(cont. from § 7) Social insurance issues (cont. SfU13)

Isabell Mixter (V)

Mr. Speaker! Thank you, Member, for your speech! I would like to dwell a little on what the Member did not speak about in the speech.

I would like to ask the member how she views the investigation regarding the sickness insurance that is now on the government's desk. The investigation's proposals imply a return to the inhumane rules that applied in the sickness insurance before 2021.

The rejection rate, both initially and at day 180, was significantly higher before 2021. People with severe cancer were deprived of their sickness benefit, and people with paralysis were considered capable of working with their hands. A young woman who had cancer and was pregnant in week 25 was deprived of her sickness benefit almost immediately after the child was born and was referred to parental benefit. A woman who had suffered from both stroke and cancer was denied insurance. Her doctor considered that she could not work. Nevertheless, Försäkringskassan referred to the fact that she could have a sedentary job. People with exhaustion symptoms were referred to jobs where one does not need to think. The list of unreasonable conditions can be made much longer.

Does the member think that the insurance policy that applied before 2021 was good?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Heindorff (M)

Mr. Speaker! Thank you, member, for the question! Sometimes I can get the impression – I do not know if the viewers at home agree with me – that we need to lower the tone a bit even in issues that evoke many emotions, which the sickness insurance does.

The investigation that the member refers to, for those who are not familiar with it, is the one titled *An utvärdering av förändringar i sjukförsäkringens regelverk under 2021 och 2022*. It can be stated that many major changes have occurred in recent years. At the same time, we see that sick leave has become increasingly long-term. Therefore, it is important that the rule changes that have occurred and the effects they have had on sick leave are evaluated. The sickness insurance, like everything else, must be based on research. We must never again hide or forget people in the statistics.

Let me say something briefly about what the investigation concluded. It is a solid knowledge base. Several of the goals that existed previously, during the time of the government that the Vänsterpartiet supported, have been fulfilled to a fairly low degree. In several cases, it has instead become the opposite.

As the member knows, the investigation is now out for consultation. I and the Moderaterna are very interested in taking part in all the views that will come in from the referral bodies.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Isabell Mixter (V)

Mr. Speaker! The member's coalition parties and you yourselves have referred to the fact that you want to await the referral response on this investigation, and that can be understood in a way. At the same time, what is proposed in the investigation is a regression to the rules that applied before 2021. We therefore have the answer key on how it actually looked, and the answer key is that severely ill people were not given the opportunity to get well. Instead, they became poor. My question to the member is how one can defend that system and think that it is reasonable.

The Chairman referred in his reply to the fact that one very much wants to listen to the research. But the fact is that the person one has appointed as investigator is an economist, who therefore looks at the figures and what it costs - not at what the actual needs in the health insurance are. Somewhere we are surely in agreement that what the health insurance should offer is security for people affected by illness? It is an insurance that we pay into through foregone wage space when we work. Should it then not be available to us when we become ill? It is something I am very curious to hear the answer to.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Heindorff (M)

Mr. Speaker! You there at home and you in the chamber who heard my opening remarks before we had the question period and the vote heard that it boils down to the fact that we need security in the safety nets. That was actually the first thing I said. For us Moderates, it is completely self-evident that there should be a secure safety net, but that it is also important to have incentives for returning to work.

We have an investigation on the table. Sometimes one might think – perhaps one does at home when listening to this debate – that the government has presented the investigation, but it is now to be sent for consultation. Then we will receive the views of the consulting bodies. I think that it is very important. I had hoped that the member from Vänsterpartiet would think it is just as important as I do to receive the views that come in from the consulting bodies.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Åsa Eriksson (S)

Mr. Speaker! We Social Democrats, of course, stand behind all our reservations but only demand approval of number 29 regarding the unfair quarantine deduction.

Mr. Speaker! The sickness insurance is a central part of the welfare and constitutes an important social contract between society and the individual. It is an insurance that we all pay into when we work and that we should be able to count on receiving a share of when we need it. The person who becomes ill should be able to expect financial security, good support, and rehabilitation to recover and be able to return to work. It is about justice, solidarity, and security. In Sweden, we shall have secure insurances built on the idea of duty and right.

Mr. Speaker! In brief, our view on the social insurances can be summarized in four points. We want to see security systems that can be relied upon, regulations that are understandable, and levels that one can live on. We say no to "stumbling blocks" and extra insurances, no to further obstacles to qualifying for the insurances, and no to all the deteriorations proposed in the recently presented review of the sickness insurance, which we just heard a rebuttal about. We Social Democrats, on the other hand, want to increase the incentives for employers to act in a timely manner and to have working conditions that make work life sustainable and contribute to getting employees back into work faster.

Mr. Speaker! Above all, the security systems must be fair and not contribute to increasing the gap between the poor and the rich or between men and women.

Sweden is unique in the Nordic region with the deduction of care in the sickness insurance of at least 20 percent of the weekly wage, plus a deductible of at least 20 percent of the sickness benefit, plus the conversion factor. No other country in the Nordic region has more than one deductible. We Social Democrats cannot understand why Swedes should need three such.

According to the Swedish Work Environment Authority, four out of ten go to work when they are sick because they cannot afford to stay home. These are most often LO women. Therefore, the unjust period of sick pay deduction must be consigned to the scrap heap of history, and therefore we move for approval of reservation 29.

Mr. Speaker! During the two parliamentary terms we sat in government, we pushed for important changes for a secure sickness insurance, even though the Riksdag had a conservative majority that wanted otherwise. We removed the "stupstock" in 2016, and during the years 2020-2022, we made completely necessary reinforcements of the sickness benefit so that people have the right to sickness benefit until they have recovered, received care, and can return to work. The Moderate-led government now seems to want to remove those reinforcements, and we Social Democrats, of course, say a clear no to that.

