Health care is an important commodity in the United States and Uzbekistan because people, the consumers of health services, place a high value on health. IN the US, health care has evolved over the last century from a service accessed by a small percentage of society to one of the biggest market sectors in the U.S. economy. During the national political campaigns, deep concerns emerged about many aspects of the health delivery and financing systems in the United States. President Obama was elected, at least in part, because he promised to reform the health care system in this country. As the debate has unfolded, however, very little of the public discussion has centered on the special plight of retirees and how health care reforms might affect them.
Judith Mazo, Senior Vice President of The Segal Company, takes up the general question of how to provide health benefits to Americans, including elderly citizens, where a distinction is made between two diverse groups of retirees: those early retirees who are not yet Medicare eligible, and those retirees over age 65 or disabled who are Medicare eligible. Before Medicare, most retirees who received Social Security benefits did not have health insurance coverage and could not afford to purchase health care coverage directly. Today, most Social Security beneficiaries aged 65 and older, as well as many disabled persons, enjoy coverage from Medicare, a program that cost American taxpayers $82 billion in 2005 (for Medicare Part A).
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FAS 106 has precipitated a massive effort at corporate consciousness raising on the cost of retiree health coverage. Whether or not FAS 106 measures it correctly and has the right answer for the expense accrual, there now is no doubt that, even though fewer than half of American workers are in plans that offer them retiree health coverage, employers’ exposure for this cost is enormous. Most employers are looking for ways to reduce that unfunded liability. Funding might be one way, but as noted, there are tax impediments that make it uneconomic, and, in any event, it would be an expensive and drawn-out process. The other way is to reduce the liability by redesigning the health coverage that companies promise to retirees. In contrast, to the US, the key parties involved in providing and administering the health care in Uzbekistan are the Cabinet of Ministers, the President Karimov, the Supreme Assembly, the Ministry of Public Health, the Ministry of Finance, local and district health managers and a number of facilities (Chenet and McKee 2003). The Cabinet of Ministers, ruled by the President, is accountable for developing national health policies. It makes decisions on allocating money to health care programs and of medical research, observes environmental health, makes sure that a standard system for collection and dispensation of health data exists and organizes and monitors the activities of all government bodies on the protection of health.
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