Skål for state-owned businesses

Absolut midsommar – keeping health care funded
pic: absolut.com

Is Sweden a socialist country?! Although even through the 80’s it was still a thing, the idea that the Swedish state owned more businesses than not has pretty much been put to rest by this time. Still, there are several huge businesses that are owned or partly owned by the state, who has proven to be, at best, only a so-so business partner. SvD‘s Torbjörn Isacson went through part of the list today, with Telia’s recent sale of its Turkish business as a starting point.

Sweden owns 39.5% of Telia. The next biggest owner of Telia is Blackrock, which owns 3.1%. It’s safe to say Sweden’s ownership is the big one. Although it’s a controlling interest, the state doesn’t control Telia. Telia has a board like any other public company, who does the day to day work (for more about Telia see this blog post). However when Telia loses value or does bad business decisions it’s the state that takes a major hit as any huge shareholder would. Also when Telia does a good deal and makes money the state makes money. In this case, this means Swedish taxpayers.

That’s why Telia’s recent sale of its holdings in the Turkish company Turkcell must make the news. Not only did Telia and its shareholders take a huge, huge loss because the board’s idea was a disaster, Telia sold its holding to a buyer whose CEO is Turkey’s authoritarian leader Recep Tayyip Erdogan. As shareholders, Sweden’s taxpayers should be in the know – but in reality taxpayers have perhaps even less power than an average shareholder since the Swedish state must resign its active partner role to prevent a truly socialist state of affairs (see China for comparison).

Still, that doesn’t mean that the state ignores its business holdings entirely. Just recently, SvD reports, the parliamentary committee on enterprise (näringslivsutskottet) called on the three top state-owned businesses – Vattenfall, Jernhusen and Swedavia – to answer some questions on business practices like annual dividends, and handling the corona epidemic.

Vattenfall has been a leading money-loser. If it’s not one thing, it’s the other: too much snow, too little sun, too little snow, too much sun – and we won’t even bring up wind – they’re all reasons why Vattenfall needs to raise prices on Swedish energy consumers. Then there are other issues like nuclear power and electricity infrastructure that the state of Sweden is directly responsible for but again, must somehow disengage from their effects on its own business, Vattenfall, which, again, is somehow the reason Vattenfall must raise it’s prices on Swedish energy consumers. But it isn’t only Sweden where Vattenfall has its business. Vattenfall has business all over the world and the current record-low cost of electricity is again a reason that Vattenfall is losing money.

Jernhusen owns buildings and other real estate all along the Swedish railroad network and also has dealings inside Norway. Swedavia runs the airports. Both of these were taking losses even before Covid pulled the rug out from under them. And then, of course, we have SAS of which Sweden and Denmark each own just under 15%.

Another 100% state-owned, and Covid-hit business like all others, is Svenska Spel where the lack of sports and the closing of casinos has been financially disastrous. One would think that the state would be happy about less gambling, but it’s uncomfortable when it’s also making money for the state. We all know PostNord, which is 70% owned by the Swedish state and 30% owned by Denmark (note: for some reason, however, voting power is split 50/50). It has the impossible task of trying to be profitable while being prevented from raising prices or laying off workers, or even quitting the business entirely, by its own owners.

To make matters worse, it was in the 100% state owned LKAB (Luossavaara-Kiirunavaara AB) mines in Gällivare that a cluster of Covid virus has recently exploded. But even before that a number of questions regarding work practices were piling up.

Corona makes life more difficult for basically everybody, and misbehaving companies are common. Plus, some essential services should be guaranteed by the state, even if they’re not profitable. But as a general rule, should states be in the business of making money? Oh. Wait. We can’t forgot the good news – Systembolaget! A sure money-winner in Covid times and not. Swedes will have to keep drinking to keep the money rolling in – good thing it’s Midsommar.

17 Jan. – where’d you get that prescription?

a happy customer with a filled prescription
pic: apoteket.se

Apoteket AB announced today that it had bought a substantial share in Doctor24, one of the online doctor services that have become so popular over the last few years. Popular because you can actually talk to a doctor from the comfort of your home and not sit in hard chairs getting coughed on by strangers for hours on end – only to be told to take a few aspirin and go home. Sadly, there is no comparison between healthcare centers (vårdcentraler) they way they’re set up now, and your phone.

What makes this news is that Apoteket AB is state-owned. The same state that is trying to limit, tax, tar, feather and drive out of town online doctor services because they are said to drive up healthcare costs by encouraging unnecessary doctor visits. They are too easy to use, it seems.

