オバマケアをめぐるカトリック内部での論争
オバマケアを批判したカトリック社会教育の見地からの論文にたいし、オバマケアを擁護するカトリック社会教育の見地からの論文が以下のもの。
つまりはカトリック社会教育内部での教義の理解の相違がオバマケアを評価するさいにも顕著に露出しているという次第。
とくに、solidarity （連帯）、subsidiarity（補完性？）という概念が重要
であり、また「市場」をめぐる理解の相違も重要になっている。
（注：オバマケアをめぐっては、アメリカではもともと賛否相半ばするというのが実態である。反対の一番大きな理由は、保険を国が個人に強制する権利はない、それは個人が自由に選べばよいことで、憲法違反である、というものである。そしてこの視点から数多くの裁判が展開され、最終的には最高裁がぎりぎりのところでオバマケアを合憲と認めたことで終止符を打ったという次第である。反対者は個人の選択の自由侵害を強調するのだが、アメリカには４０００万以上の無保険者が存在する。彼らは保険に入る資金がないのである。貧しいから食べるほうにまわし、そうした余裕はない。それに既往症のあるものにたいし、保険業界は拒絶の自由を有しているため、不利な立場にあるものが医療を受けることができないという現実が存在する。こうした点を総合して見なければならない問題である。）
A Catholic Defense of Obamacare
June 20, 2013
tags: Catholic Social Teaching, Health Care, health care reform, Obamacare
by Morning's Minion
Over at the Catholic University of America business school, Brian Engelland has written a criticism of Obamacare from the position of Catholic social teaching. I believe he is wrong, and I want to respond to the points he makes. I will first talk about what Obamacare actually does, and then move on to his substantive criticisms from the perspectives of solidarity and subsidiarity.
What Obamacare does and does not do
The basic point of Obamacare is to bring some order to the completely dysfunctional market for individual health insurance for the large number of people left out of the current system, because they don’t have insurance through their employers and they are not eligible for government programs. It does this by mandating the establishment of exchanges, which create new risk pools for these people, thus mirroring the way employer-based insurance works.
Obamacare deploys three pillars to make this new setup function properly. First, guaranteed issue and community rating – insurers must accept everybody, irrespective of medical history, and their ability to charge differently depending on individual health risk is strictly limited. Second, the individual mandate, which puts the onus on everybody to purchase insurance. Third, for those who can’t afford the insurance, subsidies will be provided, and this is complemented by an expansion of Medicaid.
Each of these legs is needed for the stool to stand. If you force insurers to take everybody and not discriminate, they need a pool of young and healthy people as well as sicker people, as otherwise the costs would prove prohibitive. This is why the mandate is needed. Without it, the young and healthy would simply opt out. And the subsidies are there to make sure insurance costs are within reach of all.
Engelland talks about none of this. He describes Obamacare in vague and misleading terms. He starts by identifying the main problem as rising healthcare costs, which make care unaffordable. For sure, the issue of rising healthcare costs is a big problem. But when we talk about US healthcare, it is not the main problem, and it is not the problem that Obamacare seeks to address. Obamacare is designed to address the fact that too many people are excluded from healthcare. It is about ending the pervasive rationing in the current system, with over 50 million uninsured and a further 25 million underinsured, and where health costs are the leading cost of bankruptcy.
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