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<<   作成日時 : 2009/06/23 01:04   >>

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 医療制度改革はオバマ大統領の選挙公約の一つで、医療費を削減し無保険者への保険拡張を訴えていた。しかし、議会予算局によると上院財務委員会提案による見積もりでは1兆6,000億ドルであったため、今週始まる予定だった委員会はバウカス委員長により延期された。
 財務委員会のプランは、コネチカットのクリストファーJ.ドッドによって統轄された上院健康、教育、労働、および年金委員会によって書かれている法律より超党派のサポートを引き付けることを期待されている。ドッド議員の委員会による提案は、10年の間に1兆ドルかかると見積もられたが、保険保証される米国人を1600万人増大させるだけにすぎない。
 サウスカロライナ共和党リンゼーグレアム上院議員によれば、この見積もりは政府管理健康保険プランへの致命傷となると言う。
 しかし、土曜日に発表されたニューヨーク・タイムズ/CBSのニュース投票は、アメリカ人が圧倒的に医療システムの大きな変化をサポートし、議会が考慮している最も論争の多い提案のひとつである、私的な保険業者と競合する政府管理保険プランを強く支持しているとわかった。
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 6月12-16日に実施された全国的な電話アンケートは、72%の人が、私的な保険業者と競合する65未満メディケア(高齢者公的医療保険)のような政府管理保険計画をサポートするとわかった。20%が反対している。議会の共和党員は、国営化された健康保険システムに発展し、医療配給を引き起こす可能性のある政府の不要な拡張として猛烈に提案を批判した。しかし、立法のための予算は、最も議員を苦しめているようである。
 約5,000万人の無保険者の1/3をカバーするために議会予算局が提供した数値を3倍すれば、3兆ドルとなり、それを支払うための提案は全くない、とマケイン議員は言う。
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Panel Might Revise Health-Care Bill
http://www.nytimes.com/2009/06/22/health/policy/22healthcare.html
By DERRICK HENRY
Published: June 21, 2009

Senator Charles E. Grassley of Iowa, the top Republican on the Senate Finance Committee, said on Sunday that the panel would consider revisiting its version of health-care legislation to gain more support.

An overhaul of the nation’s health-care system was part of President Obama’s campaign pledge to expand coverage to those who do not have health insurance while lowering costs in general. But an initial price tag for the Senate Finance Committee’s proposal came to $1.6 trillion, according to the Congressional Budget Office. That figure caused enough consternation that the chairman, Senator Max Baucus of Montana, postponed a drafting session that was to have begun this week.

“So we’re in the position of dialing down some of our expectations to get the costs down so that it’s affordable,” Mr. Grassley said on CNN’s “State of the Union,” “and most importantly, so that it’s paid for because we can’t go to the point where we are now of not paying for something when we have trillions of dollars of debt.”

The Finance Committee’s plan is expected to attract more bipartisan support than legislation being written by the Senate Health, Education, Labor and Pensions Committee, chaired by Christopher J. Dodd of Connecticut. The proposal by Mr. Dodd’s committee was estimated to cost $1 trillion over 10 years but would only increase the number of insured Americans by 16 million.

Senator Lindsey Graham, a Republican of South Carolina who appeared on ABC’s “This Week,” said estimates on overhauling health care were “a death blow to a government-run health plan.”

Dianne Feinstein of California joined Republicans in voicing reservations. Ms. Feinstein, who appeared on “State of the Union,” said that controlling the cost of a new health-care system “is a very major and difficult subject.”

Ms. Feinstein also said that Mr. Obama might not have the votes in the Senate to pass his legislation. “I think there’s a lot of concern in the Democratic caucus,” she said.

Senator Richard Lugar, Republican of Indiana, appearing with Ms. Feinstein, said that overhauling the health care system should be done slowly and not this year, as Mr. Obama has insisted. “I think it should be incremental steps,” Mr. Lugar said. Mr. Lugar also suggested a period of study to find and consider alternatives.

Ms. Feinstein also suggested that the results of Mr. Obama’s efforts to repair the economy and overhaul the financial-regulatory system should be measured before taking on health care.

“What all of the impact of this is not yet known,” Ms. Feinstein said.

Ms. Feinstein has threatened to vote against Mr. Obama’s health care bill if it draws Medicare funds from high-cost areas like California to low-cost areas of the country. Ms. Feinstein noted that California’s population is greater than that of 21 states and the District of Columbia combined.

A New York Times/CBS News poll released on Saturday found that Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers.

The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan ― something like Medicare for those under 65 ― that would compete for customers with private insurers. Twenty percent said they were opposed.

Republicans in Congress have fiercely criticized the proposal as an unneeded expansion of government that might evolve into a system of nationalized health coverage and lead to the rationing of care.

But the cost of the legislation seems to bedevil lawmakers the most. Senator John McCain, who is on the health committee with Mr. Dodd, also pointed to costs as a problem on CBS’s “Face the Nation.”

