Response to interpellation 2024/25:3 on dental care for 19-23-year-olds
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD wants to lower the age limit for free dental care from 23 to 19 years to prioritize resources for patients with greater needs 1. KD argues that young adults have good dental health, that the reform is cost-neutral for the regions, and that it creates room for necessary care as well as staff recruitment 1 2 3. KD emphasizes that priorities are required and that they are investing in dental care for the elderly 4 3. S argues that the government is implementing a cut of 500 million kronor, shifting costs onto the regions and spending money on tax cuts for the richest instead of free dental care for young people 5 6 7 8. S considers the proposal to be a student-unfriendly step 6 7 9 10.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Madam Speaker! Eva Lindh has asked me if I intend to take any measures to compensate for the transitional rules so that the regions' finances are not burdened.
Oral and dental health in Sweden is generally good. Swedish dental health has, in line with the development of the welfare state and the expansion of dental care, developed positively for a long time. However, there are groups with an increased risk of impaired oral health and groups with poorer oral health. Among older people, there are several factors that can contribute to impaired oral health. Older people often experience impaired saliva production, partly due to higher age and partly because many have medications that affect saliva production. Older people can also experience impaired motor skills and thus find it more difficult to maintain their oral hygiene. Furthermore, many older people have an incipient degree of tooth loss, which is a risk factor for developing general diseases.
The Government therefore announces in the budget bill for 2025 a dental care reform aimed at making the high-cost protection for dental care more closely resemble that which exists in other healthcare. A reinforced high-cost protection means lower dental care costs for patients aged 67 and older. The objective with a reinforced high-cost protection is that patients in need of dental care should be able to visit dental care to a greater extent as needed and thereby achieve better oral health. The Government intends to allocate approximately 3.4 billion kronor annually from 2026 to strengthen the high-cost protection for dental care.
In order for dental care resources to be utilized effectively, the government during the past year made decisions regarding adjustments in the design of the state dental care support and the age limit for free dental care. Unlike older people, young adults are a group where most have good oral and dental health. The government therefore intends to lower the age for free dental care from today's 23 years to 19 years. These young adults will instead be eligible for double general dental care allowance.
It is important to emphasize that regions, the Folktandvården organizations, and private dental care have requested this change. The proposed change was presented last autumn and is based on the proposals in the report When need takes the lead - a dental care system for more equal dental health (SOU 2021:8).
The Government assesses that the proposal to lower the age limit for free dental care from today's 23 years to 19 years provides increased opportunities for the public dental care providers to prioritize their resources toward more necessary dental care than the dental care provided to young adults, where the majority have good oral and dental health. For example, Folktandvårdsföreningen considers that a lowering of the age limit is good, because the change creates space for patients with greater needs. This, in turn, can create increased opportunities for the public dental care providers to recruit and retain staff, as the patient group changes and with it the need for a broader spectrum of dental care measures.
In addition to the increased patient revenues that the proposal is expected to lead to, it can mean more and more varied work tasks for the staff at Folktandvården, which creates conditions for skills development. Furthermore, the upcoming reform linked to the high-cost protection for dental care for persons aged 67 and older should, in the long run, reduce the regions' costs for the region-funded dental care support.
Against the background that the regions and the dental care actors will benefit from the lowering of the age limit for free dental care, the government does not plan any funding for the transitional rules.
Eva Lindh (S)
Madam Speaker! Today's debate is about dental care for 19-23-year-olds. In this debate, I could speak about the importance of equal dental care, so that it does not become a class issue whether one has functional teeth or not. I could speak about the importance of establishing good dental care routines for the future at a young age, for example, attending the dentist regularly. I could speak about how dental health generally is improving and that one reason why dental health is so good in Sweden is perhaps also that we have free dental care for 19-23-year-olds, but that it is also slowly starting to deteriorate. This does not apply to the group of Swedes in general, but for some.
I could also speak about the difficulties for young people to manage to pay for dental care, because incomes are irregular and the recent times have been tough for young adults and many students. Few people under 23 have permanent employment. They study or work irregularly, and the income is not reliable. This is something I could speak about.
I could also speak about how it feels a bit strange when the government, in budget times, goes out and says that they are introducing perhaps the biggest dental care reform in 20 years when what they intend to implement will not arrive until 2026.
All this is extremely important, and I could spend a great deal of time on this. But I want to focus on one question. It is actually about something as boring as the funding principle – it sounds boring, at least. When we nationally in the Riksdag and government decide on matters that affect at a local level – in this case, it is about the regions – we usually send along money.
