(cont.) Response to interpellation 2022/23:11 on a secure health insurance

Åsa Eriksson (S)

Madam Speaker! This is the first time that the Minister and I are debating the health insurance here in the chamber of the Riksdag, but I can guarantee that it will not be the last time. I truly look forward to it.

The Minister and I are hopefully in agreement that Sweden shall have secure insurance built on the idea of duty and right. Those who are too ill to work shall be able to rely on the sickness insurance. By securing income in the event of illness, we ensure that it pays to work and to do right by others. It is an insurance that we all pay into when we work and that we should be able to expect to receive a share of when we need it. The sickness insurance is a central part of the social contract.

Madam Speaker! The policy that the government's party, the Moderaterna, went to the election on in 2006, to weaken the safety nets and introduce a stumbling block in the health insurance, was one of the reasons why I became politically engaged. I was then a civil servant in a coordination association and well aware of how sick people would be affected by the alliance parties' dismantling of our common safety nets. Civil servants, as is well known, can only apply legislation that the Riksdag decides on, so I therefore decided to become a politician. The price for the deteriorations, however, was paid by the sick.

We Social Democrats implemented several improvements in the sickness insurance during our eight years in power to mitigate the effects of the dismantling. Among other things, we removed the "dead end" (stupstocken). Requirements for active rehabilitation measures and clear follow-ups are good, we think, but the risk of poverty does not make anyone healthier.

The three parties that now are part of the government have once again campaigned on reintroducing the "stupstock" and worsening the health insurance. The question is when and how, Madam Speaker, they intend to carry out their election promises.

The background to this interpellation is the statement that the Minister's coalition partner Jimmie Åkesson made from the rostrum of the Riksdag in the party leader debate on October 26. He said then that the Sweden Democrats had gone to the election on a platform of securing the sickness insurance in the long term and that this had also been done in the cooperation agreement with the Tidö government. In the party leader debate, Jimmie Åkesson explicitly said: "That is, in fact, my experience."

Madam Speaker! Everyone who heard the Minister's answer to my interpellation a couple of hours ago realizes that the Minister avoided answering the question of whether the sickness insurance is truly secured in the long term with the Tidö Agreement. I do not trust Jimmie Åkesson's experiences, and I am probably not alone in that. I therefore want to give the Minister a new chance to answer all those thousands of people who have serious illnesses that affect their ability to work and who fear that they will be left without income if the Minister's party turns its policy into reality: Does Jimmie Åkesson's experience of the government's cooperation agreement with him mean that the Minister will not make any cuts to the sickness insurance?

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

Statsrådet Anna Tenje (M)

Madam Speaker! To begin with, I must say that I speak for the government and for myself. I do not speak for Jimmie Åkesson's experience.

I agree with the beginning of Åsa Eriksson's opening speech and share her fundamental view on our common security system. Not surprisingly, however, I may not agree with all parts of her historical narrative.

I also look forward to seeing you in the chamber's speaking seats ahead. One can interpret your introduction as a threat or as a promise, but I truly look forward to these discussions. It is because we are talking about important matters.

The Government is concerned about the development of sickness absence. The current rate of increase for sickness benefit is 6 percent on an annual basis, and the policy must therefore be designed to specifically prevent and counteract long-term sick leave. Therefore, it is important to stimulate the drivers for returning to work, to look at the individual, and to early implement the rehabilitation measures and other measures that are needed so that one can manage to return to work.

We must design a sickness insurance system that counters unnecessarily many and, above all, unnecessarily long sick leaves, partly by clearly defining different assessment points. Now, the long sick leaves are increasing again. Those amounting to 180 days or longer have increased by 11,000 compared to last year. Today, we have a total of 104,000 long ongoing sick leaves in Sweden, and they account for approximately 60 percent of the ongoing sick leaves. Two-thirds of these are women. It is clear that one, as a government, becomes concerned then.

The new exceptions in the rehabilitation chain, which were introduced with the intention of creating more time for those on sick leave to be rehabilitated back to work with their own employer, obviously had a good purpose. But if we now see that they are increasing very much and are rather counterproductive for the individual, that one does not return to work at all but remains on sick leave, we must, of course, follow the development very closely and monitor very closely what consequences it has. Then the rehabilitation work must be effective and be initiated very early so that there is a possibility to return.

I also remember the history, and I will never ever contribute to people being hidden and forgotten in the statistics again. This system shall exist for the people who end up there, so that they can return to work early and quickly and not be hidden and forgotten in the statistics.

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

Åsa Eriksson (S)

Madam Speaker! Thank you for that, Minister, even though I still did not hear any answer to my question. It seems to be more difficult than it sounds.

I really appreciate the Minister's commitment to ensuring that people who are ill receive early interventions. It is very important; I agree with that. I also appreciate that the Minister chooses to address preventive measures, because that is the best thing we can do. The sick leave that never happens, if one can maintain their capacity to work, is the best sick leave. A third thing I appreciate is the commitment to women's illness. It is something that we share, and there I hope we can find common solutions. It is appalling how many women today are on sick leave due to various types of, above all, stress-related ailments. So we cannot have it that way.

However, the fact remains that the Minister does not want to say that she does not intend to worsen the sickness insurance. This makes me fear that it will once again be the sick who will have to pay for the tax cuts that, among others, the Moderaterna say they want to make, that it will once again be those with cancer with long periods of illness who are cast out of the sickness insurance and then forced to live on a partner or on savings or, in the worst case, go to social services to get help with their maintenance.

