The Ticking Time Bomb of American Health Care

Published in Huanqiu
(China) on 30 March 2010
by Li Ling (link to originallink to original)
Translated from by Liang Qin. Edited by Amy Wong.
Reform of the U.S. health care system has been through ups and downs. Though President Barack Obama signed the health care reform bill on March 23, the House of Representatives needs to pass a separate law to enact the changes. After this tough vote, a dream that the Democrats have pursued for more than 70 years, health care for all Americans, will come true. With his outstanding political wisdom, strong faith and make-it-or-break-it courage, Obama worked hard to win the health care reform battle. There is, however, a great difference between the bill that Obama signed and his original goals.

At the beginning of 2009, the new American President Barack Obama proposed the most sweeping health care reform plan in U.S. history, not only in terms of financial investment but also the concept of reform. Obama’s goals were historic breakthroughs: establishing a brand new foundation for sustainable development, building a supportive system and professional environment for doctors, and providing the best medical services at the lowest costs for all Americans. This system would reduce corporate pressure, encourage economic vitality, create more jobs, increase wages and boost economic growth by tens of billions of dollars every year, which would strengthen both the health care system and the economy.

The core of Obama’s health care reform was the public option, which would simultaneously ensure universal coverage and control insurance costs. The bill passed by the House of Representatives on Nov. 7, 2009, offered the public option and allowed the government to set insurance rates, similar to Medicare and Medicaid. Opposition from interest groups and ideological differences made Obama’s ideal bill nearly impossible to pass. Since November 2009, Obama had to make concessions, such as allowing states to decide whether to join the public option and allowing insurance companies to negotiate with health care providers. By the end of 2009, the public option had vanished from a significantly weakened House bill.

After the special election in Massachusetts, the Democrats fill only 59 out of 100 seats in the Senate, making it nearly impossible for them to prevent the Republicans from filibustering the bill. In order to appease Republican Senators, the reform bill degenerated to one in which the government subsidizes insurance and the public option is not an option, making the goal of lowering Medicaid costs an elusive one.

In order to gain support in the House and the Senate, the Obama administration compromised on the breadth of coverage. The House bill called for insurance that would cover 96 percent of Americans under the age of 65 years rather than universal coverage. The signed bill would cover 95 percent of the 32 million uninsured Americans instead of 85 percent.

Frankly, Obama’s health care reform is a victory watered down by compromise. Despite the expansion of coverage, the U.S. still has inefficient health care and the highest overall medical spending. Moreover, medical spending will continue to rise as more people buy coverage. The failure of the public option means that the U.S. government continues to pay for medical insurance without any safeguard to control spending, waste, abuse and fraud. The staggering cost of American health care is a ticking time bomb.

Translator’s note: The author is a professor at the Center for Economic Research at Peking University.


李玲:美国医改埋了个定时炸弹
• http://www.huanqiu.com
• 来源:环球时报
• 2010-03-30 08:00
美国医改一波三折。美国总统奥巴马3月23日在白宫签署医疗保险改革法案要再次提交众议院重新投票。困难投票通过后,全民医保———美国民主党人努力70多年的梦想才能尘埃落定。奥巴马以他卓越的政治智慧、坚定的信念、孤注一掷的勇气,在努力打赢这场医改的攻坚战。但事实上,奥巴马这次签署的医疗保险改革法案,早与他的医改初衷相差甚远。
2009年初,美国新任总统奥巴马推出了美国历史上规模最大的医疗卫生体系改革计划。这一计划不仅在投入和资金规模上大大超出历史上任何一次改革,在改革的理念上也实现了历史性突破。奥巴马将医疗卫生改革的目标定位为:为美国未来的持续发展建立全新的基础,希望建立一个全新的医疗系统,为医生提供良好的专业环境,并以最低的成本为所有美国人提供最好的医疗服务。这样的系统能够减轻企业压力,释放经济活力,创造就业岗位,增加实际工资,并在每年为美国经济带来多达数百亿美元的额外增长,让医疗系统和整体经济更为强健。
奥巴马医疗卫生改革的核心是通过建立“公共医疗保险计划”,同时实现医疗保险的全面覆盖和医疗成本的控制。在2009年11月7日由美国众议院通过的医改方案中,“公共医疗保险计划”依然存在,保险费率将在老年、残疾医疗保险的基础上由政府设定。但是,由于受到利益集团和意识形态的阻力,方案难以按照预期目标推行。奥巴马在2009年11月之后开始做出一定让步:允许美国各州自行决定是否参与这一“公共医疗保险计划”的同时,保险费率也不再由政府设定,而改为由该保险计划的筹资方与医疗服务的提供方进行谈判。但到了去年底,医改方案中,“公共医疗保险计划”已不见踪影,方案进一步弱化为政府仅可选定私营机构承包经营该保险计划。
随着马萨诸塞州特别选举结果的揭晓,民主党在参议院总共100个席位中仅占据59席,这意味着民主党人已无法阻止共和党人通过“阻碍议事程序”把医改议案“拖死”。为了使得医疗卫生改革在民主党已经不占政治优势的背景下获得通过,方案最终退化为由政府向原有商业保险直接提供补贴的做法,因此改革在效果上相当于完全背离了“公共医疗保险计划”,原先希望降低医疗成本的初衷难以实现。
  为了获得在参众两院的支持,奥巴马政府在对保险覆盖程度和筹资模式等方面也进行了妥协,在2009年11月7日由美国众议院通过的医疗卫生改革方案中,已经不再提及保险的“全民覆盖”,而是有96%的65岁以下的美国公民将获得保险覆盖。而最后的医改法案是:将让全美大约3200万没有医保的人获保,使医保覆盖率从85%升至95%。
  可以说,奥巴马的医改是妥协到最低点的“胜利”。虽然医疗保障的覆盖面大幅提高,但美国医疗机构的低效率和整体医疗体系高昂成本的顽疾依然存在,而且随着医保增加,医疗费用会继续上升。“公共医疗保险计划”的夭折使得美国政府仅有为医疗保险买单的权利,而没有控制医疗成本的手段,更无法治理美国商业医疗保险体系普遍存在的浪费、滥用和欺诈行为。高昂的医疗费用将会是美国未来发展的定时炸弹。▲ (作者是北京大学中国经济研究中心教授。)


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