CHAU MY NGAY NAY
KINH TE - XA HQI
NHITNG VAN D £ XA HOI CUA HOA KY SAU KHUNG HOANG TAI CHINH 2007-2009
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ang tmflng kinh tfi vfln la dpng luc CP bdn de thiic day su phdt trifin cua mfli quflc gia. Id nhan tc quan frpng hdng dau vd difiu kifin vdt chit dfi gidi quyfit cdc van dfi chinh tri va xa hpi. Cupc khiing hodng tai chinh My difin ra vao nam 2007 da tac dpng nghifim ttpng tfli nfin kinh tfi My, dfli sang xa hpi My, dflng thfli keo theo nhifiu hfi luy vd Id mpt ttpng nhiing nguyfin nhan dan dfin su chia re sdu sac ttfin chinh tmflng My. Bdi vifit dufli day se nfiu nhirng vdn dfi xa hfli nfli bat a My phdt sinh tii cuflc khiing hoang nay.1. That nghiep
Cupc khiuig hpdng kinh tfi bit diu tir tiiang 12 nam 2007 bupc nhifiu cflng ty vd tap dpan fl My Ufin tuc cat giam nhan cflng ttong nam 2008, khifin ty lp tiiit nghifip fl My tang tii 5% cuoi nam 2007 Ifin 7,2% vao tiiang 12 nam 2008, cao nhat ttong 16 nam qua. So nguoi hi sa thdi nam 2008 la 2,6 tiifiu ngufli'.
Bit diu tir quy III nam 2009, tang tiirong GDP da dat con sfl duong, chim dirt khodng flifli gian tang tiirflng am tiude dfl. Tfli quy III nam 2010, tang
ThS. Le Thu HSng ViSn Nghien cim Chdu My tiirflng GDP tai My la fren 2%. Tuy nhifin, ty lfi thit nghifip cua My vdn duy tii fl mUc cao frfin 9,5% tii thdng 6 nam 2009 Ifin mue ky luc 10,1% tiiang 10 nam 2009 (cao gin bing con sfl ky luc ciia nam 1982 Id 10,8%). Dfin cuoi nam 2010, ty Ifi that nghifip Id 9,8%, tiipng dupng vfli frfin 15 tripu ngupi khflng cfl vific ldm.
Nhieu cflng ty vd tap dodn cho ring suy thoai kinh tfi se frim ttpng va cfln keo ddi nfin da sflm Ifin kfi hoach cit gidm san lupng Ipn frpng nam 2009 dfi gidm chi phi va ban che thua lo. Trong sfl hon 15 trieu ngufli that nghifip nfli frfin, sfl ngufli thit nghifip tiifli gian dai (frfin 27 thdng) Id 6,3 trifiu ngufli, chifim gin 42% tong sp ngufli thit nghifip.
Ngoai CPU sfl fren 15 frieu nguoi tiiit nghi$p chinh thiic nay, ce toi 9 tiifiu ngufli dupc cpi la "that nghifip in", la nhung ngucri dang ldm viec ban tiioi gian dfi co thu nhap freng thoi ky suy thoai nhung mong muon tim vific ldm todn thoi gian vd on dinh. Nfiu tinh ca nhiing nguoi ndy thi con so thdt nghifp se la 24 tiipu nguai frong nam 2010.
Bao cdo cita BO I-ao dflng My chp biet.
CHAU MY NGAY NAY 27 lao dflng mit vific chii yfiu tap trung
frong linh vuc sdn xuit, chfi tap, xay dung (do su sut gidm cdc giao dich bit dpng san), tifip dfin Id ITnh vuc dich vu va ban Ifi. Trpng cdc ngdnh, chi duy nhit ITnh vuc y tfi van cfl nhu ciu vfi nhan cflng. Mpt sfl ngufli may min hon khi khflng bi sa thdi nhung lai bi gidm gifl lao dpng. Trong thdng 12 nam 2008, sfl gifl ldm vific ttong tuan tmng binh cita ngufli lao dpng My giam 0,2 gifl xuflng con 33,3 gifl, miic thdp nhdt kfi tir khi chi sfl ndy ra dfli nam 1964^.
Thep Van phong Ngan sdch Quflc hfli My (Congressional Budget Office CBO), ty lfi thit nghiep tang 3,5 diem phan ttam ttpng 4 nam vira qua Id do 4 nguyen nhan sau^:
Thli nhdt, cdu vfi hdng hod va dich vu thip. Nhiing thay dfli frong sdn lupng hdng hpd vd dich vu ciia nen kinh tfi gan chat voi nhung thay dfli frong vific sir dung luc lupng lao dpng cita nfin kinh tfi. Difiu ndy khflng cfl gi ddng ngac nhifin khi cac dpanh nghifip sdn xudt it hang hpd vd dich vu hon, hp sa thdi bflt cflng nhan vd sfl ngufli that nghifip tang.
CBO uflc tinh mirc ciu thip dp suy thoai vd tang tmflng cham se tifip tuc keo ddi dfin nam 2017 do mot sfl yfiu tfl nhu: chi tifiu hfl gia dinh giam, that chat tin dung, tam ly bi quan vfi thi tmflng lap dpng vd quyfit dinh tti hpan kfit hpn cita ngufli My.
