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<<   作成日時 : 2009/06/04 19:47   >>

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 オバマ大統領は水曜日に、どのような医療制度改革を望むかということについて最初の詳細具体策を示し、すべてのアメリカ人が政府保険プランを入手可能となるよう、議会に対し要請した。医療問題で先導する2人の上院議員への手紙の中で、貧困者の支払い免除をして、すべてのアメリカ人が医療保険購入を要求される方向へと動いた。オバマは選挙期間中はこうした義務化には反対してきたが、議会はますますこうした考えで動いている。上下院で8月始めまでに法案化して、10月に統一した法案として署名したいと言う。
 5,000万人の無保険者をカバーするには今後10年で1兆5,000億ドルが必要と見積もられている。慢性疾患の管理と不要な検査や再入院を避けることで、メディケアとメディケイド予算を10年間で2,000-3,000億ドル削減したいと言う。
 連邦政府はメディケアとメディケイドに年間4,500億ドルと2,000億ドルかかっている。オバマはすでに2月の2010年予算で今後10年で約3,000億ドルの予算削減を目標としている。
 大統領選キャンペーンでは、クリントンの主張する全ての人の保険購入を支持しなかった。ケネディと下院民主党は低所得層には保険購入の補助を与える考えであり、オバマは選挙期間中は反対したが、現在は議会のこうした動きを抑えていない。
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Obama outlines health care plan for all
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/03/AR2009060302449.html
By ERICA WERNER
The Associated Press
Wednesday, June 3, 2009; 7:56 PM

WASHINGTON -- President Barack Obama, providing the first real details on how he wants to reshape the nation's health care system, urged Congress on Wednesday toward a sweeping overhaul that would allow Americans to buy into a government insurance plan.

画像In a letter to two senators leading the health care debate, Obama also moved toward accepting a requirement for every American to buy health insurance, as long as the plan provides a "hardship waiver" to exempt poor people from having to pay.

Obama opposed such an individual mandate during his campaign, but Congress increasingly is moving to embrace the idea.

Obama set out the goals in a letter to Sens. Edward Kennedy, D-Mass., and Max Baucus, D-Mont., chairmen of the two committees writing health care bills. It followed a meeting he held Tuesday with members of their committees, and amounted to a road map to keep Congress aligned with his goals.

"The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold," Obama wrote.
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Obama has asked the House and Senate each to finish legislation by early August, so that the two chambers can combine their bills in time for him to sign a single, sweeping measure in October. In a statement Baucus welcomed the assignment.

"I will stop at nothing to deliver a health reform bill that works for families and businesses to the president this year," Baucus said.

Covering 50 million uninsured Americans could cost as much as $1.5 trillion over a decade, and cost is emerging as a major sticking point. Obama didn't offer new solutions to that problem in his letter Wednesday but did say he'd like to squeeze an additional $200 billion to $300 billion over 10 years from the Medicare and Medicaid government insurance programs for the elderly, disabled and poor.

He said he'd do it through such measures as better managing chronic diseases and avoiding unnecessary tests and hospital readmissions. Savings from such measures are uncertain.

Medicare benefits cost the federal government about $450 billion a year and Medicaid about $200 billion. Obama already has targeted the programs for some $300 billion in cuts over 10 years in the 2010 budget he released in February.

He also said he's open to congressional proposals to let an independent commission identify cuts to Medicare which would take effect unless Congress rejected them all at once, similar to how military base closures are handled.

The president said he supports a new health insurance exchange that Congress is crafting, a sort of marketplace that would allow Americans to shop for different plans and compare prices.

All of the plans should offer a basic affordable package, and none should be allowed to deny coverage to people with pre-existing conditions, Obama said _ big changes from how private insurance companies operate today.

"I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans," Obama wrote, weighing in firmly on one of the most controversial issues in the debate. "This will give them a better range of choices, make the health care market more competitive and keep insurance companies honest."

Republicans strongly oppose a public plan, as do private insurers, who contend it would drive them out of business.

"A government-run plan would set artificially-low prices that private insurers would have no way of competing with," Senate Minority Leader Mitch McConnell said Wednesday on the Senate floor.

The idea of what Obama called a "hardship waiver" for individual Americans too poor to buy care splits the difference between where he was during the presidential campaign and where Congress appears to be heading.

In the campaign, Obama did not support requiring everyone to buy insurance, putting him at odds with then Democratic rival Hillary Rodham Clinton. Congress is looking at doing so. The hardship waiver idea is under consideration by the Senate Finance Committee, which also is considering giving tax credits to certain individuals so they can afford health care. Kennedy and House Democrats are looking at giving subsidies to the poor to help them buy coverage.

The letter didn't address the issue of taxing health care benefits. Obama opposed that during his campaign but Congress is now considering it, and Obama hasn't shut the door on it.

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