“You do the math, it comes up to $3 trillion,” said Mr. McCain, who obtained the number by tripling the figure provided by the Congressional Budget Office to cover one third of the nearly 50 million uninsured Americans. “And so far, we have no proposal for having to pay for it.”

Mr. Grassley, on the Finance Committee, said he anticipated paying for the bill “through some savings and Medicare, and from some increases in revenue.”

Mr. Dodd said he was ready for the difficulty in establishing a national health-care system.

“If this were easy, it would have been done decades ago,” Mr. Dodd said on “This Week.” “We’re not done with this at all.”

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In Poll, Wide Support for Government-Run Health
http://www.nytimes.com/2009/06/21/health/policy/21poll.html
By KEVIN SACK and MARJORIE CONNELLY
Published: June 20, 2009

Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.

The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.

Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents’ own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.

That paradox was skillfully exploited by opponents of the last failed attempt at overhauling the health system, during former President Bill Clinton’s first term. Sixteen years later, it underscores the tricky task facing lawmakers and President Obama as they try to address the health system’s substantial problems without igniting fears that people could lose what they like.

Across a number of questions, the poll detected substantial support for a greater government role in health care, a position generally identified with the Democratic Party. When asked which party was more likely to improve health care, only 18 percent of respondents said the Republicans, compared with 57 percent who picked the Democrats. Even one of four Republicans said the Democrats would do better.

The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan ― something like Medicare for those under 65 ― that would compete for customers with private insurers. Twenty percent said they were opposed.

Republicans in Congress have fiercely criticized the proposal as an unneeded expansion of government that might evolve into a system of nationalized health coverage and lead to the rationing of care.

But in the poll, the proposal received broad bipartisan backing, with half of those who call themselves Republicans saying they would support a public plan, along with nearly three-fourths of independents and almost nine in 10 Democrats.

The poll, of 895 adults, has a margin of sampling error of plus or minus three percentage points.

Mr. Obama and many Democrats have argued that a public plan would be essential, in the president’s words, to “keep insurance companies honest.” But Mr. Obama has also signaled a willingness to compromise for Republican support, perhaps by establishing member-owned insurance cooperatives instead.

It is not clear how fully the public understands the complexities of the government plan proposal, and the poll results indicate that those who said they were following the debate were somewhat less supportive.

But they clearly indicate growing confidence in the government’s ability to manage health care. Half of those questioned said they thought government would be better at providing medical coverage than private insurers, up from 30 percent in polls conducted in 2007. Nearly 60 percent said Washington would have more success in holding down costs, up from 47 percent.

Sixty-four percent said they thought the federal government should guarantee coverage, a figure that has stayed steady all decade. Nearly 6 in 10 said they would be willing to pay higher taxes to make sure that all were insured, with 4 in 10 willing to pay as much as $500 more a year.

And a plurality, 48 percent, said they supported a requirement that all Americans have health insurance so long as public subsidies were offered to those who could not afford it. Thirty-eight percent said they were opposed.

In a follow-up interview, Matt Flurkey, 56, a public plan supporter from Plymouth, Minn., said he could accept that the quality of his care might diminish if coverage was universal. “Even though it might not be quite as good as what we get now,” he said, “I think the government should run health care. Far too many people are being denied now, and costs would be lower.”

While the survey results depict a nation desperate for change, it also reveals a deep wariness of the possible consequences. Half to two-thirds of respondents said they worried that if the government guaranteed health coverage, they would see declines in the quality of their own care and in their ability to choose doctors and get needed treatment.

“It is the responsibility of the government to guarantee insurance for all,” said Juanita Lomaz, a 65-year-old office worker from Bakersfield, Calif. “But my care will get worse because they’ll have to limit care in order to cover everyone.”

When asked their opinion of specific changes being considered in Washington, three-fourths of those surveyed said they favored requiring health insurers to cover anyone, regardless of pre-existing medical conditions. Only a fifth supported taxing employer-provided health benefits to help pay the cost of coverage for the uninsured. And there was deep uncertainty about whether employers should be required to either help insure their workers or pay into a fund for covering the uninsured.

Three of four people questioned said unnecessary medical tests and treatments had become a serious problem, suggesting that they would support calls by health researchers for a payment system that would better reward appropriate care. But an even higher number, 87 percent, said the inability of people to have the needed tests and treatments was a serious problem. One in four said that in the last 12 months they or someone in their household had cut back on medications because of the expense, and one in five said someone had skipped a recommended test or treatment.

The poll found that Americans were far less satisfied with the cost of health care than with the quality of it. Mr. Obama, who has emphasized the need to reduce costs, has found an audience for his argument that health care legislation is vital to economic recovery. Eighty-six percent of those polled said rising costs posed a serious economic threat.

Yet only a fifth of those with insurance said the cost of their own medical care posed a hardship. And only a fourth said that keeping health costs down was a more urgent need than providing coverage for the country’s nearly 50 million uninsured. That was a notable change from a Times/CBS poll taken in early April, when 40 percent said that controlling costs was more pressing.

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