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‘저소득층과 중증질환자 진료비 부담 대폭 경감’

위 문구는 보건복지가족부가 건강보험 보장을 확대한다면서 10월 27일 발표한 보도자료의 제목이다. 많은 언론은 이를 그대로 받아 썼다 .이 문구만 보면 국민들은, 특히 가난하거나 암 등 중증질환을 가진 이들은 병원비에 대한 걱정이나마 덜게 되었다고 한시름 놓을 수 있을 지 모른다. 보도자료에 따르면 기본적으로는 암과 희귀성난치질환에 대해 본인부담률을 암은 10%에서 5%로, 희귀난치성질환은 20%에서 10%로 줄어든다고 한다. 그리고 비만이 각종 합병증을 유발하여 중증질환의 원인이 되고 있기 때문에 우선적으로 고도비만환자에 대한 약제, 수술비 등에 보험적용을 한다고도 한다. 그리고 현재 보험적용이 되는 진료비의 경우에도 저소득층은 그 부담이 크기 때문에 본인부담상한액을 차등적용하여, 현재 소득수준에 관계없이 6개월 200만원 일률 적용하는 것을 하위 50%층에게는 6개월 100만원으로 하향조정된다고 한다. 그 외 의견 수렴 후에 사회적 합의를 거쳐 노인틀니, 치석제거, 치아홈메우기, 불소도포 등 진료비 부담이 큰 치과진료항목, 초음파, MRI, 한방물리요법에 대해서도 보험적용을 검토하겠다고 밝혔다.

여기까지만 살펴보면 이명박 정부가 경제위기로 인해 고통받는 서민을 위해서, 보건복지가족부가 표방한 대로 ‘생활공감, 국민행복’정책을 펴고 있구나 하는 생각을 갖게 된다. 그래도 다시 한번 의심병이 도는 건 필자의 노파심 때문만은 아닐 터이다. 위와 같은 정책을 펴려면 ‘돈이 들어갈텐데 그 돈은 어디서 나오는 걸까?’라는 게 자연스럽게 이어지는 생각이다. 당연하게도 가장 먼저 드는 생각은 올해 건강보험재정이 사상 최고의 흑자를 기록한다는 데, 그 돈으로 하려나 보다라는 생각을 갖게 된다. 올해 건강보험재정 흑자가 1조 5천억이다. 정부가 발표한 바에 따르면 우선적인 기본항목의 부담을 경감하는 데 5천5백억원이 소요된다고 하니, 그래도 1조가까운 돈이 남아돈다. 선택적으로 확대하겠다고 적시한 항목 중에서도 반 정도는 흑자재정으로 내년에 당장 적용해도 될 정도이다. 하지만 정부는 그럴 생각이 아니다. 알려진 바로는 올해 흑자재정으로는 수가인상(이건 당연히 병원과 의사의 호주머니로 들어간다)과 의료급여(정부재정부담)에서 건강보험으로 넘어온 환자에 소요될 재정을 충당하는데 쓰는 것으로 알려지고 있다.

그럼 무슨 돈으로? 보건복지부가 보도자료를 내면서 첨부한 ‘건강보험 보장성 강화방안’이란 자료에 해답이 있었다. 여기서는 네가지 안을 제출하고 있는데, 각 안마다 보장성 강화 항목과 그에 소요되는 재정 크기, 그리고 재원조달방안에 대해 적고 있다. 재원조달방안은 아주 상식적(?)으로 제시되어 있다. 지출을 줄이고 수입은 늘리는 것이다. 지출을 줄이는 방법으로는 본인부담을 높여 건강보험재정에서 감당하는 부분을 줄이는 방안이 제시되어 있다. 의원의 경우 현행 본인부담율을 30%에서 35%로, 병원의 경우 40%에서 50%, 종합병원의 경우 50%에서 60%, 그리고 종합전문병원의 경우 50%에서 70%로 늘릴 것을 제안했다. 수입을 늘리는 방안은 보험료를 인상하는 것이다. 보험료 1%인상시 2300억원이 추가 수입이 발생하고, 세대당 월 보험료 1, 030원이 추가부담된다고 밝히면서 네가지 안마다 2.4%, 6.5%, 10.9%, 16.9%의 보험료 인상규모를 제시하고 있다.

