Social insurance issues

Ulrika Heindorff (M)

Mr. Speaker! Yesterday marked half a year since the Moderate-led government took office. Exactly six months ago, the government began the work of making Sweden greener, safer, and freer. Much has been initiated, not least within our committee, the Committee on Social Insurance. It is a paradigm shift within the migration area. A number of investigations are underway within the social insurance area. The government has strengthened the incomes for those who continue to work after retirement age. And the first steps have been taken for major reforms regarding qualification for welfare and benefit ceilings.

Sweden is in a difficult economic situation, and many people are having a very tough time. Record-high inflation, high electricity prices, and a recession are putting pressure on both households and companies. And the uncertainty surrounding the economic situation is palpable.

It is crucial for Sweden that we have a government that can conduct a responsible economic policy, make tough priorities, and that is capable of acting quickly to take the right measures at the right time. The spring budget presented on Monday is an example of such a responsible policy.

Mr. Speaker! Today we are debating the motion report SfU14. It is a very extensive motion report, and I intended to make a few points in it.

The government's starting point is that the sickness insurance shall provide financial security in the event of illness. The focus shall be on rehabilitation, and the design shall counteract unnecessarily many sick leaves, especially long ones.

Mr. Speaker! Since we debated this issue in December within the framework of the budget, I have visited occupational health care in Skåne - and I will make further such visits during the spring. It became clear during these visits that employers must work more preventatively, that they must get a handle on the current sick leaves, and that there must be a clear rehab policy. There is much work left to do here.

I wanted to say a few words about Försäkringskassan. According to the 2023 management letter, Försäkringskassan shall clarify the need for rehabilitation early in the illness and work to ensure that measures for effective rehabilitation are taken. I believe that wording, and the Moderaterna, is important for Försäkringskassan's work in gaining further focus on both preventive work and early interventions.

Mr. Speaker! The increasing sickness absence must be taken with the utmost seriousness. Sickness absence increased during 2022 compared to the year before. Sickness cases that have lasted for 180 days or longer increased by 9,000 in number compared to the year before, i.e., 2021. In total, we have approximately 107,000 long-term sickness cases in Sweden, and they account for more than half of all ongoing sickness cases. Two out of three long-term sick leaves are women. It makes my stomach turn because I know that a majority of all sick leaves are due to mental ill-health, and many times it is stress-related. These are sick leaves that could have been prevented. They did not need to occur.

On March 7 this year, SKR presented that sickness absences continue to increase in municipalities and regions. The increase occurs among both men and women, but there are still significantly higher sickness absence rates among women. When it comes to women in the municipalities, it increased from 8.4 percent to 8.8 percent. In the regions, the corresponding increase was from 7.1 percent to 7.9 percent. Here, municipalities and regions have a great task ahead of them.

Right now, Mr. Speaker, many investigations are underway within the field of sickness insurance. The investigation that is to review the regulatory framework for income qualifying for sickness benefit and the final report regarding the review of the social insurance protection for pregnant women will be presented in June this year. In August, the final report from the Occupational Injury Investigation will be presented. In September, the investigation on the significance of the medical certificate in sickness benefit cases will be reported. The working group that is currently working within the Government Offices on the waiting period deduction will report its work in December. Finally, the investigation that evaluates regulatory changes within the sickness insurance will be reported in March next year. There is, therefore, a lot going on.

Mr. Speaker! The government, through the Tidö Agreement, has a clear focus on precisely the prevention of sick leave and rehabilitation measures. I have said it before in this speaker's chair: The previous government failed to prevent sick leave and thus failed to reduce sick leave. This government must succeed.

A person who is on sick leave is not a pin in the statistics. They are a human being of flesh and blood. Many of the individuals who are on sick leave due to, for example, stress would not have needed to be on sick leave if the employer, for example, had caught early signs of stress.

We can do a lot politically, but it also requires that the actors in society contribute so that sickness absence does not continue to increase.

(Applause)

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Annika Hirvonen (MP)

Mr. Speaker! The government's most important goal is said to be to bring down inflation. It is very important to bring down inflation. There are different ways to do that. There are different things one can prioritize if one wants to strengthen the households that have it toughest without fueling inflation.

