楊志良：民粹當道 事理難明

[oldlarge]

http://www.appledaily.com.tw/realtimene ... 3%E6%98%8E

2014年01月02日11:52

台北市政府曾經積欠健保局「直轄市政府應負擔健保費」達400億以上，加上高雄市及其他縣市地方政府積欠的保費，總額共達600多億。因此只要一有選舉，所謂「馬市長欠馬總統健保費」以及「只要馬市長還健保費，健保財務即可解決」之說，不斷被有心人炒作，沒有人願意瞭解一下欠費的事理，再做評斷。

首先，地方政府積欠的保費，都由健保局（今改制為健保署）列為應收款，向銀行貸款支付醫療費用，並由欠費的地方政府支付利息。因此地方政府還款，只是還銀行借款而已，對健保財務並無任何助益。

再者，欠費發生的原因，是與政府補助各類被保險人健保費，以及營業稅的收取單位變動有關。因為，依照原健保法的規定，地方政府需補助企業受雇者10%的健保費，直轄市另需補助職業勞工40%、低收入者100%等多類被保險人保費。所以都會區政府，就需負擔甚多不在籍勞工的健保費(人在外地的工廠工作，如六輕，但公司設在北、高) 。例如台北市總人口不過260萬，卻要替260多萬勞工分擔健保費。營業稅由公司所在的地方政府收取但工廠卻在他地的情況下，此負擔不會有問題。但營業稅的收取卻十分不公平，營業稅由北高市政府收取，但卻把汙染留在其他縣市。因此自89年起，營業稅改由中央統籌收取，再依地方需要重新分配。但如此一來，北高市政府既收不到營業稅，又需補助不在籍受雇者健保費，也是不合理。因此地方議會就不同意編列預算，拒繳不在籍勞工政府需分擔的健保費，因為此項支出將排擠地方其他建設經費。根本解決之道就是改為全由中央補助，不再發生拒繳。

拒交的始作俑者是高雄，達155億以上，但追隨的台北市是大戶，積欠最多（400億以上）。健保局因積欠保費追討無門，只得向行政法院控告台北市等地方政府，第一審台北市勝訴，第二審敗訴。由於原告、被告都是政府部門，形同一場鬧劇，所以台北市就期望當時的行政院出面協調，不再上訴，但一直未果。健保局只得依法（但不合情理）向行政法院執行處申請扣押多處市有土地，而導致台北市府多項建設延緩。

我擔任署長後積極處理此事，一方面向行政院長請示，一方面多次拜訪台北市郝市長及主計長。然而各地方政府積欠款達600億，不論中央或地方財政，都無法一次提撥解決。過去的欠債仍需解決，協調結果由中央、地方負擔各半，台北市每年償還80億，分5年還清(2014年為最後一年，正好郝市長任期結束)，再由市長說服議會通過預算；高雄市反而拖拖拉拉，要到民國108年才能還完，在此謹預祝陳菊市長高票連任，以免夜長夢多。

台北市積欠健保費的來龍去脈，相關立委知之甚詳，但扁政府時期，行政院不但推拖不肯出面解決，而且大搞烏龍戰術，故意模糊真相騙取選票。到了馬政府時代，解決了此問題但罵名仍然不斷，而且只要一到選舉期間，此事便會成為「提票機」。反正誰叫馬總統政績不佳，多一項「相罵本」又何妨？還有人說，誰叫他要擔任總統？又有哪個政治人物敢去罵台北市議會這些地方「角頭」不通過預算？

不過此事罵藍不罵綠，藍也不用覺得委屈。藍軍在扁政府任內，逢扁必反，類似的事也是積案如山。民粹當道、媒體亂國、事理不明、內鬥內耗，但是又奈何？

[min]

羊嘴吐不出象牙。

[lsb1567]

胡亂放砲，事理難明

[Einstein]

健保局因積欠保費追討無門，只得向行政法院控告台北市等地方政府，第一審台北市勝訴，第二審敗訴。

大法官都釋憲了，台北硬是不還，無理的市長總會有歪理硬ㄠ，楊是在罵馬或郝嗎??高雄拒交??那為何只告台北市政府，若高雄不還，那應該連高雄市政府一起告才對！楊顛倒是非??還是瀆職不告高雄市政府(煎茶院應該介入調查，楊自己講得有瀆職之嫌，查查楊任內有沒有瀆職收賄不告高雄市政府)??跟陳菊那麼好??他就是他自己講的民粹當道，事理難明。黑的說成白的，白的說成黑的！自己寫的邏輯不通，自己就是自己講的最大民粹，老大您該看看自己寫的前言不對後語！