More remains to be done, however. We regret that the improvement work has stalled and that there instead seems to be a desire to return to the previous, unsustainable situation. We will, as said, say no to that. The regulatory framework obviously led to people being denied sickness benefit and instead being thrown into unemployment with the justification that there surely was a job somewhere without requirements that one, for example, can sit, stand, or walk. The only thing it led to was that people became poor and angry and that the threats of suicide to Försäkringskassan increased by 800 percent. There must be some form of grounding in reality when the right to sickness benefit is decided.

Mr. Speaker! The Sweden Democrats, who went to the election on promises to improve the health insurance, have so far not shown any sign of keeping their promises on that issue even once. But presumably, no one is surprised by that.

Several important steps were taken by us Social Democrats to increase economic security and flexibility in the sickness insurance, but also the understanding of the regulatory framework. It is important.

Today, more people will be able to retain their sickness benefit in order to complete care and rehabilitation. Several benefits in the sickness insurance have been increased, but we need to continue the work and further improve the regulatory framework. One example is that more people with permanently reduced work capacity must be entitled to sickness compensation.

We need to have a gender equality perspective in the insurance. We all know that most people on sick leave are women. We Social Democrats want to strengthen the opportunities for rehabilitation and introduce the same concept of work capacity for the sickness and activity compensation as for the sickness benefit.

Mr. Speaker! The best sick leave is the one that never needs to occur. Better rules for preventive measures for those who need them are therefore required. We Social Democrats want to see a prevention allowance that is a more flexible allowance that can benefit more people. Strong economic incentives are also needed so that employers become better at sustainable working conditions, preventive measures against ill health, and making clear plans for how employees can return to work as soon as possible.

Mr. Speaker! I have here in the chamber over the past year repeatedly debated with the responsible minister regarding the government's cuts to Försäkringskassan's administrative grants. They lead to more inefficient work at Försäkringskassan, halted digitalization projects, and furthermore, impaired cooperation, which the Moderate Party member Ulrika Heindorff and I clearly realized in conversations with researchers yesterday. We know, after all, that people with complex issues need coordinated interventions so that their work capacity can increase so that they can enter self-sufficiency. Still, we see that cooperation is regressing point by point. One of the most important reasons for this is that one does not have sufficient resources to be able to cooperate, and then it is deprioritized.

We urge the government to give Försäkringskassan reasonable opportunities to carry out its mission and stop the fraud and to give them a clearer responsibility to prevent welfare crime.

Mr. Speaker! There are some groups that are hit particularly hard by the fact that the current regulations are not adapted to their circumstances. I am thinking primarily of athletes and cultural workers. We Social Democrats want consideration to be taken for their often very varying incomes. It does not work with SGI for them today.

We also want to modernize the insurance so that it functions more purposefully for pregnant employees and self-employed individuals as well.

Let us leave the health insurance for a moment and look at the temporary parental leave. We Social Democrats believe it should be a self-evident matter that parents of children with diabetes should be able to take parental leave, that is, use the temporary parental leave, to be with their children in preschool and school and ensure that they manage their schooling when medication and such is administered.

Another important part of the social insurances is the occupational injury insurance. We are not satisfied with how it functions today, and we therefore commissioned an investigation. We want the assessment of occupational injuries to be improved so that more are captured and receive the correct compensation. It is a matter of solidarity and cohesion. We want to ensure that no one is left to their fate when misfortune strikes.

We also see a need to include mental health as a recognized part of the occupational injury insurance. It would be a crucial step towards addressing the growing problems with stress, burnout, and other mental conditions that are exacerbated by an increasingly pressing work environment.

To wrap up, Mr. Speaker, I would like to summarize the Social Democrats' view on the social insurance systems.

The concept of insurance, with security, justice and solidarity, shall characterize our social insurances. It benefits us all, regardless of where in life we find ourselves.

No one gets healthy by being made poor or thrown into uncertainty. In order for people to be able to contribute to a long and sustainable working life, fair rules are needed that do not knock out women and low-income earners.

The sickness insurance is too important to be used as a scapegoat for tax cuts. Wage earners, employers, and the entire society deserve long-term sustainable rules of the game. Let knowledge and experience guide, and invite a broad and honest discussion on how we can create a well-functioning sickness insurance to rely on over time.

This is our message to the government.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ingemar Kihlström (KD)

Mr. Speaker! I want to begin my speech by moving for approval of the committee's majority decision, which entails a rejection of all motions within the area of social insurance issues.

Everyone should live with the security that the collective carries and provides support when, for various reasons, one is unable to manage everything alone. The Christian Democrats' starting point is that the social insurances shall contribute to an economic security regardless of when and where in life one finds oneself. At the same time, we believe that much more can be done so that more people do not have to become ill.

Social security systems are of great importance for people's security but also for behavior and motivations for working. The Christian Democrats advocate for a security system that provides economic security through life's different stages.

Society's protection shall be designed so that the individual is encouraged to participate in measures that lead to as good a health as possible and to a rapid return to working life after illness or injury. For the latter, those who have or can regain a capacity for work must be given good access to rehabilitation and other necessary support.

To reduce sickness absence rates in a real and long-term way, the preventive work is also central. Kristdemokraterna emphasizes that the preventive work must be seen in a broad perspective. It is not enough to only focus on the workplace and the problems that can arise there. The fundamental need is a policy that contributes to reducing stress and creating good conditions for an improved public health.

The possibilities for each individual to put together their life puzzle are affected by the policies pursued in several different areas. The Christian Democrats believe that policy should, to the greatest extent possible, avoid governing and dictating people's lives. Instead, it should be aimed at continuously creating better conditions for individuals and families to manage their everyday lives.

Mr. Speaker! Not all diseases can, of course, be avoided through strong preventive work. In those cases, there must be health and medical care that offers good and accessible care within a reasonable time. Health and medical care shall help us feel well and provide care when we become ill.