이 같은 방안을 보면서 떠오르는 속담이 있다. ‘병주고 약주기’ ‘아랫돌빼서 윗돌 괴기’라는 속담이 그것이다. 보장성을 강화하긴 해야 하는데 감기 등 가벼운(?) 질환으로 병원에 가면 돈을 더 내라는 것이고, 보험료도 더 올리겠다는 것이다. 달리 표현하면, 그리 심하게 아프지 않을 경우, 본인부담이 높아져 부담이 되면 병원에 가지 말고 참으라는 것이고, 보험적용을 더 받고 싶으면 보험료 더 내고, 보험료 더 내지 않으면 보장성을 확대하는 것은 어렵다는 얘기이다. 이런 내용을 갖고 의견수렴을 하겠다고 한다. 의견 수렴이라기 보다는 국민이 안 받아들일 방안을 던져 놓고, 안 받아들이면 ‘보장성 강화는 없다’는 선언을 만방에 떠들고 다니겠다는 소리이다.

이명박 정부가 종부세, 소득세, 법인세, 상속세, 양도세 등 이른바 ‘1%부자’만을 위한 감세 규모가 1년에 20조원에 달하고, 2012년까지 80조원에 이른다. 은행이 돈벌이를 하다가, 돈구하기가 어렵다고 하니 정부가 지급보증을 해준게 1000억 달러(100조를 넘는다)에 달한다. 건설사를 구하려고 무조건 퍼주겠다고 한 돈이 9조원이다. 그런데 정부는 대다수 99% 국민의 건강을 위한 정책에는 정부 돈은 한푼도 안쓰고 국민의 호주머니를 추가로 털어내야만 시행하겠다고 한다. 정부가 국회에 제출한 내년도 보건복지예산에 따르면 사회복지 230개 중 130개 사업이 예산이 올해보다 삭감되었다고 한다. 감세, 은행지급보증, 건설사 지원을 위해 쓰는 돈도 결국에는 국민이 부담해야 한다. 정부는 아마 항변할 것이다. 감세를 해야 부자들이 그 돈을 투자하거나 호주머니를 열어 소비를 할 것이고, 은행지급보증으로 수많은 직원들의 실업과 예금자들의 손해를 막을 것이며 건설사의 부도를 막아야 근무하는 노동자의 임금이 지원될 것이라고 말이다. 이런 생각은 초등학생도 아마 할 것이다. 보건복지가족부가 제출한 건강보험 보장성 강화 방안도 그리 많은 전문성이 필요치 않은 지극히 단세포적인 사고만으로도 내놓을 수 있는 방안이다. 어쩌면 이 정부는 국민들의 사고 수준이 자기와 비슷할 것이라 생각하여 이같은 ‘삽질 정책’을 계속 내놓는 것인지 모른다. 그런데 더 안타까운 점은 이명박 정부에 반대하는 세력 일각에서 현재의 건강보험의 ‘저급여-저수가-저부담’구조를 ‘적정부담-적정급여-적정수가’구조로 바꾸어야 한다면서 보건복지가족부가 제안한 ‘보험료 인상-건강보험보장성 강화’와 비슷한 ‘건강보험보장성 확대 -보험료 인상’ 등의 순서와 전제만 다를 뿐 결론은 비슷한 주장을 하고 있다는 사실이다. 국회 국정감사 때 제출된 자료에 따르면 건강보험료를 3개월이상 연체하여 건강보험 혜택을 받지 못하는 가구가 180만 가구, 300만명을 넘어섰으며, 이 중의 70%이상이 저소득층이라고 알려진다. 이래 저래 가난한 이는 고달프다.

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Final Declaration

We, over 500 women and men, representing people’s organisations and citizens from Asia and Europe joined together in Beijing at the 7th Asia Europe People’s Forum to work ‘For Social and Ecological Justice.’ We focussed on developing strategies and recommendations to our elected representatives, and to ourselves, as active citizens, for ‘Peace and Security,’ ‘Social and Economic Rights, and Environmental Justice’ and ‘Participatory Democracy and Human Rights.’

We are here to understand how the world can be remade in another image and how current crises can lead to opportunities with the renewal and regeneration of demands for social justice.

Charles Santiago, Malaysia

We met at a moment of major historical importance that has brought into sharp focus the drastic inequalities, injustice and poverty experienced by people across Asia and Europe. What is currently being presented as a ‘financial crisis’ is in reality the latest in a series of interlinked crises - food, energy, climate, human security and environmental degradation - that are already devastating the lives, and compounding the poverty and exclusion faced on a daily basis by billions of women, men and children.  

