经济学人下载:医疗保健-不快乐的生日

What will become of Barack Obama’s health reforms? 奥巴马的医疗改革会带来什么？

WHEN Barack Obama signed a sweeping set of health reforms into law on March 23rd 2010, he knew it was a historic moment—and not just because Joe Biden, the vice-president, whispered into his ear that it was a “big fucking deal”. He had successfully ridden the wave of popular support that brought him into office to deliver universal health coverage, a feat that eluded all his predecessors.

奥巴马于2010年3月23日签下一系列医改法案时，就算副总统乔·拜登没对他耳语道“这该死的大手笔”，他就已知晓那是历史性的时刻。他借民意支持成功上位以推行全民健康保险，这项功绩可谓前无古人。

But the reality of politics has obstructed that grand dream. Republican leaders in Congress are trying to repeal the law outright. Several federal judges have ruled that one of the central provisions of the new reforms, an “individual mandate” requiring everyone to purchase coverage, is unconstitutional. And a recent poll by the Kaiser Family Foundation (KFF), a non-partisan outfit, revealed that hostility to the laws among politically vital independents has shot up sharply. One year on, how fares Mr Obama’s proudest achievement?

但政治的现实性使得这一伟大梦想障碍重重。议会中的共和党领导试图彻底废除该法案。联邦法官判定新政策的核心条款为“个人强制医保”，而强制所有人购买保险显然有悖宪法精神。由非党派机构--凯萨家庭基金会近日作出的投票结果显示，政治独立派对新法的敌意与日俱增。一年年以后，奥巴马的得意之作又会有何进展？

The chief strategy used by the administration to win over sceptics and to undermine legal challenges is to present the new laws as an unstoppable juggernaut. For example, when Kathleen Sebelius, the secretary of health and human services, spoke about the reform to the Senate Finance Committee on March 16th, she pointed to evidence of an “enormous difference it has made in the lives of Americans”.

政府打击怀疑论者或化解法律挑战的首要策略便是将新法案呈现为不可逆挡的强大力量。例如卫生和公共服务部部长凯瑟琳．西贝利厄斯谈及参议员财政委员会于3月16日推行的改革时，指出“其在美国社会中业已产生的巨大影响”这一证词。

True, the administration has rushed into force provisions affecting consumers directly, in an effort to win popular support. For example, some forbid insurers from denying coverage to children with pre-existing conditions, or imposing lifetime payout caps on anyone. The new laws also already require insurers to cover children up to 26 on their parents’ policies, which will benefit some 1.2m young people. Nearly 48m people on Medicare, the government health scheme for the elderly, are to get free preventive services such as colonoscopies and mammograms. In 2010 nearly 4m of them got $250 tax-free rebates to help pay for drugs.

的确，政府部门试图通过直接影响消费者的有力措施赢得民意支持。如禁止保险公司拒绝为已患病的孩童投保；或是将终身投保强加于人。新法案同样规定，年轻人在26岁以前都可以依靠其父母的保单，这将使约120万的年轻人受益。政府推行的老年医改为约4800万的老年人提供诸如结肠镜、乳腺检测等的免费预防性健康服务。