美國的全民醫保改革方案到了關鍵時刻

美國的全民醫保改革方案到了關鍵時刻
在國會本月休會之前,全民醫保改革方案是關係到未來兩黨選舉的命運.
共和黨力圖扼殺全民醫保改革方案在本月休會之前通過,
民主黨力爭在本月休會之前通過.
但不管怎樣,美國的全民醫保改革方案是美國歷史的里程碑.
美國是發達國中寥寥無幾的沒有全民醫保的國家.
美國的醫保緊緊控制在醫保公司及其遊說團體手中.
昂貴的醫保費用,年復一年醫保費用的不斷上漲,不僅使得無醫保人口在膨脹,
而且有醫保的人口雖然費用在上漲,但醫療質量在不斷下降.
自2004 年以來,美國醫保費用上漲了30%,
2008 年,沒有醫保的人口超過了4 千6 百萬.
為什麼美國醫保改革如此困難重重?
一方面有根深蒂固的政治分歧,
另一方面有醫保成本,稅收的原因.
這一改革涉及到每個人的切身利益.
本次美國醫保改革基本內容為三點:
1.保留現有的醫保體系,增加公共醫保機構
已有醫保的群體可以繼續選擇現有的醫保體系,也可以選擇公共醫保機構.
2.沒能力加入醫保的群體可以選擇公共醫保機構
這部份人的投保費用部份有國家支付,部份有富有階層買單.
3.人人都必須加入醫保
這不僅使總體醫保費用下降,更重要的是使全民都有醫療保障.
通常情況下,年輕人由於身體健康不願加入醫保,
當把這部分人規定加入醫保時,健康人在醫保中的基數增加,總體醫保費用就會下降.

 

附上衛生部長Kathleen Sebelius幾天前有關美國醫保改革的Op-Ed一文:

Op-Ed: Health reform will empower families against market constraints

By Health and Human Services Secretary Kathleen Sebelius

Washington, DC — For decades, Washington has talked about fixing a broken health care system. And for decades Washington failed to act – allowing the special interests to stall reform while the cracks in the system turned into crevices, then craters.

But today, we are closer than ever to the change we need. Key committees in Congress have reached a striking degree of consensus about how to control costs, guarantee coverage, and provide more choices for every American. America』s doctors and nurses have announced their support. And even hospitals, drug and insurance companies have pledged to do their part to control costs.

Change is never easy and recently, some defenders of the status quo have made themselves heard.

One Republican Senator said, 「If we』re able to stop Obama on this, it will be his Waterloo. It will break him.」 And a leading political strategist urged fellow Republicans to 「resist the temptation」 to be 「constructive or, at least responsible,」 and instead work to 「kill」 health care reform.

These opponents of change may understand how to score political points in Washington, but they don』t seem to understand the stakes for the country. The health care status quo is unacceptable and unsustainable for our families, our businesses, and our nation as a whole. 

Today nearly 46 million Americans are uninsured and are one illness or accident away from losing everything. Millions more are under-insured. Since 2004, the number of under-insured families – those who pay for coverage but are unprotected against high costs – rose by 60 percent.

Even Americans with insurance find themselves paying more and getting less. In the past decade, premiums have doubled, rising three times as fast as wages and leaving families scrambling to close the gap. Last year, more than half of Americans skipped their medications or postponed medical because they couldn』t afford it.

Businesses – especially small businesses – aren』t faring much better. Skyrocketing health costs are making it even harder to compete in today』s global economy and forcing business owners to choose between staying afloat and providing health care for their workers.

At the same time, health care spending today consumes 30 percent more of state and local budgets than it did 20 years ago, forcing governments to choose between cutting services and raising taxes. And our national budget faces the same threat, with health care costs representing the single largest contributor to exploding long-term deficits.

America can』t afford to wait any longer for health care reform.

Some opponents of reform will try to scare Americans into thinking they』ll lose what they already have. Millions of Americans are happy with the coverage they have now, so let』s be clear: under any plan the Obama administration will support, if you like your health insurance you can keep your health insurance; if you like your doctor you can keep your doctor.

In fact, the real threat to what works in our system comes from doing nothing. Without action, prices will continue to spiral out of control. More Americans will not be able to afford insurance at all, and those who can will continue to pay more for less.

So what will reform actually look like?

First, to provide Americans with more affordable choices, we』ll set up a marketplace where you can compare plans and pick the one that』s right for you. None of the plans would be allowed to deny you coverage because of a pre-existing condition. And one of the options should be a public plan that would increase competition and keep private insurance companies honest.

Second, we have to align incentives for doctors and hospitals so that they』re rewarded based on the quality of care they provide, not on how many tests or procedures they prescribe.

Third, we need to move from a sickness system to a wellness system. By investing in prevention and emphasizing healthy lifestyles, we can save money while improving health.

Finally, reform must not add to our deficit over the next ten years. To that end, we have already identified hundreds of billions of dollars in savings – savings from money that』s already being spent on health care, but is funding waste and overpayments to insurance companies.

Put together, these changes will make quality, affordable coverage available to every American while bending the cost curve so that we don』t bury our children in debt. Fixing the system has never been so critical, and it has never been more squarely within our reach. Now it』s time to make reform a reality.

Kathleen Sebelius is the Secretary of Health and Human Services in President Barack Obama's Cabinet. She was the Democratic governor of the state of Kansas from 2003 to 2009.