Hudson R B
Boston University.
Milbank Q. 1993;71(2):253-77.
Today's older population is notably different than it was a few decades ago, both in well-being and in diversity, a shift that must be acknowledged in public policy. The U.S. social insurance system overprotects against highly likely, predictable, and nonvolatile events at the expense of more unlikely, potentially catastrophic, and less volatile events. The public sector, therefore, should move toward proportionally emphasizing health-related, functionally impairing events rather than income maintenance; the private sector is better suited to insuring against predictable and nonvolatile old-age events. A contingent event scheme would: (a) encourage the growth of long-term-care insurance; (b) help bridge the gap between those arguing for greater "efficiencies" in social welfare spending and those pressing for new universal benefits; and (c) bring a new perspective to the "generational equity" debate.
如今的老年人口在幸福程度和多样性方面与几十年前相比有显著不同,这一转变在公共政策中必须得到承认。美国社会保险体系过度防范极有可能、可预测且波动性小的事件,却以更不太可能发生、潜在灾难性且波动性较小的事件为代价。因此,公共部门应朝着按比例更加强调与健康相关的、导致功能受损的事件而非收入维持的方向发展;私营部门更适合为可预测且波动性小的老年事件提供保险。一种或有事件计划将:(a) 鼓励长期护理保险的增长;(b) 有助于弥合那些主张提高社会福利支出“效率”的人与那些迫切要求提供新的普遍福利的人之间的差距;(c) 为“代际公平”辩论带来新视角。