CHAU MY NGAY NAY KINH TE - XA HQI NHITNG VAN D £ XA HOI CUA HOA KY SAU KHUNG HOANG TAI CHINH 2007-2009 ["(.p-i^ ThS Le Thu HSng ViSn Nghien cim Chdu My T 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 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 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 sfl duong, chim dirt khodng flifli gian tang tiirflng am tiude dfl Tfli quy III nam 2010, tang tiirflng GDP tai My la fren 2% Tuy nhifin, ty lfi thit nghifip cua My vdn tii fl mUc cao frfin 9,5% tii thdng nam 2009 Ifin mue ky luc 10,1% tiiang 10 nam 2009 (cao gin bing 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 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 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 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 nhit ITnh vuc y tfi van cfl nhu ciu vfi nhan cflng Mpt sfl ngufli may hon 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 33,3 gifl, miic thdp nhdt kfi tir chi sfl ndy 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 nam vira qua Id 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 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 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 cc su thay dfli frpng ca cdu kinh tfi khifin 27 cho mpt sfl ngdnh nghfi bi thu hep frpng mpt sfl khac lai mfl rpng Dfi cfl thfi chuyfin lap dpng tir nganh 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 chifim 0,5 difim phan fram ciia vific gia tang ty lfi thit nghifip frpng va sau khiing hpang Tac dpng se giam din ttong nam tfli 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 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 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 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, sfl Iai ngdy mpt gia tang Doi vfli nhifiu ngufli, mit vific lam cOng dong nghia vfli mit bdo hifim y tfi Cit danh kep 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 CHAU MY NGAY NAY thfi hifin qua chfi dp cham sflc sHc khfle hifin ciia My dufli 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 nhfl dupc tdi ttp qua chuong ttinh Medicaid cua chinh phii tifiu bang'; (4) nhiing nguoi ldm nghfi tu 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 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 chu lao dpng dupc gidm gid mua CHAU MY NGAY NAY nhifiu bdo hifim cimg luc va ngufli lap dflng dupc bdp hifim frong mpi tmflng hpp, kg ca 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 nhung lai khong may hifiu qud cho nguoi lao dpng'^ Mpt sfl ngufli tim dfin vfli chuong tiinh COBRA*' 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 ciing dii difiu kifin dfi tham gia''' COBRA vd phi bdo hifim van 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 frong ngufli (73%) tim kifim mua bdo hifim tu bfin ngodi dfiu khong thfi mua dupc frong nam qua phi bdp hiem qua cae" 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 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 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" 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 Trang tdm Uu tifin Chinh sach vd Ngan sdch cho tiiiy hi nam 2008 dfin thfli difim 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 em hpc dai hpc dang Id nhihig ccn np ctia chinh phu Hdu hfit cdc hpc sinh sau 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 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 tpan kem lai Treng 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 CHAU MY NGAY NAY 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 da dan dfin mpt xu hudng 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 cdng it di, rit nhifiu sinh vifin se khflng cfl du bing cdp, chuyfin mfln dfi dam nhdn cflng vific sau 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 tpan cua cdc sinh vien My da Ifin tfli hon 1.000 ty USD"" SUih vifin 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 tiuflng hifin dang np tifin hpc phi va tiimg binh mfli ngufli np khodng 27.000 USD Nam 1989, ccn so chi la khoang 10.000 USD Dfli vdi hai ngdnh tfln kem nhit Id y khoa vd kinh tfi, khodng 10% sfl sinh vien 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 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 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 hy vpng kfii hp di hpc tifip, chinh pljii se khflng dfli np qua git gap, dflng thfli 