I have some requests. I want the government to prioritize the women who toil in the welfare sector to take care of our elderly and our children, those who live with the smallest margins both in their own finances and in the workplace. It is not enough to fight inflation by having the nursing assistants in elderly care run faster when colleagues become fewer. It is not enough to fight inflation through cuts in healthcare.

Mr. Speaker! On the one hand, I honestly do not believe that it works or is particularly effective. On the other hand, there are alternatives.

The government is underfunding welfare in a critical situation, and we now risk massive cuts in welfare, where very many women are currently struggling with the stress-related ill health that Ulrika Heindorff speaks about as a consequence. Instead, the government has prioritized electricity support for people who are very rich, who can afford their own heated pool.

It is wrong priorities. I wish that the government now comes to its senses. Otherwise, we will see even more women burning out.

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Ulrika Heindorff (M)

Mr. Speaker! Thank you, Member Hirvonen, for the question or at least for the reply! We are at least in agreement on one thing, I realize in the exchange of replies that is now taking place, and that is that healthcare staff shall not run faster. We are very much in agreement on that. But then I believe we have very different solutions.

I raised my eyebrows slightly when it came to one of the interesting motions that we have handled within the framework of this motion report. It was precisely from Miljöpartiet, and it was about universal basic income. I thought that was an issue that had long since disappeared from your agenda, but it was apparently still relevant. I do not think that is where the solution lies.

I also do not believe that the solution lies in working fewer hours, because right now we have healthcare staff who need more employees, more colleagues. We need more hands in healthcare, and I do not believe that either a universal basic income or a six-hour workday is the solution to the major problems and challenges we have regarding the skills shortage. There is much that the Moderaterna are doing there. When it comes to the supply of skills, the Moderaterna may not do it within the framework of this committee, but it lies primarily with other committees.

Our colleagues in municipalities and regions are also doing a great job there, but I do not see that the Green Party's solutions would help when it comes to the issues surrounding the competence supply in health and medical care. I find it very difficult to see that it would solve that problem.

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Annika Hirvonen (MP)

Mr. Speaker! The Moderates and the government do not see that a 40-billion investment in healthcare and the women who work and toil, and who have struggled very hard already during the pandemic, is a solution to the poor working environment in the welfare sector.

The Moderates do not see shorter working hours as a solution to the work environment problems that have led to 10,000 nurses leaving the profession and working with something else.

The Moderates also do not see full funding of the welfare system as a solution.

What is the Moderates' solution? Yes, cuts in welfare. That is what we see now.

I took the floor to ask how Ulrika Heindorff can reconcile her commitment to the women who burn out and women with stress-related ill health with the policy that her government is now pursuing, a policy that places an increased burden on those professional groups in the welfare sector who already have the highest stress-related sickness rates.

We from Miljöpartiet have many proposals to improve the working environment. The most important thing is that we fully finance the welfare during this crisis so that it is not the women working in the welfare sector who have to bear the entire burden of the government's inflation policy.

I think it is better if we do not give as much money to those who heat their own pool with electricity subsidies, but instead give more money to the municipalities so that one can afford to have enough staff in elderly care.

The Moderates have a priority, the Green Party a completely different one.

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Ulrika Heindorff (M)

Mr. Speaker! In the large budget that was laid in the autumn, large supplements were made to municipalities and regions. We also see the great need.

As I said in my opening remarks, we take the high sickness absence very seriously, especially the high sickness absence that exists within municipalities and regions. I have the image and the hope that municipalities and regions shall be good enough employers to be at the forefront when it comes to low sickness absence rates.

There we also have incredibly different solutions. As a former regional politician, I see, for example, that freedom of choice when it comes to employers is something that is good for healthcare staff. We also think that healthcare choice is good, and there I know that the member from Miljöpartiet and I disagree.

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Åsa Eriksson (S)

Mr. Speaker! I had not planned to respond to Member Heindorff because the Moderaterna have not signaled any further ambitions in this area. But I become very curious when the Member, in his statement, says that there are several investigations underway. Perhaps there are things in motion that we do not know about yet, and I would like to hear more about that.

