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贝克尔:美国的医疗改革(2 )  

2009-06-14 07:36:38|  分类: 默认分类 |  标签: |举报 |字号 订阅

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Several measures of the quality of life also favor the US. For example, hip and knee replacements, and cataract surgery, are far more readily available in the US than in Europe. The cancer survival and quality of life advantages enjoyed by US residents indicates that Americans get something for the large amount they spend on health care, but they do not indicate that the bang for the health buck is greater in the US, or even that the US health delivery system is reasonably efficient. Indeed, the American health system has several characteristics that may considerably lower its efficiency.

另外,还有一些指标有利于美国。例如,在美国换髋关节和膝关节以及白内障手术,要比欧洲更治疗治疗得好。 也有癌症存活率高以及生活质量高的优势,这表明美国人对于健康保健的投入更多。但是,并不能说明在美国健康所受到的巨大压力——甚至美国的医疗卫生系统因此才变得有效率。事实上,美国健康系统的几个明显的特征会大大降低其效率。

The American system ties medical insurance to employment by allowing company spending on medical premiums to be fully tax-deductible. Companies introduced health benefits during World War II in order to get around wage controls to be competitive in attracting employees. It was maintained as income tax rates increased during subsequent decades. This employer-based system is partly responsible for the high number of Americans who have no insurance coverage, since many small companies do not provide insurance to their employees. In addition, the system favors persons with high earnings since tax deductions for insurance premiums are worth more to them. A much better approach, so far opposed by President Obama, would provide a certain number of dollars each year to every person-perhaps $2500- as tax credits to be used only to buy health insurance and pay for medical care. Unused amounts in any year would be folded into health savings accounts (see my discussion of these accounts and other health care issues in posts for April 15, 2007 and January 13, 2008), and unused balances in any year would be carried over to spend in later years. This approach gives the same tax incentives to everyone, and it would encourage individuals to economize on their health care spending since unused balances would be available to spend in the future. It would also induce many persons without health insurance to get some since otherwise they lose access to this tax credit.

 美国医疗系统通过让公司支付医疗费用,来使公司获得全面减免税负的机会,进而将医疗保险和就业联系起来。公司会介绍二战期间的健康福利,以便能够在工资管制的条件下对雇员更有吸引力。在过去的几十年里,所得税税率持续增长。 由于很多小公司不给雇员支付保险,这个系统在大多数人没有保险的美国很有效。此外,该系统也受到高收入群的欢迎,因为对他们来说,税收减免比保险费意味获利更多。奥巴马总统正在推行的一项措施,将每年给每个人(可能是2500美金)提供一笔钱——相当于税收抵免——用于支付保险费和医疗健康费用。任何一年未使用的金额,都将并入健康储蓄账户,未使用的余额,会被转到以后几年的账户中。这项政策对所有人实行统一税率,这将鼓励公民节约健康账户的金额,因为,未使用的余额可以再将来继续使用。它还将诱使没有保险账户的公民建立一个账户。因为不这样,他们将失去税收减免的机会。

Health insurance is expensive in the US partly because most states mandate coverage of various health expenditures that have little to do with insurable risks. For example, the majority of states require insurance companies to cover the medical costs of all birth deliveries, even though these deliveries are mainly planned, and the expenses are known beforehand. The proper insurance approach would cover only unusual birth expenses caused by complications in the delivery and post delivery stages. By getting rid of unnecessary mandates, health insurance would become much cheaper, especially in states with the more onerous mandates.

 美国的医疗保险费用高的部分原因是,多数州的医保都涵盖了与保险无关的医疗花费。例如,大多数州要求保险公司负责所有生小孩的医药费,即使这些费用主要是提前已经知道的,并在计划内的。最好的保险方式,也许是只负责由于出生时或出生后非正常婴儿使用的费用。通过去除不必要的管理,医疗保险费用就会下降,尤其是对于那些涵盖了更多不必要责任的州而言。

The President wants to establish government-run health insurance companies to compete with private companies. This is a bad idea because experience from government-owned enterprises in other sectors conclusively shows that that they are run inefficiently, in good part because of political interference. Moreover, government enterprises do not compete fairly since they generally are subsidized, often generously and in hidden ways. Private health insurance companies in the US compete very strongly, although they are hampered by mandates and other regulations that frequently have nothing to do with effective and honest coverage of health needs.

 总统希望,建立政府运行的保险企业和私营企业竞争。这是个坏主意,因为政府在其它领域运行国有企业的经验证明,它们将是低效率的,部分原因是因为政府的“英明”干预。还有,国有企业并不会公平竞争,因为他们会从政府那里——公开的或是隐蔽的——接受补贴。尽管受到反对以及其它阻碍——常常与高效率以及诚实没有任何关系,在美国私人健康保险公司仍然竞争激烈。

 

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