Ibrahim Baylan, Minister for Business, Industry and Innovation and responsible for questions regarding state-owned businesses, passed on commenting more than saying that Apotek AB makes its own decisions: “It’s the company’s board that is responsible for the operation of the company. The decision to invest in Doctor24 is an operative decision that has been made by Apotek’s board” Baylan told SvD.

Anna Starbrink, healthcare councilperson for Stockholm, is seeing red. In an comment to SvD, she said “When we go to an Apotek now, we’re encouraged to turn to Doctor24 to renew our prescriptions. And then the bill for 500 kronor goes to taxpayers.”

“We’re supposed to prioritize the patients with greatest need, and here we have to pay online doctors for something that is already part of the regular care system. It fuels an unnecessary extra cost” she added.

But Tobias Perdahl, chief medical officer at Doctor24 put his finger on the problem. “She’s basically right” he said. “This should be easily covered by the regular care system. But it’s common that it takes days or weeks to renew a prescription. A patient without a prescription is a big problem.”

Anna Starbrink is looking to start a larger debate, SvD reports. ” We don’t accept that a healthcare provider owns a pharmacy – and the question is whether or not a pharmacy should be allowed to own a healthcare provider. What the effect will be is an important question and needs to be looked at.”

(PS. Apotek AB should not be confused with the other private Apotek chains like Apotek Hjärta, Apotek Lejon, etc.)

16 Dec. – get your healthcare here

which way to healthcare?
pic: aftonbladet.com

DN published the results of an investigation today in which it is reported that people with private health insurance were receiving care at clinics and hospitals many times faster than patients who were only part of the Sweden-wide general health insurance. Of the ten healthcare providers DN contacted, nine reported that they gave priority to private health care clients.

At the end of 2018, DN reports, over 618,000 Swedes had private health insurance; one person in seven. Insurance companies provide their clients with access to networks of doctors and other specialists with whom appointments can be booked without getting a formal referral (remiss) – something that patients on the tax-payer financed insurance need to do.

The official care guarantee is backed by law: Patients have the right to meet with a specialist within three months. Within three months is also the time a patient is supposed to have the operation or other treatment they need. However, the number of people who have had to wait longer than three months, sometimes much much longer, has risen from 14% to 30% over the last five years.

For patients with private insurance however, DN writes, a person can meet with a specialist within a few days even without a referral, and get the needed operation as fast as two weeks later. Even getting an x-ray or a blood test is a quick process.

It isn’t entirely bad news for the tax-payer insured though. Only four of the healthcare providers do not provide care within the regulatory three month guarantee time, meaning that although they may prioritize privately insured patients, five of the health care companies make sure their publicly-insured patients can still see the doctor they need to see within the required three months. Small mercies.

Of course, this wasn’t the way it was supposed to be when health insurance was first made available. Private health insurance was, and is, touted as relieving – unburdening – the public healthcare system. The Swedish Health and Medical Service Act (Hälso- och sjukvårdslag) stipulates that healthcare is provided with respect to the equal value of all people and for the dignity of the individual. The patient with the greatest need is always to be attended to first.

Reports like this indicate, though, that something is sick, and it’s not the patients.

14 Dec. – health care protests in Stockholm

healthcare workers hit Stockholm streets in protest
pic: Claudio Bresciani/TT

“The section is closed,
and the patient is dead,
“but everything’s fine”
the hospital board said.” *

So went the poem (roughly translated, and with a good dose of poetic license) by medical student Alexander Radkiewicz, at the demonstration protesting hospital staff layoffs in front of the parliament building in Stockholm today (SvD.se/demo). As written about earlier, in this blog post, a total of 1350 layoffs have been announced over the last several months, and an additional budget cut to the tune of 1.1 billion kronor has been mandated by Stockholm Region council.

The facebook group behind the demonstration has 16,000 members. “The younger people are the ones that are the first to be affected by the layoffs” said Laura Björnström to SvD. “This can wipe out an entire generation in health care” added Akil Awad, one of the demonstration organisers. “You hear it all the time – it’s like a mantra – that patient safety isn’t at all threatened (by these layoffs)” he continued. “But for us who are there working, we see that it is. We see it all the time.”

Anna Starbrink, Region Stockholm councilperson responsible for healthcare, told SvD that she understands the tough situation: “Obviously, a lot of thoughts go through one’s head when you see such a demonstration. At the same time, you need to remember that it’s fantastic that so many are so engaged in the healthcare issue.”

Be sure to remember that, next time you need health care in Stockholm.

* “avdelningen är stängd/och patienten är död/men på patientsäkerheten går det iiiiingen nöd