The Christian Democrats' starting point is that the sickness insurance shall be secure for those who have reduced capacity for work due to illness. The person who is to return to work - fully or partially - shall at the same time receive help and good support to return to work. Everything else constitutes a great waste of both human and societal resources.

We Christian Democrats want a health insurance system where people's opportunities are taken into account, and it is important that the system provides incentives to utilize every person's work capacity and offers different paths back to work. The individual's work capacity shall be emphasized, and therefore greater flexibility is needed.

Today, a person who is working and receiving compensation of 50 percent cannot increase their work effort by 10 percent, even if this would be possible according to doctors. Today's fixed steps in the sickness insurance, with 25, 50, 75 or 100 percent, should therefore be changed.

Today's rigid system does not preserve the individual's full capacity and opportunity for an increased work effort. We Christian Democrats therefore continue to advocate for greater flexibility through a personalized percentage between 20 and 100 percent without any fixed steps. There are examples of this in our immediate vicinity, namely our neighboring country Norway.

An additional reason to create a flexible sick leave is that such a system can be more accommodating towards people who have lost a loved one. Many go on sick leave due to grief, and today, the possibility exists for those working in a company with a collective agreement to receive some leave in connection with a death. But after that, the system's bluntness is something that makes it difficult for people who have lost someone to return to normal work capacity at the right pace. In this case, a flexible system would be of benefit to people's ability to return to work.

It can be observed that the healthcare queues are still long. We Christian Democrats have long argued for measures that can address them.

A first step is taken with a national healthcare coordination that shall ensure that existing healthcare places are allocated to residents in part regardless of where they live. Shorter healthcare queues provide the opportunity for faster recovery and to return to work as much as possible. It is very positive for every human being but also for our society.

Mr. Speaker! The new government sees a need for a focus on rehabilitation and that the design shall counteract unnecessarily many and long sick leaves. This shall be done through defined review occasions. Measures need to be put in place to counteract ill health, and a reform effort is needed to increase the labor supply.

We see a positive trend with increased life expectancy. Therefore, it is also required that more people work and create a foundation so that society can manage to meet the needs of care but also economic needs. Improved rehabilitation and work based on the ability one has provide the conditions to meet this societal mission.

The citizens of Sweden showed in the latest election which path our country should take. This is also what the new government is working to implement.

Mr. Speaker! The Christian Democrats give their support to the committee's proposal for a decision which entails a rejection of the motions. However, this motion area, like many other areas, shows that there is no unified policy within the opposition. The reservations are submitted largely individually from the parties. One can therefore wonder what the common line is, but it is a question that we probably will not get an answer to in this debate.

The parties in Tidö have agreed on a political action program as a government base which, in many areas, provides a new direction for Sweden. This also applies to this area. Investigations have been delivered and are being prepared, and investigations are also ongoing. There will therefore be further changes. We will have to return to that in upcoming debates, Mr. Speaker.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Isabell Mixter (V)

Mr. Speaker! I had not actually intended to request the floor, but I became very curious about some things that Ingemar Kihlström mentioned in his speech, and I would like to take the opportunity to ask some questions about them.

Kihlström mentioned in his speech that it is a problem that we in the opposition do not present joint proposals. But the fact is that the Tidö parties are not in agreement either in this motion report. We have a party, Sverigedemokraterna, which has a whole series of reservations on the area we are now debating. I became very curious to hear if it is the case that you have agreed that you are in agreement on these issues, especially in light of the investigation that is now on the table.

I also heard the member speak in their speech about how it is important to have a flexible sick leave with several different levels and steps, so that one can be on sick leave according to different percentages. It is something that Vänsterpartiet also considers very positive and which we have raised in a motion that is being addressed in this report. It is about having greater flexibility so that people can try working and more easily be able to return to work. But that is something that is also included in the investigation that is now on the table. There, they want to tighten the flexibility in part-time sick leave even further. I become very curious about the Kristdemokraterna's view on this.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ingemar Kihlström (KD)

Mr. Speaker! That one awakens a desire for debate and replies with their speeches is positive. I see that as a sign of health, Member Mixter.

To return to the questions that have been asked: Within the Tidö cooperation, we agree on much, but there is also room for individual opinions. We see this, among other things, in this report. We have an agreement. We negotiate and reach agreements on major issues. We have a joint budget work. But at the same time, there is naturally a distinct character to all of us parties. I represent the Christian Democrats, who sit in the government. There, the negotiations take place behind closed doors, and it may be the case that we Christian Democrats do not currently find support within the government for the opinions we hold. Here, however, we can state that there is a common view on what policy we shall pursue right now and how we shall respond to the various motions. But there is also a freedom for the Sweden Democrats to argue in the motion reports about additional matters that they want to see implemented.

Flexible sick leave is something that we in Kristdemokraterna pushed for even during the previous mandate period and which we see a benefit from. We see that it could help people get into work and meet their needs at different stages of life, as I mentioned, for example when they are struck by grief. A few weeks ago, I met with organizations that work with different occasions when one is struck by grief. One of their proposals is precisely a flexible sick leave that would meet the need; that classification in the sick leave does not quite exist. We have not succeeded with our argumentation within the government, but we will continue to argue for this. Therefore, I raise it as a point that we will continue to work on. This we can certainly discuss further.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Isabell Mixter (V)

Mr. Speaker! I am pleased that the Christian Democrats consider flexible sick leave to be positive. I therefore hope and expect that the Christian Democrats will fight for that issue now that the investigation is on the table. It is claimed that there is such great agreement on the sickness insurance, but I can state that you are obviously not.