Thi hat, co cau nganh nghfi vd vimg khflng phii hpp. Dp Id that nghifip khi cc su thay dfli frpng ca cdu kinh tfi khifin
cho mpt sfl ngdnh nghfi bi thu hep frpng khi mpt sfl khac lai mfl rpng. Dfi cfl thfi chuyfin lap dpng tir nganh nay sang nganh khdc, can phai cfl thfli gian de ddp tap lai nhan luc chp phii hpp vfli cflng vific mfli. Thfim vdo dfl, su mit cdn dfli giiia dao tao va nhu ciu hip thu thuc tfi ciia cac doanh nghifip khifin cho cimg va ciu lao dflng fl mpt sfl nganh mit cdn bing. Thep CBO, nguyfin nhan nay chifim 0,5 difim phan fram ciia vific gia tang ty lfi thit nghifip frpng va sau khiing hpang. Tac dpng nay se giam din ttong 5 nam tfli khi nguoi Iao dflng hpc dupc cac ky nang mfli vd chuyfin sang cac khu vuc, ngdnh nghe cfl mirc tang traflng nhanh hon dfi tan dung nhirng eo hpi mfli.
Thli ba, cac chuong trinh Bdo hifim Thit nghifip (BHTN). My la mpt frpng nhung quoc gia cfl nhieu Ipai hinh bdo hifim that nghifip nhat frfin thfi gioi, tieu bieu voi bay loai hinh gflm'': bdo hiem that jighifip frfin difin rpng, bdp hifim that nghifip ddnh chp nhdn vifin Ufin bang, bdp hifim thit nghiep danh chp cuu quan nhdn, bdo hiem thit nghiep cho cdc khu vuc cfl ty le thit nghiep cap, bdp hiem that nghiep dp thifin tai, bao hifim thit nghifip dp tac dpng cua thupng mai vd bdo hifim that nghifip cho nhiing nguoi tu tfl chirc cdc boat dpng kinh doanh.
Mue dich chinh cila bao hifim thit nghifip tai My Id hfl frp cho nhiing nguoi lap dpng dang ttpng tinh ttang bi thit nghifip tam thai hpac ttpng thai ki khimg hoang kinh tfi mpt khaan tai
28 CHAU MY NGAY NAY chinh de dam bdo on dinh cuflc song
ttong thoi gian mat viec vd som tim dupc mpt vific lam mci thich hpp. Tuy nhifin, vfli sfl lupng Ifln cac hinh thirc nfli ttfin, bfin canh tdc dung ho ttp ngufli lap dflng hi mit vific ldm, BHTN My ciing gflp phan ldm tang so ngufli that nghifip khi khflng khuyfin khich ngufli lao dflng tich cue tim kifim vific ldm vd chap nhan nhung vific lam tam thoi frong thfli gian ngin.
Thit lu, dinh kifin vd ky nang. Day dupc xem Id hai yfiu tfl gflp phan ldm tang ty lfi that nghifip dp nha tuyfin dung lufln cfl tam ly xem nhirng nguoi thdt nghifip frong thoi gian ddi Id nhirng nguoi khflng cfl nang luc. Bfin canh dfl, thuc tfi ciing cho thay thdt nghifip frong thoi gian ddi cfln Iam hao mfln cdc ky nang nghifip vu cua ngufli lao dflng khifin hp khfl tim lai dupc nhimg vific lam phii hpp dfi thich nghi vfli difiu kifin mfli.
2. Bao hifim y te (BHYT) Cupc khiing hodng kmh tfi da cfl dnh huong sau sdc dfin cdc gia duih ttfin khdp nuflc My. Hang tiifiu ngufli mit vifie lam vd mfli thang ttfli qua, con sfl nay Iai ngdy mpt gia tang. Doi vfli nhifiu ngufli, mit vific lam cOng dong nghia vfli mit bdo hifim y tfi. Cit danh kep nay da giang mpt dfln nang vdp an mnh kinh tfi cua cdc gia dmh My bfli hp diing tiuflc nguy co se phdi tu gdnh chiu mpt khpdn chi phi y tfi rat cao neu co vin de ve sire khoe.
Tam quan ttpng cua viec lam va BHYT ttong dfli sflng xa hpi My dupc
thfi hifin qua chfi dp cham sflc sHc khfle hifin nay ciia My dufli 4 hinh thiic sau^
(1) cdc chii su duttg lao dpng nha nuflc hay tu nhan ttd mpt phan tien bdo hiem y tfi cho nhan vifin cua minh va gia dmh hp; (2) nhung ngufli ttfin 65 tuoi hpac ngufli khuyet tat dupc chinh phu lien bang hfl frp qua chuong trinh Medicare';
(3) nhiing nguoi cfl miic luong thip, cac bd me ngheo cfl con nhfl dupc tdi ttp qua chuong ttinh Medicaid cua chinh phii tifiu bang'; (4) nhiing nguoi ldm nghfi tu do tu mua bdo hifim; va cfln lai Id nhimg ngufli khflng cfl bdo hifim.
Trong sfl 318 trifiUjdan My, 150 tiifiu ngufli dupc bdo hifim qua co sfl lam vific, 55 trifiu ngufli cao nien va ngufli tdn tat cfl Medicare, 40 tiifiu ngufli efl Medicaid vd 15 tiifiu nguoi hdnh nghfi tu do tu mua bdo hifim, eon Iai la nhung ngufli khflng cfl bdo hifim. Trong sfl nhiing ngufli My khflng cfl BHYT, 80% la nhung nguoi ldm vific bdn thfli gian hoac ldm todn thai gian cho cdc ca sfl nhfl khflng cfl khd nang mua bdo hiem cho nhdn vifin. 20%
so cfln lai thupe thdnh phin tte ttong dp tufli tir 25 den 30 cfl kha nang mua bdo hifim nhung khflng mua vi tin vdo siic khfle ciia minh*. Tuy nhifin, chfi dp bdp hiem y tfi My da gap ba vin dfi len la: (1) chi phi rit cap va tang nhanh fliee tiioi gian; (2) khflng hieu qud; vd (3) tiianh phan dan sfl My khong cfl bao hifim y tfi Id qua Ifln.
