社会保障改革 消費増税を制度安定の契機に

The Yomiuri Shimbun January 8, 2014
Editorial / Consumption tax hike must support stable social security
社会保障改革　消費増税を制度安定の契機に（1月8日付・読売社説）

　◆医療・介護費の抑制は不可避だ

In April, Japan’s consumption tax rate will be raised from 5 percent to 8 percent. The tax hike is placed as the main pillar of the nation’s integrated reform of the social security and tax systems, and the increase in tax revenues will be used exclusively for social security purposes.
　社会保障と税の一体改革の柱として、４月に消費税率が５％から８％に引き上げられる。増税分は全額、社会保障に充てられる。

We believe this is an opportunity to make 2014 the starting point to achieve the goal of building stable social security systems.
　今年を安定した社会保障制度の実現に向けた出発点としたい。

The rapid graying of society and the decrease in the working population have made our social security systems fragile.
　急速な高齢化と働く世代の減少により、日本の社会保障制度は揺らいでいる。

About a half century ago, about 10 working-age people supported each elderly person through our social security model. Now, just 2.4 working-age people shoulder the cost of supporting one elderly person. The scale of the human pyramid is expected to narrow even further by around 2050—when each elderly person will have to ride on the shoulders of one working-age person.
　約５０年前には、１０人の現役世代が１人の高齢者を支えていた。だが、今は２・４人で１人の「騎馬戦型」だ。２０５０年頃には、現役世代１人が１人の高齢者を支える「肩車型」社会が到来する。

Don’t let our children pay
　◆次代につけを回すな

The nation is highly dependent on debt, chiefly government bonds, to cover the ballooning cost of pensions, medical care and nursing care. This has become the main source of the government’s deteriorating fiscal condition. We should no longer neglect the problem by simply passing down the current burden to future generations.
　増え続ける年金、医療、介護費用の財源は、国債など借金に大きく依存し、国の財政悪化を加速させる主因になっている。将来の世代への負担のつけ回しをこれ以上、放置できない。

The consumption tax hike will enable the government—at least for a while—to finance social security costs such as basic public pensions. It will increase the sustainability of our social security systems, a step toward the goal of achieving the systems’ long-term stability.
　消費増税によって、基礎年金などの財源をひとまず確保できる。社会保障制度の持続可能性が高まることは一歩前進である。

The increase in consumption tax revenues will also be used in building a system in which medical care and nursing care services join hands in supporting the lives of elderly people who choose to continue living at home. The money will also be used to reduce national health insurance premiums.
　増税分は、在宅の高齢者を支える医療と介護の連携体制の構築や、国民健康保険の保険料軽減などにも充てられる。

The government’s social security reform measures will be implemented under the assumption that the consumption tax rate will be further be raised to 10 percent in October 2015. It will be an important task for the government to steadily realize the second hike to solidify our social security systems. To do so, the government needs to carefully scrutinize how the nation’s economy reacts after the April hike.
　一連の改革は、２０１５年１０月に予定される消費税率１０％への引き上げが前提となっている。社会保障制度を強固にするには、景気の動向を見極め、税率８％からの再引き上げを着実に実施することが課題となる。

However, it is impossible to fully cover ballooning social security costs through consumption tax hikes, even after the second hike goes into effect.
　ただ、消費税率を１０％に引き上げても、増大する社会保障費のすべてを賄うことはできない。

To realize the goal of achieving stable social security systems and putting the nation’s finances on a healthy footing, we cannot afford to put off trimming spending in the three fields of medical care, elderly care and pensions.
　安定した社会保障制度を実現し、財政健全化を図るには、医療、介護、年金の給付費抑制は待ったなしである。

The surge in medical care costs in particular is causing a headache. The government has decided to, in effect, decrease medical treatment fees paid from the national health insurance system to medical institutions for fiscal 2014, and we believe this judgment was appropriate.
　特に問題なのは、医療費の急増だ。政府が来年度の診療報酬の改定で実質的な引き下げを決めたのは適切な措置と言える。

It is also essential to improve efficiency and cut waste in medical services.
　医療を効率化し、無駄を省くことも欠かせない。

Currently, many elderly patients who have several diseases receive treatment at multiple medical institutions. As a result, the patients undergo unnecessary medical examinations and are administered drugs they do not need.
　複数の病気を持つ多くの高齢者が、いくつもの医療機関にかかり、検査や投薬を重複して受けている。

Not only is this is a waste of medical resources paid for by the government, but a considerable number of patients end up suffering from side effects of drugs excessively prescribed to them.
医療費の無駄遣いであるばかりでなく、薬の副作用により、かえって体調を悪化させているケースも少なくない。

Health insurance societies and other organizations that provide health insurance services should encourage subscribers not to seek unnecessary medical consultations. The medical expense statements of patients should be thoroughly examined, a possibility since record-keeping has improved through the use of computers.
　健康保険組合などの保険者は、電子化が進むレセプト（診療報酬明細書）の点検を徹底し、患者に重複受診の是正を促すべきだ。

