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经济学人:医疗改革 医改的闹剧

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Health reform

Medicare, the opera
Another election, another nonsensical fight over the elderly
APRIL has been a cheerful month for the Affordable Care Act, better known as Obamacare. More than 7m Americans have signed up for private coverage through the law's exchanges and, by the end of February, more than 3m people had enrolled in Medicaid, the health programme for the poor. According to the latest Gallup poll, America's share of uninsured has fallen to its lowest level since 2008. These figures are good news for anyone keen to expand health coverage. They may not be so helpful for the Democrats' election prospects.

To understand why, consider another set of figures. More than 40m older Americans are enrolled in Medicare, the public-health programme for those aged 65 and older, with more than 15m of them in private Medicare plans. These are reliable voters in elections. And Republicans are singing them the same aria again and again: Democrats are raiding their benefits to pay for Obamacare.

Democratic politicians are desperate to convince them otherwise. On April 7th health officials provided some help: after proposing in February to cut payments to private Medicare plans by 1.9%, the Centres for Medicare and Medicaid Services (CMS) said they would rise slightly instead. This will not quiet Republicans.
Obamacare does indeed lower Medicare spending by $716 billion from 2013 to 2022. Of this, $156 billion comes from Medicare Advantage, which lets the elderly use public money to buy private health plans. For years the government has paid more for these private plans, per person, than for traditional Medicare. Private insurers passed along the extra subsidy to consumers in the form of additional benefits or lower fees. Obamacare sought to bring private payments in line with traditional Medicare.
奥巴马医改确实会在2013至2022年间降低医疗开支约7160亿美元。其中,1560亿美元来自医疗照顾优先计划(Medicare Advantage),该计划允许老年人使用公共资金购买个人健康计划。多年来,政府为每个人在个人健康计划上的花费要高于传统医保。私人保险公司以给予额外好处或降低保费的形式,对消费者提供额外补贴。奥巴马医改试图将个人支付带回传统医保的正轨上来。
This was not a radical idea, but it is politically controversial nevertheless. Medicare Advantage is increasingly popular—about three in ten Medicare beneficiaries are enrolled in a private plan. Insurers argue that Obamacare's cuts, combined with other measures, will force them to raise prices or cut benefits.
Last month's special election in Florida was a cautionary tale for Democrats. “To pay for Obamacare, Washington is forcing seniors to endure deep cuts to Medicare Advantage,” purred an advertisement. “Sadly, Alex Sink supports these cuts.” Ms Sink lost her campaign. Not surprisingly, Republicans as well as many anxious Democrats implored CMS not to lower payments. In February 40 senators wrote to CMS to ask as much. On April 3rd 29 congressional Democrats and Republicans sent their own letter.
上月佛罗里达的补选一事,值得民主党警惕。一则竞选标语这样写道:“为了支付奥巴马医改,华盛顿正迫使老年人忍受医疗照顾优先计划的削减。不幸的是,Alex Sink支持这项削减政策。”随后Sink失掉了竞选。不出意料,共和党人以及许多焦虑的民主党人恳求医疗保险和医疗补助服务中心(CMS)不要削减这项支出。2月,40名参议员致函医疗保险和医疗补助服务中心(CMS)提出同样的要求。4月3日,国会中29名民主党人和共和党人致函医疗保险和医疗补助服务中心(CMS)。
In the end CMS said it would raise payments by 0.4%. The true effect on Medicare Advantage is more complex. America's Health Insurance Plans, the industry group that had lobbied against cuts, maintains that CMS's changes still amount to lower payments. Ana Gupte of Leerink Swann, an investment bank, points out that delaying cuts now may mean a bigger cut next year.
最后,医疗保险和医疗补助服务中心(CMS)表示将支付金额提高0.4个百分点。医疗照顾优先计划的真正影响比这更加复杂。美国健康保险计划是一个反对削减支出的行业组织,他们认为,医疗保险和医疗补助服务中心(CMS)的承诺仍旧意味着降低支付。来自Leerink Swann投行的Ana Gupte指出,现在的推迟可能意味着明年更大幅度的削减。
The ruckus belies a simple fact. Both Democrats and Republicans agree that Medicare spending must be contained. The budget proposed by congressional Republicans, written by Paul Ryan, would preserve all Obamacare's cuts to Medicare, including those to Medicare Advantage. Just don't expect Republicans to mention that on the campaign trail.
骚动掩盖了一个简单的事实:民主党人和共和党人均认为,必须遏制医疗支出。国会共和党提出的预算由Paul Ryan撰写,该预算保留了所有奥巴马医改中对医疗支出的削减政策,其中也包括了医疗照顾优先计划。但别指望着共和党人会在竞选中提及此事。译者:萧毛毛


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insurance [in'ʃuərəns]


n. 保险,保险费,安全措施

traditional [trə'diʃənəl]


adj. 传统的

notched [nɔtʃt]


adj. 有凹口的,有缺口的 动词notch的过去式和过

original [ə'ridʒənl]


adj. 最初的,原始的,有独创性的,原版的

contained [kən'teind]


adj. 泰然自若的,从容的;被控制的 v. 包含;遏制

reliable [ri'laiəbl]


adj. 可靠的,可信的

understand [.ʌndə'stænd]


vt. 理解,懂,听说,获悉,将 ... 理解为,认为<

preserve [pri'zə:v]


v. 保存,保留,维护
n. 蜜饯,禁猎区

desperate ['despərit]


adj. 绝望的,不顾一切的

radical ['rædikəl]


adj. 激进的,基本的,彻底的
n. 激进分