The government has now decided that there will no longer be a reform with free dental care for 19-23-year-olds. At the same time, they have decided on transitional rules. I do not oppose the transitional rules themselves. They seem reasonable, because if, for example, the public dental clinic has started a treatment, it continues for a very long time, especially at that age. What the government has now done means that the young people shall continue to receive free dental care, but the costs for this shall not be borne by the state, but the regions may do so.
At the same time, we have a healthcare crisis in Sweden. Yesterday, the government presented its entire budget. I thought that more money would be sent to healthcare, but what is happening is that less money will come in 2025 than what came this year. Furthermore, the regions now, as a small extra gift, have to pay the transition rules for dental care. It is not reasonable. Does Social Minister Forssmed think it is reasonable?
Anna Vikström (S)
Madam Speaker! I understand that the Minister wants to speak about an upcoming, completely different dental care reform and not this proposal which removes free dental care for young people between 19 and 23 years of age. It is a cut in the dental care system of approximately 500 million.
The current bill therefore means that the government is unilaterally moving forward with savings without simultaneously submitting any proposals for improvements. The proposal also contains an overwhelming of the costs for the transitional rules onto the regions over several years. The transitional rules concern that the older provisions regarding fee exemption for children and young people shall still apply to dental care treatments started before the entry into force at the turn of the year. The older provisions shall also apply if the region, before the entry into force, decided that a dental care treatment shall be fee-free for a patient.
As Eva Lindh pointed out, there is no funding for the transitional rules when the state subsidy is removed at the turn of the year. For Region Stockholm, it involves 17 million kronor that the taxpayers in the region are forced to shell out. In Dalarna, the head of dental care says it will cost 19 million, an amount that they do not have at their disposal. This amount could be much higher for other regions, which may have long queues for, for example, dental prosthetics.
As Eva Lindh also mentioned, the regions, which are already in a healthcare crisis, shall bear the dental care costs for the transitional provisions. The healthcare crisis is demonstrated, for example, by the large notices of intent to terminate employment within health and social care, which are hitting records in several regions. Up to August, 4,547 people in health and social care have been given notices of termination, which is the highest figure since 2010, according to Arbetsförmedlingen.
The unions in the welfare sector, which represent more than 1 million members, wrote yesterday about the enormous challenges that the welfare sector faces and how disappointed they were with the government's healthcare budget. The healthcare budget implies reductions in the appropriations to both healthcare and elderly care. At the same time, the increase in the general state grants to municipalities and regions is zeroed out. This means that the total supplements to care and elderly care decrease with the SD's and the government's budget. The regions are still struggling with large deficits. What the regions do not need is to additionally have further costs for dental care shifted onto them by the state.
Adrian Magnusson (S)
Madam Speaker! I thank Eva Lindh for the interpellation, which touches on an important issue and a proposal that will have a fairly large impact on the personal finances of quite many young people. The interpellation primarily concerns the funding for the regions and how they should be compensated for the increased costs they are now facing. It is an important issue. We have, in this country, a healthcare crisis that the government has pushed down the throats of the country's regions and, ultimately, on patients and staff within the healthcare system.
In the rhetoric and presentation of this proposal, the government has in some sense pitted group against group. I have reacted quite strongly to that. It has more or less been said that the country's young must have it worse so that the country's elderly can have it better. It is a rather strange message that one group must have it worse so that another can have it better.
What makes this even stranger is that the government spends just as much money on lowering the tax for the very richest. It costs 4.7 billion to give the ministers themselves 30,000 kronor more per year. That is no problem. But to give the country's 19-23-year-olds free dental care, there apparently are no funds.
Madam Speaker! This is unfortunately just one in a series of student-hostile proposals that the government is putting forward. The Minister for Housing, the Social Minister's party colleague, has stopped all housing construction and has not done much to get it started again – nothing, I would like to assert. It has led to the housing situation worsening even further for the country's students, and it was hardly rosy before. There are more student cities than before that are unable to provide housing for the students during the first semester they study. That is bad, and it is a direct consequence of the government's policy.
In the budget bill submitted to the Riksdag yesterday, it can be read that the government is also cutting the funding for student influence. It is not the first time the student unions are taking the hit. They will lose 20 million kronor in 2026. The former Minister for Education has many times expressed himself condescendingly about students' engagement, so perhaps it is not surprising. Furthermore, the government will lower the ceiling amount for the higher education institutions by 217 million kronor next year, which will hit students' educations. Alarms have already been raised that the teacher-led teaching time has dropped significantly because money is being saved, not least at, for example, Stockholm University.
