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<<   作成日時 : 2009/05/26 21:09   >>

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画像 オバマ大統領は医療費削減をめざすため、財界の指導者とホワイトハウスで会合を開いた。
 効率的な保健医療手段をとることで基本的な健康改善に至った例として、マイクロソフトと、ジョンソン&ジョンソンの2つを指名した。他の会社や連邦政府の医療改革モデルとして議論に役立つだろうと、オバマ大統領は言う。
 「応急処置は無く、優れた解決策もあるわけではない」
 こうした会社は、禁煙・減量・運動にたいして従業員へのインセンティブを与えて成功に導く実験をしていて、会社の文化を変革している。
 オバマ政権は、医療改革を重要課題としている。しかし、医療業界に自発的なコストカットを期待できないと批評家は言う。
 今後10年間、毎年1.5%の医療費削減を医療産業リーダーは月曜(5/11)のミーティングで誓約した
 節約額は2019年までに合計2兆ドルとなり、平均的4人家族で年平均2,500ドルの節約となる。価格管理についての希望的観測に過ぎず、具体策がどのように実行されるかについては、この計画が1977年のカーター大統領の失敗と同じ運命をたどるとする批評家もいる。
 法案を今年可決させること以外のオプションがなく、業界リーダーが、法案が可決される前にコストを減らすために仕事を開始することを期待していると言う。
 大統領とテーブルを囲んだ人々が良い計画だと信じると思うが、歌舞伎劇場にいるような気分にもなった。あまり多くの約束をしない方がよい。
 10年後に医療は経済の20%を占める。この変化で経済を3%縮小することになり、1年間で7,000億ドルにもなる。
 ダートマス研究所の研究が良く引き合いにだされるが、同じ治療で結果に大差が無いのに医療費に3倍もの差があるのはなぜなのだろうか?
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Obama: 'There's No Quick Fix, There's No Silver Bullet'
President Obama Meets With Businesses to Discuss Health Care Cost Cuts
By HUMA KHAN
May 12, 2009
http://abcnews.go.com/Politics/Health/Story?id=7564640&page=1

President Obama met with business leaders at the White House today to discuss ways to reduce health care costs for businesses on this second day of health care discussions.
The president talks with business leaders about employer health costs.

The president pointed to companies like Microsoft and Johnson & Johnson -- two of the five companies represented at the roundtable -- as examples of firms that have seen their bottom lines improve by putting in place efficient health care measures.

He added that these companies will be "informing the health care reform discussions that take place here in Washington" and can serve as a model for other companies and even the federal government.

"There's no quick fix, there's no silver bullet," Obama said in brief remarks following the roundtable. "When you hear what Safeway or Johnson & Johnson or any of these other companies have done, what you've seen is sustained experimentation over many years, and a shift in incentive structures, so that employees see concrete benefits as a consequence of them stopping smoking or losing weight or getting exercise. The provider incentives are aligned with the employee incentives as well, and changing the culture of a company."

The Obama administration, which has made health care a top priority, is touting its partnership with health care industry heavyweights and expressing confidence that a bill will pass this year. But some critics expressed skepticism about voluntary cost cuts.

At Monday's meeting at the White House -- which the president called a "historic" and "a watershed event in the long and elusive quest for health care reform" -- health care industry leaders pledged to trim health care costs by 1.5 percent annually over the next decade.

The savings would add up to $2 trillion by 2019, the White House said, and could save the average family of four $2,500 a year in the next five years.

But with little specifics so far on how cost cuts would actually be implemented by the industry, critics said the plan may meet the same fate as the failed health care plan President Jimmy Carter tried to put in place in 1977.

"The story today is one of largely wishful thinking about cost control," said Ted Marmor, a professor of public policy and management at the Yale University School of Management. "No one should believe either that the industry representatives can, even if they wished, control the behavior of their groups."

On how the plan would be enforced, Obama's newly minted Health and Human Services Secretary Kathleen Sebelius said the president has made it clear he wants to see action quickly. The president has said before that he wants to see an officially specified a time frame.

"I think that the industry leaders promised to come back to the president with specifics. What kinds of steps are going to be taken, how quickly. He made it clear yesterday that first of all, he's very committed to passing health reform this year," Sebelius said on "Good Morning America." "There is no other option but getting a bill passed this year, and secondly, he expects the industry leaders to begin work on cutting costs well before a bill is passed. So he wants us all to go to work together."

Obama told health care players at the meeting Monday, "You've made a commitment. We expect you to keep it," per White House press secretary Robert Gibbs.

Sebelius said there would be a transparent system so that the administration could monitor whether the industry is really keeping its end of the bargain, but she did not provide details on how that would be monitored.

Later today, Sebelius will hold a news conference with Treasury Secretary Tim Geithner and others to discuss a new report on Social Security and Medicare.

Health Care Reform Possible?

Reaction to the administration's health care reform agenda in the industry and on Capitol Hill has been mixed.

Sen. Ted Kennedy, D-Mass., probably the president's biggest supporter on health care issues in the Senate, lauded the president's efforts.
Photo: Care Industry as Discussions Continue in Washington: Sebelius: Some Leaders at Monday's Meeting 'Would Never Have Been in a Room With the President Before'
President Barack Obama speaks with Safeway President and Chief Executive Officer Steve Burd, right,... Expand
President Barack Obama speaks with Safeway President and Chief Executive Officer Steve Burd, right, as REI President and Chief Executive Officer Sally Jewell looks on during a meeting on health care reform today in the Roosevelt Room of the White House in Washington. Collapse
(Charles Dharapak/AP Photo)

"The president knows it's time to act and is providing impressive leadership. Members of Congress from both parties and leaders of the insurance industry know that the time has come to reduce costs and expand access to quality health care for all," he said. "The American people are right to call on Congress and the administration to delay no longer in easing the heavy burden of ever-increasing health costs that crush the budgets of families and businesses alike."

Others were more skeptical.

Sen. Charles Grassley, R-Iowa, the ranking Republican on the Senate Finance Committee, and a chief Republican negotiator trying to figure out how to pay for health care reform, said in a statement that the idea of the White House and the insurance industry saving $2 trillion is a great one, but he'll believe it when he sees a nonpartisan score from the Congressional Budget Office.

"For health care budgeting purposes, CBO's word is the only one that counts," he said in the statement.

A senior administration official had made it clear Sunday that the CBO does not analyze the impact on national health expenditures.

"I would not anticipate that CBO will be 'scoring' the statement or the event that is occurring tomorrow, in part because CBO traditionally does not evaluate or does not score impacts on national health expenditures, but as you look out over a long period of time, the impact on national health expenditures is absolutely crucial to achieving long-term fiscal savings for the federal government itself, because, again, if not, it's not a sustainable system," the administration official said.

Others doubt any substantial measures will come out of the meeting.

"I am convinced that the people who sat around that table and the president himself sincerely believe this was a good plan, and yet I kind of have a feeling it was Kabuki theater," said Uwe Reinhard, a professor of political economy at Princeton University. "One should be careful not to promise too much."

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