关于奥巴马医疗改革的问题！

来自经济学家网的信息:
IT WAS a rare victory for fiscal rectitude. On July 21st the Senate stripped the funding for seven more F-22 fighter jets from a big spending bill, bowing to Barack Obama’s threat to veto the aircraft.

But it was overshadowed by the much bigger setback Mr Obama had suffered a few days earlier. Three committees in the House of Representatives had presented a plan to provide health cover for the uninsured with the help of hefty tax increases on the rich. On July 16th Douglas Elmendorf, Congress’s chief budget scorekeeper, stunned Washington when he said the bill would not only fail to tame health-care costs, but would permanently shift them higher. It would add $239 billion to the deficit in the next decade and far more thereafter. The next day conservative Democrats joined Republicans on two committees in voting against the bill, though it still passed.

That Mr Elmendorf’s comments made such an impact signifies thegrowing political potency of the deficit. By a big margin, Americansthink Mr Obama is paying too little attention to it, according to onerecent poll (see chart). The proportion who consider it the mostimportant issue facing the country has risen from 12% last December to24% in June, according to another poll by the Wall Street Journaland NBC News. That is unusually rapid, says William Galston, a scholarat the Brookings Institution: “That’s now part of the political realityObama has to reckon with.” Many presidents have seen their ambitions frustrated by therealities of red ink. Ronald Reagan cut taxes shortly after takingoffice, but soon had to reverse course and raise them. George Bushsenior promised “no new taxes” and then had to break the pledge,scarring his party for years. Bill Clinton campaigned for amiddle-class tax cut, but abandoned the idea shortly after he waselected. The second George Bush managed to escape this fate because heinherited a surplus. But by the time he left office, his profligatecombination of serial tax cuts and unrestrained spending guaranteed thedeficit would again loom over his successor.
         

         
      

   
   The severity of the recession spared Mr Obama, at first, fromconfronting the deficit. Indeed, with the economy spiralling downwardand the Federal Reserve’s monetary ammunition all but spent, he rightlychose to boost the deficit in the short term through hefty fiscalstimulus.
But the recession has inflicted horrific damage on the government’saccounts. Mr Elmendorf’s Congressional Budget Office (CBO) predicts thedeficit will be $1.8 trillion this year. This is bearable given thescale of the recession; the real problem is that it will decline onlyto $1.2 trillion by 2019, still a horrendous 5.5% of GDP. On July 21stBen Bernanke, the Fed chairman, suggested that a deficit of no morethan 3% was sustainable—a figure that would arrest the growth in debtas a share of GDP.
Most of the red ink results from the enormous hole the recessionhas punched in GDP and consequently in tax revenue, the cost of bailingout the financial system, and interest on the mounting debt. Only asmall part of it comes from America’s big and growing entitlements,Medicare and Medicaid (health care for the elderly and poor,respectively) and Social Security (public pensions), whose worst fiscalproblems lie beyond 2019. “Unless we demonstrate a strong commitment tofiscal sustainability,” Mr Bernanke remarked, “we risk having neitherfinancial stability nor durable economic growth.”
Mr Obama knows all this: he promises repeatedly not to leave theproblem to his successors. Yet he has done little to back up therhetoric. His willingness to veto more F-22 spending is admirable, butthe $1.75 billion at stake is immaterial. He will release an updatedbudget outlook in mid-August, but it is unlikely to contain any notablenew initiatives. There is still no sign of a path towards fiscaltightening over the medium term as the economy recovers. Quite theopposite; Mr Obama has not wavered from his position that taxes onthose earning less than $250,000 will not go up. In fact, they’ve beentemporarily cut. He did say in an interview this week that he might setup a commission that could look at ways of reducing entitlementsspending once the recession is over.
The president has promised that health-care reform will bedeficit-neutral, but this is a slippery concept. A plan may bedeficit-neutral over ten years, but add significantly to it thereafterby front-loading revenue and backloading costs. The CBO figures showthat this is a big problem with the House plan, whose shortfall willballoon beyond the ten-year horizon.
Jim Cooper, one of the Democrats’ most fiscally hawkish congressmen,fears that if push comes to shove, his party will not long remainstalwart on deficit-neutrality. “Health care has been such animpossible dream for so many decades that a lot of today’s Congresswould overlook the deficit problems. I hear it all the time fromcolleagues in leadership: ‘We always find enough money for defence.We’ll find enough for health care’.” Mr Galston, though, thinks thatthe public’s worries about the deficit will reinforce Mr Obama’scommitment that health reform should not boost the deficit over themedium or long term. This could mean that he ends up with a plan thatcovers fewer of the uninsured than many had hoped.
None of this deals with the still-gaping hole in the budget. Indeed,a truly deficit-neutral health-care plan may make it tougher to fillthat hole: if the rich are already being taxed more to pay for healthreform, that makes it harder to use them to address the wider deficit.There are other ways to reduce the deficit, including getting rid ofthe mortgage-interest deduction, raising the age of eligibility forMedicare and Social Security, altering the inflation-indexationformula, or proposing some sort of tax reform that raises additionalrevenue. These ideas need not be implemented immediately; that wouldcontradict the purposes of stimulus. But the knowledge that they are inthe works would help reassure the public and investors that the federaldebt—forecast on current policies to explode from a net $5.8 trillionlast year to a net $11.7 trillion in 2019—may be tamed.

昨天跟一个美国麻省的upper class 聊，感觉他们对奥巴马的排斥挺大的！

依照新的改革方案，政府设立公共医保体系和私人保险公司竞争，强制每个美国公民都拥有医疗保险，且雇主须向员工提供医疗保险。另外，医疗改革计划要求对医疗保险市场进行彻底改革，禁止保险公司因以往的医疗记录而拒绝承保或索要更多保费。这，就是美国模式的“强制健康险”。

早在总统竞选中，奥巴马就提出了“全民医保”的计划，将推行医疗制度改革视为仅次于应对金融危机的美国国内第二大要务。奥巴马的医改计划首先考虑的是美国的无保险者。美国目前3亿人口当中估计有4700万人没有任何医疗保险，约占美国人口的15%。无保险者中绝大多数是有工作的穷人，包括新移民和非全日制工人。他们的收入刚过贫困线，没有资格申请政府提供的社会医疗保险，也没有能力购买私人医疗保险。他们除得重病外，获得普通检查与治疗的机会很少。除此之外，还有2500万人由于其保险无法满足需求，他们虽有医疗保险，但医疗支出仍然占其收入的很大比重。