But if we are to return to the report in its entirety: Since I have now requested a reply, I would like to take the opportunity to ask how the Christian Democrats view the investigation that is on the table, which implies a rollback of the improvements that have occurred in the sickness insurance. These improvements mean that more people now actually get the opportunity and time to rehabilitate instead of being thrown out onto a fictitious labor market with different types of made-up jobs to which they are referred as they are sick, which makes them poor. How does Kihlström view the investigation that is now on the table?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ingemar Kihlström (KD)

Mr. Speaker! I may have to be as tedious as my colleague from the Moderaterna and state that we see the sickness insurance as an important part and that this investigation is a basis for the future policy. The investigation is out for broad consultation, and we will receive input in different ways. The investigation shows that the sick leave periods are long despite these changes. It is not more people who return to work. One can always argue about which policy is most appropriate to pursue. But I am also open to what the consultation bodies say.

In the government cooperation, I will continue to argue for a flexible health insurance. I perceived a nod of approval from Mixter, and I thank him for that. We will see how it turns out. I do not want to pin down anything regarding how it should be. This is an investigation that was started by the previous government but which has received a different design. It exists as a basis, and it will be part of the basis for the continued policy. But I look forward anxiously to the responses from the referral bodies. Then we will see exactly how we proceed.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Clara Aranda (SD)

Mr. Speaker! We are now debating the Social Insurance Committee's report on social insurance issues. I move to approve the Sverigedemokraternas reservation number 37.

For me as a Sverigedemokrat, it is initially important to emphasize that our common social insurance system shall function as a safety net. Someone who, for example, cannot work due to their illness shall always be able to rely on the fact that the sickness insurance is there, while the measures for a long-term return to work must be serious and be initiated as soon as possible.

A problem that the Sweden Democrats see when it comes to the sick leave and rehabilitation process is that it very often starts much too late. The focus must be on early and active interventions, rehabilitation and adapted flexible solutions, so that those on sick leave can become healthy and return to work when it is possible. It is not the sick leave itself that makes us healthy, but it is medical treatments and other interventions that contribute to that.

In addition to the obvious need to conduct preventive work to precisely tackle problems that in the long run can lead to long-term sick leave, we need to understand the importance of the regulations becoming more flexible. Returning to work for those who have been on sick leave should not have to be complicated and cause stress. A successive return to work based on ability is better than no return at all. Therefore, we want to see a gradual and better adapted return that matches the individual's needs and the profession they are to return to.

Mr. Speaker! Just as little as someone becomes healthier by being forced into work and into a difficult economic situation will people become healthier from an unconditional and unlimited access to the health insurance. Our health insurance system shall provide a predictable economic security for the one who is ill. It shall be a guarantee and a security for us all. It is what we withhold a fairly large part of our salary for.

If demands are to be made regarding the transition, society must also be able to meet them with resources and measures. For us, it is about ensuring that those who are ill receive the right interventions, that the rehabilitation offered actually results in positive effects for health, and that it is based on a scientific foundation and proven experience.

It is in this way that we can develop society's support and measures into something that actually works purposefully and that benefits the individual and society as a whole.

Most of us know that we continue to be in a situation where sick leaves as a result of mental ill-health continue to increase and account for over half of all longer periods of sick leave. With this problematic development in mind, it is urgent that we focus on measures that can create a sickness insurance system that is better adapted to be able to handle the now most common cause of sick leave in a significantly better way than what is the case today. Therefore, I would like to take this opportunity to highlight a couple of measures that Sverigedemokraterna propose to better meet the current development.

Mr. Speaker! A relevant problem is that there is a lack of important knowledge regarding which rehabilitation interventions have a good effect for people who are on sick leave as a result of mental ill-health. Therefore, it is important that new research in the field can contribute to the development of effective rehabilitation interventions in order to reduce the incidence of sick leave as a result of precisely psychiatric diagnoses.

The collective mental ill-health in Sweden entails enormous societal costs. According to a report from the OECD, the costs in Sweden are estimated at nearly 5 percent of GDP in both direct and indirect costs. There are thus both good human and socio-economic arguments for why we must prioritize the work of preventing mental ill-health.

In order to be able to enable change in a successful way, we argue that a completely new degree of political coordination is required. Therefore, we need to start the work as soon as possible to establish a common knowledge base by establishing an expert council for mental health with a particular focus on stress-related mental ill-health, something that is particularly urgent in this context.

The expert council needs to consist of researchers from different disciplines who are placed in the Government Offices and can thus provide data and relevant recommendations, in order to create a much-needed and currently missing link between politics and research.

Mr. Speaker! The Sweden Democrats also want to see a specific mandate for the Swedish Research Council. Given that there are significant knowledge gaps regarding specifically measures against and treatment of mental ill-health, the need for research in the area is great. From the research that is available, we can see that treatment with cognitive behavioral therapy, including internet-based such, has been shown to be able to reduce symptoms.

Research also shows that it is beneficial to involve the workplace early for a faster return to work. However, there is a lack of knowledge regarding measures that can certainly lead to a rapid recovery for this large patient group, which often also has a long and protracted course of illness. In order to be able to offer successful methods that are scientifically proven, both more research in the area and better conditions for continued research are required.

The Swedish Research Council has an important responsibility in its role as a research policy advisor to the government. It should therefore be tasked with analyzing the conditions, both organizational and economic, specifically regarding measures for rehabilitation and other treatment for mental ill-health. The assignment should also include recommendations regarding how research in the relevant area can be strengthened.

In the United Kingdom, there is a program where they have created a significantly increased access to treatments for depression and anxiety. The program is based on a systematic collection of data, which in turn creates opportunities for research and follow-up. This is something that we believe Sweden can be inspired by and learn from.

Mr. Speaker! I would like to conclude by speaking about the ultimate consequence of mental ill-health, namely suicide, and why it is a relevant issue in the ongoing development work of the health insurance.

Briefly summarized, suicide can be seen as a psychological accident where an individual finds themselves in a very difficult situation in which the problems seem to be insoluble and unbearable.

In a suicide, there are also underlying factors such as living conditions and circumstances, in very many cases in connection with psychiatric conditions and in some cases in connection with physical illnesses.

