評論
打印
Health reform
醫療改革
Medicare, the opera
醫改的鬧劇
Another election, another nonsensical fight over the elderly
又一場選舉，又一場關于老年人的荒謬斗爭
APRIL has been a cheerful month for the Affordable Care Act, better known as Obamacare. More than 7m Americans have signed up for private coverage through the law's exchanges and, by the end of February, more than 3m people had enrolled in Medicaid, the health programme for the poor. According to the latest Gallup poll, America's share of uninsured has fallen to its lowest level since 2008. These figures are good news for anyone keen to expand health coverage. They may not be so helpful for the Democrats' election prospects.
四月對平價醫療法案（或者稱其為奧巴馬醫改）來說是值得歡呼的一個月。截至二月末，已有超過七百萬美國人通過法律交換簽署了私人保險，以及超過三百萬人參加了專為窮人設置的健康計劃—醫療補助。根據蓋洛普最新的調查顯示，美國人未參加保險的比例已降至2008年以來的最低水平。這些數據對所有熱衷擴大醫保范圍的人來說都無疑是個好消息。但對民主黨競選前景的改善可能沒有太大裨益。
To understand why, consider another set of figures. More than 40m older Americans are enrolled in Medicare, the public-health programme for those aged 65 and older, with more than 15m of them in private Medicare plans. These are reliable voters in elections. And Republicans are singing them the same aria again and again: Democrats are raiding their benefits to pay for Obamacare.
看看另外一組數據便知原因。美國參加了醫保的老年人數量已超過4千萬，該醫保是一項為65歲及以上的老年人制定的公共健康計劃，其中超過一千五百萬人同時參與了個人醫保計劃。這些人都是在選舉中所能夠依賴的選民。共和黨人頻頻高唱同一嘆調：民主黨人為了支付奧巴馬醫改而損害了他們的利益。
Democratic politicians are desperate to convince them otherwise. On April 7th health officials provided some help: after proposing in February to cut payments to private Medicare plans by 1.9%, the Centres for Medicare and Medicaid Services (CMS) said they would rise slightly instead. This will not quiet Republicans.
民主黨的政治家竭盡全力的想要說服他們。4月7日，衛生部官員也參與其中：在提出將在二月份削減個人醫保計劃支出費用的1.9%后，醫療保險和醫療補助服務中心（CMS）表示，其支出并非降低，反而微升。但這并不能安撫共和黨人。
Obamacare does indeed lower Medicare spending by $716 billion from 2013 to 2022. Of this, $156 billion comes from Medicare Advantage, which lets the elderly use public money to buy private health plans. For years the government has paid more for these private plans, per person, than for traditional Medicare. Private insurers passed along the extra subsidy to consumers in the form of additional benefits or lower fees. Obamacare sought to bring private payments in line with traditional Medicare.
奧巴馬醫改確實會在2013至2022年間降低醫療開支約7160億美元。其中，1560億美元來自醫療照顧優先計劃（Medicare Advantage），該計劃允許老年人使用公共資金購買個人健康計劃。多年來，政府為每個人在個人健康計劃上的花費要高于傳統醫保。私人保險公司以給予額外好處或降低保費的形式，對消費者提供額外補貼。奧巴馬醫改試圖將個人支付帶回傳統醫保的正軌上來。
This was not a radical idea, but it is politically controversial nevertheless. Medicare Advantage is increasingly popular—about three in ten Medicare beneficiaries are enrolled in a private plan. Insurers argue that Obamacare's cuts, combined with other measures, will force them to raise prices or cut benefits.
這個想法并不激進，但在政治上卻引起爭議。醫療照顧優先計劃愈發流行，約有三成的醫保受益者參加了個人計劃。保險公司抱怨到，奧巴馬醫改中與其他措施相配合的縮減政策，會迫使他們提價或削減福利。
Last month's special election in Florida was a cautionary tale for Democrats. “To pay for Obamacare, Washington is forcing seniors to endure deep cuts to Medicare Advantage,” purred an advertisement. “Sadly, Alex Sink supports these cuts.” Ms Sink lost her campaign. Not surprisingly, Republicans as well as many anxious Democrats implored CMS not to lower payments. In February 40 senators wrote to CMS to ask as much. On April 3rd 29 congressional Democrats and Republicans sent their own letter.
上月佛羅里達的補選一事，值得民主黨警惕。一則競選標語這樣寫道：“為了支付奧巴馬醫改，華盛頓正迫使老年人忍受醫療照顧優先計劃的削減。不幸的是，Alex Sink支持這項削減政策?！彪S后Sink失掉了競選。不出意料，共和黨人以及許多焦慮的民主黨人懇求醫療保險和醫療補助服務中心（CMS）不要削減這項支出。2月，40名參議員致函醫療保險和醫療補助服務中心（CMS）提出同樣的要求。4月3日，國會中29名民主黨人和共和黨人致函醫療保險和醫療補助服務中心（CMS）。
In the end CMS said it would raise payments by 0.4%. The true effect on Medicare Advantage is more complex. America's Health Insurance Plans, the industry group that had lobbied against cuts, maintains that CMS's changes still amount to lower payments. Ana Gupte of Leerink Swann, an investment bank, points out that delaying cuts now may mean a bigger cut next year.
最后，醫療保險和醫療補助服務中心（CMS）表示將支付金額提高0.4個百分點。醫療照顧優先計劃的真正影響比這更加復雜。美國健康保險計劃是一個反對削減支出的行業組織，他們認為，醫療保險和醫療補助服務中心（CMS）的承諾仍舊意味著降低支付。來自Leerink Swann投行的Ana Gupte指出，現在的推遲可能意味著明年更大幅度的削減。
The ruckus belies a simple fact. Both Democrats and Republicans agree that Medicare spending must be contained. The budget proposed by congressional Republicans, written by Paul Ryan, would preserve all Obamacare's cuts to Medicare, including those to Medicare Advantage. Just don't expect Republicans to mention that on the campaign trail.
騷動掩蓋了一個簡單的事實：民主黨人和共和黨人均認為，必須遏制醫療支出。國會共和黨提出的預算由Paul Ryan撰寫，該預算保留了所有奧巴馬醫改中對醫療支出的削減政策，其中也包括了醫療照顧優先計劃。但別指望著共和黨人會在競選中提及此事。譯者：蕭毛毛
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