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題名 揭開法律爭議的面紗—以歐記健保(Obamacare)的意識形態衝突為中心
Unveiling the Legal Debate of Obamacare in the Light of Ideological Conflict作者 曾紹萱
Tseng, Shao Hsuan貢獻者 廖元豪
Bruce Yuan-Hao Liao
曾紹萱
Tseng, Shao Hsuan關鍵詞 自由主義
保守主義
全民健保
意識形態衝突
歐記健保
Liberalism
Conservatism
Universal Health Insurance
Ideological
Obamacare日期 2016 上傳時間 2-Sep-2016 00:17:06 (UTC+8) 摘要 研究美國的公共政策,不能忽略探討自由主義以及保守主義,對於政府角色的分歧定義導致的拉扯與衝突,此種意識形態衝突不獨發生在行政機關或者國會,司法部門亦毫不遜色。其中尤以聯邦最高法院的憲法爭議判決,更能凸顯重大議題中,自由與保守兩種思潮的激盪。 本論文選擇以美國的醫療照護制度作為研究中心,主因在於美國雖然在許多領域領先世界,然而唯獨在醫療照護體系不同於其他多數先進國家而「牛步」前進,直至20世紀的晚期,都尚未建立一個「涵蓋全民」的健康照護體系。為何美國人如此抗拒以「全民一體」的政策,甚至長久以來視醫療照護為「特權」而非「權利」?原因就在於保守派根深蒂固的「反大政府」與「市場傾向」立場。然而美國式的意識形態鬥爭並非零和競賽,而是一種對等的「拉鋸」,因此任何政策都難以出現極度偏頗某一方的情形。 另一方面,由於美國特殊的政治爭議「司法化」,若沒有深入探究法律爭議背後的脈絡(尤其是意識型態與政治現實),充分理解法律政策如何在民主政治中倡議、發展並妥協,那就難以真正理解法律與政策的精神。而政治思想與法理的交錯,已經成為常態,並且能夠強化政策正當性。美國的法學論述,也正因其總是能從現實與邏輯,法律與政治等多重角度來分析法律問題,更展現其豐富與多元。此等結合法律邏輯、意識型態,與現實政治的觀察方式,在我國探討法學理論,尤其是行政法各論,或是經濟社會管制領域時,相信亦有參考價值。
The struggling between Liberalism and Conservatism has great impact upon American public policy and law. On the basis of different expectations on the role of federal government, the ideological conflicts occurred not only in the Executive and the Legislative branches, but also in the judiciary. Especially the constitutional controversies handled by the U.S. Supreme Court clearly present the crisscross of liberal and conservative thoughts. This thesis considers that the deeply–rooted ideologies of anti-government and the free market faith are part of the reason for Americans to resist any "universal health care" policy. It`s also the reason why Americans had taken decades attempting to build a universal health care system while still in vain. The war between liberal and conservative ideologies, however, is not a zero-sum game. Instead, it`s an enduring seesaw struggle until both sides get into agreements. This is crucially important to realize the nature of legal debates regarding healthcare policies in the United States.參考文獻 中文文獻 一、專書論著 石之瑜,社會科學方法新論,五南,2003年。 李連江,新保守主義,揚智,1997年。 張金鑑,美國政府,三民,1990年。 程國強,美國史(1607-1900)上,三民,1985年, 顧肅,自由主義基本理念,左岸文化,2006年。 二、期刊論文 林國明,在威權統治的歷史陰影下-全民健保與道德共同體的民主建構,收錄於平等、正義與社會福利:殷海光基金會自由、平等、社會正義學術研討會論文集(3),2002年,171-238頁。 法治斌,憲法保障人民財產權與其他權利之標準,收錄於氏著:憲法專論(一),月旦,1985年,227-271頁。 三、譯著 Michael J. Sandel著,蔡惠伃、林詠心譯,為什麼我們需要公共哲學:政治中的道德問題,麥田,2014年。 Thomas R. Dye著,柯勝文譯,權力與社會:社會科學導論,桂冠文學,2000年。 