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“We should look to countries like Denmark, like Sweden and Norway,” Bernie Sanders pleaded, “and learn from what they have accomplished.” Not everyone is impressed. “We’re not Denmark,” responded Hillary Clinton in a 2015 primary debate.
By Mark Croatti
On November 6, 2018, Maryland voters will either re-elect a Republican governor for the first time in 64 years or send someone with no previous electoral experience to the Governor’s Mansion for the second straight election, which hasn’t happened since 1779. Incumbent Republican Governor Larry Hogan, who is aiming to duplicate Theodore Roosevelt McKeldin’s re-election in 1954, also talks softly and carries a big stick. By governing from the center, Hogan has amassed an impressive list of achievements in his first term, from fighting the opioid epidemic to cleaning up the Chesapeake Bay. He faces Democrat Benjamin Jealous, a former NAACP leader and newspaper publisher. Hogan is running on a platform of government-private sector partnerships and overall experience, while Jealous is pushing an agenda of Medicare-for-all and debt-free four-year university tuition (for Marylanders) that has been endorsed by Bernie Sanders, a “Democratic Socialist” known for touting Nordic countries’ efficiency in health care and education. Steady progress or sweeping change? Either way, Maryland is poised to make history.
On November 6, 2018, Maryland voters will either re-elect a Republican governor for the first time in 64 years or send someone with no previous electoral experience to the Governor’s Mansion for the second straight election, which hasn’t happened since 1779. Incumbent Republican Governor Larry Hogan, who is aiming to duplicate Theodore Roosevelt McKeldin’s re-election in 1954, also talks softly and carries a big stick. By governing from the center, Hogan has amassed an impressive list of achievements in his first term, from fighting the opioid epidemic to cleaning up the Chesapeake Bay. He faces Democrat Benjamin Jealous, a former NAACP leader and newspaper publisher. Hogan is running on a platform of government-private sector partnerships and overall experience, while Jealous is pushing an agenda of Medicare-for-all and debt-free four-year university tuition (for Marylanders) that has been endorsed by Bernie Sanders, a “Democratic Socialist” known for touting Nordic countries’ efficiency in health care and education. Steady progress or sweeping change? Either way, Maryland is poised to make history.
The Nordic Model Overview: Health Care Success and Debt-Free Education
Health care and education comprise the twin pillars of what The Economist calls “The Nordic Model,” adding that “The Nordic states are probably the best-governed in the world.” Enamored Americans have jumped on the Viking bandwagon. “Why Can’t America Be Sweden?” Thomas Edsall asked in The New York Times. “How to Make America More Like Scandinavia,” Clare Foran explained in The Atlantic. “What Americans Keep Ignoring About Finland’s School Success,” observed Anu Partanen.
“We should look to countries like Denmark, like Sweden and Norway,” Bernie Sanders pleaded, “and learn from what they have accomplished.” Not everyone is impressed. “We’re not Denmark,” responded Hillary Clinton in a 2015 primary debate.
When Sanders lost to Clinton, and then Clinton lost to Trump, candidates at the state level looked at ways to implement the Nordic Model. Although endorsed by Sanders, Jealous has never really come out and said that Maryland—or even the United States—should become Scandinavia; he’d be very happy if Maryland simply looked to Oregon, rather than Iceland, because Oregon is considering a public health option plan that would reduce the percentage of Oregonians without health coverage and overall per capita health care expenditures. However, when contrasted with the alternatives Hogan has enacted, the Jealous proposals are criticized as
“too far to the left.” But are they?
The Maryland Model: Health Care Access and Affordable Education
While Oregon's progress is unmistakable, the Rand Corporation didn't specifically say that the Oregonian plan would succeed in Maryland. In fact, Governor Larry Hogan has already signed into law what he calls "the Maryland Model," a unique all-payer program that allows Maryland to set their own fees, thereby already maximizing the savings ($1 billion over five years) that the Oregon proposal could provide. “My focus is on providing access as well as affordability,” Hogan told me during our telephone call. Jealous doesn’t see the Maryland Model solving everything. In our own telephone call, he said, “I would ask the voters, ‘How has Larry Hogan made your life better?’ Most American families are living on a fixed income but their bills continue to rise. Health care costs are skyrocketing. Don’t try to solve half a problem,” he directs at Hogan, “because you’ll still have a problem. We need to LEAP forward, not crawl forward. We need to move to single payer, not all-payer, because that would cut overhead costs. We need to go the rest of the way. We need to do what every other western nation has done.”
Critics counter that America’s founders didn’t specify health care as a governmental responsibility, but neither did Norway’s constitution—the second oldest in continual use in the world (since 1814), behind the United States (1789). Much later, Norway adopted universal health care; now they are ranked No. 11 globally in health care, according to the World Health Organization. The United States is ranked No. 37.
The American Model: Health Care Bankruptcy and Student Loan Debt
Like Norway, Finland has made health care and education the top priority, and now their educational system ranks No. 2 globally, according to The Guardian. The United States is ranked No. 14, even though it spends 27 percent of its annual budget on health care—17 percent of its GDP—and 6 percent on education—seven percent of its GDP—while Denmark spends 10 percent of its GDP on health care and seven percent of its GDP on education. According to WTOP News, among U.S. states, who spend most of their annual budget on health care and education, averaging 30 percent for health care and 32 percent for education, Maryland—which will spend an even 33 percent on both for fiscal year 2019—has the eighth-ranked K–12 system. “We invested $25 billion in K–12 education,” Hogan notes. Maryland boasts the seventh most college graduates nationally, according to US News & World Report, thanks to its four-year degrees being among the most affordable nationwide. While the national average is $10,000 for annual in-state tuition and fees, in Maryland it’s $9,000 (Wyoming is the lowest at $5,000; New Hampshire the highest at $16,000). According to the Institute for College Access and Success, average U.S. student loan debt is $37,000; however, in Maryland, according to Yale University, it’s $27,500 (in Sweden, it’s about $20,000). Despite low tuition, Maryland has the 15th highest rate of bankruptcy out of 50 states and Washington, D.C., mostly due to health care debt.
