“川普医保”：美国人的灾难？

“川普医保”：美国人的灾难？

特朗普在竞选时就宣称一上任就要让前任总统奥巴马提出的《可担负医疗法》卷铺盖走人，但在国会和共和党内等多方压力的影响下，这位新总统提出的替代法案也没能得到众议院的批准。美国国会预算办公室估计：如果新法案通过，近千万美国人将失去医疗保障。

测试中可能遇到的词汇和知识：

predicament窘况；状态[prɪ'dɪkəm(ə)nt]

commissioned受委任的，受任命的[kə'mɪʃənd]

comprehensive综合的；广泛的[kɒmprɪ'hensɪv]

deliberation审议；考虑；从容 [dɪ,lɪbə'reɪʃ(ə)n]

electorate选民；选区[ɪ'lekt(ə)rət]

slapdash草率的；马虎的 ['slæpdæʃ]

decency正派；体面；庄重['diːs(ə)nsɪ]

aversion厌恶；讨厌的人[ə'vɜːʃ(ə)n]

Rushed healthcare reform will deliver an unholy mess（860words）

By Evelyn Rothschild

It is a shame that Donald Trump is so proud of not reading, for he could learn a great deal about his present predicament over healthcare by consulting the history books. The most important lesson of the past is that sound public health policy is not devised overnight.

Take the UK's National Health Service, which is funded by the taxpayer and is free at-point-of-need to the patient. The NHS did not spring fully formed in the blink of an eye. In fact, the first investigation into such a system was undertaken in 1919 by Lord Dawson, the first British minister of health, who was commissioned to examine schemes for the “systematised provision” of health services. But it was not until 1941 that Ernest Brown, health minister in Winston Churchill's wartime government, proposed that comprehensive hospital care should be available to everyone who needed it.

Three years later, after much debate and intellectual heavy lifting, a legislative plan for the NHS was finally published. Considerably amended, and under a different (Labour) government, the National Health Service Act became law in 1946, and the NHS formally launched in July 1948.

It is precisely because the NHS was constructed with patience and deliberation that it remains so dear to the British electorate. Though its structure has changed over the years, politicians dare not undermine its central principles.

Contrast the floundering efforts of President Trump and Republican congressional leaders to “repeal and replace” Barack Obama's Affordable Care Act. As a candidate, Mr Trump made foolish claims that he would repeal Obamacare on “day one” of his new administration.

After the election, he met the outgoing president and confused matters by conceding that the existing system might only need to be “amended”. Once in office, however, he reverted to his campaign promise that Obamacare would have to go.

Confused? The president certainly is. Yet, instead of drawing breath and weighing his options, he has insisted on steaming ahead as if speed were the principal criterion in such an important reform. The consequence — predictable to anyone who knows the first thing about healthcare — is an unholy mess. Mr Trump has now given his full backing to the American Health Care Act drawn up by Paul Ryan, the speaker of the House of Representatives, and other senior Republicans. One only has to see the president discuss this slapdash plan to grasp that his only priority is to pass it into law. But his haste is a great disservice to Americans.

According to the non-partisan Congressional Budget Office, 14m people will lose insurance coverage next year under the new proposals, rising to 24m by 2026. This alone drives a coach and horses through Mr Trump's repeated pledge on the campaign trail that nobody would find themselves uninsured as a result of his reforms.

The plan would also eliminate the cost-sharing subsidies available under Obamacare. The existing measures reduce co-payments for those earning between 100 and 250 per cent of the federal poverty level. The Republican plan shifts the fiscal benefit available to patients from subsidy to tax credits. But analysis of the plan suggests that the average enrollee would pay $1,542 a year more if the bill were implemented now, and $2,409 more by 2020. The impact would be greatest on the elderly — scarcely sensible or fair in an age of dramatically increased longevity.

Mr Trump is caught in a political pincer movement. On the one hand, he stands accused of forcing Americans to pay more for healthcare, and breaking campaign promises. On the other, he faces the dissatisfaction of Republican fiscal hawks who want the cost of the new plan to be reduced significantly. At the moment, the president looks like a man running on a treadmill while trying to play Jenga.

Healthcare has long presented the US with a philosophical dilemma. More than Europeans, Americans are suspicious of state intervention, and fear that a huge health bureaucracy would introduce socialism through the back door.

At the same time, the American people have a strong sense of decency, and an awareness that the medical-industrial complex favours insurers and pharmaceutical companies rather than patients. It is an embarrassment to a country of the US's prosperity that so many of its citizens have no health cover at all — a number that is set to increase dramatically.

Instead of rushing towards failure, Mr Trump should present a strategy for success. He should appoint a commission of the best and the brightest to study systems that operate well in Canada, the UK, Australia and elsewhere, adapt their findings to the specific US context and design a system that caters for all citizens. America's federal structure and its aversion to big government probably rules out a scheme like the NHS. But that does not mean that a hybrid approach cannot be devised that is genuinely universal in its reach, and puts patients first.

Such a task should not be beyond the nation of the New Deal and the moon landing. But it will require diligence and political patience. Mr Trump's instinct to press the reset button may be justified. But that should be the last step of the process, not the first.