英文文獻 一、專書論著 ALAN DERICKSON, HEALTH SECURITY FOR ALL: DREAMS OF UNIVERSAL HEALTH CARE IN AMERICA (2005). BEATRIX HOFFMAN, HEALTH CARE FOR SOME: RIGHTS AND RATIONING IN THE UNITED STATES SINCE 1930 (2012). BRUCE ACKERMAN, WE THE PEOPLE, VOLUME 1: FOUNDATIONS (1993). CASS R. SUNSTEIN, ARE JUDGES POLITICAL? AN EMPIRICAL ANALYSIS OF THE FEDERAL JUDICIARY (2006). CASS SUNSTEIN, THE SECOND BILL OF RIGHTS: FDR`S UNFINISHED REVOLUTION AND WHY WE NEED IT MORE THAN EVER (2006). DAN T. COENEN, CONSTITUTIONAL LAW: THE COMMERCE CLAUSE (2004). DONALD A. BARR, INTRODUCTION TO U.S. HEALTH POLICY: THE ORGANIZATION, FINANCING, AND DELIVERY OF HEALTH CARE IN AMERICA (2ND ED. 2007). JACOB S. HACKER, THE ROAD TO NOWHERE: THE GENESIS OF PRESIDENT CLINTON`S PLAN FOR HEALTH SECURITY (1999). JEFFREY TOOBIN, THE OATH: THE OBAMA WHITE HOUSE AND THE SUPREME COURT (2012). JENNIE JACOBS KRONENFELD & MICHAEL R. KRONENFELD, HEALTHCARE REFORM IN AMERICA: A REFERENCE HANDBOOK (2004). KEVIN D. WILLIAMSON, THE POLITICALLY INCORRECT GUIDE TO SOCIALISM (2010). LAURENCE TRIBE & JOSHUA MATZ, UNCERTAIN JUSTICE: THE ROBERTS COURT AND THE CONSTITUTION85 (2014). MARK TUSHNET, IN THE BALANCE: LAW AND POLITICS ON THE ROBERTS COURT (2013). ROBIN L. WEST, PROGRESSIVE CONSTITUTIONALISM: RECONSTRUCTING THE FOURTEENTH AMENDMENT (1994). SEE JILL QUADAGNO, ONE NATION, UNINSURED: WHY THE U.S. HAS NO NATIONAL HEALTH INSURANCE 26 (2006). STAFF OF THE WASHINGTON POST, LANDMARK: THE INSIDE STORY OF AMERICA`S NEW HEALTH-CARE LAW-THE AFFORDABLE CARE ACT-AND WHAT IT MEANS FOR US ALL (2010). THEODORE R. MARMOR, UNDERSTANDING HEALTH CARE REFORM (1994). TOM DASCHLE & DAVID NATHER, GETTING IT DONE: HOW OBAMA AND CONGRESS FINALLY BROKE THE STALEMATE TO MAKE WAY FOR HEALTH CARE REFORM (2010). 二、期刊論文 Barry Friedman, History of the Countermajoritarian Difficulty Part Four: Law`s Politics, 148 U. PA. L. REV. 971 (2000). Beatrix Hoffman, The Challenge of Universal Health Care: Social Movements, Presidential Leadership, and Private Power, in SOCIAL MOVEMENTS AND THE TRANSFORMATION OF AMERICAN HEALTH CARE (Jane C. Banaszak-Holl et al. eds., 2010). Brian G. Gilmore, Brown V. Board Of Education And National Federation Of Independent Business V. Sebelius: A Comparative Analysis Of Social Change, 36 U. ARK. LITTLE ROCK L. REV. 621 (2014). Bureau of Labor Statistics, Compulsory Health Insurance Proposed By Social Insurance Commission of California, 4 MLB 497 (1917). Catherine V. Kilgore, Health Care and Social Security Update-2001, 70 MISS. L.J. 1007 (2000-2001). D. Yankelovich, The Debate That Wasn`t: The Public and the Clinton Plan, 14 HEALTH AFF. (MILLWOOD) 7 (1995). Forrest A. Walker, Compulsory Health Insurance: The Next Great Step in Social Legislation, 56 J. AM. HIST. 290, 290 (1969). Franz Goldmann, I. The Problem—The Role of the Federal Government, 49 AM J PUBLIC