So now comes the next blow against the country's students, when free dental care is scrapped. Instead, taxes are to be lowered for those who earn the most in this country. If the government truly wanted to improve welfare, they wouldn't have had to let the country's students, a group that already has it tough to say the least, foot the bill. For example, a pulled tooth can cost 7,705 kronor, while CSN gives 13,156 kronor. If a student happens to suffer this, those 30,000 kronor that the ministers give themselves in tax cuts would have sat quite nicely.
I believe that there are many elderly people out there who would more than gladly have seen that this country's wealthiest not received a tax cut, but instead that their grandchildren did not have to choose between going to the dentist and paying the rent. They know, after all, that their grandchildren who are studying at one of the country's universities are quite short of money. But it could also be that the students cannot afford an apartment. It is not certain with this government's housing policy.
Madam Speaker! The government's student policy really leaves much to be desired. This proposal shows that one continues on the path already taken. It is a great disappointment.
TREDJE VICE TALMANNEN
I remind that the debate is about dental care for 19-23-year-olds.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I understand that it is primarily dental care that we are to discuss. That is why we have this interpellation debate, not to create "content" or whatever it is in the social channels.
I wonder if the interpellor and other fellow debaters have read Veronica Palm's investigation. There, she states that the free dental care for 19-23-year-olds conflicts with the principle of need and leads to displacement effects that result in people with greater – and large – needs for dental care not receiving that dental care. Is the principle of need not very important to safeguard within dental care? I think so. I think we have provided too little dental care in Sweden based on need and too much based on other premises, and I think it is reasonable to change that.
I interpret the interpellor and other fellow debaters as [meaning] that the Social Democrats will be against the lowering of the age limit to 19 years. This also means, then, that one is not in favor of the improvement that we are making for the country's elderly, who have greater dental care needs, because it is difficult to do these things simultaneously given the capacity shortages we have in dental care. This is also very clear in Veronica Palm's investigation.
My question in return is: Will you reject the increased high-cost protection for the elderly and the opportunities for increased capacity that the removal of free dental care for 19-23-year-olds entails? For 19-23-year-olds, a double dental care subsidy is introduced instead, which means they will have good opportunities to continue with good dental care and good oral health.
The interpellator and other debaters are hardly listening to the profession. The organizations of Folktandvården, the private dentists, and the regions have requested this, because they see exactly what we describe: that we need to focus on those with the greatest needs. Folktandvården's conditions also need to improve so that one can increase the revenues to Folktandvården in a different way than today and give them increased opportunities to compete with private actors.
I think it is important to try to do something about this. But I note that my opponents, Eva Lindh and others, do not want to do this but believe that it is possible to be the giver of all good things. That is not the case with the problems and deficiencies we have in dental care. This has been pointed out very clearly, not least by Veronica Palm's investigation.
Regarding the transitional rules, our assessment is that this change will lead to an improved economy for the regions initially and that it will be cost-neutral in total. Therefore, there is also no reason to add funds, as we do when we place increased costs on the regions. We do not do that here, but this is cost-neutral. In the long run, it will also lead to improvements for the regions.
It can of course make a difference in some region. But the assessment is not that it should lead to increased costs. On the contrary, in the long run, it should lead to increased revenues and increased opportunities, not least for the public dental care, and that is very important.
Eva Lindh (S)
Madam Speaker! I can begin by stating that the Minister for Social Affairs did not even touch upon the question I asked. I will ask it again.
Of course, politics is not just about wanting, something that is good. We want a lot. Wanting is important. But it is very much about prioritizing. The Minister for Social Affairs is absolutely right about that. It is about prioritizing between different things that are important. For us Social Democrats, it is and will always be very clear what we prioritize.
We have always prioritized and will always prioritize the welfare. It is healthcare, care, school, and elderly care. We do that here as well. What the SD-led government is prioritizing now is not the welfare. It prioritizes tax cuts for those who already have. That is what the politics has stood for very much in these recent days.
I am seriously very upset and actually also surprised by what is seen and what I see in my everyday life. I believe that most people see that we have a healthcare system that is on its knees. It is very clear in my own home region, Region Östergötland. There, we will have extremely fewer staff members towards the end of the year. They have to run faster just to be able to manage what is their mission, to help, support and care for those who are sick in our county.
