ALMOST PARADISE?
A look at life in contemporary Sweden from a
citizen’s perspective
Memphis in May International Teacher’s Conference
Focus on Sweden
Memphis, TN
February 23, 2013
Susan L. Holmberg, Ph.D.
Visiting Scholar, Department of Scandinavian Studies
University of Washington
Seattle, WA
susanleeholmberg@gmail.com
CONTENTS
1. “Utopian” aspects of life in Sweden (from US
perspective)
a) Health care
b) Family policy
c) Democracy
2. Shadows on the horizon
HEALTH CARE
”Health care: Equal access — key to keeping Sweden
healthy”
Everyone in Sweden has equal access to health care services
under a largely decentralized, taxpayer-funded system. Like
many other countries, Sweden faces numerous challenges,
such as funding, quality and efficiency of its health care
services.”
(from Fact Sheet on Health Care, Swedish Institute, www.sweden.se)
SWEDISH HEALTH CARE DISTRICTS
(Landsting)
Price Ceilings (in US Dollars)
Item
Maximum costs
Medication
Max $328.00 /year
Doctor visits (GP)
Max $30.00 (free after total $164.00
spent)
Specialist visits, ER visit
$44.80
Hospital visit
$12/day (first 10 days), then $9/day
Diagnostic tests (pap smear, pregnancy
test, other regular tests) without doctors
appointment
$15.00
Conversion rate:
SEK 100 = $15.13
Average net annual income in
Sweden = $ 34, 920
PRICE COMPARISON of SELECTED DRUGS
US Dollars per 30 Day Supply
1200
1000
800
600
US
Sweden
400
200
0
NEXUM
ACIPHEX
PLAVIX
SIMVASTATIN
FLUTICASONE
ASMANEX
What the pharmacist told me…
After explaining my initial idea of asking pharmacy customers to
guess how much Americans pay for the medications they are
picking up, a pharmacist told me:
”They won’t be able to make a guess because they don’t need
to think about it like that. There is a price ceiling above which
they do not spend any money, regardless of the type of
medicine.”
Exact ceiling level is set at the county or municipal level: no higher than
SEK 2,200 ($328.00) per year
”The best feature of the Swedish system is…”
Male, 20’s
..that it doesn’t cost money,
you just pay one fee and
it’s protected
Female, 20’s
..that you don’t have to
pay much, like in some
other countries…
Male, 70’s
...when you are sick you
are well taken care of –
one need never worry that
one cannot afford care
Male, 50’s
…that it is available to
everyone – everyone has a
right to health care
Male, 60’s
..that it is open for everyone,
regardless of your social position, it
makes no difference if you are rich
or poor
Female, 70’s
…all citizens are covered,
if you are born here you
have a right to it
”The worst feature of the Swedish system is…”
Male, 20’s
..that it can be uneven quality
at different clinics…
Female, 20’s
..it depends, I’ve heard bad
things about some clinics
where they don’t greet you
well
Male, 70’s
…that everything is being cut back to
save money because of the increasing
costs, new machines, equipment so
expensive
Male, 50’s
…the long waiting periods,
several hands working
together so it takes time (?)
Male, 60’s
..that doctors are not on a fixed
schedule like other health care
employees – most Landsting don’t
have enough doctors, causes long
waits
Female, 70’s
…that it’s gotten worse over
time, long waiting periods,
lines, even cancer care can take
up to 2 or weeks..
FAMILY POLICY
Child Allowance
All children are entitled to tax-free allowance
($164/mo) until the age of 16*
* Note that additional money is
given per additional child
Study Allowance
At 16, children in school receive study allowance
(SEK 1050/mo except July and August) until
they are 20 years old, provided they are
studying full time
Paid Parental Leave
• A total of 480 paid
days provided to
parents
Free Daycare
• Children
between the
ages of 1 and 5
• National
standards
Free Education
Tuition-free
schooling from
primary through
PhD levels
Free lunch for K-12
DEMOCRACY
Voter Turnout
Sweden maintains relatively high levels of voter
turnout, generally above 80% over the past
60+ years
Political Parties
Proportional Representation system with 4%
minimum to gain representation in Parliament
(or local, regional legislatures)
Party Distribution in Parliament following 2010
election
Level playing field
• All parties receive funding for election campaign
• Interest representation generally inclusive, collective
– lobbying in the US sense does not exist
• Restrictions on political advertising on commercial
(and public service) television and radio – campaigns
not dominated by TV ads as in US
• In Sweden, money is not as necessary a precondition
for political mobilization as it is in the US
Independent, accountable media
Public service broadcasting in Sweden is oldest
and most trustworthy source of political
information
Financial and editorial independence
• Funded 100% by license fees (BBC model), not taxes
or advertising
• This keeps broadcast budgets independent of
political alignments in Parliament
• It also maintains independence from corporations
(i.e no advertising)
Accountability and transparency
Because it is funded by the public, program content
must maintain certain standards of quality and
responsibility – in news reporting, standards of
impartiality and substance are required
Shadows…?
Health care
• Aging population with low population growth
• Increasing costs for medical equipment and
medication
• Provision of quality across the board, in urban and
rural areas, wealthier and poorer neighborhoods
• Recruitment of quality medical personnel –
doctors, nurses, technicians and home help/elder
care
Family Policy
• ”benefits addiction”? Extensive and generous
universal benefits are costly, but expectation and
sense of entitlement are deeply entrenched
• ”curling generation” might not be motivated to
work, sacrifice for others
• Parental leave creates uneven pockets in the
workforce, increases need for temporary workers
Democracy
• Recent decades have seen rise in right wing extremism,
reactions against influx of immigrants and refugees –
Sweden Democrat Party now established in Parliament
and regional governments
• ”American style” politics in the form of lobbying and
political advertising are edging into the Swedish system
• The media landscape is rapidly changing, becoming
increasingly commercial - public service is struggling to
maintain its prominence and the license fee is a
recurring issue
SUMMARY
•
To an American, life in Sweden can seem like a dream or fantasy where many of the
economic burdens of everyday life simply don’t exist
•
Health care is practically free across the board, with price ceilings and protections,
along with guarantees of quality treatment for all
•
All children receive money each month and free school lunch, along with free schooling,
and parents are given a year and a half of paid leave when a child is born
•
Political participation is widespread and inclusive, and political discourse takes place in
a (relatively) responsible and ethical media environment
•
One of the main challenges for the future is maintaining this high level of universal
benefits and guarantees, all of which are tax-based – without universal benefits, the
consensus to contribute (and receive benefits) may erode
•
Another major challenge to the Swedish ”paradise” is creeping intolerance against
”outsiders”, particularly non-European ethnic groups, as competition for scarce
resources increases
For more information, try the following links
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www.sweden.se - The Swedish Institute Home Page (Gateway to Sweden)
www.riksdagen.se – The Swedish Parliament – the Riksdag
www.fhi.se — The Swedish National Institute of Public Health
www.scb.se — Statistics Sweden
www.forsakringskassan.se - The Swedish Social Insurance Agency
english.skl.se — The Swedish Association of Local Authorities and Regions
www.socialstyrelsen.se — The National Board of Health and Welfare
www.sweden.gov.se — The Government Offices of Sweden