HEALTH 161 (1959). Gillian E. Metzger, To Tax, To Spend, To Regulate, 126 HARV. L. REV. 83 (2012). Henry R. Seager, Plan for a Health Insurance Act, 6 AM. LAB. LEGIS. REV. 21 (1916). House Of Delegates, Proceedings Of The New Orleans Session: Minutes Of The Seventy-First Annual Session Of The American Medical Association, Held At New Orleans, 74 JAMA 1317 (1920). Iwan Morganat, Reaganomics and Its Legacy, in RONALD REAGAN AND THE 1980S: PERCEPTIONS, POLICIES, LEGACIES (Cheryl Hudson & Gareth Davies eds., 2008). Jacob S. Hacker, Learning From Defeat? Political Analysis and the Failure of Health Care Reform in the United States, 31 BRIT. J. POL. SCI. 61 (2001). Lynn A. Baker, Conditional Federal Spending after Lopez, 95 COLUM. L. REV. 1911 (1995). Mark A. Peterson, Health Care and the Hill: Why Is This Year Different from All Others?, 27 POLITICAL SCI. POLITICS 202 (1994). Martha Bebinger, Personal Responsibility: How Mitt Romney Embraced The Individual Mandate In Massachusetts Health Reform, 31 HEALTH AFFAIRS 9 (2012). Mary Ann Chirba-Martin & Andrés Torres, Universal Health Care In Massachusetts: Setting The Standard For National Reform, 35 FORDHAM URB. L.J. 409 (2008). Robert F. Rich et al., The Patient Process and Affordable Care Act of 2010: Implementation Challenges in the Context of Federalism, 16 J. HEALTH CARE L. & POL`Y 77 (2013). Theodore R. Marmor & Kip Sullivan, Medicare at 50: Why Medicare-for-all Did Not Take Place, 15 YALE J. HEALTH POL`Y, L. & ETHICS 141 (2015). Thomas R. McCoy & Barry Friedman, Conditional Spending: Federalism`s Trojan Horse, 1988 SUP. CT. REV. 85 (1998). Viseltear, Arthur J., Compulsory Health Insurance in California, 1915–18, 2 J HIST MED ALL SCI 151 (1969). William Forbath, Social and Economic Rights in the American Grain, in THE CONSTITUTION IN 2020 (Jack M. Balkin & Reva B. Siegel eds., 2009). William Green, Trade Union Sick Funds and Compulsory Health Insurance, 7 AM. LAB. LEGIS. REV. 91 (1917). William W. Fulton, General Practice in the U.S.A., 1 BRIT. MED. J. 275 (1961). Woody R. Clermont, A Brief Introduction to Medicare and the Office of Medicare Hearings and Appeals, 5 PITT. J. ENVTL. & PUB. HEALTH L. 103 (2011). 三、報紙新聞 Adam Clymer, The Health Care Debate: The Overview; National Health Program, President`s Greatest Goal, Declared Dead In Congress, N.Y. TIMES, Sep. 27, 1994, at A1. Adam Liptak, Events Upend Predicted Tilt of the Court, N.Y. Times, June 29, 2016, at A1. Andres F. Costas, To the Editor, Johnny One-Note on Health Care, N.Y. TIMES, Mar. 14, 1993, at F11. Carl Hulse & Robert Pear, Sweeping Health Care Overhaul Passes The