我国退休职工医保缴费政策及其理论争议的再反思

"退休人员应否缴费"不仅是当前我国职工医保制度面临的一道政策选择难题,也是理论争议的焦点问题之一。虽然医保基金的短缺风险或退休职工的收入水平限制,都是评估现行医保缴费政策应否转向所必须考虑的现实问题,但它们并不构成退休职工缴费与否的决定性因素,而制度本身的性质定位及其内在的权利义务安排,才是决定的根本性原因。由于有无医保缴费义务与是否具备缴费能力以及如何具体承担是分属不同层面的问题,故应予以区分讨论。无论是从我国职工医保制度的内在机理还是社会经济外部环境的变迁来看,退休职工个人承担缴费义务都是一个应然性要求。而在实行普遍性缴费原则的同时,对于经济上真正困难而无力缴纳保费的人员,可以考虑通过费用减免或政府个别补贴等方式予以解决。

Reconsideration on the premium policy of medical insurance for retired workers and its theoretical disputes in China

The problem about whether or not retirees should pay for basic medical insurance is not only a policy problem, but also one of the focus of theoretical controversy in China. The risk of fund shortage for medical insurance or the limited income of the retired workers is the practical issue to be considered when assessing whether the current medical insurance premium policy should be changed or not, but do not constitute a decisive factor in evaluating whether it is or not to affordable for the retired workers. The nature of the system and the inherent rights and obligations are the fundamental reasons for the decision. Because of the obligations for medical insurance payment, the ability to pay and how to undertake are all belong to the problems at different levels, it should be discussed separately. In view of the internal mechanism for medical insurance system and the change of the external environment of social economy, retired workers bearing the obligation of payment is a necessary requirement. In addition, while implementing the principle of universal payment obligation, for the employees who are economically challenged and unable to pay their insurance premiums, can solutions such as lighten burden, through paying duty exemptions, individual government subsidies and other ways.