There is a strong consensus across Asia and Europe that the dominant approach over the last decades - based around deregulation of markets, increasing power of multinational corporations, unaccountable multilateral institutions and trade liberalisation - has failed in its aims to meet the needs and rights of all citizens. We need to go beyond an analysis and response that focuses solely on short term measures benefiting a few financial institutions.  

Our governments and the citizens of Asia and Europe have a unique and historic opportunity to transform our social, economic and political futures so that all can live in peace, security and dignity. We all need to take responsibilities to work together to create and implement the radical and creative solutions needed for people centred recovery, change and a harmonious world - we will not have this opportunity again. 

We therefore call upon the ASEM to implement people centered responses to the current financial crisis, in an effective and responsible manner. Urgent need must be given to poor, excluded and marginalised people and governments must work with citizens to develop and implement policies that will lead to a just, equal and sustainable world, and more accountable and democratic institutions – based on respect for gender equality, our environment and fundamental human rights.

This is a people’s forum - state leaders at ASEM should listen to our messages. We need a new type of regulation – markets don’t solve problems and we need social and economic justice.

Heidi Hautala, Finland

The 7^th Asia Europe People’s Forum urges the ASEM and it’s member governments to take action to recognise the following issues, priorities and recommendations:

1. Peace and Security

-          Develop long term solutions to promote peace, human security and sustainable development that prioritise non-violent means of conflict resolution, people-to-people interactions, use of international conventions and regional co-operation.  

-          Recognise and address security threats both multilaterally and multi-dimensionally through the United Nations, and adhere to principles of international law.

-          Establish an inter-regional conflict resolution mechanism to develop common visions on foreign policy and security, based on respect for national sovereignty and human rights.

-          Fully implement UNSC Resolution 1325 that recognises women are both disproportionately affected by conflict and key actors in promoting peace, reconstruction and reconciliation.

-          Abolish the anti-terrorist laws that have been developed as a response to the ‘war on terror’ and that are being used on a daily basis to impose restrictions on citizens, and to criminalise peaceful organisations and minorities. Ensure any additional security measures - whether national, regional or international - are subject to democratic scrutiny by citizens, parliaments and respect internationally agreed legislation.  

-          In tackling religious extremism give special emphasis to the role of education and inter- and intra-convictional/faith dialogues at all levels. Ensure full freedom of expression and information to enable rational debate and understanding.

-          Enact national legislation to guarantee full and public disclosure of government defence, arms exports and security budgets.

-          Cut military expenditure that is being funded at the expense of health and education programmes.

-          Democratise the security sector and its policies, programmes and decision making.

-          Implement existing national constitutions that safeguard human security, peace and dialogue.

-          Take concrete steps to strengthen the International Criminal Court.

-          Use the Non-Proliferation Treaty as the basis of regional co-operation and take steps to denuclearise Europe and Asia while striving for a nuclear free world. Strengthen global mobilisation towards a participatory review of the Non-Proliferation Treaty in 2010.

-          Take primary responsibility to control the trade and proliferation of arms. Develop and agree transparent and binding mechanisms, overseen by the UN, to control arms imports and exports.

-          Support civil society in their role and capacity to participate in arms control.

-          Sign and ratify the Cluster Munitions Convention in Oslo in December 2008.

-          Introduce legislation to make the European Code of Conduct on Arms Exports legally binding (with respect to European Union member states) and take steps to negotiate a Code of Conduct (with respect to states in Asia).

-          Include the reduction of armed violence as one of the Millennium Development Goals.

-          Support and protect survivors of the use and effects of weapons of mass destruction. Hold companies responsible for the production of weapons of mass destruction and toxic chemicals to account so that victims are compensated.

-          Undertake legislation to remove US bases from their soil.

-          Ensure the phased withdrawal of foreign troops from Iraq and Afghanistan within an agreed timetable.

2. Social and Economic Rights, and Environmental Justice

    -          Use the opportunity of the current financial and political crisis to put in place an alternative financial architecture and infrastructure that will promote and enable a more equitable, carbon neutral and just global economic system, reclaiming national development policy rights and empowering working people. Financial institutions and financial decision-making must become truly accountable and transparent.

    -          Implement social protection policies that have been shown to be affordable and essential in alleviating poverty. Acknowledge that social security for all without discrimination is a universal right (employment guarantee schemes, living pensions, disability benefit, carer support etc).

    -          Responding to Climate Change - Develop decentralised, renewable energy sources to combat climate change and contribute to sustainable development. Implement legislation that will support all citizens in reducing their energy consumption.