House, N.Y. TIMES , Nov. 8, 2009, at A1. CLINTON`S HEALTH PLAN; Transcript of President`s Address to Congress on Health Care, N.Y. TIMES, Sep. 23, 1993, at A24 IN THEIR OWN WORDS; Transcript of Speech by Clinton Accepting Democratic Nomination, N.Y. TIMES, July 17, 1992, at A14. Kathleen Parker, Easing The `Death Panel` Fear, THE WASHINGTON POST, Aug. 12, 2009, at A21. Medical Care Plan Leaders, A. M. A. Clash, CHICAGO TRIBUNE, Aug. 3, 1961, at 6. Montgomery Lori, President`s Budget Strategy Under Fire, THE WASHINGTON POST, Mar. 18, 2009, at A1. Obamacare`s Future, THE WASHINGTON POST, Mar. 2, 2016, at A24. Paul Kane & Karl Vick, Republican Wins Kennedy`s Seat, THE WASHINGTON POST, Jan. 20, 2010, at A1. Paul Krugman, Pride, Prejudice, Insurance, N.Y. TIMES, Nov. 7, 2005, at A23. Reed Abelson & Margot Sanger-Katz, Obamacare Premiums Are Rising, Not a Littlei, N. Y. TIMES, June 16, 2016, at B1. Rhoda H. Karpatkin, To the Editor, Johnny One-Note on Health Care, N.Y. TIMES, Mar. 14, 1993, at F11. Robert Pear, Candidates Outline Ideas For Universal Health Care, N.Y. TIMES, Mar. 25, 2007, at P. 1.22. Shailagh Murray & Lori Montgomery, Senate passes health-care bill on 60-39 vote, THE WASHINGTON POST, Dec. 25, 2009, at A1. Sheryl Gay Stolberg & Robert Pear , A Stroke of a Pen, Make That 20, and It`s Official, N.Y. TIMES, Mar. 24, 2010, at A19. The Obamacare Software Mess, THE ECONOMIST, Oct 12, 2013. 四、政府文件 THE DECLARATION OF INDEPENDENCE (U.S. 1776). THE FEDERALIST No. 45 (1788). U.S. CENSUS BUREAU, P60-236(RV), INCOME, POVERTY, AND HEALTH INSURANCE COVERAGE IN THE UNITED STATES: 2008 (2009). 五、網路資源 HEALTHCARE.GOV: https://www.healthcare.gov HOUSE.GOV: http://www.house.gov KAISER FAMILY FOUNDATION: http://kff.org WHITEHOUSE.GOV: https://www.whitehouse.gov Eric Zimmermann, Pelosi to reporter: `Are you serious?’ (2009). http://thehill.com/blogs/blog-briefing-room/news/64547-pelosi-to-reporter-are-you-serious Frequently Asked Question - Notice of Coverage Options (2015). http://www.dol.gov/ebsa/faqs/faq-noticeofcoverageoptions.html Jeff Davis, How Reconciliation Would Work (2010). https://newrepublic.com/article/72605/how-reconciliation-would-work Jess Bravina, Liberal But Restrained Supreme Court Term (2015). http://www.wsj.com/articles/a-liberal-but-restrained-court-term-1435710679 Jim Rutenberg & Jackie Calmesaug, False ‘Death Panel’ Rumor Has Some Familiar Roots (2009). http://www.nytimes.com/2009/08/14/health/policy/14panel.html?