It should therefore not be particularly difficult to see the context when it comes to suicide risk and the fact that people who are on long-term sick leave constitute a risk group. Sverigedemokraterna therefore see a particular need for a targeted suicide-preventive focus in the work with the sickness insurance.

We propose, among other things, that the possibility of implementing requirements for medical suicide risk assessments in the insurance medical decision support should be reviewed. Just as in other relevant contexts, the issue of suicide prevention needs to be given space here as well.

We also have great hopes that the work that the Sweden Democrats, together with the government, is now carrying out in this area will yield good effects in a long-term and more overarching perspective. This is especially true since we have finally appointed a national coordinator with the mandate to strengthen society's ability to prevent suicide and develop suicide prevention work.

This is an issue that we in the Sweden Democrats have championed and fought for for many years and which we turned into reality as soon as we had the opportunity.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Isabell Mixter (V)

Mr. Speaker! We have heard the Sweden Democrats say that they want to improve the sickness insurance. We have heard high-ranking representatives promise their voters not to worsen the sickness insurance. It must be the smallest flag ever that anyone has waved. It is difficult to know whether it is disinformation or truth.

When it comes down to the core issue, the Sweden Democrats don't care about the health insurance. The Sweden Democrats are the largest party in the government support. We notice how the Sweden Democrats steer the policy at the Government Offices. But in this question, they are lying flat.

Clara Aranda has said in interviews that she wants to await the referral response before the Sweden Democrats take a position on the investigation that has now been presented. The investigation's proposal implies a total rollback of the improvements that the Left Party had passed in 2021.

The improvements that were then introduced meant a long-awaited stop to the mass-terminations at day 180. The assessments regarding sickness benefit became more reasonable, and more people were entitled to sickness compensation. It was simply more people who were given the opportunity to get well without being impoverished.

We know how it functioned before 2021. Nevertheless, the member wants to await the referral response, and nevertheless, the member's party agreed to the directives for the investigation.

I want to ask the member: Why are the Sweden Democrats betraying the sick?

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Clara Aranda (SD)

Mr. Speaker! Thank you, Member, for the question!

We are debating the report on social insurance issues today and not some investigation. I just want to point that out. There is much to talk about and discuss today. But instead, the member from Vänsterpartiet chooses to take the floor and speak about something that one has no clue about and about something that one does not know.

I wonder: Which proposal has the government placed on the Riksdag's table? Which proposal have the Sverigedemokraterna presented? What is there to take a position on today? What is there that would mean deteriorations within the health insurance? There are not any such proposals on the Riksdag's table at all. It is that simple.

However, there is a final report from an investigation where a number of changes to the sickness insurance regulations have been examined. Those proposals are now out for consultation. That is where we are in the process. We are looking at it just as we look at all investigations, and we are, of course, awaiting the consultation responses. Then negotiations will take place, and after that, we will be able to return to the issue.

I still think that we should debate the report that is relevant for today's debate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Isabell Mixter (V)

Mr. Speaker! It is not strange that one begins to wonder. We have today a report which, just as the member is pointing out, deals with motions from the general motion period concerning the sickness insurance. There, one sees that the Sweden Democrats present proposals that in many ways aim to improve the sickness insurance. Such things as the Left Party in many instances presents proposals about, you have similar proposals about.

Still, it is like this: Your party is in the Government Offices. Your party can say yes or no to whether an investigation should be submitted. You cannot play dumb and believe that an investigation means nothing. Of course, a government and its coalition partners are steered in a direction when one chooses to submit an investigation.

You must answer to your voters and those on sick leave as to why you agreed to submit this investigation and why you agreed that the investigator was the person who was involved in producing the proposals regarding the stupstocken. Why did you think it was a good idea? And will you back down if now member Aranda is so incredibly negative about this? I would very much like to have an answer to that.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Clara Aranda (SD)

Mr. Speaker! Thanks again to the member for the questions!

You in the Left Party do what you can to create a misleading picture of what the Sweden Democrats stand for and want to do regarding the health insurance. I truly regret that. I think it is irresponsible to try to scare voters by painting this picture - absolutely!

We will return to this issue in the future. There must be room for discussions and negotiations. That is how it works when one has a serious cooperation. It differs slightly from the Left Party's experience, with a small, crumpled secret note that no one is allowed to see. This cooperation is so much more than that.

It is, in itself, pleasing that Vänsterpartiet wants more of the Sverigedemokraternas policy. I can say this: We stand behind and follow up on all the proposals we have in our committee motion. We have not changed our policy in any respect when it comes to the health insurance. We will fight for those issues in negotiations. I can promise the member that. But we will take our cooperation into account. It is important for us, and it is important for Sweden.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mauricio Rojas (L)

Mr. Speaker! Today we are debating a large number of motions on various social insurance issues. A good deal of these motions contain valuable views and proposals that I am sure the government will take into account in the policy development within the social insurance area. The most interesting thing, however, is something else. The motions we are discussing show with all clarity that there is no united opposition, but four parties pulling in different directions and that have not even been able to agree on a single reservation.

Here, there are extreme parties such as Vänsterpartiet, which want to spend 18 billion more than the government proposes within expenditure area 10, which concerns economic security during illness. But there are also parties such as Centerpartiet, which want to spend 4 billion less than the government. And there are parties such as Socialdemokraterna, which want to spend almost as much as the government. The budget difference between Socialdemokraterna and the government is 0.2 percent within this budget area.

All this underlines a simple but important point: What the opposition parties promise has no possibility whatsoever of becoming a reality. It is merely rhetoric, flowery words without substance and political theater for the gallery. Politics is not about wanting, as a famous Social Democrat used to say, but about being able to realize what one wants.

Mr. Speaker! The opposition parties' budget discrepancy within the social insurance area also tells of something else, which is even more important.