LTu diem ciia chuong tiinh mua BHYT qua noi lam vific Id chi phi tiiip do chu lao dpng dupc gidm gid khi mua
CHAU MY NGAY NAY
nhifiu bdo hifim cimg luc va ngufli lap dflng dupc bdp hifim frong mpi tmflng hpp, kg ca khi da ofl benh. Ngupc lai, doi vfli cdc chuang trinh bdp hifim cd nhan tu mua, cdc cflng ty bap hifim se lay miic phi cao hon, yfiu cau khdm sire khofi vd tham chi tir choi ban bdo hiem neu cd nhan dfl da mac mpt so bfinh'.
Trong nam 2009, cdc chu lao dpng My chi frd tnmg binh khodng 83% phi bdo hifim y tfi cho cd nhan vd 73% phi bdo hifim y tfi cho gia dinh hp'°. Dp dfl, chfi dp BHTY qua npi ldm vific thuc su lam gidm nhp gdnh nang tai ehinh frong vific cham sflc sire khfle cd nhdn vd siic khoe gia dinh ngufli lao dflng My.
Khung hodng kinh tfi da ddy hang trifiu ngufli My cfl BHYT tai noi ldm vific dfin nguy ca nil rp vfi y tfi. Mac dii mang lufli cdc chupng trinh bdp hifim y tfi cflng nhu Medicaid vd CHIP (Chuang trinh Bdo hifim Y tfi Tre em)" ciu frd bdo hifim chp mpt sfl nguoi hi mat bdo hifim qua noi ldm, nhung quy dinh hifin hanh chi gifli han chi ttd bdo hifim dua ttfin thu nhap vd hodn cdnh gia dinh.
Medicaid vd CHIP thuc su la mang luoi an sinh hifiu qua cho tte em frong giai doan nay nhung lai khong may hifiu qud cho nguoi lao dpng'^. Mpt sfl ngufli tim dfin vfli chuong tiinh COBRA*' khi bi mit vific lam vfli hy vpng dupc hfl ttp dfi tiep tuc mua bdp hifim y tfi qua nai ldm thfim mpt thfli gian. Tuy nhifin, khflng phdi ai ciing dii difiu kifin dfi tham gia''' COBRA vd phi bdo hifim van con rdt cao dii da dupc COBRA ttp cip. Chang
han, vfli fra cip COBRA, mpt gia dinh vin phdi frd gin 400 USD phi bdo hifim mfli thdng'' Difiu ndy cfl nghia Id chi rifing phi bao hifim y tfi da chifim hon 30% tien bao hifim thit nghifip hang thdng cua gia dinh"
Nhirng ngufli khflng dii tifiu chuan tham gia COBRA hoac khflng efl khd nang tifip tuc mua bdo hifim qua nai ldm phdi diing tmflc quyfit dinh khfl khan, hoac phdi tu frd chi phi bao hiem y tfi cao, hoac hoan todn khflng cfl bdo hifim y tfi. Mpt sfl ngufli cfl ging mua bdo hifim y tfi frfin thi traflng tu nhan, nhung hdu hfit hp dfiu khpng tim duac nhiing chuong trinh cfl kha nang chi tta.
Mpt nghifin ciiu gan day cho thay cii 3 frong 4 ngufli (73%) tim kifim mua bdo hifim tu do bfin ngodi dfiu khong thfi mua dupc frong 3 nam qua do phi bdp hiem qua c a e " va da sfl hp chap nhan khflng cfl bao hifim. Dfli vfli nhung ngufli My bi mit vific lam va thu nhap, mit bap hifim y tfi thue su la mpt tai hpa cd vfi mat thfi chdt ldn tdi chinh. Hp se khong dupc cham sflc siic khpe khi can vd tifip den, vifie tri hoan tim kifim cac dich vu y tfi ttpng thfli gian ddi tpi da se khifin tinh frang sue khpe eiia hp ngay mpt tpi tfi hpn, ddn dfin phd sdn nfiu efl benh nang vi khflng chiu nfli cac ehi phi chflng ehdt dfi difiu tri bfinh"
3. Giao due
Cupc khung hoang tdi chinh bit diu nam 2007 da tac dflng manh den nfin giao due My. Bdo cap tiidng 9/2012 cua
30 CHAU MY NGAY NAY Trang tdm Uu tifin Chinh sach vd Ngan
sdch cho tiiiy hi nam 2008 dfin thfli difim ra bdc cdo da cfl 35 bang a My cit giam ngdn sdch giao due". Ci My hifin nay, tifin hpc phi tai cdc traflng dai hpc da tang dfin miic chflng mat, cao gdp ba lan gld hang hfla ngodi thi tmong. Hfi qua cda vific tang hoc phi chflng mat Id cac sinh vifin phdi gdnh thfim np mdi cfl thfi ttang ttai tifin hpc dfi tifip tuc ngfli frfin ghfi nhd tmflng. Hang trieu hp gia dinh My cfl con em hpc dai hpc dang Id nhihig ccn np ctia chinh phu. Hdu hfit cdc hpc sinh sau khi tct nghifip tnmg hpc, mupn hpc tifip Ifin dai hpc ma khflng du kha nang tai chinh cfl the ldm don xin vay tifin cua chinh phii dufli su bao lanh ciia bfl me. Cdc khodn vay ndy se ddo han khi sinh vien tot nghifip vd bat dau di ldm.
