基于价值理念对社会政策项目的讨论和评估——由退休人员医保缴费的论争说起

Discussions and Evaluation on Social Policy Programs from the Value Perspective:On the Proposal Requiring the Retirees to Pay Social Security Premiums for Their Health Care

社会政策讨论和政策制定活动都是由价值和理念所支撑的,因此,这些讨论不能仅仅停留在对策分析层面,更应从价值理念的层面展开。从社会公平、社会公正、社会正义三个价值理念出发对退休人员继续缴纳医保费用这一政策提议展开讨论,说明退休人员缴纳医保费用这一提议既有违公平、公正原则,又与社会发展大势背道而驰,且无益于解决医保费用缺口问题。通过对这一政策的价值分析,强调价值理念在社会政策分析中所具有的功用,从而拓展社会政策研究的价值维度。

Social policy proposals and the policy-making actions are all value-embedded. The debate about a proposal asking retirees to pay attribution to the social insurance program of health care could disclose the nature of values, both as the instrumental means and guiding ideals, in the evaluation of social policy program. This policy proposal, initiated in the beginning of 2016, requests the pensioners to pay their attribution to the statutory healthcare insurance program. This could, in the view of some supporters, increase the financial sustainability of this program, and for some supporters, this may help to prevent inequality occurred if the retiring pensioners spending more costs in health care than young workers, do not pay for the program but young workers as current employees pay for. On the other hand, some scholars claimed that this policy proposal violates the Social Insurance Law, and it runs against the state＇s commitment of insuring employees. Considering the low level of income for pensioners and their limited capacity of earning, we may assume that this policy proposal wii1 increase retirees＇ difficulties in living. To assess the＇ rationale of this policy proposal, we need to evaluate its significance from the approach of values. Three key notions are involved in this assessment including social equality, social fairness, and social justice. The norm of social equality requires us to look at the redistribution effect of social insurance in terms of equality cross-groups and cross-generations. In particular, in the current pay-as-you-go system, the effect of cross-generation distribution of income transfer is evident. This implies that in this system, employees should pay the program for the pensions of the last-generation employees, while their pension in the future should be sourced from their next-generation employees. From the prospective of social fairness, the principle of social insurance assigns the payers a duty of making contribution, whereas the state takes a duty of program operation. Therefore, no matter the fund runs a deficit or surplus, the state should take this operational duty alone, not to shift the financial burden of program operation to the payers or contributors. The value of social justice requires consistency between social policy design and social development trend. In the contemporary world, most developed countries in Europe have achieved free health care or universal coverage of public health care service, and in the same way, Taiwan and Hong Kong in Great China region are also striving for universal coverage of the public health care system. In this global context, a voice that asks retirees to pay medical insurance as a ＂duty＂ is quite unpleasant to hear, and run against the development trend. Hence, discussions over social policy schemes should be examined from the prospect of ＂what should be done,＂ and reflect upon underlying values. At present, the Chinese levels of pubic spending on health care, education, and social protection stand low in international comparisons, efforts should be made to increase the pubic spending on these areas in order to reach at the stand of ＂ bottom-line fairness.＂ However, the policy proposal that asks retirees to continuously contribute to the health care program is contradictory to the principle of the ＂moderate inclusiveness.＂ Still, we should also remind that the pressure of health care cost mostly come from those problems in hospital administration and the patient-doctor relationship, etc. And therefore, the right way of handling with these problems is to resolve these problems and to decrease abuse of medical resources by the advantaged groups, instead of the way of increasing the burden of pensioners for charging fees.