Among the opposition parties, there are two completely different ways of viewing public finances. On one hand, there are two parties, Socialdemokraterna and Centerpartiet, who in broad strokes follow the government's description of the problems and likewise have the will to pursue a responsible fiscal policy that does not allow the households' worst enemy, inflation, to flare up. On the other hand, there are two parties, Vänsterpartiet and Miljöpartiet, who seem to live in a completely different world and propose a very expansive fiscal policy with enormous tax increases, large deficits, and a rapidly growing indebtedness. It is characteristic of populist parties of the type that have ruined so many countries around the world.

Miljöpartiet proposes an increase in public expenditure of approximately 465 billion kronor for the years 2024-2026 in comparison with the government's expenditure frameworks. It is financed with large tax increases totaling 178 billion kronor. But that is not enough: A bill of 289 billion kronor is also passed on to future generations via the national debt. It is a prime example of a reverse intergenerational solidarity, where tomorrow's Swedes are forced to pay for today's fiscal excesses.

Vänsterpartiet, on the other hand, wants to increase public expenditure by approximately 410 billion kronor during the mentioned three-year period. This is financed by a tax shock of 225 billion kronor and a debt increase of, in rounded figures, 185 billion kronor.

In comparison with these two parties' enormous generosity with others' money, the Center Party's and the Social Democrats' spending increases for the next three years are almost Spartan.

Mr. Speaker! The big problem behind these completely opposing positions is that these four parties want to govern together. Two distinctly populist deficit parties would in that case rule Sweden together with the Social Democrats and the Center Party. How this would happen without jeopardizing Sweden's future is a mystery to me that I leave for others to ponder.

With this, I conclude my remarks and move for approval of the committee's proposal.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Isabell Mixter (V)

Mr. Speaker! Everyone can get sick. We all have an interest in a good sickness insurance. Sickness insurance is a fundamental pillar in our social insurance system that is to provide financial security in the event of illness and support to return to work. Today we are discussing motions from the general motion period regarding sickness insurance.

About a month ago, however, an investigation regarding the sickness insurance was presented that must be mentioned. The proposals in the investigation imply a return to the rules in the sickness insurance that applied before 2021.

The changes in the sickness insurance 2021/22 were a historical break with the disability insurance policy that has existed in various forms since 2008. Vänsterpartiet was one of the forces that ensured that the shift in the sickness insurance became a reality. The number of people over 60 years old who were granted so-called security pension doubled after 2022. The initial rejections in the sickness benefit and the rejections at day 180 decreased significantly between 2020 and 2021. We demanded those improvements in the sickness insurance when our mandates were needed.

The Sweden Democrats, who promised their voters not to worsen the sickness insurance, instead shrugged their shoulders and sat on their hands when their government produced new directives for the investigation that now lies on the table. Already when the directives were produced and a new investigator was appointed, it was obvious that it would lead to proposals for worsening.

There are many stories about how it worked before the improvements in the sickness insurance. People with severe cancer were considered capable of working, and people with exhaustion were considered capable of having a job where one does not need to think. How many jobs are there where one does not need to think? And how does that help the person who cannot get out of bed in the morning? Nurses and nursing assistants with post-covid were referred to seek new jobs. These are people whom we need in healthcare and elderly care.

Sick people ended up in limbo. Försäkringskassan judged them as too healthy to receive sickness benefit; Arbetsförmedlingen judged them as too sick to seek work. Many were forced to live on their partner's income or apply for social assistance. Many also went back to their regular jobs, even though they couldn't manage it. The consequence was that they returned to the sickness insurance within a short time.

No one here in the chamber wants to see long sick leaves. But the most important thing must be that people get well so that they can work, not to make them poor and unemployable. That is precisely the effect if one implements what is proposed in the investigation currently lying on the table. Now the government and the Sverigedemokraterna want to await the referral responses. But we have tried that system before, and we know what it entails.

Mr. Speaker! This investigation should be placed on the scrap heap of history. That is where it belongs.

We need to improve the sickness insurance, not worsen it. Even though some improvements occurred in 2021/2022 that have made a big difference, much more needs to be done. Vänsterpartiet also believes that those who have been affected by the previous deficiencies in the sickness insurance need to receive redress. Both the Alliance government's and the S-MP government's handling of the sickness insurance is an unacceptable betrayal. Therefore, a crisis commission should be appointed to provide redress to those affected.

Mr. Speaker! For the sickness insurance to function, it needs to be need-based. In recent times, other ambitions have been all too dominant. The ambitions to reduce the state's costs have led to the sick being viewed with suspicion and the system being tightened. Instead, we need to invest in preventive work, a sustainable working life, and rehabilitation.

There is no contradiction between a robust sickness insurance that provides support and security to those who are ill and a society where people feel well, work, and contribute to the common good to the best of their ability. On the contrary, the security that a functioning sickness insurance provides is a prerequisite for such a society. Therefore, a new sickness insurance was needed that meets the requirements that we should all be able to place upon it.

For far too many people in Sweden, illness is synonymous with poverty. That should not have to be the case. The worst economic standard is among those who live on sickness or activity compensation. This group often receives the compensation for a longer period. Therefore, the standard of living is often strained.

Vänsterpartiet considers that income-related benefits, including ceilings and base levels, should be income-indexed. Cost-related benefits should be price-indexed, and fixed amounts should be used only in exceptional cases. Furthermore, we believe that benefit levels and ceilings should be designed so that 80 percent of wage earners receive 80 percent of the wage.

For people to be able to return to work and become healthy, care and support, not fixed time limits, are crucial. No cancer is magically cured because 180 days have passed. Paralysis in someone's arms and legs does not disappear because 360 days have passed. The rehabilitation chain therefore needs to be abolished and replaced by a step-by-step model, which applied before the current bourgeois government introduced the rehab chain in 2008. The step-by-step model worked well in many ways. The rehabilitation chain, on the other hand, has entailed all too sharp time limits, with the consequence that many people do not get the time to become healthy.

