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2009-08-03 15:32:46|  分类: 默认分类 |  标签: |举报 |字号 订阅

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Trust


 qianlaoda[]

 

 

In a post on healthcare, Paul Krugman makes this observation:

 

保罗·克鲁格曼,在一篇讨论保健体系的博文中,有如下的议论1

 

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost. [Emphasis in the original.]

你可以依赖某个保健组织,让它来帮你来做选择,让它来进行成本管理,在一定程度上,我们就是这样做的。但是,这些保健组织(health maintenance organization),在实现成本效率这个问题上,能力极其有限,因为人们不相信它们——这些组织都是牟利机构,你的治疗就是他们的成本。[强调句,原文如此。]

Paul's comment got me thinking. Perhaps a lot of the disagreement over healthcare reform, and maybe other policy issues as well, stems from the fundamental question of what kind of institutions a person trusts. Some people are naturally skeptical of profit-seeking firms; others are naturally skeptical of government. (There is, of course, the issue that an HMO can be run as a nonprofit organization. The one I use through Harvard is an example. But let's put that issue aside for another day.)

克鲁格曼的议论,惹我深思。可能,保健体系改革上的大量分歧(也许其它的政策问题也是如此),都源于“人们相信何种机构”这个基本问题。有些人天生地对牟利企业持怀疑态度;其他人则天生地怀疑政府。(当然,也有以一个非盈利组织来运行的保健组织的情形。我在哈佛使用的这个保健组织,就是一个例证。但是,让我们先把它放在一边,改天再来讨论。)

I tend to distrust power unchecked by competition. This makes me particularly suspicious of federal policies that take a strong role in directing private decisions. I am much more willing to have state and local governments exercise power in a variety of ways than for the federal government to undertake similar actions. I can more easily move to another state or town than to another nation. (I am not good with languages.)

我对于不受竞争约束的权力,具有不信任的倾向。这种倾向,使我对积极引导私人决策的联邦政策,持特别的怀疑态度。我更愿意让州政府和地方政府以多种方式来实施权力,而不愿意联邦政府采取相似的行动。让我移居到另一个州或另一个镇,会比让我移居海外,更容易一点。(我没有多国语言的天分。)

Most private organizations have some competitors, and this fact makes me more comfortable interacting with them. If Harvard is a bad employer, I can move to Princeton or Yale, and this knowledge keeps Harvard in line. To be sure, we need a government-run court system to enforce contracts, prevent fraud, and preserve honest competition. But it is fundamentally competition among private organizations that I trust.

大多数私人组织都有一些竞争对手,这使我在与它们打交道时,更觉宽慰一些。如果哈佛是一个不好的雇主,我就可以转到普林斯顿或耶鲁去,这种认识对哈佛形成了约束。确实,我们需要政府主持的法院体系,来实施合约、防范欺诈、维护诚实竞争。但是,本质上,正是私人组织之间的竞争,才是我信任的。

This philosophical inclination most likely influences my views of the healthcare debate. The more power a centralized government authority asserts, the more worried I am that the power will be misused either purposefully or, more likely, because of some well-intentioned but mistaken social theory. I prefer reforms that set up rules of the game but end up with power over key decisions as decentralized as possible.

我所具有的这种哲学倾向,很可能影响了我在医疗保障问题上的看法。一个集权政府所拥有的权力最大,我就越担心这种权力的误用(或者是有意误用,或者更可能地,是因为某种用意不错但根本错误的社会理论而造成误用)。我所偏好的改革是:它制定了游戏规则,但是,却以“在关键决策上尽可能地分权”而告终。

What puzzles me is that Paul seems so ready to trust solutions that give a large role to the federal government. (In the past, for instance, he has advocated a single payer for healthcare.) I understand that trust of centralized authority is common among liberals. But here is the part that puzzles me: Over the past eight years, Paul has tried to convince his readers that Republicans are stupid and venal. History suggests that Republicans will run the government about half the time. Does he really want to turn control of healthcare half the time over to a group that he considers stupid and venal?

使我困惑不解的是:克鲁格曼似乎更愿意采信“联邦政府发挥极大作用”这样的解决方案。(譬如,以前,他还提倡过“在医疗保障上只有一个支付人”的作法。)我也理解,在自由主义者之间,信任集权的想法还是很常见的。但是,让我觉得困惑不解的政治问题是:在过去八年间,克鲁格曼一直试图使他的读者相信“共和党人既愚蠢又唯利是图”。但是,历史表明:差不多有一半的时间,将由共和党人来主政。那么,他是不是真的愿意让医疗保障控制权的一半时间转交到那个“愚蠢又唯利是图”的团体的手上呢?

These thoughts, I appreciate, are broad generalizations. They don't immediately lead to a specific set of reform proposals. But I wanted to give Paul credit for a key insight: A central question in this and perhaps other debates is, Whom do you trust?

我知道,这些想法是非常一般化了。这些想法还不能马上产生一套具体的改革建议。但是,我想让克鲁格曼有一个更重要的洞识,那就是:在这个论题上(也许在其他的论题也是如此),其核心的问题就是“你信任?”

 

注释

 

1.保罗·克鲁格曼强调了医疗保障不是一个“市场”。原文及译文,见今天的克鲁格曼中文博客的文章。


编辑手记

* 修改了译文中的一个误译:your treatment 句。(8月3日)

 

 

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