Khflng giflng cdc dang "hfl tta tdi chmh" (financial aid) nhu hpe bflng chinh phli hpac hpe beng ciia cdc tfl chirc, ca nhan, cdc khpdn vay na dfi hpc dai hpc ciia sinh vifin phdi dupc thanh tpan kem lai. Treng khi tai hiu hfit cdc nuoc phdt tiifin, gido due dai hpc gin nhu mifin phi, hoac dupc bao cip phin Idn thflng qua dpanh dm til thue thi fl My, chi phi hpc dai hpc khflng dupc bap cip hay ho frp, sinh vifin va gia dmh hp phdi tu ttang ttdi. Hpc dai hpc fl My dupc xem nhu mpt cupc diu tu nhifiu hon vd kfit qud la sinh vifin My thuflng tot nghifip vdi mpt khoan np ldn. Nhifiu tiirflng dai hpc hiyen smh vifin ma khflng yfiu ciu chimg muih tdi chinh
xem lieu sinh vien cfl thfi ttd dupc hpc phi hdng nam thep quy dinh hay khflng.
Thay vdo dfl, nhiing traong ndy lai gidi thifiu sinh vifin tfli nhiing noi cfl the vay mupn de ttang frdi chi phi hpc. Tinh frang nay da dan dfin mpt xu hudng ngay cdng gia tang Id. sinh vifin frfl nfin thieu tu tin va chpn nhung traflng cfl miic hpc phi thap hoac phai bfl hpc giiia chimg. Chi khoang hem mot nira sinh vifin dai hpc tai My hoan thdnh chuong trinh hpc vd nhan dupc chimg ehi. Ty lfi tflt nghifip ngay cdng it di, rit nhifiu sinh vifin se khflng cfl du bing cdp, chuyfin mfln dfi dam nhdn cflng vific sau khi da buflc chdn vdp cflng tmflng dai hpc.
Hdu qud cua cuflc khimg hodng tdi chmh 2007-2009 khifin nhifiu suih vifin khflng thfi kifim nfli vific lam dfi tta np chp chmh phu. Dfin cuoi nam 2012, tong SP tien np dfin ban nhung chua thfi thanh tpan cua cdc sinh vien My da Ifin tfli hon 1.000 ty USD"". SUih vifin ra tiirong rat khfl kiem vific ldm cfln cha mp hp hoac bi mat vific ldm, hoac Ufin tuc bi giam luong din dfin he qua Id vifie ttd np chinh phu cdng ttfl nfin khfl khan. Thflng ke cho bifit, cfl it nhat 68% so sinh vifin My da tflt nghifip ra tiuflng hifin dang np tifin hpc phi va tiimg binh mfli ngufli np khodng 27.000 USD. Nam 1989, ccn so nay chi la khoang 10.000 USD. Dfli vdi hai ngdnh tfln kem nhit Id y khoa vd kinh tfi, khodng 10% sfl sinh vien ra tiirong ciing vfli khodn np Ifin tdi 62.000 USD^'
Nam 2012, mpt sfl phpng frap phdn dfli ehinh phu cua sinh vifin da nfl ra fl
CHAU MY NGAY NAY
My. Cdc smh vifin kfiu gpi chinh phu xda np cho nhung ngudi vay tifin dfi hpc dai hoc thay vi chi nhung khoan ciiu frp tri gia nhifiu nghin ty dfi cim edc ngan hang sap phd sdn. Tinh frang np nin luin quan ndy se khifin tifiu dimg hi cat gidm manh va gflp phdn khifin nfin kinh tfi ngdy mpt hi frfi hon. Trafle thuc frang dfl, nhifiu ngufli tuy da kifim dupc vific ldm nhung dp lupng thip va np nan dep ding nfin hp da quyet dinh bfl vific dfi di hpc tifip nham tipn np. Nhiing ngufli nay hy vpng kfii hp di hpc tifip, chinh pljii se khflng dfli np qua git gap, dflng thfli khi cfl trinh dp cap hpn h « e kifim dupe mpt viec ldm tot hpn frpng tupng lai
Hifip hpi tpan quflc cdc ludt su vfi pha sdn vd vo np cua ngufli tifiu diing (NACBA) che bifit sfl lupng sinh vifin My npp don xin bdo Ianh vo np frpng vdi nam qua da vd dang gia tang vfli toe dp ddng bdp dpng, khflng it sinh vifin ra traflng dfin tupi 60 van chua frd hfit np.
Khodn np khflng lo ciia sinh vifin cung dupc xem Id nguy hifim khong kem khodn vay thfi chap dudi chuan da day nude My roi vdo eupc khimg hpdng tai chinh frim ttpng ndy^'
4. Tinh trang vo gia cu
Thit nghifip con ldm thay dfli difiu kifin sflng va sinh boat cita hdng nghin nguoi My. Dfli vfli nhifiu ngufli, that nghiep cung dflng nghia vfli vipc hp cd thfi ttfl thdnh nhirng nguoi vfl gia cu.
