(R)evolutionära idéer: Förändring i svensk sjukförsäkringspolitik 1995-2015

Abstract

Since the post-war period, the Swedish welfare state has largely been based on the principles of emancipation and economic security for individuals. Some refer to this as the idea of progressive individualism. However, major changes in the Swedish sickness benefit system came about in the noughties. Reforms were implemented that weakened the ‘loss of income’-principle, which meant that a large proportion of the population lost their right to economic compensation. The sickness benefit system changed from being a sort of social insurance system to more of an adjustment insurance system. Formerly based on the idea of progressive individualism – where the state should liberate the citizens from the market – the system came to rely on the idea of morality paternalism with a new paradoxical purpose: the state should save the citizens from the state. This change did not occur as a result of a new political regime and the implementation of the change was not characterized by compromises or conflicts. The initial proposals were introduced by the Social Democratic government but most of the reforms were brought into effect by the center-right government in 2007. How then did this retrenchment policy in the Swedish sickness benefit system come about? In this study a theoretical argument is put forth on how to understand and conceptualize how social policy can be changed from within and occur without any critical junctures. The study will illustrate how gradual but profound institutional change of the Swedish sickness benefit system occurs through an ideational evolutionary process. The book especially calls our attention to the manner in which previously dominant ideas are never entirely supplanted by newer ideas that gain traction. Indeed, it demonstrates that previous ideas play a considerable role in the process of limiting the scope of new ideas that may be candidates for adoption and in the process of social policy change. Ideas consist of different components in the form of norms and values, linked through events, concepts and information. This means that ideas may rely on their own contradictions as the world around them changes and has to be dealt with. However, when ideas end up contradicting, this does not always create a lacuna ready to be replenished with new “fresh” ideas, as is often stated in previous research. Instead, this study show that it is the very complexity, ambiguity and composite nature of ideas that enable them to lead directly to the next idea. Norms and values that previously had lower priority, or were taken for granted, are reactivated and repeated. Therefore, ideational change can come about without the occurrence of a major crisis and without political regime changes or major structural transformations. On the contrary, change can be triggered by what seems to be rather minor events. At the same time the study also highlights how social policy institutions are primarily building on normative rather than distributional tensions. In the studied case, the state institutionalizes an idea of quid pro quo: material benefits should be offered in exchange for moral behaviour and the obedience of common norms. Therefore, to understand how and why social policy change we need to investigate the ideas that have been institutionalized in earlier phases, and how such ideas create norms and moral expectations which, in a higher degree than interests and structural factors, are the guiding forces in creating new social policy.