成人小说亚洲一区二区三区,亚洲国产精品一区二区三区,国产精品成人精品久久久,久久综合一区二区三区,精品无码av一区二区,国产一级a毛一级a看免费视频,欧洲uv免费在线区一二区,亚洲国产欧美中日韩成人综合视频,国产熟女一区二区三区五月婷小说,亚洲一区波多野结衣在线

立即打開
怎么理解美國醫(yī)保問題?牙疼一次就知道

怎么理解美國醫(yī)保問題?牙疼一次就知道

Clitin Leaf 2017-04-05
如果想著僅僅改變誰為醫(yī)保付錢以及如何支付就轉(zhuǎn)為自由市場,在熱愛自由的美國人心中,可能還不如眼下這個破綻百出的系統(tǒng)。

這次“春假”,我和家人享受了一周天堂般的生活,所以非常確定一點,我真的很想徹底放松一個星期,沒打算考慮醫(yī)療問題。

但老實說,想躲還是沒躲過,到最后還是跟醫(yī)生打上交道。這次在島上度假期間,不管觀賞鯨魚、海底潛水、去瀑布探險,泡泳池玩滑水,還是在沙灘上閑逛,我的牙都疼得厲害。只要咬到比木瓜瓤硬的東西就會齜牙咧嘴,疼到從躺椅上跳起來,連喝混合椰汁的可拉達都只能像嬰兒一樣小口抿。我一拖再拖就是不愿看牙醫(yī),到最后是妻子幫我打了電話。(現(xiàn)在看來,比放假時趕上牙疼更糟糕的是,跟牙疼的配偶一起度假。)

妻子找到一位出色的牙醫(yī),我心懷感激。不過這段假期插曲主要還是說明,其實對醫(yī)療的需求無處不在。要改革醫(yī)療體制的人應該注意。

過去幾周我們看到,共和黨領(lǐng)袖先是推動特朗普的醫(yī)保方案立法,后來又放棄了,因為有少數(shù)議員堅決不愿“修改”或者替代奧巴馬醫(yī)改法,寧可直接廢除,然后建立一個純粹自由的市場機制。理論上新體制下愿意買醫(yī)療服務(或者醫(yī)保覆蓋險種)的人在實際需要時購買,不想買或者無力負擔醫(yī)保的人不必購買。畢竟,從Froot Loops的早餐麥片、手機,到將萬圣節(jié)期間女超人主題的寵物貓狗穿戴裙裝,市場中很多商品都是這么運作的。

這種理念對經(jīng)濟自由派很有吸引力。四天前,我也曾是堅決的“自由派”,完全不能接受在夏威夷毛伊島的寶貴假期忍受牙醫(yī)電鉆,浪費逛品牌折扣中心的時間。

但我放棄了原來的想法,這不是自由市場的問題,而是因為醫(yī)保本身的特殊性質(zhì)。以下是兩個最重要原因:

無論是牙齒感染、胰腺手術(shù),還是化療、治療槍傷,醫(yī)療需求之所以叫“需求”是有道理的。如果你買不起Froot Loops麥片,最新款iPhone或者給小寵物的裙子,問題不大,沒有也能過下去。但不管買沒買醫(yī)保,需要急救的人必須得急救。到最后,人們會不計一切代價涌進急救室求醫(yī),很多沒有醫(yī)保的人逼急了就能做出來(然后由所有人均攤開銷)。如果滿足不了需求,很有可能就會死人。

在社會里生活,有很多機會例子可以解釋這種需求的差異。比如鄰居的房子著火了,你可能希望消防員立即趕到現(xiàn)場滅火,即便事后消防局不向鄰居收費也沒什么。我估計,你不會為此舉著牌子到鄰居家門前的草坪上高喊對方是“特權(quán)階級”或者“寄生蟲”。雖然傾向自由主義,但我們要把需求和愿望區(qū)別對待。

