米国医療制度改革/パーフェクトストームへの挑戦 オバマ大統領

 金融市場がきりもみ降下に陥らず、経済が長期の景気後退に落ち込まなくても、年収20,000-60,000ドルの低中所得層家庭の非高齢米国人は医療に起こるパーフェクト・ストームの中へと出航してゆく。米国の家庭の1/3がこのカテゴリーに入り、それぞれが年30,000ドルの総賃金“gross wage base”の2人の働き手による家族を想定してみればよい。一方はタクシー運転手、もう1人はデパートの事務員。
 Milliman Medical Index によれば、典型的な4人家族で2008年に平均で年15,600ドルの総医療費となり、2004年の11,192ドルから年平均8.6%の増加率だった。
 今後10年、収入の伸びが年3%で、医療費の伸びが年8%だとすると、収入は2017年に80,600ドルだが、医療費は33,700ドルとなり、総収入の41%となってしまう。収入増加が年4%だとしても総収入の1/3を占めることになる。
 米国人にとっての心地よくない選択が待っている。
 高所得者の増税により低所得層の医療費を補助するのか、半数の低所得層に対する低水準の基礎医療と高所得層に対する高水準のハイテク医療という二層あるいは多層になった医療制度を推し進めるのかといった選択である。
 新大統領バラック・オバマの直面する心地悪い選択の一つである。
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オバマ新大統領の保険医療計画/米国医療事情
http://kurie.at.webry.info/200811/article_7.html
7900万米国人を苦しめる医療費「パーフェクト・ストーム」
http://kurie.at.webry.info/200808/article_40.html
クリントンとオバマの医療制度改革/米国医療事情
http://kurie.at.webry.info/200802/article_42.html
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November 7, 2008, 10:14 am
The Health Care Challenge: Sailing Into a Perfect Storm
By Uwe E. Reinhardt
Uwe E. Reinhardt is an economist at Princeton.
http://economix.blogs.nytimes.com/2008/11/07/the-health-care-challenge-sailing-into-a-perfect-storm/

Even if the financial markets had not gone into a tailspin and the economy had not slouched toward a prolonged recession, non-elderly Americans in lower-middle-income families – those with family incomes between $20,000 and $60,000 – would have sailed into a perfect storm brewing in health care. Roughly one-third of American households fall into that category.

Consider a family headed by two income earners each with a gross wage base of $30,000. One might be a taxi driver, and the other a sales clerk in a department store or at, say, Home Depot.

By “gross wage base” is meant here the sum of all of the debits that an employer makes to the account “Payroll Expense” for an employee. It includes the employee’s cash take-home pay, all the income taxes and Social Security taxes and other deductions – for example, the employee’s contributions toward health insurance and pensions ― withheld from the employee’s paycheck, as well as the employer’s share of Social Security taxes and the employer’s contributions toward the employee’s health insurance, pension, vacation pay, sick days and so on. It is a sum that supports all taxes paid by or on behalf of the employee and all fringe benefits earned by the employee, whether formally paid by the employer or taken out of the employee’s paycheck.

It follows from this definition of gross wage base that it must support all of the health expenditures made by or on behalf of the family in a given year ― that is, the employer’s contribution to premiums for the employee’s health insurance, the employee’s own contribution and the employee’s out-of-pocket health spending.

According to the Milliman Medical Index, this total health spending figure for a typical non-elderly American family of four had reached an average of $15,600 by 2008. It had grown at an average compound growth rate of about 8.6 percent from $11,192 in 2004.

To return to our family with an assumed gross wage base of $60,000: If that gross wage base grew by, say, 3 percent per year over the next decade, to $80,600 by 2017, while total family health spending grew by, say, 8 percent per year over the same time frame, to $33,700 by 2017, then about 41 percent of the family’s gross wage base would be taken up by health care alone, before any deductions for taxes or fringe benefits. If the wage base grew by 4 percent, health spending still would absorb about a third of the family gross wage base.

These numbers, which are realistic, suggest that before long the gross wage base earned by American households will become too small a donkey to carry the load of the family’s spending on health care. It will put before Americans an uncomfortable choice.

Either Americans in the higher income strata must step up to the cashier’s window to help subsidize, with higher income taxes, the health care of the most hard-working members of the lower income classes, or the United States will have to evolve toward a noticeable two-tiered or multi-tiered health care system, with bare-bones, low-tech health care for families in the bottom half of the income distribution and increasingly superior, high-tech health care for families in the upper-income strata.

It is one of the several unpleasant trade-offs facing President-elect Barack Obama.

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Milliman Medical Index
http://www.milliman.com/expertise/healthcare/products-tools/mmi/
Milliman's fourth annual study of average medical spending for a typical American family of four looks at key components of actual medical spending and tracks the changes over time. In addition to analyzing changes in national average health costs, the Milliman Medical Index™ (MMI™) this year presents health-cost data for 14 major U.S. metropolitan areas.

Key findings include:

* The total medical cost in 2008 for a typical American family of four is $15,609 (compared with $14,500 in 2007).
* The average annual medical cost of the family increased by 7.6% from 2007 to 2008. While the $1,109 increase is a big expense, the rate of increase was down for the second straight year and is the lowest rate of increase in the past five years.
* There is a wide variation in costs across the country. Among the 14 metropolitan areas studied, healthcare costs varied by more than 35% from lowest to highest.
* While the overall rate of cost increase was down this year, the rate of prescription-drug cost increase was up for the first time since 2006.
* For the employee's share of spending on healthcare services, 2008 marks the second consecutive year of double-digit increase.

http://www.milliman.com/expertise/healthcare/products-tools/mmi/pdfs/milliman-medical-index-2008.pdf

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この記事へのコメント

2008年11月10日 09:48
パーフェクトストーム

なんてスゴイ名前。

おなじ題名の台風映画
を見ましたけど、
大自然の驚異の前には
人間なんて無力が当然
って叩きつけられた
そんな映画でしたね。

そんな、パーフェクト
ストームって名前で
呼ばれるほどの米国危機。
何もできやしないって
遠まわしに言ってるのか。

パーフェクトストームが
いくつも発生してるような
そんな大変な状況になって
はじめて明け渡された
大統領の座。

本当に傑出した才能とは、
並外れた才能でなければ
生き残れないという
いい例なのかも知れませんね。

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