_r=1 Lyndon B. Johnson: Remarks Before the National Convention Upon Accepting the Nomination (1964). http://www.presidency.ucsb.edu/ws/?pid=26467 Megan McArdle, The New Louisiana Purchase: Obamacare`s $4.3 Billion Boondoggle (2012). http://www.theatlantic.com/business/archive/2012/03/the-new-louisiana-purchase-obamacares-43-billion-boondoggle/254003/ Paul Waldman, Why Republicans won’t object to the return of ‘death panels’ (2015). https://www.washingtonpost.com/blogs/plum-line/wp/2015/07/09/why-republicans-wont-object-to-the-return-of-death-panels/ Ted Kennedy And Health Care Reform (2009). http://www.newsweek.com/ted-kennedy-and-health-care-reform-82011 描述 碩士
國立政治大學
法律學系
100651042資料來源 http://thesis.lib.nccu.edu.tw/record/#G0100651042 資料類型 thesis dc.contributor.advisor 廖元豪 zh_TW dc.contributor.advisor Bruce Yuan-Hao Liao en_US dc.contributor.author (Authors) 曾紹萱 zh_TW dc.contributor.author (Authors) Tseng, Shao Hsuan en_US dc.creator (作者) 曾紹萱 zh_TW dc.creator (作者) Tseng, Shao Hsuan en_US dc.date (日期) 2016 en_US dc.date.accessioned 2-Sep-2016 00:17:06 (UTC+8) - dc.date.available 2-Sep-2016 00:17:06 (UTC+8) - dc.date.issued (上傳時間) 2-Sep-2016 00:17:06 (UTC+8) - dc.identifier (Other Identifiers) G0100651042 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/101141 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 法律學系 zh_TW dc.description (描述) 100651042 zh_TW dc.description.abstract (摘要) 研究美國的公共政策,不能忽略探討自由主義以及保守主義,對於政府角色的分歧定義導致的拉扯與衝突,此種意識形態衝突不獨發生在行政機關或者國會,司法部門亦毫不遜色。其中尤以聯邦最高法院的憲法爭議判決,更能凸顯重大議題中,自由與保守兩種思潮的激盪。 本論文選擇以美國的醫療照護制度作為研究中心,主因在於美國雖然在許多領域領先世界,然而唯獨在醫療照護體系不同於其他多數先進國家而「牛步」前進,直至20世紀的晚期,都尚未建立一個「涵蓋全民」的健康照護體系。為何美國人如此抗拒以「全民一體」的政策,甚至長久以來視醫療照護為「特權」而非「權利」?原因就在於保守派根深蒂固的「反大政府」與「市場傾向」立場。然而美國式的意識形態鬥爭並非零和競賽,而是一種對等的「拉鋸」,因此任何政策都難以出現極度偏頗某一方的情形。 另一方面,由於美國特殊的政治爭議「司法化」,若沒有深入探究法律爭議背後的脈絡(尤其是意識型態與政治現實),充分理解法律政策如何在民主政治中倡議、發展並妥協,那就難以真正理解法律與政策的精神。而政治思想與法理的交錯,已經成為常態,並且能夠強化政策正當性。美國的法學論述,也正因其總是能從現實與邏輯,法律與政治等多重角度來分析法律問題,更展現其豐富與多元。此等結合法律邏輯、意識型態,與現實政治的觀察方式,在我國探討法學理論,尤其是行政法各論,或是經濟社會管制領域時,相信亦有參考價值。 zh_TW dc.description.abstract (摘要) The struggling between Liberalism and Conservatism has great impact upon American public policy and law. On the basis of different expectations on the role of federal government, the ideological conflicts occurred not only in the Executive and the Legislative branches, but also in the judiciary. Especially the constitutional controversies handled by the U.S. Supreme Court clearly present the crisscross of liberal and conservative thoughts. This thesis considers that the deeply–rooted ideologies of anti-government and the free market faith are part of the reason for Americans to resist any "universal health care" policy. It`s also the reason why Americans had taken decades attempting to build a universal health care system while still in vain. The