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Bernie Sanders的医疗保健计划走错了方向

作者:admin 来源:未知 时间:2017-09-14 阅读: 字体:

Bernie Sanders’ health care plan is headed in the wrong direction
Bernie Sanders的医疗保健计划走错了方向。
The Democratic party finally has a rallying cry: Medicare for All.
民主党终于有了一个团结一致的口号:全民医疗保险制度。
Too bad it’s a hopeless cause.
太糟糕了,这是没有希望的事业。
Sen. Bernie Sanders has turned a key plank of his quixotic presidential campaign into new legislation meant to expand health care coverage to all Americans. It’s a bold idea that addresses a genuine problem, which is why liberal Democrats such as Sens. Elizabeth Warren and Kamala Harris back the idea. But Sanders et. al. are aiming for the impossible when something more plausible could accomplish the same thing.
Bernie Sanders把他的总统竞选进入新的立法意味着不切实际的扩大医疗保险覆盖到所有美国人的一个重要支柱。这是一个大胆的想法,解决真正的问题,这就是为什么如参议员伊丽莎白·沃伦和Kamala Harris的思想自由民主党。但是Sanders et. al。当一些更可信的东西能完成同样的事情时,它的目标是不可能的。
Sanders wants to scrap the entire private insurance system and enroll everybody in Medicare, the health care program for seniors. Doctors and other providers would stay the same, in theory, but there would be no insurance companies and workers would no longer get coverage through an employer. The elimination of middlemen, along with the government’s enhanced bargaining power, would supposedly lower costs, benefiting everybody (except insurance company employees).
妮其·桑德斯想废除整个私人保险制度,并让人人都参加老年人医疗保险计划。理论上,医生和其他提供者将保持不变,但不会有保险公司,工人也不会通过雇主获得保险。消除中间商,加上政府议价能力的增强,理应降低成本,惠及所有人(保险公司雇员除外)。
The Sanders model is “single-payer”: The government would pay for everything. It would lead to “universal coverage,” which means everybody would have insurance. But single-payer and universal coverage are not the same thing, and it’s possible to have universal coverage without the government running everything.
桑德斯模型是“单一支付者”:政府将支付一切费用。这将导致“全民保险”,这意味着每个人都有保险。但是单一支付者和全民保险不是同一回事,没有政府管理一切,全民医保是可能的。
Sanders rightly points out that every other developed country has universal coverage for its citizens. Even President Donald Trump has said he’d like to see “insurance for everybody.” But that doesn’t mean a giant government program is the only way to do it.
妮其·桑德斯正确地指出,每一个发达国家都有其公民的全民保险。就连唐纳德·特朗普总统也说过,他希望看到“人人都有保险”,但这并不意味着一个庞大的政府项目是唯一可行的办法。
How to achieve universal coverage
如何实现全民覆盖
A hybrid system, with both public- and private-sector elements, is probably the most likely path to universal coverage in the United States. Employer-sponsored plans already cover nearly 160 million Americans — half the nation’s population. Rolling everybody off those plans into some kind of government program would be inconceivably complex. The scale of snafus would make the botched rollout of Obamacare in late 2013 look like a well-choreographed ballet.
一个兼具公共和私营部门要素的混合系统可能是美国普遍覆盖的最有可能的途径。雇主资助的计划已经覆盖了将近1亿6000万美国人——占全国人口的一半。滚动大家那些计划到一些政府计划将不可思议的复杂。对混乱的规模将在2013年底,看起来像一个精心设计的芭蕾舞让拙劣的部署奥巴马。
The employer-sponsored health care system could definitely be cheaper and better, and it imposes the strange burden of providing health care on companies that don’t exist for that purpose. But it’s also one part of the health care system that works reasonably well, and leaving it in place would amount to doing no harm.
雇主资助的医疗保健系统肯定会更便宜更好,它给那些不存在的公司提供医疗保健的奇怪负担。但它也是卫生保健系统的一部分,它运作得相当好,只要把它放在原位就不会造成伤害。