兩者的區(qū)別部分在于分擔風險的意識。鄰居的屋子著火可能燒到你家。不過很多傳染病也一樣。

醫(yī)療市場上買方可能不計其數(shù),賣方卻受到法律嚴格監(jiān)管。顯然,沒有哪部聯(lián)邦政府和州政府的法律禁止人們在eBay網(wǎng)上賣掉西施犬穿的裙子,也沒人禁止給狗狗穿裙子(但可能有人會覺得應該禁止)。但醫(yī)療系統(tǒng)面臨全方位監(jiān)管,除了法律法規(guī),還有行業(yè)協(xié)會確立的行規(guī),都跟法律的震懾力差不多。

先從容易理解的說起:社會中很多工種都具有準入門檻,就好比我們不會讓某某郵差去開飛機,除非經(jīng)過長年累月的訓練拿到飛行執(zhí)照。醫(yī)療市場也類似,所以本質(zhì)上就有壟斷因素,具體看提供醫(yī)療服務的類型。

在行業(yè)協(xié)會保護下醫(yī)療供應商對市場的掌控力堪稱超乎想象。還沒有收到賬單以前,他們就已經(jīng)定下費用(或者更通常情況下,知道你能通過醫(yī)保支付多少費用)。所以,醫(yī)療市場的消費者在了解醫(yī)療成本之前,甚至在不知道服務質(zhì)量以前就上了 “賊船”。事實上,需要住院的人幾乎必須向院方承諾為所有服務付錢,有些服務可能都等不到用上,另一邊醫(yī)療機構(gòu)卻可以獅子大開口。自由市場可不是這么運轉(zhuǎn)的。

當然,如果沉浸在自由主義氛圍里,喜歡事事親力親為,我是可以給自己拔牙,去沃爾瑪買瓶漱口水對付了事??杉幢隳茏龅侥且徊剑疫€是沒法給自己開抗生素(拔牙以后需要服用)。處方藥可能看上去實現(xiàn)了自由市場,因為過去幾年里商家已經(jīng)證明可以隨意叫價。不過,政府有上千條法規(guī)規(guī)定哪些藥丸和藥方可以賣給誰,誰來賣,具體用途以及發(fā)售時間。這些門檻對對有意開拓市場和推廣新藥的商家來說也是極高的,所以推升了價格。

坦白說,假如醫(yī)療市場真能像自由市場一樣運作再好不過。目前有一些還不錯的想法在推動醫(yī)療走向自由市場。比如美國科氏工業(yè)集團掌門人查爾斯?科赫與大衛(wèi)?科赫兩兄弟支持的非營利組織Freedom Partners最近發(fā)布了一份戰(zhàn)略備忘錄。其中建議,立法者改變當前的規(guī)定,允許個人和企業(yè)跨州購買保險項目,“鼓勵培育”多年期保單甚至壽險保單市場,至少在某種程度上可以避免投保人因長年身纏重病陷入赤貧。同時,我們應該大幅提高稅前健康儲蓄賬戶的存款上限,拓寬賬戶資金的用途(最明顯的例子,可以支付保費或者基礎醫(yī)療團體計劃的會員費)。重要的是,我們應該修改當前嚴重阻礙跨州遠程醫(yī)療服務發(fā)展的法令。(點擊此處了解相關(guān)背景。)

隨著國會的領(lǐng)袖翻開醫(yī)改新篇章(他們最近開玩笑似地表示會采取行動),可以考慮下我提的建議,眾所周知醫(yī)療市場盤根錯節(jié),距自由市場機制還有漫漫征途。任何“改革”,如果想著僅僅改變誰為醫(yī)保付錢以及如何支付就轉(zhuǎn)為自由市場,在熱愛自由的美國人心中,可能還不如眼下這個破綻百出的系統(tǒng)。(財富中文網(wǎng))

譯者:Pessy

審稿:夏林

I spent the week in paradise—on a “spring break” vacation with my family—and I can attest with the utmost certainty that it is better to spend a week not thinking about healthcare than thinking about it.