Ldn sflng tich bifin nhd sifit np tifip difin tai cdc thdnh phfl ciia My da khifin
nhifiu ngufli mat nha va nhifiu ngufli thufi nha ttfl thdnh vo gia eu. Duong phfl diy riy nhung can nhd dung tam bp, nhting tiip Ifiu chat nlch phu nu vd tte con. Trong khoang thfli gian tir 1/10/2007 tfli 30/9/2008, cfl khodng 1,6 trifiu ngudi My vfl gia cu su dung cac Ifiu tam hay nhd tam thoi lam nai ttii ngu. Ty lfi ndy tuang duong vfli sfl ngufli vfl gia cu ciia nam trudc dd, nhung nfiu tinh vfi sfl lupng cde gia dinh v6 gia cu thi con sfl frfin tang 9%, tii 473.000 gia dinh Ifin 517.000 gia dinh. Dac bifit, frong nam 2008, sfl gia dinh nguoi My vfl gia cu fl cdc vimg ngoai fl vd nong thon tang 24% so vdi cimg ky nam trade. Theo danh gid cua Co quan Phdt frifin Dfl thi vd Nhd fl My (HUD), sfl lupng nhd bi sifit np se cfln tang bfli ngay cdng nhifiu ngufli khflng thfi frd cdc khpdn vay mua nhd dao han do mdt vific lam^''
Thanh phan tham gia vdo ty lfi nguoi vfl gia cu ttong giai doan khiing hodng kinh te ciing thay doi so vfli tnidc. Trfin khip nudc My, hang chuc nghin ngufli fre tufli that nghifip du da hoan thdnh tin chi dai hpc hpac cfl kinh nghifim Iam vific. Nhflm ngufli 18 dfin 24 tufli dupc xem Id thdnh vifin mfli gia nhap vdo luc lupng vfl gia cu fl My. Cfl nguoi chpn cdch quay vfi song cimg cha me, mpt s6 khdc khflng cfl lua chpn khi ehinh cha me hp eiing phai ganh chiu nhiing anh huflng nang nfi cua nfin kinh tfi hipn tai.
Ty lfi that nghifip va sp lupng ngufli frfi tufli khong cfl khd nang hpc dai hpc
CHAU MY NGAY NAY ciing la mpt yfiu to khifin lupng ngupi
vp gia cu tang Ifin dang kfi ttong itiiflm tufli 18-24. Tat cd dfiu phdi vat Ipn de tim npi td tiie frpng giai doan suy thodi kinh tfi. Dfli vdi nhdm ngiroi vfl gia cu Id cuu chifin binh timg tham gia cac cupc chifin ttanh ciia My vfli nudc ngodi thi hinh anh quen thupc cua hp van la ngii qua dfim dudi gam cau hay ngay tten cdc duflng phfl. Hp phdi lang thang khap nai tim kifim vific lam nhung gdn nhu vc vpng ttong thai khimg hodng kinh te.
Kfit qud mpt cupc difiu tta cho thiy nam 2012, so ngudi vfl gia cu vd thifiu ddi dang tang Ifin nhanh chdng tai cac thdnh phfl ldn ciia My ttong boi ednh ty Ifi that nghifip vdn fl miic cao. Cupc difiu tta tai 25 thdnh pho ldn do Hpi nghi Thi tmflng My thuc hifin chp thiy so ngufli rai vdo tinh cdnh khflng nhd cua phdi xin Cliu tto da tang 7% so vfli nam 2011.
Trong khi dfl, 30% sfl nguoi vfl gia cu bi mac cdc bfinh vfi tam thin, 18% la ngudi khuyet tdt, 16% la nan nhdn cua bao hanh gia dmh, 13% Id cuu chien binh va 4% Id ngufli nhifim HIV/AIDS"
Theo ket ludn cua co quan tien hdnh difiu tta, thit nghifip, ngheo dfli, gid nhd cao, tinh frang tich bifin nha sifit np va nan bao hdnh gia dinh Id nhung nguyfin nhan hdng dau khifin sfl ngufli vfl gia cu tai My tang cao. Bfin canh dfl, kfit qud dieu tta cung eho fliiy tai hiu hfit edc thdnh phfl tham gia cupc difiu fra ndi tten, sfl lupng nguoi lin diu tifin xin Cliu frp Iupng thuc ciing gia tang.
S. Tinh tr^ng b i t on tam ly Khiing hpdng kinh te cfl thfi din din khimg hpdng cd nhan doi vfli nhitng ngufli bi mit vific lam, dac biet vfli nhung ngufli dupc coi Id tra ept gia dinh. That nghifip khifin hp mit cdu triic vfi thoi gian (khflng thee gifl lam vifie nhu tmflc), mat ciu tnic vfi lpi ich (khpng cfl lutmg vd cac che dp uu dai di kem) va mat cau true ve xa hfli (khong Ufin hfi vfli dflng nghifip). Nhiing yfiu to nay lam gia tang miic dp frim cdm d nhung ngufli cMu dnh huflng nang nfi tii khiing hodng kinh tfi vd J i n dfin su gia tang ty lfi tu tu ttong thoiTcy ndy^'
Khung hodng kinh te keo theo gidm thu nhdp, mit vific ldm, ciing voi mpt hrong lai bat dinh la nhiing nhan tfl Iam ban eung hfla va dfl va gia dinh, din den cdc hanh vi cfl khd nang tao ra hpac thuc day cdc bfinh tam thin nhu ttim cdm, nghifin raau va tu til. Khuynh huong ndy hifiu hifin ro net fl ddn flng vd ph\i nil da ttdng ttong nhom tuoi tir 35-64, chifim 64% cdc vu tu til fl My. Trong khi dfl ty Ifi vin khong dfli noi nhdm tufli tie va gia hon. Thay dfli cung khong dang kfi doi vdi nhflm trung nien da den, Hispanic vd hdu hfit cde sic ddn vd chiing tflc khac.