I believe that many who are currently on sick leave and watching this debate know that, despite efforts, they do not appear to regain their capacity for work before they reach the time limits that the previous Moderate-led government introduced when they kicked people out of the sickness insurance, which we then loosened. I wish that the Minister could give them the promise that one will not make the same mistake once again.

I am pleased, Madam Speaker, that the government in the budget bill wants to extend the temporary exemption that we Social Democrats introduced due to the longer healthcare queues caused by the pandemic. I would like to commend the government for that. But still, many people who are affected by illness are being impoverished because the insurance is not good enough.

I want to urge the Minister to not be satisfied but to take initiative to improve the insurance for Swedish wage earners. Let me give a couple of tips along the way.

Most importantly, I believe, is to rectify the unfair quarantine deduction. It hits hardest against all those workers who go to work every day and who ensure that society functions. It is about bus drivers, nursing assistants, shop assistants, construction workers, and a lot of others who cannot work from home. They often work in contact professions and are exposed to a lot of infection. This is terribly unfair and something I want to urge the government to rectify – otherwise, we Social Democrats will do it when we get the chance.

Another tip concerns people with long-term reduced work capacity. There, we need to strengthen the possibility for rehabilitation and return to work. We also need to ensure that the same labor market concepts are used as when assessing sickness allowance. There are ready-made proposals on this in the investigations commissioned by the Social Democratic government.

Madam Speaker! Once again, I want to give the Minister the opportunity to answer my question in the interpellation: Is the health insurance long-term secured with the Minister as responsible?

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Statsrådet Anna Tenje (M)

Madam Speaker! The answer to Åsa Eriksson's question regarding the health insurance being secured with me as Minister is actually quite simple. Anything other than answering yes to that question would be very strange. And to the question of whether I will introduce any deteriorations, the answer is obviously no.

I have not engaged in politics to make things worse. If I introduce changes in the health insurance system together with the rest of the government, I naturally believe that they are improvements. Regarding the interpretation and definition of this, it may perhaps continue to differ between us. But it is clear that I, as a minister, have not engaged in these issues to worsen a system, but it is naturally about making improvements.

When we talk about improvements, it is largely about more of society's actors having to engage so that sickness absence does not increase. It does not lie solely on the individual to ensure they do not become signed off on sick leave, but it is incredibly important that the employer, the health and medical care, Försäkringskassan, and not least we in politics work preventatively and prevent sick leave. When it does happen, we must be there with a safety net and at the same time never forget what the goal is. For the vast majority, it is to return to work, and then we cannot just let the months pass. We have tested it before, and we saw how the statistics looked then. People were hidden and forgotten in the statistics, and they were never asked for. I think that is a clear sign that a system definitely does not work. That is where I never, ever want to end up again.

The preventive work is therefore extremely important. I am pleased that Åsa Eriksson shares the view that we need to do more for women's health. We know that a very large part of the sick leaves today concern mental ill-health, and therefore I am extremely pleased that our government is now investing in countering mental ill-health and involuntary loneliness. It is not least about public health and the preventive work but also about equal healthcare. Women in menopause with migraine issues or other women-related diseases should be seen and receive help before they potentially end up in social exclusion and sick leave.

Madam Speaker! I do not think perhaps that Åsa Eriksson and I are entirely in agreement on what constitutes a deterioration or an improvement in different parts of politics. But we can probably still agree that we must never again end up in a situation where we hide and forget and the months just pass.

I think we still share the view that a rehabilitation intervention initiated as early as possible increases the chances of returning to work. When the figures are now increasing by 6 percent on an annual basis and more and more people end up on long-term sick leave, I think that this was not really an improvement. This is not good - or how does Åsa Eriksson view that matter?

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

Åsa Eriksson (S)

Madam Speaker! Thank you, Minister, for a clear answer! I really appreciate it, even though I believe those watching this debate will find it difficult to interpret the promise to reintroduce the "stupstock" in the health insurance as anything other than a deterioration.

The Inspectorate of Social Insurance, ISF, has examined the time limits that the Moderaterna introduced the last time they held government power. The review clearly shows that four out of five those whose insurance was terminated were left without income for a quarter. Then, four out of five returned to sickness benefit as soon as it was possible. Of those who were on full-time sick leave when their insurance was terminated by Moderaterna, 95 percent were back on sickness benefit within a three-year period.

One does not get healthy by being poor, Minister! Moderate politics force sick people into poverty and continued ill health. I hope that you learn from your mistakes.

We Social Democrats want to instead strengthen the sickness insurance. We know that economic security is a foundation for being able to be rehabilitated, regain one's capacity for work and return to work. We will do what we can to change the period of absence deduction so that it becomes more fair for all of Sweden's wage earners. Sweden shall have secure insurances that are built on duty and right and insurances that one can rely on.

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

Statsrådet Anna Tenje (M)

Madam Speaker! I note that Åsa Eriksson did not answer my question as to whether she is satisfied with the development we are seeing with an increase of 6 percent in sick leaves on an annual basis.

I appreciate this discussion and debate. However, I do not appreciate when Åsa Eriksson puts words in my mouth. I never said that I would be satisfied and think that it was an improvement if the stalemate was reintroduced. I never said those words.

I can promise Åsa Eriksson that we will carefully monitor the development that the new rules provide and what effects they have. This is done by the Government Offices, by the handling authority, and by other external parties. If it turns out that one or more of the changes that have occurred lead to longer sick leaves and to people moving further and further away from the labor market and risking being hidden and forgotten in the statistics - previous governments have been good at this - we will take action. I will never contribute to that. A special investigator is looking at the effects of what we have just implemented, and we will follow up on this carefully.

There is probably every reason to come back and discuss how we can together address any negative effects.

The interpellations debate was hereby concluded.

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