What’s wrong when people do not want to vote on the most important things that affect their daily lives? Here is one great example from last week!
It has taken 20 years to “reform” one of the most important parts of our famous Nordic welfare state, the way we manage public health- and social-care. We will call them “SOTE” for short (a Finnish language abbreviation using the first two letters for “Sosiaali- ja terveydenhuollon” if you are interested…)
Up until now our public SOTE system was managed by the almost 400 municipalities and cities, universities with medical teaching departments, together with a motley collection of third sector and private companies.
The system has been run on hundreds of IT systems that are not compatible, with long patient queues, horrible telephone and digital systems for booking a time with doctor, and messy systems for following your own health history.
There are simply too few doctors and nurses in public healthcare meaning that surgical operations and long-term care are too limited to handle the demands of an ageing nation.
It is the same with public social care. There is a lack of homes for the elderly, far too few caregivers, nurses and doctors for people who are too old or too infirm to manage. Younger people with severe personal problems, the mentally impaired, and others in need of help because of serious social problems are all under-served by the public sector, which is obliged by law to provide adequate services for these people.
In both cases, it is partly a question of money, but also there are many inefficiencies in the system which is full of duplication as various municipalities build their own systems without coordinating with neighbouring regions.
The duplication, the lack of standardisation and agreed processes to stimulate productivity improvements make it impossible to manage the whole system in a cost-efficient manner, which could shorten patient queues and speed up the required care. These different systems are so confusing that few decision-makers and few voters really understand how our taxes were being used for SOTE services. Municipalities and cities pay for the system, with central government support, but this complexity and lack of effective controls means that money is wasted big time.
The present chaotic system that wastes money on needed SOTE services is precisely the reason why we needed this big reform!
The SOTE reform is basically replacing the municipal management of SOTE services with the management by some 20 SOTE Regions. These Regions are effectively controlled by Central Government who will pay the bills. The Regions do not have the right to tax just now, but they have their own local organisation with locally elected leaders – hence the new election this week.
The objective is to have each Region locally and democratically managed with budgets allocated and supervised by the Ministry of Finance.
Regional differences in care costs are calculated using demographic data from each Region. The various ministries will try to ensure that budgets are adhered to and productivity improved. New national digital systems are being rolled out to replace the patchwork of incompatible ones. It is planned that new duplications will be avoided in the future, and many present duplications will be removed.
You would think that ordinary people would want to vote in huge numbers to ensure that good officials are elected to ensure adequate and well-run SOTE services in their respective Regions, but this was not the case.
Instead, many of the candidates were the same old politicians from Parliament and local municipal councils, with very few new faces. The election theme was more about general taxation, the price of fuel and electricity and Nato membership! Many of the politicians promised everything for voters even though SOTE cuts are inevitable in both healthcare centres and hospitals! After 30 years social care is still lacking sufficient funding, and there is little hope for more cash after Covid. Voters could easily see that these politicians who have been running the country for the last 20 years are not going to change their habits very quickly – so what is the point of voting unless you are an ardent party member!
Naturally the next day, all the “winning” political leaders started talking about their huge successes, even though less than half the population voted – around 47%.
These political leaders should be ashamed of themselves because they deliberately mislead voters with false promises by speaking to much about fuel prices, Nato and general taxation when trying to score points in TV panel discussions. Voters are not stupid and they reacted by not voting! That was the real message!
SOTE services account for the largest share of public sector costs and this is growing – hence politicians should speak up about these matters and defend their positions with voters.
Right-wing politicians want the private sector to take a bigger role in SOTE services, while left-wing politicians prefer to have SOTE services covering most of these public services at all costs.
The problem was that the debate was dominated by the two sides repeating unsubstantiated stories (by the right) that the private sector is always stories more productive, or (by the left) that the public sector can be more effective only if it receives more resources.
The truth is that the private sector is not the best solution for basic services like healthcare for the great mass of the population because we end up with aggressive pricing practices and profit maximisation. Just look at the USA, Japan, Germany, and a few other big countries where the private sector has grown too large – and look how big Pharma operates.
In Finland the private sector has tempted hundreds of doctors and nurses to join their ranks doctors with substantially higher salaries, thus decimating public sector SOTE services . The Doctors Association, a very influential and powerful lobby group here, has demanded and achieved to place limits on the numbers of doctors being trained, and they even seek to prevent foreign doctors working here with various barriers. These limitations must be breached, but do not hold your breath.
The left side of the political wall should accept that public sector must improve productivity and this is best managed with the new system that gives central government control over costs and productivity management. With a fast ageing population new and more cost effective solutions are available, but they require courage to present because they are not all convenient for voters, unlike the empty promises made by politicians.