Last summer, the Canadian media was awash with stories about how the socialist Swedes had supposedly turned their back on public ownership. Most notably, they were said to be selling their major public hospitals to corporations. Not surprisingly, researchers associated with right-wing think tanks were quick to jump on the story. After all, with Sweden's history of international business success and socialist government, it is associated with all things both efficient and egalitarian. If for-profit hospitals work there, why can't they work in Canada?
Given the impending release of the Romanow report, and Alberta's recent decision to license Canada's first for-profit hospital equipped to perform major surgery, it is worth revisiting this story, both to correct an important misunderstanding, and to find out how the story turned out.
Many of the press accounts from last summer regrettably confused Swedish with socialist. Most stories featured the decision of Stockholm County Council to turn over operation of St. Goeran's hospital to a private firm and to contract-out an increasing volume of care to other private facilities. However, few of the stories noted that Stockholm County was governed by a coalition of parties led by the Moderates (Sweden's equivalent of our Alliance party). Shut out of power nationally and in most local councils, the Moderates chose to use their position in Stockholm, where they won control of both the county and city councils, to showcase their agenda of public restraint and privatization.
Far from turning their back on public provision, socialists vigorously opposed the "Stockholm agenda." In the health sector, the Social Democratic government (supported by the Communists and Greens) issued a moratorium blocking further hospital privatizations until this fall. During this summer's election campaign they highlighted the Moderate's privatization program in Stockholm and asked voters for a strong mandate to fight for a health care system owned by the public, not corporations, and run in the public interest, not in the interest of those most profitable to serve.
So how has the Stockholm County experiment turned out? The financial world has certainly not been impressed by the Moderate-led council. Standard and Poor's lowered Stockholm County's debt rating last fall. In terms of patient care, there have also been worrying signs. There have been allegations that the private hospitals and clinics in Stockholm are pre-disposed to cream-skimming, making it more difficult for seriously ill patients to get care.
For example, on September 5th, the pro-business Svenska Dagbladet published an opinion piece co-authored by one of Sweden's leading heart specialists. The piece states that Stockholm County's decision to favour private care has placed the health of cardiac patients in jeopardy. Unlike the public hospitals, which treat patients regardless of their condition, the private sector will not handle the most seriously ill patients. Having chosen to divert funding from the public to the private sector, the Moderate-led County Council turned logic on its head. Spaces have been created by for-profit firms to treat patients least in need of care, who now receive speedier treatment. Meanwhile, those most in need of care face longer waits, as the public hospitals no longer have the funds to work at full capacity. In short, the authors assert that the ability of medical opinion to set treatment priorities has been seriously undermined.
Politically the decision has turned out even worse for the Moderates. Far from attracting voters with their Stockholm showcase, the party suffered its worst performance since 1973 in the September 15th election. Meanwhile the Social Democrats strengthened their grip on power at the national level and ousted the Moderates and their allies from control of both Stockholm County and Stockholm City Councils.
In Sweden political parties run on platforms that voters expect them to implement. The strengthened national coalition led by the Social Democrats will make the temporary moratorium on further hospital privatizations permanent. In post-victory interviews, the new leader of Stockholm County Council interpreted the vote as sending one message above all else: "stop the giant sell-off" in health care. This does not mean there will be no private sector presence whatsoever in Swedish health care, but the public has soundly rejected the notion of a health care system in which for-profit facilities play a leading role.
Last summer Canada's private health lobby held Sweden up as an efficient and egalitarian society willing to embrace for-profit hospitals. In fact it was only a narrow right-of-centre political coalition that made that choice. Swedes have rejected both them and their for-profit hospitals. Take it from the roughly 6.7 million Swedish experts on efficiency and egalitarianism who voted on September 15th: private hospitals and the public interest do not mix.
Daniel Cohn, is an assistant professor in the department of political science at Simon Fraser University, and a research associate with the Canadian Centre for Policy Alternatives.