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 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^' Tinh trang vo gia cu Thit nghifip 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 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 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 cdng nhifiu ngufli khflng thfi frd cdc khpdn vay mua nhd dao han 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 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 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 ldn 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 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 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 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 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 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 8,1/100.000 ngufli Su gia tang ro rdng den vd Hispanic; (2) tinh ttang kinh tfi nhit Id nhdm nam gifli frong dp tuoi 50 suy thoai keo ddi tir cufli nam 2007 cho dfin 59 Ty lfi tu hi d nhflm chifim dfin giiia 2009 vdi thi traflng vific lam gdn 50%, tuong duong vfli 30 ngufli tu qud yfiu, tlu fruong nha cira bap bfinh da tu/100.000 nam gidi d nu gifli, ty lfi tu dfln nhirng ngufli vfln dang gap khfl til cao nhat fl nhflm 60 dfin 64 tufli, khan vdo buflc duflng ciing; (3) thfi he chifim gin 60%, tuong duong ngufli tu "baby - boomer^'" vfln mang sdn miic tii/100.000 nu gifli^' khiing hodng tinh than cao gap phdi Trong va sau cuflc khiing hodng tdi nhifiu vin dfi vfi sue khoe tdm thin hon chinh 2007-2009, sfl bfinh nhdn mac khimg hodng kinh tfi; (4) vific bdn bfinh tdm than tang vpt, nhdt la bfinh vd lam dung thuflc gidm dau tang manh fram cdm, dart dfin nhu cau ve dich vu frong thap nifin qua^' cham sec siie khcfi tam thin cung tang Miic tu tu cua gidi trang nifin My da thep Tuy nhifin, hp thflng chdm sdc siic nhdy vpt tir hdng thir tdm frong cdc khpe tdm thdn cua My Id mpt hfi thflng nguyfin nhan tu vong Ifin hang thir tu, da tifiu tfln nhifiu ty dflla My nhung van chi sau cdc bfinh ung thu, tim vd tai nan khpng dil cung ling (Uch vu chp nhung Tu til bang cdch dimg thuflc qua lieu frfl ngufli cin nfl Nam 2011, Hoa Ky da chi thdnh nguyen nhdn cao hdng thir hai, sau 113 ty USD frong vific difiu tti bfinh tam Sling dan Trong nam 2010, My cfl hon than Con sfl ndy chi vdp khpdng 5,6% 38.364 nguoi chfit vi tu til frong cfl sfl tifin chi cho dich vu cham sflc sire 33.687 ngufli chfit vi tai nan giao thflng khoe todn qu6c'° Tir tli thuong dupc xem Id van de cita Cham sflc sire khofi tdm thin Id vin dfli tupng thifiu nifin vd ngufli gia dfi khfl khan hon so vfli tit ca cdc loai D P vdy, su gia tang dpt bifin ty lfi tu til fl eham sdc y tfi khde Thflng kfi cua Bp dp tufli trang nifin tai My frpng thfli ky Lap dpng My uflc lupng ttong nam khiing hpdng Id mflt diu hieu dang ehu 2010 nudc My efl khodng 156.300 y Til nam 1999 den nam 2010, ty lfi tu ngufli cfl van vfi siic khoe tam thin, tii frpng dp tufli 35 den 64 da tang gdn frpng dd cd tdi 89,3 frieu ngufli My sflng 30%, tii miic 13,7 ngufli tu til/1000 frong nhiing khu vuc thieu bac sT tam ngufli Ifin miic 17,6 nguci tu tir/1000 than, 55,3 trifiu ngufli song ttong vimg ngufli Mac du ty lfi tu hi dfiu tang fl nil thifiu bdc si gia dinh vd 44,6 tripu ngufli gidi vd nam gidi tufli trung nifin, nhung sflng ttong khu vuc thifiu nha si" ty Ifi d nam gidi cao hon gdp hon ldn Chi phi cham sflc siie khofi tam thin so vdi nil gifli Sfl heu cho thay, cii ciing rat cao Theo mpt nghifin cim can 100.000 nam gidi flu cd 27,3 ngufli tu Cli vdp nhiing dieh vii eung cap tir nam tir, frong fl nii gifli sfl ndy Id 2005 tfli 2009 tiii 20% ttpng sfl 15,7 s 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 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'' CHAU MY NGAY NAY 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 nam 2009, Tflng thflng Barack Obama da ky Luat Tai diu tu va Phuc hfli nuflc My {American Recovery and Reinvestment Act) Dao ludt 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 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 (Washmgton: Kaiser Family Foundation, September 2009) II Chinh phli My l?ip chucmg trinh CHIP nam 1997 giiip tre em tir - 19 tuoi 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 Chu thich: (Washington: Kaiser Family Foundation, Linda Levine January 24, 2013 The January 2009) Increase in