照顧考，或二十一世紀台灣長照制度啟示錄

On the Order of Caring: Revelations from the Long-Term Care System in Twenty-First Century Taiwan

本報告採取公元2108年政策史研究者的視角，往回考據二十一世紀前中葉，台灣的長期照顧制度，分析為何以隨收隨付制為財務基礎的長期照顧保險無法永續經營，最後導致公共長照制度崩解。本報告發現，首先，民主制度的內在限制，使得公民傾向作出短視近利之決策，而忽視未來公民之利益；其次，過度樂觀主義的發展期待，使得人們無視於福利制度的「經濟」與「人口」均衡兩個條件難以達成的現實；第三，缺乏合理證成的世代間連帶，使得制度對於未來公民而言缺乏正當性。此三者為造成制度崩解之主要原因。長期照顧為台灣刻正發展中之福利政策，照顧需要不滿足之議題亦日漸受重視，本報告藉以假想情境對真實結構之探討，旨在敦促關懷此議題者思考，如何可能突破當前遭遇之巨觀結構限制。 This report adopts a policy history perspective, investigating the publicly funded long-term care (LTC) system in twenty-first century Taiwan from the viewpoint of 2108, providing an analysis of the reasons why long-term care insurance based on a pay-as-you-go system collapsed. Three major reasons were identified. First, due to the limits inherent in a democratic institution, citizens tended to make shortsighted decisions, neglecting the interests of future generations. Second, an over-optimistic estimation of the progressive development of the economy, population, and technology compelled people to ignore the fact that the welfare system’s assumptions of perpetual growth of the economy and of the population are false. Third, imposed intergenerational solidarity lacked justification, making the LTC system illegitimate for future citizens. In recent years, the LTC system has expanded in Taiwan; society’s needs for LTC services are also receiving greater attention. Through a hypothetical scenario grounded upon real social and demographical structures, the purpose of this report is to urge those who are at stake to consider and debate possible alternatives for the LTC system in Taiwan.