    -          Whilst fulfilling the Kyoto Protocol work together to ensure far reaching and binding agreements in Copenhagen in December 2009 including the firm and binding commitment by OECD countries to reduce emissions by at least 80% within an agreed time period.

    -          Substantially cut global emissions based on common yet differentiated responsibilities and support and finance adaptation and mitigation initiatives across the world.

    -          Stop financing projects that contribute to hunger, poverty, social and political injustice, and climate change.

    -          Ensure that decisions about adaptation funding are inclusive of civil society and reflect the needs, solutions and rights of poor women and men. Transfer the control of Climate Investment Funds and other climate programs to the UN and to stop loan-financing of climate programs.

    -          Trade - Renegotiate existing and end current negotiations on all unjust and unfair free trade agreements (bilateral and multilateral).

    -          Debt - Cancel or stop payment of all illegitimate debt and end the use of loans and debt relief to impose conditionalities. Conduct a comprehensive and participatory debt review/audit to help establish who owes who.

    -          Provide reparation for the ecological and historical debts owed to the South.

    -          Debt cancellation is a major requisite for aid effectiveness and aid should not exacerbate the burden of debt. Return stolen assets kept in banks in the G8 and other Northern countries and take steps to prevent tax evasion by transnational corporations and capital flight from South to North.

    -          Aid - Ensure that aid is free from imposed trade and procurement conditionalities. Abolish tied aid.

    -          Respect and fulfil the right and obligation of all countries and peoples to reverse the harmful policies that have led to the debt, food, and climate crises, such as Structural Adjustment Programmes, unjust Trade Agreements, Investment Protection Treaties and Infrastructure Integration Initiatives. Recognise that people’s organizations, social movements, trade unions, NGOs and other citizens’ groups as independent development actors, contributing to democratic processes.

    -          Food Security - Food safety, sovereignty and access should be at the centre of agricultural and trade policies in order to achieve food security for all and to address the current food crisis.

    -          Governments should realize that there are increasing numbers of people living in hunger. Causes include the speculation on grains for agro fuel, grain futures and increased oil prices. Current privatisation, deregulation and liberalisation policies are marginalizing small food producers and grabbing land for the purpose of profit and speculation. The UN Comprehensive Framework for action on the food crisis was developed without consultation with civil society organisation and therefore lacks legitimacy.

    -          Responses to the food crisis must take into account the greater impact on women and girls. In the longer term attention must be placed on supporting women small holder farmers and enabling their access and control to land.

    -          Respect the right to food and healthy and culturally appropriate food produced through ecologically sound and sustainable methods-protecting biodiversity. Food producers and fisherfolk should have access to and control over the means of production (e.g. land, seeds, water, appropriate technology). There must be full recognition of the rights and roles of women in food production.

    -          To implement agrarian reform programmes, strengthening local food production and consumption, diversification, controls on agribusiness and decreasing dependence on international markets.

    -          Implement a moratorium on agro-fuel production.

    -          Take immediate action to curb speculation on food stocks and prices.

    -          Ensure that research, science and technology are publicly accountable and address the pressing issues of food security, safety and sovereignty.

    -          In the context of stabilizing national food efforts, it is essential that in taking action to secure their own food security, countries do not undermine the human right to food in other countries.

    -          Labour rights - Ensure decent working conditions for all workers and respect for core labour standards. Develop and implement legislation to recognise, protect and promote informal workers, migrant, domestic and homeworkers.

    -          Ratify the UN Convention on the Protection of Rights and Well Being of migrant workers and members of their families and other relevant conventions as a minimum requirement for protecting the rights, decent work and well being of migrant workers. Recognise and protect the rights of migrant domestic workers and provide for the protection of their labour and human rights – in consultation with civil society and trade unions. Develop one standard for all countries in relation to recognising the skills and training of workers.

    -          Remove all legislation that criminalises migrants and detainees, undocumented migrants including minors up to 18 years (e.g. the EU Return Directive) and regulate recruiters and recruitment agencies.

     -          To take the responsibility and take remedial steps against the negative social and environmental impacts of foreign investments.

    -          Implement binding international legislation to ensure corporate social responsibility.

    -          Prevent the future privatisation of public resources such as water, health and education and, where possible, reverse current privatisation policies to ensure greater public control and public financing.

    -          Reaffirm that access to safe water and sanitation is a fundamental human right and to implement this right for all citizens. Market based solutions cannot solve the issue of governments irresponsible water policies, such as letting water resources be damaged by industrialisation or intensive agriculture. Transparency, accountability and good governance of water management, ensuring public participation are key to effective and democratic water delivery. All forms of water service delivery must be based on principles of affordable access, provision of quality water and based on consultation and participation.