[image]

楊本來就欺善怕惡

高雄一開始就沒說要賴帳 展現還錢誠意 只是請多分幾期還 北市則是捍拒

有誠意本來就可以協商到比較好得還款條件

健保局因積欠保費追討無門，只得向行政法院控告台北市等地方政府，第一審台北市勝訴，第二審敗訴。

大法官都釋憲了，台北硬是不還，無理的市長總會有歪理硬ㄠ，楊是在罵馬或郝嗎??高雄拒交??那為何只告台北市政府，若高雄不還，那應該連高雄市政府一起告才對！楊顛倒是非??還是瀆職不告高雄市政府(煎茶院應該介入調查，楊自己講得有瀆職之嫌，查查楊任內有沒有瀆職收賄不告高雄市政府)??跟陳菊那麼好??他就是他自己講的民粹當道，事理難明。黑的說成白的，白的說成黑的！自己寫的邏輯不通，自己就是自己講的最大民粹，老大您該看看自己寫的前言不對後語！

[李誠民]

"是自己講的最大民粹，老大您該看看自己寫的前言不對後語"....!!!
當初就任衛生署長時,就開始已"辭官"要脅(?)政府,或德國人的掌聲(尤其是一批大公衛學者),引起許多台灣社會的磨擦與對立,這不是民粹?!...鬼相信!!!...安全下台,留了一堆爛攤子!!!.....再回去當教授!!!.....

與現在的行政院的財經小內閣--爺們 有甚麼不同!!!當政務官就搞一堆爛攤子,再學官兩棲,薪資與退休給付一點都不少,;這就是Bumbler的教授治國(Bumbler當完政務委員救回政大當教授,台灣教授是從石頭中蹦出來的?!),....台灣能翻身嗎?!.......台灣要走民主的路,就從不斷政黨輪替學起!!!.....

[李誠民]

"或德" 應為"獲得"筆誤!!
"大公衛學者"應為台大(?!)公衛學者---醫改會,督保盟(--藤西華?)等....

[ayok2001]

自己就是最大的民粹發電機，當官時沒作為，卸任後放砲一堆
這不是民粹，什麼才是民粹???

[newshine]

民粹

啐

[woodatwan]

有趣的點在：為甚麼蘋果會讓這人去寫專欄？有什麼難言之隱嗎？

[李誠民]

今天媒體有兩件大新聞(?!--美國紐約市長彭博下台,與科羅拉多州立法通過大麻合法化--年滿21歲就可在商店購買,而不需要醫師處方!!!).....關於大麻合法化,世界各先進國家,都是事先有管制的措施,再慢慢演進的(相似是醫療合法化,--醫療用途,再通過公民的公共議題, 甚至公投......;;個人先引用NEJM文章作為引子, 供討論!!!
Medicinal Use of Marijuana
N Engl J Med 2013; 368:866-868February 28, 2013DOI: 10
Case Vignette

Recommend the Medicinal Use of Marijuana
J. Michael Bostwick, M.D.
Within established doctor–patient relationships, I endorse thoughtful prescription of medicinal marijuana for patients in situations similar to Marilyn's. A largely anecdotal逸事趣聞 but growing literature supports its efficacy, particularly for pain or nausea that is unresponsive to mainstream treatments.1 In 1970, marijuana was designated a Schedule I drug under the Controlled Substances Act, a classification indicating a high potential for abuse and a lack of medical value.2 But physicians face a catch-22: although 18 states have legalized medicinal marijuana, physicians in those states who write prescriptions violate the law of the land.

Federal policy has failed to keep pace with recent scientific advances. Laboratory research has elucidated the far-flung endocannabinoid system that modulates neurotransmitter networks throughout the body through cannabinoid-1 (CB1) receptors that are preferentially distributed in the brain and cannabinoid-2 (CB2) receptors that are prominent in gut and immune tissues. Among dozens of cannabinoids in raw marijuana, two show medicinal promise. The first, Δ9-tetrahydrocannabinol (Δ9-THC), is the CB1 ligand that recreational users prize. The second, cannabidiol (CBD), acting on CB2, lacks psychoactivity but works synergistically with Δ9-THC to minimize “highs” and maximizeanalgesia.2,3

