El impacto global del debate sobre el sistema de salud de Estados Unidos

CAMBRIDGE – Desde que asumió la presidencia a comienzos de este año, el principal interés legislativo de Barack Obama ha estado centrado en reformar el financiamiento del sistema de salud norteamericano. Sin embargo, sus propuestas se topan con una fuerte oposición de los demócratas fiscalmente conservadores así como de los republicanos, debido a su potencial impacto en futuros déficits fiscales. Como esos déficits son la causa principal del déficit de cuenta corriente de Estados Unidos -y, por ende, de los desequilibrios globales-, el resultado del debate sobre el sistema de salud afectará a gobiernos e inversores de todo el mundo.

Aproximadamente el 85% de los norteamericanos hoy están cubiertos por alguna forma de seguro de salud. Todos los individuos de más de 65 años tienen derecho a estar asegurados por el gobierno federal a través del programa Medicare. Las familias de bajos ingresos (y aquellas cuyos ingresos y activos se han visto afectados por los altos costos médicos) están cubiertas por el programa Medicaid, que está financiado conjuntamente por los estados y el gobierno federal. Muchos no asegurados obtienen atención gratuita en guardias de emergencia de hospitales públicos y privados y reciben atención gratuita para enfermedades crónicas en esas mismas instituciones.

En el presupuesto más reciente, está proyectado que los desembolsos del gobierno federal destinados a Medicare en 2010 superen los 500.000 millones de dólares, mientras que Medicaid le costará a los contribuyentes más de 250.000 millones de dólares. El seguro de salud privado normalmente es proporcionado por los empleadores, lo cual se incentiva ya que los pagos del empleador para el seguro médico son considerados como un gasto comercial deducible de impuestos, sin incluir el valor de ese seguro como ingreso tributable para los empleados. Ese régimen reduce los impuestos a las ganancias y sobre la renta de las personas físicas en más de 200.000 millones de dólares.

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