The worst part of the U.S. health care system involves people who don’t get coverage from an employer and don’t qualify for Medicare or Medicaid. The 2010 Affordable Care Act addressed that problem by subsidizing insurance premiums for lower-income people and expanding Medicaid. But there are still roughly 28 million adult Americans with no insurance, many who simply find it too expensive. A couple million more don’t qualify for subsidies and pay exorbitant premiums to buy coverage in the individual insurance market. This is where any effort to achieve universal coverage needs to begin.
美国医疗体系中最糟糕的部分是那些没有从雇主那里得到保险,也没有资格享受医疗保险或医疗补助的人。2010负担得起的医疗法通过补贴低收入人群的保险费和扩大医疗补助来解决这个问题。但仍有大约2800万的美国成年人没有保险,许多人只是觉得太贵了。还有200多万人没有资格获得补贴,支付过高的保费购买个人保险市场的保险。这就是任何实现全民覆盖的努力必须开始的地方。
Counting everybody who receives an ACA subsidy, there are perhaps 40 million Americans who aren’t covered by Medicaid, Medicare or an employer plan. If they could get insurance, we’d have universal coverage, or come very close. Meeting the needs of 40 million people is daunting, but it’s better than dealing with the 200 million who would need insurance if we scrapped the employer system. And the smaller target would require fewer of the tax increases that would be needed to pay for a Sanders-style program.
就算每个接受ACA补贴的人,也可能有4000万美国人不被医疗补助、医疗保险或雇主计划所覆盖。如果他们能得到保险,我们就有全民保险,或者非常接近。满足4000万个人的需要是令人畏惧的,但如果我们废除雇主制度,那就比处理2亿个需要保险的人更好。而较小的目标将需要较少的税收增加,将需要支付桑德斯风格的程序。
If the employer-sponsored system remained intact, the government could then be the insurer of last resort for everybody who didn’t get insurance through their job. Some people worry about the creep of “socialized medicine,” but the idea of government-provided catastrophic care has had support among Republicans in the past. The legendary conservative economist Milton Friedman proposed government-provided catastrophic care back in 2001. Mitt Romney, when he was the Republican governor of Massachusetts, put a government-backstop plan in place statewide in 2006. Instead of Medicare for All, the more workable idea is Medicare for More.
如果雇主支持的系统保持不变,那么政府就可以成为那些没有通过工作获得保险的人最后的保险人。一些人担心“公费医疗”的蔓延,但政府提供灾难性护理的想法在过去的共和党人中得到了支持。传奇保守主义经济学家米尔顿·弗里德曼建议政府在2001提供灾难性的医疗服务。Mitt Romney,当他是马萨诸塞州州的共和党州长时,在2006全州制定了一个政府支持计划。而不是全民医疗保险,更可行的想法是医疗保险更多。
What Medicare for All means for prices
什么医疗保险对价格意味着什么?
Sanders argues that all Americans need to be in the same insurance pool — Medicare — for the government to negotiate the best prices. But there are already 44 million people in Medicare, and 62 million in Medicaid, making them both giant insurance pools. Switzerland boasts lower costs and better health outcomes than the U.S., with a total population of just 8.5 million. Medicare is more bound by laws that limit its bargaining power — on prescription drug prices, for example — than by lack of heft.
妮其·桑德斯认为,所有美国人都需要在同一个保险库——医疗保险——为政府谈判最好的价格。但已经有4400万人在医疗保险,6200万的医疗补助,使他们两个巨大的保险池。瑞士拥有比美国更低的成本和更好的健康结果,总人口只有850万。医疗保险更受限制议价能力的法律——比如处方药价格——而不是缺乏分量。
Even a hybrid system of universal coverage would be politically difficult to pull off. Critics worry that any effort to expand the government’s role in health care could inevitably lead to a single-payer system, so there would need to be safeguards meant to keep the employer-sponsored system in place. Medicare is due to start running short of money in 2029, and anything that adds to its financial burden will hasten that day of reckoning. Finally, voters usually dislike change, so they’d have to be thoroughly sold on Medicare-for-more to pressure Congress to give it a shot. But Medicare for All might be a start.
即使是一个普遍覆盖的混合系统,在政治上很难摆脱。批评人士担心,任何扩大政府在医疗保健中作用的努力都不可避免地会导致单一的支付系统,因此需要有保障雇主到位制度的保障措施。医疗保险计划在2029年底开始资金短缺,任何增加财政负担的事情都会加速这一天的清算。最后,选民通常不喜欢改变,所以他们必须彻底出售医疗保险,以更多的压力国会给它一个镜头。但是全民医保可能是一个开始。

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