Theo Trang tam vfi Kifim sodt vd Phflng ngua benh tat (CDC), nguyfin nhan din den su gia tang cdc vu tu tii ttong nhflm tufli nay bao gflm: (1) khung hodng kinh tfi khifin nguoi da tting bi chdn thuong tam ly nhifiu han vi hp khflng cd dupe su hfl ttp cua nhd tho va
CHAU MY NGAY NAY
ba can than thupc nhu nhflm ngufli da den vd Hispanic; (2) tinh ttang kinh tfi suy thoai keo ddi tir cufli nam 2007 cho dfin giiia 2009 vdi thi traflng vific lam qud yfiu, tlu fruong nha cira bap bfinh da dfln nhirng ngufli vfln dang gap khfl khan vdo buflc duflng ciing; (3) thfi he
"baby - boomer^'" vfln mang sdn miic khiing hodng tinh than cao nay gap phdi nhifiu vin dfi vfi sue khoe tdm thin hon do khimg hodng kinh tfi; (4) do vific bdn vd lam dung thuflc gidm dau tang manh frong thap nifin qua^'
Miic tu tu cua gidi trang nifin My da nhdy vpt tir hdng thir tdm frong cdc nguyfin nhan tu vong Ifin hang thir tu, chi sau cdc bfinh ung thu, tim vd tai nan.
Tu til bang cdch dimg thuflc qua lieu frfl thdnh nguyen nhdn cao hdng thir hai, sau Sling dan. Trong nam 2010, My cfl hon 38.364 nguoi chfit vi tu til frong khi cfl 33.687 ngufli chfit vi tai nan giao thflng.
Tir tli thuong dupc xem Id van de cita dfli tupng thanh thifiu nifin vd ngufli gia.
D P vdy, su gia tang dpt bifin ty lfi tu til fl dp tufli trang nifin tai My frpng thfli ky khiing hpdng Id mflt diu hieu dang ehu y. Til nam 1999 den nam 2010, ty lfi tu tii frpng dp tufli 35 den 64 da tang gdn 30%, tii miic 13,7 ngufli tu til/1000 ngufli Ifin miic 17,6 nguci tu tir/1000 ngufli. Mac du ty lfi tu hi dfiu tang fl nil gidi vd nam gidi tufli trung nifin, nhung ty Ifi d nam gidi cao hon gdp hon 3 ldn so vdi nil gifli. Sfl heu cho thay, cii 100.000 nam gidi flu cd 27,3 ngufli tu tir, frong khi fl nii gifli con sfl ndy Id
8,1/100.000 ngufli. Su gia tang ro rdng nhit Id nhdm nam gifli frong dp tuoi 50 dfin 59. Ty lfi tu hi d nhflm nay chifim gdn 50%, tuong duong vfli 30 ngufli tu tu/100.000 nam gidi. d nu gifli, ty lfi tu til cao nhat fl nhflm 60 dfin 64 tufli, chifim gin 60%, tuong duong 7 ngufli tu tii/100.000 nu gifli^'
Trong va sau cuflc khiing hodng tdi chinh 2007-2009, con sfl bfinh nhdn mac bfinh tdm than tang vpt, nhdt la bfinh fram cdm, dart dfin nhu cau ve dich vu cham sec siie khcfi tam thin cung tang thep. Tuy nhifin, hp thflng chdm sdc siic khpe tdm thdn cua My Id mpt hfi thflng da tifiu tfln nhifiu ty dflla My nhung van khpng dil cung ling (Uch vu chp nhung ngufli cin nfl. Nam 2011, Hoa Ky da chi 113 ty USD frong vific difiu tti bfinh tam than. Con sfl ndy chi vdp khpdng 5,6%
sfl tifin chi cho dich vu cham sflc sire khoe todn qu6c'°
Cham sflc sire khofi tdm thin Id vin dfi khfl khan hon so vfli tit ca cdc loai eham sdc y tfi khde. Thflng kfi cua Bp Lap dpng My uflc lupng ttong nam 2010 nudc My efl khodng 156.300 ngufli cfl van vfi siic khoe tam thin, frpng dd cd tdi 89,3 frieu ngufli My sflng frong nhiing khu vuc thieu bac sT tam than, 55,3 trifiu ngufli song ttong vimg thifiu bdc si gia dinh vd 44,6 tripu ngufli sflng ttong khu vuc thifiu nha si"
Chi phi cham sflc siie khofi tam thin ciing rat cao. Theo mpt nghifin cim can Cli vdp nhiing dieh vii eung cap tir nam 2005 tfli 2009 tiii 20% ttpng sfl 15,7
s o 09-2014 CHAU MY NGAY NAY trifiu ngufli My nhan cham sflc dieh vu
tam thin vin Id ngufli chi tta chinh cho cdc dich vu Phin Itrii nhiing nguoi chira ttl ngoai khpa phdi ttd flifim tir 100 dfin 5.000 USD. Ben canh dfl, fliai dp dfli vfli dich vu cham sflc sire khoe tam than cung khien viec cham sflc gap ttfl ngai Ifln. v i n dfi cdt giam ngan quy y tfi cung dnh huflng den vific cham sflc siic khoe tam thin. Theo mpt bdo cdo cua National Alliance Mental Health nam 2011, chinh phu da cdt 1,6 ty USD tii nam 2009 dfin nam 2012. Dieu ndy se khifin he fliong cham sflc y tfi ttong tuong lai phdi dfli mat vfli thu thach cdi tfl va xay dung mpt chfi dp cham sflc sue khoe tam than hifiu qua vdi mflt chufli nhung dich vu y tfi doi hfli tifin bac, cong sue va thfli gian'^
