‘‘Filippa, where are you?” The question is asked every Thursday at public meetings in Tensta, a poor suburb north-west of central Stockholm. Filippa Reinfeldt of the Moderate Party is responsible for health care in Stockholm County Council, where the centre-right majority has introduced Health Choice Stockholm (Vårdval Stockholm). The new system makes it easier for private companies to compete with the public sector in primary health care.
According to the centre-right parties, Health Choice Stockholm empowers citizens by allowing them to choose their health-care provider. Critics, including the Swedish Medical Association, claim that the market-oriented approach puts poor people at a disadvantage because it does not pay enough attention to their additional health-care needs. In Tensta and many other suburbs, public health centres have been forced to reduce staff. However, Reinfeldt has yet to accept the invitation for a public debate with the Social Democrats in Tensta.
The principles behind Health Choice Stockholm will be mandatory for all Swedish counties. This is only one of the far-reaching changes decided since the four centre-right parties of the Alliance for Sweden came to power in 2006. More fundamental alterations to the Swedish model of high-quality social welfare will take place over the next few years, especially if Alliance for Sweden wins the next national election in September 2010.
After the electoral success of 2006, Reinfeldt’s husband, Fredrik, formed a four-party government, encompassing the Moderate Party, the Liberal People’s Party, the Christian Democrats and the Centre Party. Since they took office, taxes have been reduced substantially, financed to a large extent through reductions in social benefits.
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The difference in living standards between people with a job and those without has increased. Now, in the wake of the global economic crisis, government ministers have acknowledged that changes to unemployment benefits might have been too drastic, leaving Sweden ill-equipped to face historically high unemployment. Fredrik Reinfeldt became prime minister by rebranding his party as a defender of ordinary workers. Yet his long-term agenda seems to involve a radical overhaul of the Swedish model – and this is where structural reforms such as Health Choice Stockholm fit in.
To begin with, citizens may appreciate being able to choose their primary health centre. However, since private health-care providers are free to establish themselves anywhere, in the process securing taxpayers’ money for treatments that might not be needed, ultimately cuts have to be made elsewhere in the public sector, especially when taxes are reduced.
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A similar situation prevails in education. In 1992, a centre-right government allowed private entrepreneurs to establish new schools in areas where public money was short. Although Social Democratic governments of the past had provided extra money to support public schools in poor areas, this funding has been withdrawn. The result has been that parents who can navigate the system take their children out of state schools, leaving others behind.
The government is undermining public services in many other ways, slashing spending on affordable housing and privatising state-owned companies. When the quality of public services falls, so does the public’s willingness to pay high taxes, which has always been one of the foundations of the Swedish welfare model. In a speech at the London School of Economics last year, Fredrik Reinfeldt questioned whether there has ever been such a thing as the “Swedish model”. However, Tensta is giving Social Democrats some hope. In the European elections on 7 June, voter participation there increased substantially. One reason was surely the weekly protests against Health Choice Stockholm.
Mats Engström writes for the Swedish newspaper Aftonbladet