Before the 2021 improvements, day 180 of the sick leave meant that many were declared unfit for work and forced to seek so-called work normally available on the labor market. Many times, it was pure make-believe work. Now, instead, the person on sick leave shall be tested against work normally available within the specified occupational group. It is a clear improvement. Additionally, it can now be postponed for half a year if there are reasons for it. More people now receive sick leave for a longer period. It is a step in the right direction, but now the Tidö parties are considering tearing it up.

Mr. Speaker! The requirements to receive sickness benefit, formerly called early retirement, are today unreasonably harsh. After the tightenings implemented by the bourgeois government in 2008, Sweden now has the strictest requirements of all OECD countries when it comes to granting sickness benefit. It is now required that the capacity to work is judged to be impaired for the entire foreseeable future.

The harsh requirements and the lack of alternatives mean that people who are too ill to work are referred to social assistance or to live off their partner. It is an inhumane order that must be addressed. Vänsterpartiet believes that the regulatory framework for sickness and activity compensation needs to be reformed.

Mr. Speaker! In 2023, the retirement age was raised to 66 years. For many people with physical jobs, the body is worn out long before then. For LO workers, such as healthcare assistants, cashiers, kitchen assistants, and truck drivers, the average retirement age is 64.2 years. The working environment needs to be significantly improved, so that more people can manage to work a full working life without wearing themselves out prematurely.

But we also need to ensure that those who are worn out at work receive a decent income until retirement. During the last parliamentary term, important steps were taken in that direction when we improved the guarantee pension. But we need to ensure that more people can benefit from it. Therefore, we want to see an investigation into how the guarantee pension can be expanded, so that more of those at the end of their working lives can be covered.

Mr. Speaker! It is truly time to scrap the care deduction. It means a great economic burden for many, so great that many LO workers refrain from staying home even though they are sick. So we cannot have it.

The sick pay deduction is unequal. For someone who has a white-collar job and can work from home, the need for sick leave may not be particularly great. For someone who needs to be at work, there is no alternative. Many people who work in contact-based professions are also more exposed to infection. This was made visible, not least during the pandemic.

In the bourgeois parties, it often sounds as if it would be some kind of Armageddon if the sick pay deduction were removed; everyone would get Monday blues every week and stay home. But the fact is, as the member from the Socialdemokraterna profitably explained, that the other Nordic countries do not have such a sick day as we do. Let us look at how it looks there! It is time to abolish the sick pay deduction and the economic burden that illness entails for many wage earners.

Mr. Speaker! Finally, I would like to move for approval of reservation 25.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Mr. Speaker! It is an interesting debate to follow. What we are discussing and debating this afternoon concerns the social insurance system, which is a completely crucial part of the security system in Sweden. If one is affected by illness or injury and thus has reduced work capacity, it should not mean that one also faces very large economic problems in connection with it.

Just the tone of the debate and the diversity of proposals show that we have problems, not least regarding sickness benefit and sickness compensation. The clearest sign of this can be seen when looking at a time series 20 years back. Then one can see what incredibly strong variations we have had in the figures for ill health. It does not correspond to any epidemic of cancer, severe infectious diseases, or anything of the sort. It corresponds to the fact that we as responsible politicians have not been able to find a stable system that we agree on.

It has been free rein here for many heated political discussions. This has caused the system to have changed time and again, and not always through legislative changes or changes in ordinances and regulations but through regulatory letters and perhaps statements from ministers. These can be read directly in the decline or rise of the health figures.

What worries me about it is that it affects the individual. It means that one cannot feel security regarding what will happen in a situation where one is affected. What political winds will then apply?

It was therefore an important initiative when a parliamentary social insurance inquiry was appointed a number of years ago. The goal was that just as the pension system is a crucial building block in the Swedish security, with a large political consensus, the sickness insurance should also be made such a system where citizens can feel secure in which rules apply not only for the coming years and the coming mandate period but also for a longer period.

The investigation submitted a very good final report in 2015. There was great consensus - not with the extremist parties, but otherwise there was great parliamentary breadth. It is sad that the government at the time could only turn a few of the proposals into legislation. Instead, the debate focused heavily on what is called the stalemate. It also led to a removal of the outer parenthesis in 2016 without having evaluated what consequences it would have. In this area, the research is clear, namely that both within the sickness insurance and in adjacent systems, clear time limits fulfill an important function.

During the previous parliamentary term, changes were also made. The Centre Party voted for them. These primarily concerned a reassessment of what happens at 180 days of sick leave. 180 days, half a year on sick leave, is a long time. But there, we listened to the arguments that said if it is the case that one is close to returning to their normal work, it is unreasonable to have a sharp limit there. We therefore voted to make these changes. It is that investigation that has been discussed during this debate.

Our hope was that the changes would lead to more people returning to the work they had once been signed off from. I may receive the question that others have also received, namely how we view the investigation. Among other things, I am grateful that the Social Democratic government commissioned the investigation, that is, to conduct a serious evaluation of major changes within the sickness insurance.

I then felt a great disappointment when I received the investigation. It did not turn out as our hopes were, namely that the changes would lead to more people returning to their regular work. Therefore, I can understand that the investigation that was tasked to look at measures basically said: Do it over, do it right. Here, it was a change that was made from the outside to reach a certain goal, that more should return to regular work, and then it did not happen. The sick leaves have become longer, the return to the own employers has decreased, and there were no effects on financial support or for the individuals' health.

Just as in the rest of healthcare, I believe that one should have a scientific approach, regardless of whether it is new medicines being introduced or at changes in the health insurance. It is actually a therapeutic element to get people to become healthy.