Ket luan
Khiing hoang tdi chinh 2007-2009 fl My da gdy nfin tinh ttang that nghifip cao, keo dai vd ddn dfin nhihig hau qua ddng bufln frong cdc vdn dfi xd hpi. Dfi khac phuc cupc khung hcdng, kich thich nfin kinh te phuc hfli vd tang truflng, Chinh phit My da ba ldn dua ra cdc gfli kich thich kinh tfi vfli sfl tifin Ifin dfin hang ty dflla, cu thfi:
Ngay 13/2/2008, Tflng fliong George W. Bush da ky Ludt kich thich Kinh te {Economic Stimulus Act of 2008), theo dfl Chinh phu My se dp dung mpt chuong trinh kich cdu tflng hpp tti gid 168 ty USD chti yfiu dufli hinh thiic hodn thufi thu nhdp ca nhdn''
Ngay 3/10 2008, Tong thong Bush da ky Luat fln dinh Kinh te Khin cip {Emergency Economic Stabilization Act of 2008), cho phep fliuc hifin gfli kich fliich 700 ty USD'"
Ngdy 17 thdng 2 nam 2009, Tflng thflng Barack Obama da ky Luat Tai diu tu va Phuc hfli nuflc My {American Recovery and Reinvestment Act). Dao ludt nay cho phep Chinh phu thuc hien gfli kich thich Oi gid 787 ty USD''
Tir tiirde dfin nay, nhirng dinh chfi tai chinh eiia nudc My bi ddnh gid Id chi mang lai lpi ich che ngufli gidu va day gdnh nang thue sang nhiing ngufli thupc tang ldp trang luu vd ngheo khfl. Nhir vdy, Ifl hflng Xim nhdt cita ehinh sach kinh te vT mfl cua My la khflng tinh toan diy dli dfin vdn dfi an sinh xa hpi, den dfli spng ciia cdc ting ldp ddn cu. Thuc tfi nay da khifin chinh quyfin Tflng thong Obama thiy cin thifit phdi tang cuong cdc bifin phdp vd chinh sdch an sinh xa hpi. Ong ciing dfi xuit tang thufi doi voi ngufli giau nhdm dam bdo nhiing tiifiu phu eiing se dflng mpt mirc thufi toi thifiu bdng vfli tdng lap tnmg luu. Tuy nhifin, cdc nha nghifin ciiu vd da sfl cong ehung My dfiu cho ring, dfi gidm dupc khpdng each giau nghep vd bdt buih ddng xa hpi thi viec tang thufi thu nhap cita gidi idid gidu My la chua du va chinh quyfin My can dp thufi ddnh ti^c tifip len tai sdn cua gidi nhd gidu. Phong ttao bifiu tinh phfl Wall tai My nam 2011 chinh la hfli chuong cdnh tinh nha lanh dao cae nudc ring chinh sdch kinh
CHAU MY NGAY NAY 35 te phai gan vdi an sinh xa hdi, phat trien
kinh te phai gan vdi cdng bang xa hdi.
Su phan hoa giau ngheo, phan ting xa hgi qua miic se dua lai nhung hau qua khdnludng •
Chu thich:
1 Linda Levine January 24, 2013. The Increase in Unemployment Since 2007. Is It Cyclical or Structural? Congressional Research Service 7-5700 www.crs.gov R41785.
2. Calculated by Congressional Research Service (CRS) from the U S Bureau of Labor Statistics' (BLS) Current Employ- ment Statistics (CES) program National data from the CES program are available at http,//stats, bis .go v/ces/.
3. Congressional Budget Office (CBO) Stydy.
Feb 2012. Understanding and Responding to Persistently High Unemployment, www,cbo.
gov/publication/42989
4. http://workforcesecurity doleta gov/unem ploy/uifactsheet asp
5 Kim Bailey, Zee Bendixen, Kathleen StoU One-Two Punch: Unemployed and Unin sured © Oct 2009 by Families USA. This publication is available online at www. familiesusa.org
6. Medicare la chucmg trinh bao hiem siic khoe quoc gia danh cho ngudi tir 65 luoi trd len.
Ngoai ra, mot so nguai chua tcfi 65 tuoi cung du tieu chuan hudng Medicare nhu ngudi bi tan tat Chuang trinh Medicare giiip tra mot phan chi phi y te hay chi phi cham soc dai han 7. Medicaid la loai bao hiem y te thupc cap tieu
bang Vai loai BHYT nay benh nhan khong phai chl tra bat cir le phi nao tii phi benh vien, tham bac sT den thuoc men. Nhung ngucri co luang thap hoac khong co viec Iam, khong the mua bdo hiem y te tu nhan cho minh va cho gia dinh deu co the npp dan
8 Xem chii thich 6
9, Kaiser Family Foundation, How Pnvate Health Coverage Works: A Pnmer, 2008 Update (Washington Kaiser Family Foundation, April 2008).
10, Kaiser Family Foundation/HRET, Employer Health Benefits: 2009 Annual Survey
(Washmgton: Kaiser Family Foundation, September 2009).
