Controverse sur la santé aux Etats-Unis et conséquences mondiales

CAMBRIDGE – Dès qu’il a pris ses fonctions, le président Barack Obama a fait de la réforme du financement du système de santé sa grande priorité législative. Mais certains démocrates, conservateurs en matière fiscale, s’opposent fortement à ses propositions, ainsi que les républicains, pour qui elles ne manqueront pas d’aggraver le déficit budgétaire. Ce déficit étant le premier responsable du déficit des comptes courants – et par conséquent des déséquilibres globaux – l’issue de cette controverse aura un impact sur les Etats et les investisseurs du monde entier.

Pour le moment, 85% des Américains bénéficient d’une manière ou d’une autre d’une couverture médicale. Les plus de 65 ans sont pris en charge par “Médicare,” système public d’assurance santé, et le système “Medicaid,” financé conjointement par les Etats et le gouvernement, prend en charge les familles à faibles revenus (et ceux dont les revenus et le patrimoine sont dilapidés par le coût des médicaments). Beaucoup de non-assurés ont accès gratuitement aux services d’urgence des hôpitaux publics ou privés, où ils peuvent être soignés, non moins gratuitement, pour des maladies chroniques.

Le dernier budget prévoit de consacrer plus de 500 milliards de dollars en 2010 pour Medicare, et plus de 250 milliards de dollars sur l’argent des contribuables pour Medicaid. L’employeur est généralement encouragé à fournir une assurance privée, dépense qu’il peut gérer comme faisant partie des frais généraux pour lesquels il bénéficie de déductions fiscales, tandis que la valeur de cette assurance est déductible du revenu imposable du salarié. Cette disposition réduit la recette des impôts de plus de 200 milliards de dollars.

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