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zoom RSS 民主党議員の不安/米国医療事情 医療制度改革

<<   作成日時 : 2009/07/19 22:52   >>

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画像 オバマ大統領の提案に沿って、医療制度改革のための立法に取り組んでいる5つの議会委員会のうちの3つは今週法案を通した。こうした成功を祝福するというより、多くの民主党員は不安で神経質で防御的となっているには、3つの理由がある。
 (1)議会予算局が、医療費の増大を止められないだろうと警告している。(2)重要問題が超党派の方法を模索できなかったことは明白である。(3)増えつつある民主党内の少数派が法案の及ぶ範囲や予算、連邦政府の役割の拡大、新税などについて制限をするように主張し始めた。
 オバマ大統領はどうしても今年中に医療制度改革をやり遂げようとしている。
 議会の動きはそう単純ではない。新税が景気後退に悪影響を及ぼすことを心配する議員もいる。
 議員がオバマ大統領の野心的な日程表に苛立つ中で、財務委員会の2人のメンバーを含む6人の上院議員の超党派のグループは上院リーダーに対してより多くの時間をとるよう嘆願する書簡を送った。8月休み前に上院通過させることは不可能だという。拙速な医療改革は高いリスクを意味する。
 下院教育労働委員会は終夜の審議の後金曜日の朝に26対22で承認したが、民主党の3人が反対に投票した。下院財務委員会は23対18でほとんど同一の法案を承認した。
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Democrats Grow Wary as Health Bill Advances
http://www.nytimes.com/2009/07/18/health/policy/18health.html
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: July 17, 2009

WASHINGTON ― Three of the five Congressional committees working on legislation to reinvent the nation’s health care system delivered bills this week along the lines proposed by President Obama. But instead of celebrating their success, many Democrats were apprehensive, nervous and defensive.

Even as Democratic leaders and the White House insisted that the nation was closer than ever to landmark changes in the health care system, they faced basic questions about whether some of their proposals might do more harm than good.

And while senior Democrats vowed to press ahead to meet Mr. Obama’s deadline of having both chambers pass bills before the summer recess, some in their ranks, nervous about the prospect of raising taxes or proceeding without any Republican support, were pleading to slow down.

Democrats had three reasons for concern. The director of the Congressional Budget Office warned Thursday that the legislative proposals so far would not slow the growth of health spending, a crucial goal for Mr. Obama as he also tries to extend insurance to more than 45 million Americans who lack it.

Second, even with House committees working in marathon sessions this week, it was clear that Democrats could not meet their goal of passing bills before the summer recess without barreling over the concerns of Republicans and ending any hope that such a major issue could be addressed in a bipartisan manner.

Third, a growing minority of Democrats have begun to express reservations about the size, scope and cost of the legislation, the expanded role of the federal government and the need for a raft of new taxes to pay for it all. The comments suggest that party leaders may not yet have the votes to pass the legislation.

Mr. Obama tried Friday to shift the political narrative away from the grim forecasts of the Congressional Budget Office. He said he and Congress had made “unprecedented progress” on health care, with even the American Medical Association endorsing the House bill this week.

He acknowledged a treacherous path ahead, saying, “The last few miles of any race are the hardest to run,” but insisted, “Now is not the time to slow down.” And he vowed: “We are going to get this done. We will reform health care. It will happen this year. I’m absolutely convinced of that.”

On Capitol Hill, the picture is more complex. Representative Jared Polis, a freshman Democrat from Colorado who voted against the bill approved Friday in the Education and Labor Committee, said he worried that the new taxes “could cost jobs in a recession.”

To help finance coverage of the uninsured, the House bill would impose a surtax on high-income people and a payroll tax ― as much as 8 percent of wages ― on employers who do not provide health insurance to workers.

Mr. Polis said these taxes, combined with the scheduled increase in tax rates resulting from the expiration of Bush-era tax cuts, would have a perverse effect. “Some successful family-owned businesses would be taxed at higher rates than multinational corporations,” he said.

In a letter to the House speaker, Nancy Pelosi, Mr. Polis and 20 other freshman Democrats said they were “extremely concerned that the proposed method of paying for health care reform will negatively impact small businesses, the backbone of the American economy.”

And in the latest sign of lawmakers’ chafing at Mr. Obama’s ambitious timetable, a bipartisan group of six senators, including two members of the Finance Committee, sent a letter to Senate leaders pleading with them to allow more time.

“While we are committed to providing relief for American families as quickly as possible,” they wrote, “we believe taking additional time to achieve a bipartisan result is critical for legislation that affects 17 percent of our economy and every individual in the United States.”

The group included three senators, Ben Nelson, Democrat of Nebraska; and Olympia J. Snowe and Susan Collins, Republicans of Maine, who met with Mr. Obama at the White House this week and urged him not to rush the process.

Senator Joseph I. Lieberman, the Connecticut independent, who also signed the letter, said rushing the health care bill would mean a high risk of failure.

“The legislative process right now is going in the wrong direction,” Mr. Lieberman said in an interview. “I think it’s extremely doable to get this done before the end of the year. But just to try to get it passed in the Senate before we leave for the August recess seems just about impossible. It’s just too big a bill.”

The House Committee on Education and Labor approved the health care bill by a vote of 26 to 22 on Friday morning, after an all-night session. Three Democrats crossed party lines and voted against the bill.

The vote came eight hours after the House Ways and Means Committee approved a nearly identical bill, 23 to 18, with 3 Democrats voting no. On Wednesday, the Senate Committee on Health, Education, Labor and Pensions, approved a generally similar bill on a party-line vote, 13 to 10.

The House and Senate bills would require insurers to take all applicants and would vastly expand coverage, with the help of federal subsidies for millions of people.

But the director of the Congressional Budget Office, Douglas W. Elmendorf, testified on Thursday that doing so would come at a steep cost and that the proposals would not curb the rise in health spending by the federal government, which he called “unsustainable.”

House Democrats who voted no cited various concerns.

“We are not doing enough to reform the health care delivery system, to change the incentives so reimbursement will be based on the value, rather than the volume, of services,” Representative Ron Kind of Wisconsin said.

Others worry that a government-run health plan, to be created under the House bill, would underpay doctors and hospitals by using Medicare reimbursement rates.

“I have a serious problem with the public plan in this bill because it’s based on Medicare rates,” Representative Earl Pomeroy of North Dakota said. “North Dakota is underpaid by Medicare.”

Mr. Obama said he was confident that Congress and the White House would ultimately reach a deal on how to pay for the bill, and lower health care spending over the long term ― an optimistic view that not all lawmakers share. But on one of Mr. Obama’s points, there was no dispute: “We’re going to be putting in a lot more hours,” the president said. “There are going to be a lot more sleepless nights.”

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民主党議員の不安/米国医療事情 医療制度改革 医師の一分/BIGLOBEウェブリブログ
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