My view is, in fact, that what the Moderate-led government has done is to shut down investigations that the Social Democratic government has commissioned. They have changed some directives on investigations that the Social Democratic government has commissioned, and they have extended the time so that they postpone proposals from investigations that the Social Democratic government has commissioned.

I therefore wonder what it is that the Moderate-led government has in store that we do not know of yet?

The reason for my curiosity, Mr. Speaker, is that I am also concerned because we all know what the Moderaterna campaigned on, for example, the reintroduction of the means test in the health insurance despite it being established that poverty does not make people healthier – on the contrary. Is it perhaps about the reintroduction of a second care day, which the Moderaterna have also wanted and which quite recently was included in directives to an internal investigation? Or is it perhaps the removal of the security pension which we Social Democrats introduced and which both the responsible minister and the member Heindorff have been very critical of in several different contexts?

I wonder, Mr. Speaker, what it is that the Moderates have in store in the area of health insurance. How worried should we and all the sick and disabled be?

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Ulrika Heindorff (M)

Mr. Speaker! Not worried at all, I would say to the Social Democratic member Eriksson.

After an election, I do not think it is strange that investigations are redone in the way the new government wishes to see them, and that has, of course, been done. I read from the list of investigations that are underway. Some of them have been tweaked, and some of them have received a clearer focus following the wishes of the Moderate-led government. I do not think that is particularly strange in itself.

Regarding the quarantine deduction, which is one of the investigations that I believe the member is referring to when she says "lay down," was it instead the case that one chose to tie it even more closely to the Government Offices. The investigation is to report its final assignment in December this year, so it remains but in a different form. One can think differently, but I do not think it is to lay down an investigation, but rather one has simply converted it into an investigation that is more closely tied to the Government Offices.

I believe that the member and I have some similarities, but our focus as it exists in the Tidö Agreement is very clear, namely to actually avoid all the unnecessary sick leaves that exist today, especially the long ones, because the long sick leaves are a real problem.

I would also say that we have a different focus on the work line, which is particularly important in the tough economic situation we find ourselves in now.

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Åsa Eriksson (S)

Mr. Speaker! I believe the member's commitment to women's health and mental health is genuine, and I know the member has raised it previously. It is something that worries me and the Social Democrats very much as well, so there I hope that we can join forces and do something together.

But I must nevertheless say for the sake of clarity to the member that if an investigator has been given a mandate and a directive and one then removes that mandate and the directive, then one has laid down an investigation. That one then wants to do something else, internally in the Government Offices with its own officials - fine. But it is still to lay down an investigation.

What is it that the Moderates want? Now there are three years left of the mandate period. What does the Moderates intend to do? What can we expect? What is in the pipeline?

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Ulrika Heindorff (M)

Mr. Speaker! I believe I accounted for that relatively well in that contribution, even though I did not have time to say everything. There is a clear ambition in the Tidö Agreement for what we want to do. We have a focus on precisely those unnecessary sick leaves, especially the long ones.

It is a great challenge and a big problem today for all those who could work but who have not been handled correctly, who have ended up in a situation where they are on sick leave even though they actually did not need it. I am primarily thinking of the stress-related sick leaves, which constitute more than half of all sick leaves.

I look forward to us presenting proposals in the future, both for the member and others in the chamber, that are in line with what is within the scope of the Tidö Agreement.

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Åsa Eriksson (S)

Mr. Speaker and dear members! This debate is about how we view the motions on the health insurance that have been written during the general motion period in the Riksdag. I want to dedicate my speech to all those who are long-term ill and have disabilities and who are constantly worried about how they will manage their finances. They wonder when they will get a secure financial future and when political parties intend to fulfill the promises that were made during the election campaign. I know that several of you are watching the debate.

These are pressing issues for all those who do not know how they will get money next month, who must live on their parents or need to go to the social services and apply for social assistance because they have a disability or are chronically ill and therefore cannot work. I am sorry that you do not receive the news you expected today.