Access to health care is but one measurement of overall health. According to the Kaiser Foundation, the United States had the highest life expectancy in the world in 1960; today, Sweden ranks No. 5 (at 82.3 years) while the U.S. has the lowest life expectancy at birth among comparable countries (78.8 years—the only comparable country under 80 years). In fact, the U.S. has the lowest life expectancy at birth for both women and men within comparable countries and has seen slower growth in life expectancy, for both men and women, than in comparable countries. Factoring in “healthy life expectancy” risk factors related to cancer, body weight, drug use, mental health, and traffic accidents, Business Insider lists Maryland, at 68 years, about halfway down at No. 22 out of 50 states (New Jersey is No. 10 at almost 69 years). Furthermore, Maryland had several healthy life expectancy-related setbacks this past year, from the opioid epidemic to public shootings, including multiple gun-related fatalities at Great Mills High School and inside the newsroom of the Annapolis Capital Gazette newspaper. “I was very impressed with how quickly law enforcement arrived at those locations,” Hogan told What’s Up? Media. “In Annapolis, I left a meeting, jumped in the car, and drove to the paper’s offices immediately. The gunman was already under arrest when I got there.” On gun-related deaths, Hogan says, “We need to get guns out of the hands of the mentally ill, ban bump stocks, and make sure 3D printers can’t provide guns that are untraceable and undetectable. That is just outrageous. And we need tougher mandatory sentencing.” Yet Jealous believes the increasing prison population is due to tougher mandatory sentencing laws and other measures designed to arrest people. “We need more emphasis on education and less on incarceration,” he says. Noting that over half of all prison inmates are there for non-violent drug offenses, Jealous adds, “We can cut prison costs by 30 percent, which is $60 million a year. These are the things we can do to free up public
funds for college students.”
Hogan just signed a bill into law providing scholarships up to $5,000 to students whose families qualify for financial assistance, adding, “I just announced an expansion of this program: an extra two years of tuition after an AA degree for those who meet the financial need requirements.” Not good enough, Jealous says. “In the last half century, public universities have become unaffordable. We need to get upstream on this issue with four-year, debt-free university tuition.” Hogan disagrees. “Not everyone can’t afford college. Those who can’t afford it the most should get this kind of assistance first.” Jealous counters that students must be presented with better options even before college. “High school students need more incentives to take college credit courses. Tell them, ‘We will make all four years of your public university education tuition-free if you commit to training in an occupation with major shortages.’”
While student loans are not dischargeable through bankruptcy, health care debt is, and it happens to be the leading cause of bankruptcy in both Maryland and the United States. Ironically, not having a college degree is also a factor; according to the Urban Institute, the typical American who files for bankruptcy is a high school graduate head of a lower- to middle-class household. Still, the bigger bankruptcy factor is health care debt; less than nine percent of people declaring bankruptcy have not experienced a medical problem or a loss of medical benefits related to divorce or unemployment. In Sweden, which has universal health care, the formal bankruptcy process is rarely carried out for individuals; for those who do file, unpaid debts remain after bankruptcy but if the amount of debt is substantial, a payment plan is arranged whereby Swedes pay as much as they can for five years and then all remaining debts are forgiven. “In Maryland, 60 percent of college graduates have thousands of dollars in debt,” Hogan says. “I have ideas about dealing with that, too, like 100 percent of student loan interest being deductible or rolling student loan debt into the purchase of a home, a ‘smart-buy, you’ve earned it’ initiative. We haven’t been able to get enough tax credits and incentives passed, but we’ve made progress, and I want to keep heading in that direction.”
Other Models
I ask both candidates if they have heard of PNWER, the Pacific Northwest Economic Region, whereby eleven Canadian provinces and American states—including Oregon—cooperate to find solutions to multi-jurisdictional problems such as traffic, economic development, sanitation, and transportation. Bruce Katz, formerly of the Brookings Institution and the author of Regionalism advocates that states like Maryland work with neighbors such as Virginia, Pennsylvania, and Delaware to pool their health care and education resources to avoid overlap, waste, and fraud. “No,” Jealous says, “but I’ll read his book.” Hogan adds, “I haven’t heard of that particular effort (PNWER), but we believe very strongly that working together as a region makes a lot of sense. We already do so within a six-state commission cleaning up the Chesapeake Bay
and a nine-state coalition reducing carbon dioxide emissions.”
Final Thoughts
Hogan tells me that Marylanders overwhelmingly believe that the state is headed in the right direction, so his second term will be more of what he did in his first. “There will be no real dramatic changes or reversals. “We will continue to move Maryland forward.” Jealous has had to fight accusations that he, like Bernie Sanders, is promoting an unsustainable model for health care and education based on “Scandinavian socialism.” People tell him that Americans don’t want higher taxes like in the Nordic states. Although the Swedish corporate tax rate is 22 percent—much lower than America’s—the average personal income tax rate is 56 percent compared to 37 percent in the U.S. However, “A Swede pays tax more willingly than a Californian because he gets decent schools and free health care,” The Economist argues, adding that the U.S. “must be ready to abandon tired orthodoxies of the left and right and forage for good ideas across the political spectrum.” Hogan agrees. “I’d be open to anything that works.” Jealous feels the same way. “We have to have the courage of our common sense,” he implores, “because we can no longer afford the status quo.”
Mark Croatti teaches Comparative Politics and American Government at The United States Naval Academy.