That one chooses to allocate less money to healthcare leaves me almost speechless. The millions we are talking about now might seem like a small part. But it is outrageous that resources are not being allocated to the healthcare that is bleeding and that truly needs resources. Then one makes a decision that not only affects people but also affects healthcare as a whole because it shifts costs onto the regions, which have the responsibility to provide healthcare in Sweden.
In Östergötland, it is estimated that it concerns at least 450 people. I want to say again that I do not have a problem with that there are transitional rules. It is reasonable that those who have entered into, for example, getting a dental correction or something else with the premise of getting it for free should also get it moving forward. The problem is that the government is not transferring money to the regions to be able to meet those transitional rules. Then there will be even less money for healthcare, and of course also for dental care.
All of this is very problematic, and it seriously upsets me. The Minister for Social Affairs nods here and suggests that he answered my question. I want to ask the question once again: Does the Minister for Social Affairs think it is reasonable to further shift costs onto healthcare in this situation? That is actually what the government is doing with this decision.
Anna Vikström (S)
Madam Speaker! Thank you, Minister, for the answer!
The Minister of Justice speaks about the needs principle. I would like to say that something that really stands out in the bill is how it is emphasized how positive the proposal is for the private dental care market, which now receives 500,000 patients. It is emphasized several times.
The proposal implies no investment in dental care but a deterioration. The government is removing 576 million from the dental care system. That is what the bill is about. At the same time, the government is placing the costs for the transitional rules on the regions.
It is a couple of months during the autumn that it is possible to qualify for the transitional rules for those patients who have not started their treatments, in order that they can hopefully have their treatment assessed as fee-free.
We must remember that many patients are in a queue for a long time, and it is nothing they can influence themselves. Many worried parents in Region Stockholm are reaching out and are desperate. They do not know if they dare to start orthodontic treatment for their children for fear that it will cost them too much.
In some regions, the queues are very long for this type of treatment. There are young people who have been in queue for eight to ten years. We recently read about it in the media. It is not strange that many become worried - both children, young people and parents - when dental care does not function and there are cuts that make it uncertain whether they will be able to receive their treatments.
Adrian Magnusson (S)
Madam Speaker! That such a clear deterioration hits the age group that is to such a large extent composed of students must nevertheless be considered relevant to highlight in a debate like this. I cannot understand how it cannot be so. But I must accept that the Minister for Social Affairs does not want to talk about it.
I want to demonstrate that there is a pattern where the government constantly targets the student group and makes deteriorations for that specific group. As was said here just before by Member Vikström, there is a widespread concern within the age group regarding what this will lead to.
Quite a few students have dental care interventions. They now feel an anxiety about what will happen in the future. What will happen if I should need dental care? How will it affect my private finances?
As I said, an extracted tooth can cost almost 8,000 kronor. There have been costs of 13,000 kronor. We have a situation in Sweden where rents are rising, and we have a skyrocketing housing shortage. It is clear that it has an impact. Politics are interconnected. That is what I am trying to prove here.
The Minister for Social Affairs wants to downplay it to that I want to create content. I then get even more evidence of how the government views the age group of students. It is composed to a considerable extent of the group in the age range 19-23 years.
It would have been possible to do both. It would have been possible not to lower the tax by 30,000 kronor for, for example, the country's ministers and the very richest. Or one could have, for example, done as has been requested here, to move money over to the regions. It would at least have been possible to do.
But it is more important to lower the tax by 4.7 billion kronor for the very richest. As we heard here, it is apparently more important to nourish the private dental care market than to ensure that the regions receive the resources they need.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I could, of course, have abstained from my comment. I only note that a large part of the member's contribution concerned completely different matters than dental care.
I am here in my capacity as Minister for Social Affairs. I am responsible for dental care. That is how the interpellation system works. One calls upon a minister to speak on the minister's area of responsibility and not on a thousand other issues.
Then we can have a different debate. We can gladly have that. It was just a small comment on that. If one wants to talk about housing prices, one talks to Andreas Carlson. If one wants to talk about other things, one must talk to other ministers.
This is a situation that, above all, the dental care service experiences, creating a situation where it cannot offer dental care based on need and where the principle of need is set aside. This has been established in Veronica Palm's investigation.
It is important to do something about this so that more people with increased needs will receive dental care. That is what Anna Vikström describes so well regarding the people who are standing in line for dental care. If one asks the dental care system itself about what reasons there are for this, it points out several different things. One thing they point out is free dental care for 19-23-year-olds. It has contributed to the queues. It has contributed to the need principle being sidelined.
Sometimes one also wonders if the Social Democrats know how the 24-year-olds are doing. Is it hell that hits them? Excuse the choice of words; I take it back immediately. I am just a bit tired.