Mr. Speaker! We Social Democrats naturally stand behind all our committee motions, but for the sake of time, I move for the approval of only reservation 33.

The reservation concerns something that is very important for the people I just mentioned. The tiny needle's eye that exists today for obtaining sickness and activity compensation needs to be widened so that all those who are entitled to this compensation can also receive it.

Mr. Speaker! Since 2008, there has been a decline in the number of people receiving sickness benefit. The reduction cannot be explained by changes in demographics, health status, or conditions in the labor market. New grants decreased sharply after 2015, and the rejection rate has increased from 43 percent to 70 percent in 2019.

Case officers at Försäkringskassan who work with sickness benefit, and who have exhausted all possibilities to get people into work - they do not have a capacity for work - become frustrated themselves when the unit for sickness benefits nevertheless rejects the applications. They know that these people are being sent out into a life without means of support. So we cannot have it that way.

That is why the Social Democratic government appointed an inquiry to see how we can remedy the problem. Those with the most severe disabilities risk being left without their compensation the day they turn 30 because today's regulatory framework is so rigid. I am ashamed that we in Sweden treat people with disabilities in that way today.

Mr. Speaker! The investigation commissioned by the S-MP government has submitted proposals - that happened already in 2021. The report is titled A health insurance with prevention, rehabilitation and security. The report has been subject to consultation, and there are finished proposals. We believe that the proposals should become a reality as soon as possible to help those people who truly have the right to take part in what is in the health insurance.

Oh, Mr. Speaker, we are not alone in thinking so. Several parties in the Riksdag want to make the same changes that we want. Several parties therefore demand that the government proceed with the investigation proposals, but the Sweden Democrats, who every year have stood in this speaker's chair and in the debates demanded precisely those changes, have now backed down. The party has laid flat. If the Sweden Democrats stood for what they have promised their voters, and promised the sick and the disabled, we would have a majority in the chamber to today, or tomorrow, force the government to take measures and implement the changes that these people have a right to. Do right!

Mr. Speaker! It seems to be as usual when right-wing populist parties come to power. In opposition, they say they want to invest in welfare, but when they actually get power - which they have today - they prioritize other things. Unfortunately, all of you who are ill and have disabilities and who are watching the debate: the Sverigedemokraterna chose in their negotiations with the government to prioritize lower taxes for high-income earners, a possible - perhaps - reduction of the plastic bag tax, a possible census, or whatever it is called, which the Skatteverket is to carry out - and other strange issues. They were more important than providing a secure livelihood for the sick and disabled in Sweden. It is pathetic. The chance still exists to change one's mind. If the Sverigedemokraterna mean business and vote on reservation 33, we can force through a better economy for the most vulnerable in society.

Mr. Speaker! The sickness insurance is a cornerstone of the Swedish security system. We Social Democrats always prioritize our common welfare, where security systems based on the idea of duty and right are an important part. We are proud of the changes that we made during eight years in government for both the sick, the elderly, the disabled, and others, but we are really not satisfied. More needs to be done. That we have removed the stumbling block enables more to become healthy faster; everyone knows that this becoming poor does not make us healthy.

Mr. Speaker, we still live in a class society. One of the greatest injustices is precisely that illness and disability affect people financially. Many of you watching the debate today truly feel that. And that is why it is high time to both rectify the unjust care deduction, and change the regulatory framework so that the long-term ill and those with disabilities can obtain a secure financial situation. We Social Democrats mean business, and we have allocated money for this in our budget proposals. The proposals have unfortunately been voted down, but we have in any case shown that we truly prioritize these issues. This is not enough, and we need to do more to achieve a secure and good sickness insurance - but this is a very important beginning.

Mr. Speaker! We Social Democrats will always fight for a health insurance that is to be an insurance worth trusting, an insurance that we pay into when we work and that is there the day we are unable to work. It is the insurance principle, and it is part of the social contract. We contribute when we are strong, and we must know that the day we are not strong, society is there - and we can trust it. That is how a social democratic society works. Today, or tomorrow, we have a chance to force the government to take a small step to improve society.

(Applause)

(cont. § 13)

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