.

**For employers:** Swedish companies don't compete for workers on generous
health packages, because they don't need to. That's a hidden advantage
often forgotten when comparing "tax burdens."

**Politically, no campaign is fought over the basics.** Here's what
surprises Americans most: whether everyone should have access to care is
**not politically contested in Sweden.** Neither the conservatives
(Moderaterna) nor the Sweden Democrats want to abolish the publicly funded
system. The debate is about:

- **Private vs. public operation** — the right wants more competition and
more private providers; the left wants to limit profits in welfare. That's
the real "government takeover" fight, and it's about *who provides* the
care, not who pays.
- **Wait times and access** — the perennial battleground. The national care
guarantee promises same-day contact, an assessment within 3 days, and
specialist visits and treatment within 90 days — but in April 2025, about
35% waited longer than 90 days for planned procedures ([Socialstyrelsen](
https://www.socialstyrelsen.se/statistik-och-data/statistik/alla-statistikamnen/lagesbild-och-statistik-tillganglighet-vantetider-och-vardgaranti-i-halso-och-sjukvard/),
[1177](
https://www.1177.se/sa-fungerar-varden/lagar-och-bestammelser/vardgaranti/)
).
- **Priorities** — with a fixed budget, politicians are forced to openly
say no to certain treatments and expensive new drugs. It becomes a visible
political fight, instead of the invisible negotiation between insurers and
hospitals that you're used to.

**The honest tradeoffs — so this doesn't read like a brochure:**

| | Sweden | U.S. |
|---|---|---|
| Cost (% of GDP) | ~11% | ~18% |
| Coverage | Everyone, automatically | ~92% insured, with gaps |
| Cost if you get sick | Max ~$140/year | Can reach tens of thousands
(deductibles) |
| Wait for planned care | Often months; ~35% wait >90 days | Often shorter
— if you're insured |
| Choice | Choose your clinic (private included), but no insurance to pick
| Pick your insurance, but network restrictions |
| The citizen's "cost" | High income tax (~30–35% total) | Lower taxes, but
employer premiums |

Here's my closing point: Swedes didn't choose between freedom and
government — they made a tradeoff. They accept higher taxes, waiting lines,
and less consumer choice in exchange for nobody going bankrupt from a heart
attack and small businesses never having to shop for employee health
insurance. And structurally, the system is more market-oriented and more
decentralized than its reputation: private providers, competition for
patients, and 21 local "states" that get to adapt the system to their own
needs. You can dislike the price of that tradeoff — but dislike the actual
price, not a caricature of Britain's NHS.

---

Want me to adjust the tone (more formal, or punchier op-ed style), or
tailor it for a specific audience like a business owner or a fiscal
conservative?

Den ons 4 nov. 2026 14:55spike jones via extropy-chat <
extropy-chat at lists.extropy.org> skrev:

>
> > On Behalf Of Ben Zaiboc via extropy-chat
>
>
>
> On Tuesday, 3 November 2026 at 17:52, spike at rainier66.com <
> spike at rainier66.com> wrote:
>
> >
> > ...> On Behalf Of Ben Zaiboc via extropy-chat
> >
>
> >...I'm happy to be living in a country that has socialised healthcare
> (that actually saved my life at a time when I wouldn't have been able to
> afford the treatment if I'd been living in the US, so I'd be dead now), and
> can, according to you, sponge off the wonderful achievements of the US
> medical system that it is so generously giving to the rest of the world
> while its own people have the poorest health and lowest life-expectancy of
> all the developed countries.
>
> Thanks!
>
> ---
> Ben
>
> _______________________________________________
>
>
> No need to thank me Ben, for I have never been a big investor in medical
> companies.  The payoff on those is high, but also the risk.  There is a lot
> of competition in medical research, which means most of those companies
> lose money.  But one of them makes a ton of money to compensate those who
> take the risk.  Citizens from your country and your government are among
> those investors, as are investors all over the planet.
>
> The socialists suggest the payoff should be lower.  If so, investors go
> elsewhere to other more profitable industries.  Had not obscene profits
> been a possibility, your life would not have been saved.  Capitalism is our
> friend.
>
> spike
>
>
> _______________________________________________
> extropy-chat mailing list
> extropy-chat at lists.extropy.org
> http://lists.extropy.org/mailman/listinfo.cgi/extropy-chat
>
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.extropy.org/pipermail/extropy-chat/attachments/20261105/7ac5c43d/attachment-0001.htm>