Arguments for and against medicinal marijuana are manifold. Under federal law, the drug is illegal. However, given widespread state defiance, the cannabis horse long ago burst from the federal jurisdictional barn. In Colorado, a handful of physicians write half the state's prescriptions for medicinal marijuana, for questionable indications.4 Just because a few rogue doctors flout lax legislation to abet pot-mill commerce, that doesn't justify depriving all physicians of the right to prescribe medicinal marijuana. No trials under the auspices of the Food and Drug Administration (FDA) have compared medicinal marijuana with traditional analgesics.5 Because of marijuana's Schedule I status, industry is thwarted 橫跨穿越阻饒in its attempts to develop compounds with endocannabinoid agonist or antagonist qualities that might have analgesic, appetite-modulatory, immunosuppressant, antiemetic, neuroleptic, or antineoplastic effects, among other possibilities.2 Some people may contend that dose determination by patients deviates from modern medical practice,3,6 but adjustment of medications by patients is ubiquitous普遍存在 in hospitals through patient-controlled analgesia pumps. Some people argue that as a drug of abuse, marijuana has no business being used for clinical purposes. Yet, several Schedule I drugs have close cousins with legitimate合法的 medical applications. Heroin and morphine derivatives have an illicit–licit kinship, as do “ecstasy入迷”迷幻狀態 (3,4-methylenedioxymethamphetamine) and stimulant drugs central to the treatment of attention deficit–hyperactivity disorder, as well as phencyclidine and ketamine, an anesthetic agent.2

Meanwhile, Marilyn seeks relief from the consequences of metastatic breast cancer. Neither acetaminophen nor oxycodone has proven to be effective against the serious pain of spinal and visceral metastases. Neither ondansetron nor prochlorperazine has relieved the nausea, which may have been induced by doxorubicin. More aggressive narcotics could be prescribed (risking the worsening of gastrointestinal symptoms), but Marilyn asks her doctor whether medicinal marijuana might offer the singular advantage of reducing pain and nausea simultaneously.........
.............;要討論大麻就要先討論不合法藥物(Illigal drugs)---多數Narcotics(止痛劑), 興奮劑(Epinephrine類藥物, 甚至咖啡因等)..........請指教!!!(楊某人任衛生署長時,提出二代健保, 它是經濟學者嗎?! 受刑人納入健保.....都是公共議題,被他操作成民粹議題!!!)

[李誠民]

Marilyn is a 68-year-old woman with breast cancer metastatic to the lungs and the thoracic and lumbar spine. She is currently undergoing chemotherapy with doxorubicin. She reports having very low energy, minimal appetite, and substantial pain in her thoracic and lumbar spine. For relief of nausea, she has taken ondansetron and prochlorperazine, with minimal success. She has been taking 1000 mg of acetaminophen every 8 hours for the pain. Sometimes at night she takes 5 mg or 10 mg of oxycodone to help provide pain relief. During a visit with her primary care physician she asks about the possibility of using marijuana to help alleviate緩和減輕 the nausea, pain, and fatigue. She lives in a state that allows marijuana for personal medicinal use, and she says her family could grow the plants. As her physician, what advice would you offer with regard to the use of marijuana to alleviate her current symptoms? Do you believe that the overall medicinal benefits of marijuana outweigh the risks and potential harm
Treatment Options

Which one of the following approaches do you find appropriate for this patient? Base your choice on the published literature, your clinical experience, recent guidelines, and other sources of information.

[Sawa]

政府制定政策有瑕疵
搞到公務人員自家鑽漏洞
然後欠債中央，再去銀行借款
反正東牆補西牆
不是中央政府倒債就是地方政府倒債
我看最後會變成被借款的公營銀行先倒。

[WINDOW]

有趣的點在：為甚麼蘋果會讓這人去寫專欄？有什麼難言之隱嗎？

原因不就是:民粹當道，事理難明

[lsb1567]

有趣的點在：為甚麼蘋果會讓這人去寫專欄？有什麼難言之隱嗎？

原因不就是:民粹當道，事理難明

今日最正解

[kwojohn]

有趣的點在：為甚麼蘋果會讓這人去寫專欄？有什麼難言之隱嗎？

原因不就是:民粹當道，事理難明

今日最正解

[ayok2001]

有趣的點在：為甚麼蘋果會讓這人去寫專欄？有什麼難言之隱嗎？

原因不就是:民粹當道，事理難明

[項介]

不要臉的健保政客當道，事理難明

[NEO]

說得好!如果不是民粹當道，怎麽會有人當選那個叫「最有guts的歐吉桑」什麼的，啐!