美国的全民医保改革方案到了关键时刻

美国的全民医保改革方案到了关键时刻
在国会本月休会之前,全民医保改革方案是关系到未来两党选举的命运.
共和党力图扼杀全民医保改革方案在本月休会之前通过,
民主党力争在本月休会之前通过.
但不管怎样,美国的全民医保改革方案是美国历史的里程碑.
美国是发达国中寥寥无几的没有全民医保的国家.
美国的医保紧紧控制在医保公司及其游说团体手中.
昂贵的医保费用,年复一年医保费用的不断上涨,不仅使得无医保人口在膨胀,
而且有医保的人口虽然费用在上涨,但医疗质量在不断下降.
自2004 年以来,美国医保费用上涨了30%,
2008 年,没有医保的人口超过了4 千6 百万.
为什么美国医保改革如此困难重重?
一方面有根深蒂固的政治分歧,
另一方面有医保成本,税收的原因.
这一改革涉及到每个人的切身利益.
本次美国医保改革基本内容为三点:
1.保留现有的医保体系,增加公共医保机构
已有医保的群体可以继续选择现有的医保体系,也可以选择公共医保机构.
2.没能力加入医保的群体可以选择公共医保机构
这部份人的投保费用部份有国家支付,部份有富有阶层买单.
3.人人都必须加入医保
这不仅使总体医保费用下降,更重要的是使全民都有医疗保障.
通常情况下,年轻人由于身体健康不愿加入医保,
当把这部分人规定加入医保时,健康人在医保中的基数增加,总体医保费用就会下降.

 

附上卫生部长Kathleen Sebelius几天前有关美国医保改革的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.