评论：奥巴马医改方案糟透了(2)

本次调查是tvbs民意调查中心于去年12月23日至25日晚间进行的电话访问调查，共接触1479位20岁以上台湾地区民众，有效样本1049位，在95%的信心水平下，抽样误差为正负3个百分点。台湾师范大学公布的民意调查中发现，对“文化部”的施政表现，明确表达“不满意”的民众比例占36.6%，是历次调查中的最高。美国有线电视新闻网民意研究机构7日发布的一项调查报告显示，对于近期美联邦政府因财政问题被迫关闭，63%的受访者对共和党的处理态度表示愤怒，有57%的民众认为民主党也应为此负责，同时有53%的民众对奥巴马的做法表示愤怒。

Further, from the mid-2000s to the passage of the AffordableCare Act, there was virtually no movement in Gallup’s survey results on thisquestion. Only after Obamacare was instituted did significantly more Americansbegin to claim they had to stay away from their doctors, even while sick,because health care had become too expensive.

Ÿ一、暂停“奥巴马平价医疗法案”。Ÿ 一、暂停“奥巴马平价医疗法案”。2010年3月23日，奥巴马签署《平价医疗法案》。

The sharp increase in the number of people avoiding theirdoctors is almost certainly the result of the increasing health insurance coststhat have occurred in the wake of the Affordable Care Act’s passage. In 2018alone, health care premiums for Silver Plans — the benchmark ACA insurance plan— sold on an Obamacare exchange increased by a shocking 31 percent, accordingto an analysis by Health Pocket. Health Pocket also reports the averageObamacare Silver Plan premium is now $477 for a 30-year-old and greater than$1,100 for 60-year-olds.

拒绝就医人数的攀升几乎就可以归结于法案通过带来的医疗费用的增加。用一位来自保险公司健康口袋的分析师的话来说，仅2018年白银计划（译注：奥巴马医保有四个等级，青铜、白银、黄金、白金，其中白金最高）-医保中较为基础的一款计划-续费费用就增加了31%。该公司还称在白银计划中平均一位30岁的投保人年费是477美元（约合人民币2993.13元），而平均一位60岁的投保人保费是1110美元（约合人民币6902.39元）！

Premiums are just the tip of the Obamacare iceberg, however,especially because many people who purchase their insurance plans on Obamacareexchanges receive government subsidies. Deductibles — the total amount thatmust be paid out of pocket for many services before a health insurer picks upthe full cost of a service — are a much better indicator of just how bad theObamacare crisis has become.

年费的问题还只是奥巴马医改方案中众多问题中的一个，毕竟不少该方案下的投保人会得到政府补贴。自付额-即投保人在保险公司结算之前必须自己支付的金额-是奥巴马医改方案中明显有缺陷的一环。

The average deductible for a family purchasing a Bronze Planon an Obamacare exchange is now $12,186. The average family Silver Plandeductible is $8,292, although the average maximum annual out-of-pocket costfor Silver Plan families is greater than $13,700.

一个家庭投保青铜计划后平均的自付额是12186美元（约合人民币76465.93元）。投保白银计划的家庭平均自付额是8292美元（约合人民币52031.47元），而一个家庭投保白银计划最多情况下需要支付13700美元（约合人民币85966.13元）的年费。

With deductibles this high, health insurance for most lower-and middle-income individuals and families becomes useless, even if they areeligible to receive subsidies that help offset higher health insurancepremiums.

鉴于自付额之高，就算他们可以获得政府补贴以减轻高昂年费带来的压力，医保对于中低收入者和家庭而言已然无用。

The problem isn’t limited to Obamacare, either. The ACAimposed significant regulations, fines, and mandates that distorted the entirehealth insurance marketplace, causing health care costs to rise for everyone,regardless of whether they receive health insurance from an employer or from anObamacare exchange.

当然，这不全是奥巴马医改方案的错。《平价医改法案》中制定了相当数量的规章、罚款、审批，搅得整个医疗保险市场不得安宁，最终导致医疗费用超出了所有人的负担能力，无论他们是否有员工保险还是有符合奥巴马医改方案规定的保险。

It’s true that people enrolled in Medicare or Medicaid arepartially immune to some of these health insurance cost increases, but theyface plenty of unique health care challenges of their own. For instance, about30 percent of doctors don’t accept new Medicaid patients, in large part becausereimbursement rates are so low. In some states, such as New Jersey, researchhas shown a majority of doctors refuse to see new Medicaid patients. In manycases, finding a good specialist is particularly difficult for Medicaidrecipients.

联邦医疗照顾保险和贫困医疗补助保险的投保人群的确在一定程度上没有受到医保费用增加带来的冲击，但此类人群就医仍然困难重重。比如，约有30%的医生拒绝接受有贫困医疗补助保险的新病人，很大程度是由于给医生的报酬太低。以新泽西州为例，调查人员发现医生拒绝有贫困医疗补助保险的新病人是一个普遍现象。不少实际情况中，找到一个有针对性的医师对于此类参保人员尤为困难。

America’s health care system has had numerous problems for manydecades, but Obamacare did nothing to fix them. Instead, it created an evenmore dysfunctional, bloated, bureaucratic model and forced everyone to join itor be greatly affected by it. Obamacare has been a complete and utter disaster,and without significant reforms, it will only get worse in the coming years.

数十年来，美国的医疗体制有着数不清的问题，然而奥巴马医改方案并未针对性的解决这些问题。相反，它使得现行体制变得更加运行不畅、臃肿官僚；它强迫人人加入或者因为不加入而深受其苦。奥巴马医改方案是一个不折不扣的灾难，倘若不进行重大改革，它会在未来带来更大的麻烦。