II. Chinh phli My l?ip ra chucmg trinh CHIP nam 1997 giiip tre em tir 0 - 19 tuoi trong cac gia dinh co thu nhap cao han miic duac xin huang Medicaid nhung lai khong dii tien de mua BHYT tu nhan.
12 John Holahan and A. Bowen Garrett, Rising Unemployment, Medicaid, & the Uninsured (Washington: Kaiser Family Foundation, January 2009)
13. Dao luat Consolidated Omnibus Budget Reconciliation Act (COBRA) duac ban hanh nam 1986, de nhiing nhan vien, hay cac thanh vien gia dinh ho dang co bao hiem qua noi lam cua hp c6 the tiep tuc mua bao hiem them mpt thai gian, neu nhiing nguai nay bi mat bao hiem vi nhiing ly do dupc chip thuan, chang han khi nhan vien bi mat viec hay ve huu, hoac trong truang hpp nhan vien ly di thi nguai vp hay chong cu van dupc tiep tuc mua bao hiem qua chuang trinh COBRA nay,
14. Nhiing nguai dupc hucmg quyen lpi COBRA phai la vp chong hay con cai cua nhan vien truoc, ho&c ngay ngay xay ra bien CO lam cho ho mat bao hiem siic kho^. Tuy nhien, neu nhan vien c6 them con trong khi ho CO COBRA thi nhiing ngucri con nay ciing se duac huang quyen lpi ciia COBRA.
NhSn vien hay than nhan ciia hp phai mua bao hiem sue khoe cvia hang, va bao hiem nay van dang co hieu luc liic bien co xay ra lam hp mat bao hiem sue khoe, Ngoai ra, nhiing nhan vien dai dien cho hang (agent), inpedendent contractor, hay giam doc {director) ciia cong ty cung co the dupc mua bao hiem qua chuang trinh COBRA, 15. Families USA calculations based on premium
data from Kaiser Family Foundation/HRET, op. cit. The average femily premium for job- based coverage was $12,680 m 2008 and rose to $13,375 m 2009. Under COBRA, workers who continue coverage must pay the full premium plus a 2 percent administrative charge. The ARRA subsidy covers 65 percent ofthe 102 percent COBRA fee
16. Families USA calculations based on the average monthly imemployment insurance income of $1,278 for a femily See Cheryl Fish-Parcham and Claire McAndrew, Squeezed: C^aught between Unemployment
36 CHAU MY NGAY NAY Benefits and Health Care Costs (Washington:
Families USA, January 2009).
17 Michelle M Doty, Sarah R Collins, Jennifer L. Nicholson, and Sheila D. Rustgi, Failure to Protect. Why the Individual Insurance Market Is Not a Viable Option for Most U S. Famihes (New York: The Commonwealth Fund, July 2009).
18 Kaiser Commission on Medicaid and the Uninsured, The Uninsured. A Pnmer, Key Facts about Americans without Health Insurance (Washington: Kaiser Family Foundation, October 2008).
19. http://www.cbpp.org/cms/'fe=viewid= 4011 20. http://www,cbsnews com/news/student-loan
-debt-nears-l-trillion-is-it-the-newsubprime/
21. wwwfoxbusinesscom/personalfina nce/2012 /07/I l/bleak-future-68-grads-saddledwith- 40kin-debt-with-no-jobs-in-sight/
22 infonet vn/The-gioi/Sinh-vien-My-Nhung- con-no-khung-cua-chinh-phu/54196.info 23. http,//finance tvsi com vn/News/2012830/
216 871/kinh-te-my-no-sinh-vien-tang-gan- 4-lan-trong-thap-ky-qua.aspx
24. The U.S Department of Housing and Urban Development Office of Community Plan- ning and Development. Volume 1 of the 2012 Point-in-Time Annual Homeless Assessment Report
25. The United States Conference of Mayors.
Hunger and Homelessness survey. A Status Report on Hunger and Homelessness in America's Cities A25 - City Survey Dec 2012.
26. Ly thuyet ve t\r tir va suy thoai kinh te ciia Durkheim.
27. The he sinh ra trong thai gian biing no dan so My sau chien tranh, tir 1946-1964, 28. Centers for Diease Control and Prevention,
Suicide Among Adults Aged 35-64 Years - the US,, 1999-2010. WeekIy/Vol.62/No.l7 29. Xem chii thich 24
30 Tami L. Mark et al. Changes In US Spending On Mental Health And Substance Abuse Treatment, 1986-2005, And Implications For Policy http./Zcontent.healtli affairs.org/content/30/2/284 full 31. Sarah Kliff. Seven facts about America's
mental health-care system The Washington Post I7/I2/I2. http://viTvw.washingtonpost, com/blogs/wonkbIog/wp/2012/12/17/seven- facts-about-americas-mental-health-care- system/
32. Xem chii thich 29
33. The Huffington Post' "Rebate Checks in the Mail by Spring " http ://www, huffington postcom/2008/02/13/rebate-checks-in-the- mail_l n_86525 html?
34 www.cand.com.vn/vi-VN/quocte/ 2008/10/
100661 cand
35. The New York Times: "Signing Stimulus, Obama Doesn't Rule Out More".
http://www.nytimes,com/2009/02/I8/us/poli tics/l8web-stim.html?_r=I&hp
(Bdl viit cho Di tdl c6p Bo "-Diiu chinh chinh sach an sinh xa hdi cua My sau khung hoang 2008 ". Vien Han lam KHXH Viet Nam).