    -          Take steps to finance and develop community disaster preparedness plans.

 3. Participatory Democracy and Human Rights

    -          Eliminate the stigma, discrimination and human rights violations experienced by millions of people due to their race, gender, disability, sexual orientation, age, caste, HIV status and ethnicity.

    -          Recognise that meeting the Millennium Development Goals (MDGs) is dependent on the realisation of women’s and girls’ rights. Ensure that gender equality and women’s rights concerns are central to the proposed 2010 review process for the MDGs.

    -          Provide accountable timetables and budgeted commitments to fulfil promises made to contribute 0.7% of Gross National Income in official assistance to help to address the financing gap for the MDGs.

    -          Ensure that donor governments enable the policy space needed to adapt the MDGs and develop country specific implementation plans by an immediate end to harmful economic conditionalities. It is also essential that poor women and men fully participate in policymaking.

    -          Ensure that existing consultations and mechanisms mandated by governments for consultation with their citizens are truly representative and inclusive. People who are recipients of development aid should define what they need and participate in development of their projects.

    -          Establish an international solidarity fund to support women entering politics.

    -          We need more women at more levels - to support the development of campaigns, learning networks and supportive mentorship links to ensure more women can gain entry and maintain their full participation in all levels of public life.

    -          Implement quotas for women candidates and elected representatives at all levels (including within political parties) with sanctions for non-adherence.

    -          Include indicators and strategies for increasing women’s political participation in all national economic and social development plans.

    -          Take concrete steps to tackle the violence that is a major barrier preventing women from participating in political life – enact legislation to make it illegal for men to hold office if they have been convicted of violence against women.

    -          Participatory democracy is more than free elections, all stakeholders should be involved in democratic processes. There should be positive and constructive engagement on regional issues including promotion of ceasefires and the ending of internal conflicts.

    -          Protect and ensure optimum expression and freedom to information and transparency.

    -          Support initiatives that promote local participatory democracy, in addition to strengthening accountability within local governance.

    -          Develop, resource and effectively implement decentralisation policies. Introduce legislation to ensure free and fair local elections where there is not already in place.

    -          Ratify and fully implement UN Conventions on the Rights of Disabled People. Realise that this will not happen without the meaningful participation of disabled people at all levels.

    -          Call on all countries to mainstream disability concerns into local and national economic and social development

    -          Urge governments to take proactive positive measures to further eradicate disability discrimination and create accessible and inclusive environment for people living with disabilities

    -          To empower people with disabilities and their organisations for their equal participation and full inclusion in all respects of life, through partnerships amongst stakeholders including civil society and government.

    -          Support national programmes to train disabled people to become experts on disabled issues.

    -          Recognise the leadership of people living with HIV in reducing the impact of HIV, and to meaningfully involve people living with HIV in policy and programme development. Recognise and address the gender dynamics of the pandemic.

    -          Implement and adequately finance the International GIPA Declaration (Greater Involvement of People Living with HIV).

    -          Ensure those responsible and complicit are brought to justice for those missing and disappeared and that there is legally agreed compensation for their families.

    -          Protect the rights of people living with HIV from stigma, exclusion, discrimination and human rights violations, and to ensure access to free treatment, care and support – exempting lifesaving medications from global trade agreements. To give special support to children who have lost their parents to HIV.

    -          Release all political prisoners and asylum seekers in Europe and Asia.

    -          Over 260 million people worldwide continue to suffer from exclusion, segregation and human rights violations on the basis of caste discrimination. Take urgent action to implement international and national legislation and initiatives to ensure its elimination.

    -          Develop multi-pronged and adequately financed regional anti-human trafficking policies.

    -          To establish an Asian wide regional human rights mechanism. AEPF welcomes the ASEAN Charter that could protect and promote human rights and the establishment of a regional human rights body. To ensure that the terms of reference of this body guarantee its independence and effectiveness. AEPF calls on ASEM to explore the possibility of expanding the ASEAN human rights mechanism to other Asian countries in the region and strengthen closer inter-regional cooperation of regional human rights mechanism between Asia and Europe.

It has taken a huge amount of commitment and dedication from Asia and European participants to make the AEPF happen and to develop joint partnerships and common goals. The fact we can sit together, exchange and treat each other as equals is a remarkable thing. We will suffer and fail if we don’t work together to tackle the global challenges facing humankind.

Zhang Zhijun, President, China NGO Network for International Exchanges