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医保竞争力的谬误  

2009-05-28 12:33:25|  分类: 默认分类 |  标签: |举报 |字号 订阅

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[曼昆的英文博客]

久经世故的时评人往往老生常谈:美国需要改革医疗保健制度来保持国际竞争力。不管你对医保改革的看法如何,这个观点,说穿了,荒唐之极。很早之前,保罗?克鲁格曼写过一篇很好的文章,批驳了全部关于把提升国际竞争力作为国家经济政策的主旨的观点。最近,国会预算办公室出色地解释了把国际竞争力作为医改原因的观点是谬误的。下面,虽然表述上一如既往的保守──来自国会预算办公室(CBO)分析文档第167页的观点还是明确的:

国际竞争力

一些观察者声称,国内为工人提供医疗保险的生产商,相比不实施就业医保国家的那些竞争对手,面临更高的工资成本。医保制度的根本性变化将减少或消除这种不利因素。然而,这样的成本降低是不太可能发生的,除非在短期内。

经济体系中的均衡工资水平是由劳工的供应和需求所决定。补贴(例如医疗保险)仅是报酬中的一部分。实际上,工人主要以获得较低工资的形式承担了补贴的成本,如果没有雇主的这类补贴,他们会收益得更多。

以政府管理体系取代雇工基础的医保制度可能会减少雇主为员工所付的保险费用,但是,总体所必须付出的薪水总额其实没有变化。即使改变医疗保健系统可能对劳动力的供应产生各种各样的影响,但在任何特定的工资水平上,劳动力供应的基本数量将很难被医保制度左右。就是说,现金工资和其他形式的补贴将不得不提升约等于医疗补贴所减少的数额,从而使企业有能力吸引同样数量和类型的工人。

工资可以通过一些时间来调节其市场出清水平(供需平衡点)。在这期间,原先提供医保的企业——特别是雇佣长期合同工人的企业——可能会经历劳工成本的大幅减少,这会暂时增加他们的利润。但是,这些企业的竞争状态不会发生永久性变化。

注意:在今后的日子里,这一谬误很可能渲扬得愈加荒谬和离谱。


英文原文(地址:http://gregmankiw.blogspot.com/2009/05/healthcare-competitiveness-fallacy.html):

The Healthcare-Competitiveness Fallacy

A common argument, often made by ostensibly sophisticated commentators, is that the United States needs to reform its health care system to maintain its international competitiveness. Regardless of your views of health care reform, this particular argument is, to put it bluntly, nonsense. Long ago, Paul Krugman wrote a nice piece demolishing the whole concept of international competitiveness as a motive for national economic policy. More recently, the Congressional Budget Office has done a nice job explaining why the idea of international competitiveness as a reason for health care reform is fallacious. The passage below, from page 167 of the CBO analysis, is written in the CBO's traditional understated way, but the point is clear:

International Competitiveness

Some observers have asserted that domestic producers that provide health insurance to their workers face higher costs for compensation than competitors based in countries where insurance is not employment based and that fundamental changes to the health insurance system could reduce or eliminate that disadvantage. However, such a cost reduction is unlikely to occur, except in the short run.

The equilibrium level of overall compensation in the economy is determined by the supply of and the demand for labor. Fringe benefits (such as health insurance) are just part of that compensation. Consequently, the costs of fringe benefits are borne by workers largely in the form of lower cash wages than they would receive if no such benefits were provided by their employer.

Replacing employment-based health care with a government-run system could reduce employers’ payments for their workers’ insurance, but the amount that they would have to pay in overall compensation would remain essentially unchanged. Even though changes to the health care system could have various effects on the supply of labor, the underlying amount of labor supplied at any given level of compensation would hardly be
affected by a change in the health care system. As a result, cash wages and other forms of compensation would have to rise by roughly the amount of the reduction in health benefits for firms to be able to attract the same number and types of workers.

Compensation could take some time to adjust to its market-clearing level (the point at which supply and demand are equal). During that time, firms that formerly provided health benefits—especially firms that employ workers under multiyear contracts—could experience substantial reductions in labor costs, which would boost their profits temporarily. But those firms would experience no permanent change in their competitive status.

Be ready: This fallacy may well be rearing it ugly, and illogical, head in the days to come.
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