Health Ministry's number-juggling act
(From The Japan Times Nov. 26 issue)

「三位一体改革」と厚労省

    The plan calls for seven ministries to cut a total of ¥630 billion in subsidies provided by the state. The response has been tantamount to rejection: Five ministries have agreed to cut only ¥28.9 billion, and two others (the Ministry of Land, Infrastructure and Transportation and the Ministry of Education, Culture, Sports, Science and Technology) have offered practically no concessions.

    Bureaucrats are prone to conformity. Usually, a ministry in a prominent position sets the pace for other ministries involved. This time around, the pacesetter has been the Ministry of Health, Labour and Welfare, which has offered a small subsidy cut of ¥10.9 billion — a far cry from the ¥504 billion requested by the prime minister's office.

    On the other hand, the Health Ministry has made a proposal to local governments: to reduce more than ¥900 billion in subsidies, including cuts in the central government's share of welfare payments to needy people. The arithmetic involved here — one that would likely benefit the Health Ministry — needs a little explaining.

    The government wants to transfer tax-collecting authority worth ¥3 trillion to local governments and cut the same amount of subsidies to offset the revenue loss. However, agreement has yet to be reached on ¥600 billion in subsidies. If the ministry cuts subsidies by more than ¥900 billion, that will create a considerable surplus in its budget. Other ministries appear interested in this calculation.

    Cutting the central government's share of welfare payments is problematic, however. National associations of local government heads, including the association of prefectural governors, are dead set against the proposal, saying that Tokyo is trying to "pass the buck" to local governments. There are good reasons to oppose it.

    Laws and regulations set detailed payment standards for "livelihood protection." Therefore, the local government groups say, curtailing the state subsidies "will not increase local autonomy and goes against the spirit of decentralization." They also say, correctly, that the aging of the population is adding to these payments.

    Chief Cabinet Secretary Shinzo Abe is right to demand that the ministries involved review their responses. Indeed, they should make more positive replies, rather than engage in a number-juggling exercise that would increase neither the fiscal freedom nor the discretionary authority of local governments.

    Health Minister Jiro Kawasaki appears in favor of cutting welfare subsidies. He should reconsider, given the strong opposition from local administrators. He should slash other subsidies (totaling ¥475 billion), including operating expenses for medical institutions and maintenance expenses for social welfare institutions. If the ministry falls short of the requested sum of ¥504 billion, then it can look to the list of proposed cuts prepared by the local government groups.

    Livelihood protection, a constitutionally guaranteed social safety net for those in dire poverty, is primarily the responsibility of the state. That's why such assistance is provided uniformly throughout the nation, with city, town and village halls acting as proxies for the central government. However, a Health Ministry plan for livelihood protection presented to a joint council makes one wonder whether the central government is forsaking its responsibility.

    The plan would reduce from three-fourths to one-half the rate at which the central government subsidizes livelihood and medical assistance. The subsidy rate for child allowances would be cut by the same margin. Of the livelihood payments, housing assistance would be provided entirely by local government, and prefectural governments would have the authority to set payment standards for livelihood and housing assistance. That could disintegrate the social-welfare system.

    Health Ministry is facing growing protests from local governments. Fourteen large cities have stopped sending statistical reports on welfare recipients to the central government. The association of mayors in Kyushu and the Saga Prefectural Government decided in October not to send these reports, as did Tokyo and three neighboring prefectures. Other districts are likely to follow suit.

    Last year, the ministry shaved subsidies related to health insurance, imposing an extra burden on local government. Its latest number-juggling proposal to slash welfare subsidies also rubs them the wrong way. At stake is the political leadership of Cabinet ministers in charge of structural reform. Of course, the buck stops at Mr. Koizumi's desk.

Dec. 3, 2005
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    計画では、7省が地方自治体への政府補助金を計6300億円削減することになっているが、5省が同意した削減額は289億円、国交省、文科省は削減予定を示していない。

    今回は厚労省が削減の中心となり、109億円の削減案を発表したが、首相官邸側が求めた割当5040億円には程遠い。同省はまた、生活保護費関係の補助金9000億円に相当する地方への税源移譲を提案した。

    国は計3兆円に上る税源を地方自治体に移譲し、同額の補助金削減を計画しているが、そのうち6000億円分の補助金については未決着だ。厚労省が補助金を9000億円以上削減できれば、政府予算がかなりの黒字になる。

    しかし、生活保護費の補助率削減について、地方自治体は「政府が責任を転嫁しようとしている」として提案に反対している。

    生活保護には厳しい法律、規則がある。自治体側は、補助率削減は地方自治強化にならず、地方分権の精神に反するという。

    川崎厚労相は、自治体の反対を十分考慮し、生活保護費関係の補助率引き下げについて再考すべきだ。

    生活保護は、憲法で保証された貧困層のためのセーフティネットで、国が責任を持ち、全国一律基準で給付される。しかし生活保護合同部会に提示された厚労省案では、政府が責任を放棄したように見える。

    同案は政府の生活・医療扶助、児童扶養手当の補助率を4分の3から2分の1に削減しようとしている。生活保護費のうち住宅扶助は地方自治体が全額負担することになり、生活保護、住宅扶助の給付基準は各県の判断に任される。これでは社会福祉制度が崩壊する。

    この問題に自治体は強く反対、政府への生活保護費支給に関するデータ報告を停止する自治体が増えている。

    昨年、厚労省は健康保険関係の補助率を削減、地方自治体の負担が増えた。同省が発表した福祉関係の補助率削減案は自治体を憤激させている。構造改革担当閣僚の指導性が問われるが、最大の責任を負わなければならないのは小泉首相自身である。