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医疗改革要劫富济贫?  

2009-07-22 00:24:34|  分类: 默认分类 |  标签: |举报 |字号 订阅

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Should the rich finance healthcare reform?

Choosing to finance health care reform by taxing the rich is bad economic policy, bad health policy, bad budget policy and poor leadership.

通过对富人课税来支持医疗改革,是很糟糕的经济政策,很糟糕卫生政策,很糟糕的预算政策,很糟糕的领导能力!

It is bad economic policy because, coupled with the scheduled expiration of the Bush tax cuts, it would raise marginal tax rates by 10 percentage points for high-income households. While I object to the general hue and cry that occurs anytime anyone discusses any potential tax increase for the rich, it is nevertheless quite fair to say that a 10 percentage point increase in taxation on the return to labor and capital income is a lot and shouldn’t be the first choice. (But please spare me the small business arguments.)

之所以是糟糕的经济政策,是因为随着布什减税政策的到期,奥巴马这项政策将导致高收入家庭的边际税率上升10个百分点。

It is bad health policy because we need to fix the structural problems in health care in order to cut costs and be able to expand coverage. One of the biggest structural problems is the non-taxation of employer-provided health care. Fixing that – converting it to a refundable fixed credit a la Furman and McCain – would not only raise a lot of money, it would improve incentives for health care. Taxing the rich does not address this issue at all – it may raise the same amount of revenue but it does not address the incentive problem that arises from nontaxation of employer provided health care.

之所以是个糟糕的卫生政策,是因为我们需要解决医疗卫生上的结构性问题来减少开支,并且扩大医疗覆盖范围。现在最大的结构性问题之一就是雇主医疗的免税问题。解决它——以Furman和McCain的方式把它转换成可返还的固定贷款形式——不仅可以增加收入,而且会提高医改的刺激性。对富人征税根本不能解决这一问题——它只可会增加同样数量的税收收入,但并不会解决雇主医疗免税带来的积极性问题。

It is bad budget policy because we are using up one of our options on the revenue side not to cut the deficit but to finance new spending. We need to save our powder for deficit reduction activities – use the change in tax treatment of employer sponsored health care to finance health care and use general revenue increases to finance general deficit reductions.

之所以是糟糕的预算政策,是因为我们正在消耗税收的一项功效,非但没有去消除赤字,反而在扩大开支。我们需要做的是集中力量消灭赤字——利用在雇主担保医疗上的改变为医改提供资金,并且用政府收入的增加来弥补政府赤字。

It is poor leadership because it furthers the myth that we can solve our fiscal problems by taxing “other” people or with gimmick taxes. It has been said many times already and will be said many times again: we are going to need broad based tax increases and spending cuts to bring the fiscal house into order and the more politicians continue to act as if we can just foist the financing on a small group (be it rich people or foreign corporations or obese people or people who drink soda, etc.) the worse are our prospects for solving the problems.

之所以是糟糕的领导力,是因为他在虚构一个我们可以通过对“他人”征税或者利用小诡计骗税来解决财政问题的神话!一个已经被反复强调并且仍将被强调的事实是:我们需要拓宽税率基准,削减开支以使财政政策合理有效。越多的政客想继续把这些财政问题连蒙带骗的丢给少数群体(富人,跨国公司,肥胖患者,喝汽水的人等等),那么我们解决问题的希望就越渺茫……

Jeff Frankel of Harvard's Kennedy School (and a veteran of the Clinton CEA) agrees
   a clearly more efficient way of getting the necessary revenue would be to eliminate employers' tax exemption for health care benefits, at least for upper income workers, as proposed by Furman, McCain and others. And another would be auctioning off most emission permits rather than giving most of them away, at least after the first five years or so. It is just another case of good economics getting steamrollered by politics.

来自哈佛大学肯尼迪学院的Jeff Frankel (同时也是克林顿内阁的资深经济顾问)表示赞成:

  一个清晰有效的增加财政收入的办法就是减少雇主因为卫生医疗福利而得到的免税,至少对于高收入工人的医疗福利的免税,这一点就像Furman, McCain和其他人支持的那样。另一种增加收入的方法就是在至少第一个五年左右的时间里,拍卖废气排放的牌照,而不是像以前一样免费发放其中的大部分。这仅是在政治推动下的良性经济学的又一案例而已。

I highlight these comments because they both come from well respected, slightly left-of-center, mainstream economists, which only goes to show how far leftward congressional healthcare reform efforts have drifted.

我强调这些讨论的目的就是因为它们都是出自备受尊敬的,中间偏左的主流经济学家的看法。

这些都能告诉大家,国会对于医改的努力已经向左偏离了多远!

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