We need to change dental care so that it is provided more according to need. I respect that one can be critical of this change, but then one also needs to explain how we are going to handle the capacity shortages and how we are going to solve the principle of need. One probably also needs to say that one will reject a dental care reform for those who have great needs and who are older. We want to create a dental care reform for them simply to ensure that they receive lower dental care costs.
These are the priorities that need to be made. Is it reasonable to make these priorities? Yes, it is. The dental care organizations want to see this, and investigations want to see this. It means savings or reduced costs, but we are also adding many times larger amounts, not least for elderly dental care - in terms of investing in welfare.
Tax cuts are mentioned. I have noted that the Social Democrats have been involved in abolishing the wealth tax. It is their choice and their opportunity to do so. When the father is super, it is right, so to speak. But one has the opportunity to do both things. One can lower the tax so that it pays off better to work. Then we get more growth so that we also manage the welfare of the future. It is extremely important.
Regarding the transitional rules, our assessment is that the reform is cost-neutral and that, in the long run, it leads to increased opportunities for revenue for the public dental care, increased opportunities to retain staff, increased opportunities for skills development and, not least, increased opportunities for revenue. The intention is not to favor the private dental care market, but the purpose is for dental care to function better and, not least, to facilitate things for the public dental care.
Eva Lindh (S)
Madam Speaker! We were not supposed to be talking about anything other than dental care, but since the Minister for Social Affairs is raising some other issues, I would just like to make some clarifications.
When it comes to tax policy, I believe the Minister for Social Affairs knows very well that the abolition of the defense tax was not something the Social Democrats came forward with as a proposal. It is about cooperation, and sometimes you have to do things that you do not want to. This would not have been our priority; I believe the Minister for Social Affairs knows that.
We are talking about taxes because it is about priorities. Politics is about both what we wish to do and about prioritizing. To prioritize that the already wealthy receive much more feels very bad, at least in my gut. It feels bad when one sees what the welfare looks like - when one sees the needs in healthcare, the needs in dental care, and the needs in school. More resources are needed. That is one thing.
The second thing is this: Now that we see how the regions themselves have calculated what the reform will cost, I trust that they are making a reasonable assessment, that is to say, that it will cost more. It is not reasonable in this situation, when we have a healthcare crisis. When we talk about a healthcare crisis, it is also a crisis in dental care. Prioritize dental care! Prioritize healthcare! It is something one would wish for from this government and perhaps from a social minister who at least says that he is very committed to healthcare and dental care issues. Then this should be prioritized.
I think it sounds very wrong to say that this might be the century's dental care reform. This is going to be tough for many 19-23-year-olds. It is going to be tough for 24-29-year-olds, who also do not get as much money now. It is going to be tough for the future of dental care. And above all: Do not shift costs onto a healthcare system in crisis!
Socialministern Jakob Forssmed (KD)
Madam Speaker! When did the Social Democrats last allocate 3.4 billion to dental care? Please tell us that, Eva Lindh!
We are making an enormously large improvement for all elderly people and their high-cost protection that comes into effect in 2026. It is the first step in continuing to expand the high-cost protection for even more so that even more get lower dental care costs in order to be able to meet dental care needs.
In order to be able to do this, one needs to prioritize. Then one needs to see what the dental care organizations have pointed out and what investigations have pointed out. Veronica Palm, S, has investigated this and seen that free dental care for 19-23-year-olds crowds out the possibilities for others to receive dental care. It crowds out the possibilities for those with the greatest need to receive dental care, and it makes it difficult for the public dental care system to obtain good revenues for its operations so that one can provide high-quality dental care for the entire population.
We provide double dental care to 19-23-year-olds. They are not left high and dry in any way, but are given good opportunities to continue going to the dentist and receive good dental care.
Regarding the transitional rules, I can say again that of course there are costs. But there are also increased revenues, and the assessment is that this will be cost-neutral for the regions. In the long run, it will naturally improve their opportunities to provide good dental care.
This is how it must be done. One must analyze how things look and make the trade-offs and the priorities that are requested. To answer Eva Lindh's question: This is a reasonable prioritization to make.
I believe it will be very difficult to maintain the free of charge and at the same time do the other with the capacity problems that exist in dental care if one wants to honor the needs principle. One can do it in opposition, but it is difficult to do it in a government position. I therefore assume that the Socialdemokraterna will reject our major dental care reform for the older part of the population. But we will have to see how the Socialdemokraterna choose to act.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.