I look forward to the consultation process. But I and the Centerpartiet will not attach any significant weight to any form of anecdotal evidence in the consultation responses of the type "I have heard about a woman with cancer who became pregnant and did not receive an extension." It is another matter if a number of researchers in the field can say that there are flaws in the evaluation. One point that can be heard is that the pandemic may have had a major impact. But when the consultation process is finished and the work with the consultation summaries is to begin, it is easy to press the button once more and produce that type of statistics - when another year has passed since the pandemic has left us.

At the core, I am disappointed by the result, but I am glad that a proper evaluation has finally been made. If one cannot show in a serious way that the statistical calculations are incorrect, one must as a politician draw the consequences of this and say that the work was done with good ambition, but unfortunately it failed and it did not become what we had hoped for. In some cases, it turned out in another way.

We in the Center Party have a number of proposals for further changes that we would like to see in the social insurance system. This concerns the possibility of qualifying for parts of the social insurance system. We would like to see further changes to facilitate things for small business owners, and furthermore, the threshold should be lowered for returning to work after having been on sick leave. After someone has been on sick leave and away from work for three months or six months, there are enormously high thresholds on the mental plane for returning to work.

Another issue we are highlighting is the coordination unions (samordningsförbunden). They make a uniquely important contribution for a group that is extremely difficult to help back into work. It is a collaboration between Försäkringskassan, Arbetsförmedlingen, regions, and municipalities. We hope that the government will as quickly as possible ensure that Försäkringskassan and Arbetsförmedlingen can contribute with personal identity number-based statistics, so that the coordination unions can evaluate the effect of the measures implemented. This is what is being called for by the coordination unions. Given that large sums of money are involved, it is important to be able to measure the effect.

Mr. Speaker! I move for the approval of our reservation number 3.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Annika Hirvonen (MP)

Mr. Speaker! The idea that we can collectively contribute to an insurance system that ensures that everyone who loses their capacity to work due to illness or injury can be protected is not new. It already existed in the guilds and corporations of the pre-industrial cities.

When the welfare society emerged during the 20th century, social insurances became a fundamental pillar in the state's responsibility for welfare and security in working life. The idea is simple. Those who become ill or cannot work due to injury should not also become poor.

Not least during the Alliance's time, much was destroyed in the system. Illness was often equated with exactly poverty. During our time in government, we made several important changes, but, Mr. Speaker, more was needed. The sickness insurance needs to be overhauled fundamentally. It was good that we introduced new conditions that make it easier to retain sickness benefit at 180 and 365 days respectively. It is good that the time limit at day 180 has become less strict. It means an increased possibility to return to work at the pace that best suits the individual.

It is also good that we have received a new labor market concept that is anchored in reality so that people are not tested against jobs that do not actually exist.

We also think it is good that the compensations have become higher for hourly substitute workers and so-called gig workers. This is a group that actually often ends up poorly off in today's system, and we are waiting for a finished, investigated proposal that has been referred and is ready to become a reality.

We think it is important to have increased flexibility in part-time sick leave, but even here we need to go further.

The reforms that have been made have had the effect that more people who are ill are able to keep their compensation and that the number of incorrect rejections has decreased significantly.

Twice as many elderly people receive sickness benefit, and the sickness benefit has increased among the elderly. It is an important security during the final years before retirement for many who have worn out their bodies through heavy work, and it is particularly important given that the retirement age is now being raised.

But, Mr. Speaker, as we have said, we have not finished. There are ready proposals remaining to strengthen the sickness and activity allowance. They can become law. There are proposals for prevention and better preventive work.

I must ask: What is the government waiting for?

During the election campaign, we heard loud tones from the Sweden Democrats, who wanted to strengthen the sickness insurance. What we have seen so far are proposals to roll back just those improvements that I and several others have spoken about in the debate. They want to go back to a system where even more people are insured out and become poor because they are sick.

Mr. Speaker! I cannot help but ask whether it was actually the case that the Sweden Democrats wanted to pretend to care about people who fall through the cracks in the health insurance system in order to be able to focus on and blame all problems on immigrants – this not least in light of the horrific revelations about hateful troll accounts that paint specific immigrants as the root of societal problems.

The fact is that the social problems, for example within the health insurance, are something we can solve through political decisions. And it is really not the immigrants' fault that the government has not yet presented those proposals to the Riksdag.

Mr. Speaker! There are many proposals that can reform and improve today's system. But we in Miljöpartiet want to fundamentally carry out a larger reform where we get a completely new and coherent system for employment security. We want to merge the different insurances so that people will never run the risk of falling between two stools, for example between the unemployment insurance and the sickness benefit.

A person who one authority considers too healthy to receive sickness benefit can be considered by another authority to be too ill to be able to get a job. People are being bounced back and forth today. This hinders recovery, and it does not contribute to people returning to work sooner.

A common, coherent system for work-life security could, in a different way than today's, truly ensure the objective that those who cannot work shall have a compensation that it is possible to live on.

We also think that a focus is needed that is supportive, preventive and rehabilitative rather than one that is based on a lot of control and administration and is sometimes perceived as almost judgmental.

The hard deadlines need to be converted into check-in points to ensure that the right interventions are made so that the person can regain their health and be able to return to work.

Social insurance issues

We have not yet received support for these proposals, but we hope that it can happen - and that while waiting for a larger reform, we can get these concrete improvements through, for which there should be support in this chamber.

Mr. Speaker! I also want to say that I think it is a problem that we continue to have the double deductible in the sickness insurance system. It is almost unique to Sweden that one both receives a maximum of 80 percent of the salary in compensation and receives nothing at all for the first day one is sick.

During the pandemic, we removed the care deduction. It was foolish to reintroduce it. It should simply be removed.

I naturally stand behind all of the Miljöpartiet's reservations and proposals, but for time-saving reasons, I move for approval of only reservation 27.

(Applause)

The deliberation was hereby concluded.

(The decision was to be taken on 22 May.)

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