war between liberal and conservative ideologies, however, is not a zero-sum game. Instead, it`s an enduring seesaw struggle until both sides get into agreements. This is crucially important to realize the nature of legal debates regarding healthcare policies in the United States. en_US dc.description.tableofcontents 第一章 緒論 9 第一節 研究動機與目的 9 一、我國的全民健保制度起源 10 二、臺美制度起源之異 11 第二節 研究方法與限制 13 一、研究方法 13 (一)文獻來源與蒐集 13 (二)個案分析 13 二、研究限制 14 第三節 本文架構 14 第二章 當代美國式的自由主義與保守主義 16 第一節 政府與市場的抉擇與拉鋸 18 一、美洲獨立運動的「地方自治」啟發 18 二、保守派的「小政府主義」與市場偏好 19 三、進步時期的經濟管制爭論 21 四、1937年之「憲法革命」:政府介入市場的強化 22 (一)延續保守派的市場偏好思想 22 (二)自由主義的「憲法革命」:政府干預市場全面正當化 25 (三)第二次世界大戰後的自由主義思潮 26 五、保守主義的再次興起:雷根革命 27 六、小結 28 第二節 聯邦主義的投射 29 一、聯邦與州的垂直分權 31 (一)通商權 31 (二)課稅權 35 (三)支出權 37 二、小結 40 第三節 本章結論 41 第三章 美國的全民健保政策發展歷程 43 第一節 進步時期 43 一、《標準法》草案 44 二、老羅斯福與「社會與工業正義政綱」 44 三、《標準法》草案對各州的影響 45 四、結論:永遠的「草案」 46 第二節 新政時期 47 一、經濟安全委員會 47 二、社會安全法 49 三、國家健康會議 50 第三節 二戰後的醫療政策 51 一、1940年代 51 (一)杜魯門的「國家健保」 51 (二)「醫療照護計畫」的起源 53 二、1960年代:醫療照護計畫與醫療補助計畫 54 三、1980年代:停滯的政策 56 四、1990年代:柯林頓的《健康安全法》 58 (一)政策背景 58 (二)「管理式競爭」的構想 59 (三)政策的挫敗 59 第四節 本章結論 61 第四章《病患照護與可負擔醫療法案》評析 64 第一節 立法目的與爭議初探 64 第二節 「妥協」的歷程 66 一、「政府選項」的出局 67 二、安撫利益團體 69 三、整合議場內的分歧與制肘 71 第三節 PPACA簡介—以強制投保條款為中心 74 一、法案架構初探 74 (一)立法初衷 74 (二)法律整體架構 76 二、醫療保險平台:個人與小型企業的新選擇 78 (一)方案 79 (二)保險費率與補貼 82 三、強制投保條款 84 四、PPACA評析 85 第四節 強制投保條款之合憲性爭議:National Federation of Independent Business v. Sebelius 87 一、背景事實及爭點 87 二、聯邦最高法院之判決及論理 89 (一)強制投保條款是否逾越聯邦政府的「通商權」? 89 (二)強制性的要求是否「必要且適當」? 90 (三)課處罰鍰是否屬於聯邦的「課稅權」範疇? 91 三、協同意見書及不同意見書之論理 93 四、判決評析 96 第五節 本章結論 97 第五章 結論 102 參考文獻 104 zh_TW dc.format.extent 1955280 bytes - dc.format.extent 1955280 bytes - dc.format.mimetype application/pdf - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0100651042 en_US dc.subject (關鍵詞) 自由主義 zh_TW dc.subject (關鍵詞) 保守主義 zh_TW dc.subject (關鍵詞) 全民健保 zh_TW dc.subject (關鍵詞) 意識形態衝突 zh_TW dc.subject (關鍵詞) 歐記健保 zh_TW dc.subject (關鍵詞) Liberalism en_US dc.subject (關鍵詞) Conservatism en_US dc.subject (關鍵詞) Universal Health Insurance en_US dc.subject (關鍵詞) Ideological en_US dc.subject (關鍵詞) Obamacare en_US dc.title (題名) 揭開法律爭議的面紗—以歐記健保(Obamacare)的意識形態衝突為中心 zh_TW dc.title (題名) Unveiling the Legal Debate of Obamacare in the Light of Ideological Conflict en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 中文文獻 一、專書論著 石之瑜,社會科學方法新論,五南,2003年。 李連江,新保守主義,揚智,1997年。 張金鑑,美國政府,三民,1990年。 程國強,美國史(1607-1900)上,三民,1985年, 顧肅,自由主義基本理念,左岸文化,2006年。 二、期刊論文 林國明,在威權統治的歷史陰影下-全民健保與道德共同體的民主建構,收錄於平等、正義與社會福利:殷海光基金會自由、平等、社會正義學術研討會論文集(3),2002年,171-238頁。 法治斌,憲法保障人民財產權與其他權利之標準,收錄於氏著:憲法專論(一),月旦,1985年,227-271頁。 三、譯著 Michael J. 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