Unemployment Since 2007 Is It 13 Dao luat Consolidated Omnibus Budget Cyclical or Structural? Congressional Reconciliation Act (COBRA) duac ban Research Service 7-5700 www.crs.gov hanh nam 1986, de nhiing nhan vien, hay R41785 cac vien gia dinh ho dang co bao hiem Calculated by Congressional Research qua noi lam cua hp c6 the tiep tuc mua bao Service (CRS) from the U S Bureau of hiem them mpt thai gian, neu nhiing nguai Labor Statistics' (BLS) Current Employnay bi mat bao hiem vi nhiing ly dupc ment Statistics (CES) program National chip thuan, chang han nhan vien bi mat data from the CES program are available at viec hay ve huu, hoac truang hpp http,//stats, bis go v/ces/ nhan vien ly di thi nguai vp hay chong cu Congressional Budget Office (CBO) Stydy van dupc tiep tuc mua bao hiem qua chuang Feb 2012 Understanding and Responding to trinh COBRA nay, Persistently High Unemployment, www,cbo 14 Nhiing nguai dupc hucmg quyen lpi gov/publication/42989 COBRA phai la vp chong hay cai cua http://workforcesecurity doleta gov/unem nhan vien truoc, ho&c ngay xay bien ploy/uifactsheet asp CO lam cho ho mat bao hiem siic kho^ Tuy Kim Bailey, Zee Bendixen, Kathleen StoU nhien, neu nhan vien c6 them One-Two Punch: Unemployed and Unin ho CO COBRA thi nhiing ngucri sured © Oct 2009 by Families USA This ciing se duac huang quyen lpi ciia COBRA publication is available online at NhSn vien hay than nhan ciia hp phai mua www familiesusa.org bao hiem sue khoe cvia hang, va bao hiem Medicare la chucmg trinh bao hiem siic khoe van dang co hieu luc liic bien co xay quoc gia danh cho ngudi tir 65 luoi trd len lam hp mat bao hiem sue khoe, Ngoai ra, Ngoai ra, mot so nguai chua tcfi 65 tuoi cung nhiing nhan vien dai dien cho hang (agent), du tieu chuan hudng Medicare nhu ngudi bi inpedendent contractor, hay giam doc tan tat Chuang trinh Medicare giiip tra mot {director) ciia cong ty cung co the dupc mua phan chi phi y te hay chi phi cham soc dai han bao hiem qua chuang trinh COBRA, Medicaid la loai bao hiem y te thupc cap tieu 15 Families USA calculations based on premium bang Vai loai BHYT benh nhan khong data from Kaiser Family Foundation/HRET, phai chl tra bat cir le phi nao tii phi benh vien, op cit The average femily premium for jobtham bac sT den thuoc men Nhung ngucri co based coverage was $12,680 m 2008 and rose luang thap hoac khong co viec Iam, khong the to $13,375 m 2009 Under COBRA, workers mua bdo hiem y te tu nhan cho minh va cho who continue coverage must pay the full gia dinh deu co the npp dan premium plus a percent administrative Xem chii thich charge The ARRA subsidy covers 65 percent 9, Kaiser Family Foundation, How Pnvate ofthe 102 percent COBRA fee Health Coverage Works: A Pnmer, 2008 16 Families USA calculations based on the Update (Washington Kaiser Family average monthly imemployment insurance Foundation, April 2008) income of $1,278 for a femily See Cheryl 10, Kaiser Family Foundation/HRET, Employer Fish-Parcham and Claire McAndrew, Health Benefits: 2009 Annual Survey Squeezed: C^aught between Unemployment 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 • 36 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-saddledwith40kin-debt-with-no-jobs-in-sight/ 22 infonet vn/The-gioi/Sinh-vien-My-Nhungcon-no-khung-cua-chinh-phu/54196.info 23 http,//finance tvsi com vn/News/2012830/ 216 871/kinh-te-my-no-sinh-vien-tang-gan4-lan-trong-thap-ky-qua.aspx 24 The U.S Department of Housing and Urban Development Office of Community Planning and Development Volume 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 CHAU MY NGAY NAY 26 Ly thuyet ve t\r tir va suy thoai kinh te ciia Durkheim 27 The he sinh 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/sevenfacts-about-americas-mental-health-caresystem/ 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-themail_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) ... Budget Office CBO), ty lfi thit nghiep tang 3,5 diem phan ttam ttpng nam vira qua Id nguyen nhan sau^ : Thli nhdt, cdu vfi hdng hod va dich vu thip Nhiing thay dfli frong sdn lupng hdng hpd vd dich... Thep CBO, nguyfin nhan chifim 0,5 difim phan fram ciia vific gia tang ty lfi thit nghifip frpng va sau khiing hpang Tac dpng se giam din ttong nam tfli nguoi Iao dflng hpc dupc cac ky nang mfli vd... thich nghi vfli difiu kifin mfli 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