In carrying out this plan, it will be advisable to take advantage of the “my number” system that will go into effect in 2016. The system will enable government offices in charge of three types of administrative duties and services—taxation, social security and disaster response—to manage the personal information of all individuals through 12-digit numbers.
　１６年に創設される共通番号制度（マイナンバー）も活用したい。

After it goes into force, the system will for some time be used to carry out procedures for tax and social security benefit payments. If the scope of its use is expanded to include records of medical services received by individuals, it would do much to prevent them from seeking needless treatment and medication.
当面は納税や社会保障給付の手続きに使われるが、診療情報に利用範囲を拡大すれば、重複受診・投薬の防止に役立とう。

To relax the financial burdens shouldered by corporate and other workers, it also will be inevitable to require well-off elderly people to share burdens commensurate with their financial means in receiving medical services.
　現役世代の負担を軽減するため、経済力のある高齢者に相応の負担を求めることも不可避だ。

Excessive burden
　◆過重な現役世代の負担

In April, there will be a rise in the percentage of medical fees paid by elderly people. The figure for those aged 70 to 74 will increase to 20 percent, as initially set in the revised Health Insurance Law of 2008. Despite this revision, the government has kept the ratio at 10 percent as an exceptional measure, fearing possible angry reactions from elderly people.
　７０～７４歳の医療費の窓口負担が４月、法定の２割に引き上げられる。

This means the government has had to dip into the national coffers to make up for massive losses since 2008. Therefore, it is reasonable for the government to raise the ratio of medical fees to be paid by those in that age bracket.
高齢者の反発を恐れ、政府は０８年以降１割に据え置き、穴埋めに巨額の国費を投入してきた。引き上げは当然の措置である。

A similar measure will also be taken in regard to government-administered nursing care insurance services. The share of expenses covered by high-income recipients will be raised from 10 percent to 20 percent. This is essential if the state-run nursing care insurance system is to be maintained.
　介護保険サービスでは、高所得者を対象に、自己負担率を現在の１割から２割に引き上げる。制度維持のためにはやむを得まい。

What should be done to halt the drop in the number of workers, which form the backbone of the social security systems? The entire matter must be explored from this point of view, when it comes to sustaining the systems in future.
　担い手となる現役世代の減少をどう食い止めるか。社会保障制度を将来にわたって安定させるには、この視点も不可欠だ。

The nation’s total fertility rate (TFR)—the number of babies born to a woman during her lifetime—stands at only 1.41. The number of newborn babies was at an all-time low last year. The total population declined by a record 244,000 in 2013, an indication that the reduction will likely accelerate further in future. Efforts should be made to encourage young people to marry, while also assisting parents in raising their children.
　１人の女性が生涯に産む子供の数を示す合計特殊出生率は１・４１にとどまり、昨年の出生数は過去最少だった。人口減は最大の２４万４０００人に達し、今後一層、加速する。若者の結婚、育児支援に力を入れる必要がある。

We hope the government will take a broad range of steps to address problems arising from the low birthrate. Measures should be taken to ensure no children are on waiting lists for day care centers. This would enable parents to raise their children while continuing to work outside their homes.
　働きながら子育てできる環境を整えるため、保育所の待機児童解消など、政府は幅広い少子化対策を講じてもらいたい。

The growth in the number of nonregular employees is another cause for worry. In most cases, they earn so little that they pay low taxes and social insurance premiums. Measures should be taken to improve their employment conditions.
　非正規労働者の増大も懸念材料である。所得が低く、税や社会保険料の納付額が少ないからだ。非正規雇用の待遇改善を図ることも求められる。

There is a mountain of tasks to be carried out in resolving problems related to social security systems. However, political leaders have been slow to reform these systems.
　社会保障制度を巡る問題は山積しているが、改革を進める政治の動きは鈍い。

Push 3-way discussions
　◆自公民協議を推進せよ

This is evident in the fate of a three-party reform plan adopted in 2012, under an administration led by the then ruling Democratic Party of Japan. The DPJ, the Liberal Democratic Party and New Komeito agreed to reform the social security and tax systems in an integrated manner, mainly featuring an increase in the consumption tax rate.
　消費増税を柱とする社会保障と税の一体改革は、民主党政権時代に自民、公明、民主３党の合意で決定された。

However, the DPJ withdrew from three-party negotiations in August 2013 after the government’s National Council on Social Security System Reform put together a final report detailing its recommendations. The DPJ defended its move by saying its recommendations had not been reflected in the report.
　だが、昨年８月、社会保障制度改革国民会議の報告書がまとまった際、民主党は自らの主張が反映されていないことを理由に、３党協議から離脱した。

Though the DPJ said it would return to the three-party talks later, little progress has been made in facilitating discussions on the issue. It should cooperate in the talks, given its earlier initiative in forming the three-party accord.
　その後、協議に戻ることを表明したが、議論は停滞している。３党合意を主導した民主党は、協議の進展に協力すべきだ。

Social security reform is an important task that must be tackled by whatever political party is in power.
　どの党が政権を担っても、社会保障制度の改革は避けて通れない重い課題である。

(From The Yomiuri Shimbun, Jan. 8, 2014)
（2014年1月8日01時27分 読売新聞）