二代健保規劃與實現之落差討論─以平面媒體為例之語藝分析

Research on The Diferrence between Design and Attainment of The Second-Generation NHI: A Rhetorical Analysis of Mainstream Newspapers in Taiwan.

黃志勳(ZHI-XUN HUANG)

指導教授 ： 陳孝平

國立中正大學/社會科學院/社會福利學系/碩士(2015年)

摘要

全民健康保險作為臺灣標誌性的社會政策之一。但隨後而來的財務問題使得全民健保必須作出相對應的改革。2011年完成的二代健保便是一系列應對措施中最具野心的嘗試。但是這樣的努力並沒有如預期般成功地將六類十四目的分類轉化為家戶總所得，而僅是保留大部分既有設計後、以補充保費發揮預定的功能。因此本研究便是要找出在完成修法之前的一年間，臺灣的主流報紙上所發揮的語藝效果，究竟讓二代健保發生了怎樣的改變。

經過對四大報的分析後發現，媒體確實擁有特殊的立場存在。自由時報與蘋果日報擁有較為民粹的特色、中國時報與聯合報則偏向改革者的立場。改革的主要目的在政府與民眾對公平性的定義差異下逐漸偏離，民眾希望不要影響自己利益的想法，導致財務更加難以平衡；除了衛生署外，其他行政、立法部門在政策的宣傳上皆未能扮演正向的角色，總統與行政院長更僅是消極地表示他們的支持。最終，衛生署必須自行處理好二代健保的大部分工作。除此之外，改革者在宣傳時有時未能聚焦於框架的辯駁，而是對反對者進行批評，民間團體、立法院以及媒體等，都曾成為受攻擊的目標，它們後續的回應也變得偏向反對改革乃至於改革者或政府本身。

政府整體形象的不佳使得外界更加確信他們的質疑，國民黨的消極與內鬨公開於報紙媒體上，衛生署改善制度的努力也一直被認為不足夠。不信任的發酵最終使得改變反對者的想法成為空想。因此，本研究認為將來的社會政策改革應當要上升到足夠的階層高度，以及確保政府方擁有一致的說詞與改革方式；此外，對反對者的說服語藝最好也要能夠專注於議題上，並避免引發更多的敵意。

關鍵字

平面媒體 ； 語藝分析 ； 二代健保 ； newpaper

並列摘要

The National Health Insurance (NHI)is one of the landmark social policies in Taiwan.A series of finantial problems made the reforms neccessary. The second gereration NHI introduced in 2011 is the most ambitious attempt over the NHI’s history, but it did not come out as the original design, i.e, the replace payroll with household gross income as the premium base. The aim of this study is to find out how the rhetoric presented in the mainstream newspaper in Taiwan between 2010 to 2011 has dislocated the outcome.

A scrutiny of the newspapers led us to believe that the media did holdspecific poistions. The Liberty Times and the Apple Daily have some charactreristics of populism; in the mean time the Chna Times and the United Daily News revealed reform-friendly preference. But the people and the government had different definitions of equity, and as the people still resist the negative effects introduced by the reform, it would be much more difficult to balance the books of the NHI. The adimnistration and the legislature branches of the government both provided weak support for policy advocacy, while the President and Premier only claimed that they were on the same side of the reform without corressponding actions. And as it developed, most of the government appeared to be more on the side of anti-reform.

A government with weak and incapable image could strengthen opposition. The passive attitude and infighting of KMT was laid bare by the media; and the determination of the Department of Health was always thought to be inadequate.These factors combined, it became nearly impossible to bring around those who thought the second gereration NHI as a downgrade strategy in solving problems. This research suggested that the reforms should be led by the appropriate level in the government and anyone in the name of the government must speak with one voice. Apart from this, the rhtoric should focus on the issues themselves and avoid aggitating more hostility.

並列關鍵字

rhetoric analysis ； second generation NHI ； newspapers

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