後期高齢者医療

(Sep. 28, 2008) The Yomiuri Shimbun
Unclear what Masuzoe means by 'drastic review'
後期高齢者医療　意味不明な「抜本的見直し」（9月28日付・読売社説）

The government and ruling parties have been blowing hot and cold over the new medical insurance system for those aged 75 and older.
　後期高齢者医療制度をめぐって、政府・与党が迷走している。

Health, Labor and Welfare Minister Yoichi Masuzoe proposed a drastic review of the system, and Prime Minister Taro Aso backed the idea. However, it is not clear what such a "review" would mean in effect, and some lawmakers even within the ruling parties oppose the move.
　舛添厚生労働相が、現行制度を抜本的に見直すとの方針を表明し、麻生首相も同調した。だが、「見直し」が何を意味するか判然とせず、与党にも反発が強い。

The Liberal Democratic Party and New Komeito referred to the system in their latest agreement to maintain the coalition government, saying they would try to improve the system by taking into consideration elderly people's feelings about it.
　自民党と公明党の政権合意では「高齢者の心情に配慮して、より良い制度に改善する」という表現にとどまった。

It goes without saying that governments should strive to improve every policy and system. But this is different from drastically reviewing them.
　すべての施策や制度は絶えず改善することが必要だ。しかし、抜本的見直しとは話が違う。

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Proposal ill thought out

Masuzoe said his proposal focuses on three principles: not distinguishing those insured only by their age; changing the current system of mandatorily deducting insurance premium payments from participants' pension accounts to a voluntary system; and ensuring that any changes to be made do not exacerbate feelings of inequity between working people and retirees receiving insurance premium payments.
　舛添厚労相は後期高齢者医療制度の見直しについて、ポイントを掲げている。加入者を年齢のみで区分しない、年金からの保険料天引きを強制しない、世代間の対立を助長しない、の３点だ。

The first point may be the most important. The current system was intended to create a united medical insurance system for those aged 75 and older, whose medical fees have increased steeply in recent years, and to support aged people equally, notwithstanding the fact that working generations subscribe to various corporate health insurance plans.
　特に問題となるのは、年齢で区分しない、とする点だろう。
　医療費が急激に増える７５歳以上の人を対象に、統一した医療保険制度を作り、現役世代は様々な健保組合に属していても公平に高齢者全体を支えよう、というのが現行制度の精神である。

If the government and ruling parties decide to do away with the new system's age-bracket provisions because they worry overly that elderly people aged 75 and older have loudly protested against being described as koki koreisha (late-stage elderly people)--as the system refers to them--they will have to rebuild the system from scratch.
　「後期高齢者」という呼称が招いた感情的な反発に配慮するあまり、年齢区分そのものを否定するのならば、制度の根幹から作り直さなければならない。

If those who continue to work regardless of their age are allowed to subscribe to corporate health insurance plans as members of the working generations, the government and ruling parties will merely have broadened the options of such people. This does not go beyond the framework of system improvement.
　何歳になっても働き続けている人は現役として企業健保に所属できる、というのなら、選択肢を広げるだけで制度改善の範疇(はんちゅう)だ。

It is difficult to describe the first of the three points of Masuzoe's proposal--not distinguishing between those insured in regard to their age bracket--as a "drastic review" because an "improvement" is not the same as a "drastic review."
　全く次元の異なる話であり、同じ「見直し」とは呼び難い。

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Alternative plan needed

The third point--aiming at a system that will not worsen feelings of inequity between working people and retirees--also is unclear. After all, the health insurance system for elderly people that lasted until fiscal 2007 hit a wall due to ambiguous rules on sharing burdens between working people and retirees.
　世代間の対立を助長しない制度をめざす、という点も意味不明である。昨年度までの老人保健制度は、世代間の負担のルールがあいまいだったために、行き詰まったのではなかったか。

Masuzoe said he intends to ask an expert panel to discuss the makeup of an ideal new system from square one. But there are too many ambiguous points of contention.
　舛添厚労相は、有識者会議に一から議論を委ねるという。不透明な論点があまりに多い。

In a Yomiuri Shimbun poll held immediately after the launch of the Aso Cabinet, 67.5 percent of respondents said they highly evaluated the agreement between the LDP and New Komeito to review the new medical insurance system for those aged 75 and older. This figure reflects people's dissatisfaction with the current situation.
　麻生内閣発足に合わせて読売新聞が行った世論調査では、自公両党が後期高齢者医療制度の見直しに合意したことを６７・５％の人が「評価する」とした。現状に対する不満を反映した数字だろう。

But merely parroting the vague slogan "review" without offering a clear future vision can only be seen as a vote-catching gambit ahead of the forthcoming general election. Under the current situation, the government and ruling parties are in no position to criticize the opposition parties, which have demanded the abolition of the current system without putting forward an alternative plan.
　だが、明確な展望を示さないまま、漠然と「見直し」を唱えるだけでは総選挙をにらんだ人気取りとしか見えない。これでは政府・与党は、代案を出さずに「まず現行制度を廃止せよ」と主張する野党を批判できまい。

A long-range outlook is needed for reform of the social security system, including medical care for elderly people. If the government and ruling parties run about in confusion every time an election approaches, public anxiety and dissatisfaction will accumulate.
　高齢者医療を含め、社会保障制度改革で必要なのは長期展望である。選挙が近づくごとに右往左往していては、そのたびに国民の不安と不満が蓄積される。

(From The Yomiuri Shimbun, Sept. 28, 2008)
（2008年9月28日01時42分 読売新聞）