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
Trang 1KINH TE - XA HQI
NHITNG VAN D £ XA HOI CUA HOA KY
SAU KHUNG HOANG TAI CHINH 2007-2009
["(.p-i^
Tang 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
Trang 2lao 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
Trang 3chinh 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
Trang 4nhifiu 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
Trang 5Trang 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
Trang 6My 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
Trang 7ciing 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
Trang 8ba can than thupc nhu nhflm ngufli da
den vd Hispanic; (2) tinh ttang kinh tfi
suy thoai keo đi 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 quấ
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 giạ
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
ỵ 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
nguflị 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 giflị 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 nguflị 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 gidị 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 khdẹ 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 đ 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 caọ Theo mpt nghifin cim can Cli vdp nhiing dieh vii eung cap tir nam
2005 tfli 2009 tiii 20% ttpng sfl 15,7
Trang 9s o 09-2014 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
Trang 10CHAU MY NGAY NAY
te phai gan vdi an sinh xa hdi, phat trien
kinh te phai gan vdi cdng bang xa hdị
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) Stydỵ
Feb 2012 Understanding and Responding to
Persistently High Unemployment, www,cbọ
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 USẠ This
publication is available online at
www familiesusạorg
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)
IỊ 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 Ạ 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 khộ 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 COBRẠ 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 chargẹ 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