The Nordic secret to battling coronavirus: trust
Norwegians locked themselves down on March 12 to deal with a spike in positive tests for the new coronavirus. The government in Oslo moved quickly and efficiently, closing schools and universities, canceling cultural and sport events, shuttering bars, restaurants, gyms, pools, and personal care businesses such as hairdressers, tattoo parlors, and the like. Most retail businesses, except those selling food and pharmaceuticals, also were closed.
All this took place before the country recorded a single fatality from the COVID-19 disease. The first death was reported later that evening, and as of March 16, two more Norwegians had died.*
In addition, many workplaces have closed, and arrangements have been made for people to work from home when possible. International travelers arriving in the country are to be quarantined automatically for two weeks, regardless of symptoms. As a result, thousands of flights to Norway have been canceled, and most cruise ships are being turned away, except when they need to load provisions.
Similar protective measures were enacted in recent days by Sweden and Denmark, although those countries’ rates of infection didn’t spike as sharply as Norway’s.
As someone who has lived and worked in Norway, I see several ways in which the Norwegians’ prompt and efficient response draws on the advantages of what economists call “the Nordic model”—a design much different from that of the United States.
Meanwhile in the United States, a recent survey by the First National Bank of Omaha found that 49% of Americans live paycheck to paycheck. What is to be done if those people can’t get to the jobs that keep them barely afloat? What does “self-quarantine” mean in that context? Or if employees receive no paid sick leave and can’t afford to stop working when they get sick? And what about the many who haven’t even had a job lately and find each day a struggle for food, including food-insecure college students whose colleges are closing?
Such conditions are nearly inconceivable in Norway, where the social safety net is intact. A century ago, poverty was widespread, but mass movements waged a successful nonviolent revolution in the 1920s and ’30s. By the time I got there, 1959, poverty had already been nearly eradicated, with everyone’s basic needs being met.
Norway’s readiness for health emergencies comes from its choice, all along, to prioritize the wellbeing of the people as a whole. Norway was not a wealthy country until its discovery of oil, which didn’t begin to flow until the late 1970s. As it developed its universal single-payer health system in the 1940s, it couldn’t afford to include dental services. At the time, working class Norwegians were infamous for their poor teeth. Studies revealed that one cause was the lack of calcium because of the high cost of milk. The government then began to subsidize the price of milk, increasing consumption, and teeth got healthier. As prosperity increased in the 1950s, it became possible to raise taxes and include dental service in everyone’s health care.
That early investment in health care is now paying off. Norway today has more doctors per capita than the United States, and that’s partly because medical schools are free. If a qualified university grad can’t find a place in a Norwegian medical school, the government pays for them to get their training abroad. And doctors in Norway don’t experience the high burnout rate of U.S. doctors, and that’s because the socialized system is not only patient-friendly, but also doctor-friendly. Doctors aren’t harassed by private insurers refusing treatments, and they don’t need a bevy of staff keeping track of bill payments. Nor do they have to worry about ordering needless tests to avoid the threat of malpractice suits: single-payer systems support cooperation and trust rather than grievances and retaliation.
As a direct result of this, the Norwegian health care system, with the single payer (the government) using taxes to administer the program, is more efficient and less expensive than the U.S. model, with its emphasis on private health insurance companies. This means coronavirus tests and treatment are free in Norway. Everyone’s on the same side: that of the patients’ wellbeing, and that translates into a level of trust in the government that is not shared in the United States.
Building trust in the government and other major institutions didn’t come easily. A century ago, most Norwegians distrusted their government, because it was run by the economic oligarchy, for the benefit of the oligarchy, much like the way the United States is today. After the revolution, the dominance of the elite was replaced by democracy. The transformed parliamentary institutions became transparent, incidents of corruption exposed, and government became the servant of the people.
The result of new economic policies was to dramatically reduce economic inequality, and Norwegians enjoy high levels of individual freedom—from personal rights to the ability to launch new businesses. Studies show that people in more equal societies have much more trust in major institutions than unequal societies. The United States has one of the most unequal societies on earth, and—as we’d expect—trust in government is in the toilet. The U.S. government’s bungling of its early response to the coronavirus outbreak hasn’t helped.
Over and over, structures that support trust pay off, even on the financial side. According to the Organization for Economic Cooperation and Development (OECD), the Norwegian health care system costs their economy less than 60% of what the profit-inflated U.S. system costs Americans. And the Norwegian system covers everyone (even me when I was a foreigner studying there), while the United States leaves out tens of millions of people.
As you’d expect, people in Norway live longer, with an average life expectancy of 82 years, and growing. The U.S. expectancy is 79, and in recent years was slipping. The OECD, which publishes statistics for its 35 member countries, compared countries by how many people die from preventable and treatable causes, the United States has among the most needless deaths, and Norway is among those with the least.
Even in ordinary times, Norway’s system takes care of everyone with increased access to doctors, less stress, zero bankruptcies, and better outcomes. In ordinary times the U.S. system reduces access, burns out doctors, punishes people without money, increases stress, and results in more deaths.
Even parenting is less stress stressful, because all parents receive child support, parental leave, and paid days off to be with children who fall sick (and all employees also receive paid sick time off work). Those who care for special-needs family members get a respite with qualified workers being supplied. Norwegians benefit from strong unions and generally are paid well, so they can easily save money. Health care is a right, and so is elder care, either at home or in retirement communities.
In times of emergency like now, we can see how this political-economic design pays off. The narrative goes something like this: I know I have a remarkable degree of freedom to make life choices, in a polity where my voice can be heard, so I become a team player, and when we need unity to achieve a goal—such as overcoming a global pandemic—then count me in.
A great American, President Franklin Delano Roosevelt, declared that everyone in the world should enjoy “four freedoms”: freedom of speech, freedom of worship, freedom from want, and freedom from fear.
As far as I know, the Nordic countries have come the closest to realizing those freedoms, enabling their societies to rise to the fore in meeting emergencies such as the coronavirus in a just and efficient way. Their public health systems, although excellent as shown by OECD statistical comparisons, do not exist in a vacuum. Mass movements had to arise, sweat, and suffer to gain what we see today. Americans can also be proud of our progressive social movements, but up until now we have not gone as far as the Nordic movements did. It’s time we learn from their example.
*At the time of press, the coronavirus death toll in Norway had reached 26.
The opinions expressed by opinion writers featured in “On the Edge” are not necessarily those of The Norwegian American, and our publication of those views is not an endorsement of them. Comments, suggestions, and complaints about the opinions expressed by the paper’s editorials should be directed to the editor.
This article first appeared in YES! at www.yesmagazine.org on March 17.
This article appeared in the April 3, 2020, issue of The Norwegian American.