医療制度改革法案が上院通過/米国医療事情

 8710億ドルの上院医療制度改革法案が通過し、今後10年の医療への影響はどうなるか?
 お金に困っている数千万人の米国人に良質で入手可能な医療保険と医療が受けられるようになる重要な一歩であると製薬業界Pharmaceutical Research and Manufacturers of Americaは言う。
 歴史上初めて、連邦政府がどういう保険に入る必要がありいくら払う必要があるかを教えてくれることになる。
 11月に成立した下院案との違いは、一つは財源で、二つ目は公的オプションの問題である。下院案の方が低所得層への補助が大きく、論争となっている流産にたいするカバーでも異なる。
 上院案は10年で8710億ドルかかるが、開始が2014年とすると約6年間、年1450億ドルが低所得層へ割り振られる。合計で3100万人が健康保険を手に入れる。議会予算局の概算では10年で1320億ドルの赤字を減らすというが、共和党は上院法案では1兆ドルの赤字を追加するだろうと主張している
 持病の有無を問わず同じ保険を提供することを賞賛する人もいる。
 新たなメディケアシステムは患者安全と医療の質を高めるだろうというが、必然的に医療費の増大に繋がるのではないか。
 医師は治療法の選択で変化を矯正されることになるだろう。
 メディケア・メディケイドセンターが治療機器・薬剤の使用規則と価格設定の新たな権威を与えられるべきである。
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「医療制度改革」
http://kurie.at.webry.info/theme/64293b0b07.html
医療制度改革法案が下院を通過/米国医療事情 オバマ政権
http://kurie.at.webry.info/200911/article_11.html
上院財務委員会で医療制度改革法案が可決/米国医療事情 オバマ政権
http://kurie.at.webry.info/200910/article_18.html
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Now That It's Passed: What You Need to Know About the Senate Health Care Bill
Legislation Clears First Hurdle; Debate Is Far From Over
ABC News Medical Unit
Dec. 25, 2009
http://abcnews.go.com/Health/HealthCare/senate-health-care-bill/story?id=9419537

画像Now that the Senate's $871 billion health care overhaul bill has passed, many may still have questions about the exact nature of the bill -- and how it may affect their health choices in the decade to come.
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The vote comes after 25 consecutive days of often bitter debate.

To learn more, the ABC News Medical Unit reached out to some of the nation's top experts in health care policy. More than a dozen replied. Below are some of their comments on the Senate bill, its potential impact and how it differs from the House bill.

What Will It Mean?

Health reform proponents overwhelmingly spoke out in favor of the bill -- though some noted that more remains to be done.

"It's a start," said Donald Kemper, chairman and CEO of Healthwise Incorporated. "It focuses on reducing the inequities, and that's not a bad place to start."

Karen Davis, president of the health care reform group the Commonwealth Fund, called the bill "another milestone on the way to historic and significant changes to the U.S. health care system."

The Senate's passage of the bill had its share of industry support as well.

"We applaud the Senate for taking an important and historic step toward expanding high-quality, affordable health care coverage and services to tens of millions of Americans, many of whom are struggling today financially," said the Pharmaceutical Research and Manufacturers of America in a statement.

But not all were in favor of the bill.

"For the first time in our history, the federal government will tell you what type of insurance you have to have and -- effectively -- where you will get it and even what price you have to pay," said John Goodman of the conservative think tank National Center for Policy Analysis.

How Is It Different From the House Bill?

Of course, the Senate version of the health care reform bill is only one side of the story. Lawmakers will now begin the task of reconciling the Senate legislation with the House bill, which passed in November.

"The major unresolved issues that the conference committee will have to resolve are one, the sources of financing for the program, and two, the fate of the public option," said Daniel Blumenthal, chair of the department of community health and preventive medicine at the Morehouse School of Medicine in Atlanta, Ga.

"[The House bill] has better premium and cost-sharing assistance for low-income families," Davis said, adding that the House and Senate bills have different provisions on abortion coverage, which could also be a major point of contention.


In its current form, the Senate bill asks for $871 billion over the next 10 years. What would Americans get for this sum? Uwe Reinhardt, professor of economics and public affairs at Princeton University in Princeton, N.J., said poorer families would be one group that would come out on the winning end.

"Starting somewhere between 2013-14, but no later than 2014, the bill will channel about $870 billion divided by roughly 6 years ... $145 billion a year toward lower-income American families that would otherwise find themselves priced out of health insurance by the ever rising cost of coverage."

In total, 31 million more Americans would ostensibly receive health coverage with the passage of the bill. But Republicans argue that the Senate health care bill would add an extra $1 trillion to the budget deficit -- a figure that differs from the nonpartisan Congressional Budget Office's estimate that it would reduce the deficit by $132 billion over 10 years.

"Politics has caused compromises that may make the 'victory' hollow in that $1 trillion will not buy adequate truly affordable health care for a large segment of the population," said Arthur Garson, dean of the school of medicine at the University of Virginia in Charlottesville.

What It Might Mean for Americans

Health care reform proponents lauded the fact that the bill would provide the same coverage to people regardless of pre-existing conditions.

"The industry will no longer be able to base the individual's premiums on the individual's health status," Reinhardt said.

David Orentlichter, co-director of the Center for Law and Health, Indiana University, concurred. "Insurers will have to charge the same rates to all persons -- with some freedom to charge higher rates based on age."

Others noted that the legislation, if ultimately passed, will have other beneficial effects as well.

"New Medicare payment and quality reporting strategies will improve patient safety, cut medical errors, and increase the quality of care," said Washington and Lee University law professor and health care expert Tim Jost.

But some expressed concern that the effort could have unintended consequences.

"Every one of these new regulations ... will necessarily increase costs of insurance and raised premium costs -- exactly what the Democratic leadership claims won't happen," said Richard Saltman, an international health expert at Emory University in Atlanta.

"Doctors will be forced to change how they make their medical decisions," said Scott Gottlieb of the conservative think tank American Enterprise Institute. "[The Centers for Medicare and Medicaid Services] will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced."

Going Forward: What It Means for Politics

If there is one matter upon which those from both sides agree, it is that the fierce fight over the direction of health care in the next decade will lead to lasting rifts between those in favor of the bill and those who are opposed to it.

"The nearly complete detachment of one of our main political parties from addressing the challenges of either coverage or cost control is also found nowhere else in the world," noted Alan Sager, director of the Health Reform Program at the Boston University School of Public Health. And Saltman said the battle is "only the first chapter in a new phase of what will become an increasingly acrimonious and politically volatile period in our health system -- one that many politicians on both sides of the political divide may soon wish had never begun."

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