quinta-feira, 25 de janeiro de 2007

Plano Bush na saúde: mais atrapalha do que ajuda.

Analisei um pouco mais a proposta Bush para a atenção médica. Incrível, mas o "país com o melhor sistema de saúde e atenção médica do mundo" (Bush) está estimulando os planos individuais. Aqui, no Brasil, onde esquerdistas (versão sindical) e direitistas (versão corporativa) adoram falar na "vala comum do SUS" comprova-se dia a dia que planos individuais estão fadados ao fracasso, a não ser quando os valores dos prêmios são elevados, fora da possibilidade dos mortais. A solução são planos nacionais bem orçamentados com administração descentralizada, como cada vez mais se comprova desde a implantação do SUS, tanto pelos acertos, como pelos erros. Voltando aos EUA, O plano Bush irá atrapalhar as propostas de estados como a California que estão estimulando os empregadores por meio de subsídios. Lembro que Mitt Rommey, ex-governador de Masschusetts é candidato à Presidência pelo Partido Republicano e, criticou também a proposta. Se a questão Iraque estiver "resolvida" até 2008, Rommey será páreo duro aos democratas com a sua proposta na área da saúde.
Maiores detalhes na reportagem de hoje do The Wall Street Journal.
Bush Health Plan Shifts Onus to the Consumer Proposal Contrasts EffortsBy States, Democrats to Push Employers to Secure Coverage By JANE ZHANG and SARAH LUECKJanuary 25, 2007; Page A6 President Bush's proposal for easing the nation's health-care woes -- encouraging families to buy insurance on their own instead of relying on employer-provided insurance -- differs from approaches favored by Massachusetts and California as well as many Democrats in Congress. In their bids to extend health-care coverage to millions of uninsured, former Massachusetts Gov. Mitt Romney and California Gov. Arnold Schwarzenegger, both Republicans, aim to shore up existing coverage, which has been offered by fewer employers in recent years. The Massachusetts plan, which was supported by Democratic Sen. Edward Kennedy, requires all but the smallest employers to offer health insurance, or else pay an assessment to the state. In California, a similar requirement would compel employers that don't offer insurance to pay a 4% payroll tax. WALL STREET JOURNAL VIDEO President Bush outlines a new tax deduction for families and individuals with private health insurance and other health initiatives. Plus, Health-care policy expert Dr. Paul Ginsburg speaks with the Journal's Matt Murray about how Bush's health-care reform would be funded. Mr. Bush, in contrast, avoids mandates and instead would use the tax code to make individually purchased health insurance more appealing and affordable. In a break with the past, he would make employer-provided health insurance taxable, but create a tax deduction of $15,000 for families and $7,500 for singles, for everyone who gets insurance, through work or on the open market. That is designed, the White House says, to be fair -- by treating individuals who buy insurance and now receive no tax break, the same as employees who are covered through their work and can exclude the value of the insurance from taxable income. Another part of the president's plan would help states extend coverage to the uninsured by diverting money from hospitals that care for the poor into state insurance pools. "What you are seeing is indicative of sharp philosophical differences," said Robert Laszewski, a health-policy analyst. "One is to build on the employer-based system that most Democrats embrace and the other is to develop an entirely new system controlled by the consumer, not the employer," which many -- though far from all -- Republicans and the president endorse. Both states would require all residents to have health insurance, offering government coverage or subsidies to those who are without coverage through an employer. Whether Mr. Bush's plan will contribute to a further erosion of employer-sponsored health coverage was debated yesterday. Health and Human Services Secretary Michael Leavitt told reporters that the president's plan will "absolutely not" have a negative effect on the employer-based system. Rather, he said, it does something that states can't: changes the federal tax code to help individuals buy health insurance. "I do not see employers leaving the employment-based system," he said. Not everyone in the administration agreed. At a White House briefing on Tuesday, Joel Kaplan, deputy chief of staff for policy, acknowledged that the proposal could accelerate the trend of employers dropping insurance, but emphasized that workers left without coverage would, thanks to the new tax deduction, have the means to "buy insurance in the individual market in a way that they can't now." Some employer and industry groups fretted about the proposal. Neil Trautwein, vice president of the National Retail Federation, said, "The fear is that if it becomes more attractive for people to decline employer coverage and buy on the open market, then you could get great spirals in the employer plans. I'm not convinced we should take away one of the pillars that has been supporting the health-care system." Democratic lawmakers said that expanding government programs, not changing the tax code, is a cheaper, simpler way to lower the ranks of uninsured than relying on the individual market, where policies often are expensive and people with health problems have trouble buying coverage at any price. "With the individual market, people pay more for [policies]; they also pay for insurance company overhead. And [private insurers] traditionally discriminate against people with prior medical problems," said Rep. Henry Waxman, a California Democrat and a senior member of a House committee that oversees health-care issues. Nina Owcharenko, a senior policy analyst for health care at the Heritage Foundation, said the Bush plan would complement states' effort to expand coverage: "The states control the regulatory structure of the individual market," especially for small businesses and individuals, and "this proposal is saying, 'How do we work together?' " Ms. Owcharenko added: "This is trying to find a way to make sure there's a market for an individual so they can buy health insurance. Both can co-exist. "It's not removing the employer system. It's not keeping the individual market as it is," she said. "The overall impact is combining the tax code with state innovations. The end goal will be to increase the number of people who have private insurance."

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