| 關 鍵 詞： |
美國社會福利計畫；公共福利計畫；私營化後對政府職能之公共價值；私營化後信賴保護原則之違反；特別係營利化之私人組織 |
| 中文摘要： |
本文行政契約（或公法契約）之觀點，導入 Pennhurst State School，Chevron U.S.A., Inc., Arlington Central School 等判決，討論美國社會福利政策在社會安全法下，執行層面之行政法律關係，與受國會有條件補助之影響，分析優劣成敗，並從以下主題切入，期將法律事實與關係完整呈現。一、美國社會福利計畫（social benefit programs）或公共福利計畫（publi c welfare programs）之基本架構。二、美國社會福利計畫與聯邦或州預算之搏奕。三、福利計畫私營化之源頭、執行與結果。四、政府職能之福利計畫私營化與私企提供產品與服務之市場化之間應有區隔。五、福利計畫私營化可節省成本、增加效率之迷思。六、回歸公法契約之必要性。其中最大之亮點即強調學者 Michele Estrin Gilman 之理論，闡明社會福利計畫之執行，經私營化後，並無法達到完全競爭及提高效率之目的，反造成“圍標”、“任務與表現無法衡量”、“貪腐及不適任”之現象。回歸美國學者 David A. Super 站立契約之立場，論述私營化可節省成本、增加效率之迷思，充份解釋了私營化後信賴保護原則違反之理由，而非一味地以公法價值批評之。該公法價值，不外如下：（1）私營化後對政府職能之公共價值（public value）之扭曲。（2）私營化結果已傷害了正當保護程序（due process of law）。（3）私營化已侵害了聯邦體制（federalism），以及聯邦與各州間之法規範分立（diversity）與負責（accountability）之界限。（4）私營化後信賴保護原則之違反，特別係營利化之私人組織（for-profit private organization），可能無法實現社會福利計畫時，而被公民拒絕認同。最後，必須回歸問題本源，美國政府對醫療健保之支出，從 1995 年以來，急遽上升；支出費用占 GDP 比率，從該年之 10.1%上升至 2010 年之 16.8%，如此將逐年增加預算赤字。如不徹底改革，根據美國白宮經濟顧問委員會之推估，2040 年該比率將劇增至 34%，後果堪虞。同時，並據以提出我國長治久安之計，應厲行我國 2001 年司法院大法官釋字第 553 號解釋，確認了中央健保局與公私立醫療事業間之法律關係為公法上之關係，所簽訂之合約係公法上之契約，則公共價值之內涵：資訊公開、立法監督、利益迴避、基本權不中斷等，均應予一體適用於公法契約之上，方足以解決查核醫藥之價格黑洞與厲行分業制度之問題。
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| 英文關鍵詞： |
social benefit programs；public welfare programs；public value；for-profit private organization |
| 英文摘要： |
This article originated from the concept of public contract, by introducing the US federal judgments of Pennhurst State School、Chevron U.S.A., Inc.、Arlington Central School, aims at the analysis of U.S. public welfare program operated under social laws ecurity, the execution of its administrative legal relations and the influences from conditional federal grants by the Congress. Also, with the discussion of the following subjects, the administrative legal fact and relation shall be presented completely. 1.The basic structure of US social benefit programs （or public welfare programs）. 2.The struggle of US public welfare programs relating to federal or state budget. 3.The origin, execution, outcomes of privatization of public welfare programs. 4.The government function of privatization of public welfare should be out of line with the private sector function of product & service marketability. 5.The query imposed on the cost down and efficiency increased to the privatization of public welfare. 6.The necessity to return to public lawcon tract. The highlight of this article is to emphasize the basic theory brought up by Mr. Michele Estrin Gilman who reiterates the undesirable results such as entrenchment, weightless performance & mission and corruption & incompetence might be consistent, far from reaching full competition and promoted efficiency, after the prevailing of privatization and marketability of social welfare programs. In addition, it supports the Professor David A. Super standing point of public contract that explains the said privatization is against the full-protection principle of reliability under which the cost down and efficiency increased should be questioned. The values of public law contract nevertheless could be classified as followed, though they are not always utilized by the Professor David A. Super to uphold his criticisms, （1） Privatization twists the government function of public value. （2） Privatization injures the principle of due process of law. （3） Privatization is over the line of federalism and crossing the border of diversity & accountability balanced by federal and state regulations. （4） Privatization violates the Reliability- protective principle; especially, the for-profit private organization could not be accredited or even refused by citizen due to dishonoring the realization of the social welfare programs. Finally, we have to resort to the origins of the questions in conflict.The US government medical insurance spending has sharply increased since 1995. Its total spending to GDP ratio hits up to 16.8% at 2010 compared to the 10.1% only in 1995. Thus, it might highly accelerate the budget deficit year by year. Without radical reform, the consequence is worrisome considering the fact that the said ratio shall hit to 34% at 2040, as the cruel warning brought up by the White House Council of Economic Advisers. Comparatively, this article suggests the idea of long term project for Taiwan. At least we should abide by the Grand Justice Interpretation No.553 and ascertain the public lawre lations among the Bureau of National Insurance and the private or public medical treatment sectors. Especially, the contract made among them should be classified as a public contract and that the core spirits relating to the open information, legislative surveillance, benefit evasion, and uninterrupted basic rights should therefore be applicable to that public contract. As a consequence, the examination problems of price black hole arising from the medicine and pharmacy imbalance & separation could also be radically resolved.
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| 目 次： |
壹、問題提出
貳、美國社會福利計畫（Social Benefit Programs）基本架構
一、源起與現況
二、雷根總統之福利改革
三、柯林頓總統之福利改革
四、小布希總統之福利改革
參、福利計畫私營化之源頭執行與結果
一、源起
二、執行
三、執行結果評估
肆、政府職能之福利計畫私營化與私企提供產品與服務之市場化之間應有區隔
伍、福利計畫私營化節省成本，增加效率之迷思
陸、回歸公法契約之必要性
一、憲法上之高度
二、行政法上之高度
三、私法上之高度（或稱契約法上之高度）
柒、結論
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