But truth be told, not thinking about healthcare got me thinking of it. And eventually in need of it. That’s because in the midst of a whale-watching, snorkeling, waterfall-exploring, pool-supersliding, beach-bumming island vacation, I had one heck of a toothache. I grimaced with each bite of anything harder than papaya, jumped from my chaise with the babiest baby-sip of colada—but still pushed off calling a dentist until…my wife called one for me. (The one thing worse than having a toothache on vacation, it appears, is vacationing with a spouse who has a toothache.)

She found an amazing dentist and I’m grateful for it. But the long and short of this episode was that the need for healthcare found me. And therein lies a lesson or two for anyone who hopes (in earnest) to reform it.

As we saw in the past few weeks, as Republican party leaders pushed for Trumpcare and then abandoned it, there is a small and determined group of lawmakers who don’t want to “fix” or replace Obamacare, but rather to repeal it outright and then institute a purely free market system in its place. That system, in theory, would let those so inclined buy healthcare (or insurance coverage for healthcare) when—and only when—they want it, and would leave those who don’t want it (or can’t afford it) alone. That’s, after all, how the market for Froot Loops works—and the one for mobile phones and for Supergirl-inspired Halloween tutus for your dog or cat.

There is a certain appeal to such economic liberty. And for four days or so, I myself was a Freedom Caucus’er—dead set against trading an afternoon of precious vacation for one in a Maui strip mall with a jawful of drill.

I lost that intellectual battle not because of the nature of free markets, but rather because of the nature of healthcare itself. Here are two fundamental reasons why:

A medical need—whether it be a tooth infection, pancreatic surgery, chemotherapy, or gunshot wound—is called a “need” for a reason. Dare the thought that you can’t afford a box of Froot Loops or a new iPhone or a tutu for your pet. It’s okay: You can probably live without it. But those who require urgent care will still have the same need for urgent care whether or not they have insurance. In the end, they might storm an emergency room to get it—which is what many without coverage still do (and which we still, collectively, pay for). And if they don’t address the need, they might well die.

As a society, we’re pretty good about recognizing that distinction in other contexts. When your neighbor’s house catches fire, chances are you’d want firefighters to race to the scene to put it out. You’ll probably even be okay with the fact that the fire department won’t send your neighbor a bill afterward—and I’m guessing you won’t post a sign on his front lawn saying, “Entitled!” or “Freeloader!” Freedom-loving folks though we are, we treat need differently than want.

Some of that distinction is due to the perception of shared risk, of course. A fire in your neighbor’s house could spread to yours. But then, the same can be said for many infectious diseases.

This market may have unlimited buyers, but sellers are strictly limited by law. There is, apparently, no federal or state law that prohibits a person from selling a tutu for your shih tzu on eBay, or for dressing your pet in one (though one might argue there should be). But our medical systems are thoroughly enveloped in laws and regulations, as well as practices so entrenched by guild or industry convention that they have the force of law.

Start with the obvious: We, as a society, don’t give everyone the keys to the operating room, any more than we let Joe from the mailroom fly a commercial jet—not without many moons of training and a license, that is. So the healthcare market has a bunch of built-in monopolies, depending on the particular service being offered.

Those guild-protected medical providers also have another uncanny market-controlling power: They can demand that you pay (or more commonly, have proof that you can pay through insurance) before they see you—and before you see the bill. So medical consumers are on the hook for payment long before they know what the total cost of the service is, or how well that service was provided. Indeed, those who require a stay in the hospital will almost certainly have to promise to pay for services from providers they may never see—and who can charge pretty much whatever they want. Not many free markets work like that.

Sure, in the euphoria of liberty-cherishing DYI-philia, I could have pulled my own tooth and gargled in Walmart peroxide. But even then, I couldn’t prescribe myself an antibiotic (which, it turns out, I needed). Our prescription drug trade may look like a free market—because sellers have proven over the past several years that they can charge whatever they want. But the government has thousands of rules about which pills and nostrums can be sold to whom, by whom, for what purpose, and when. The barriers to entry for those who want to create and market a new medicine are enormous—which drives up prices on its own.

It would be great, frankly, if healthcare did operate more like a free market. And there are some good ideas out there for how to push it in that direction. For example, Freedom Partners, a group supported by Charles and David Koch, suggested in a recent strategy memo that lawmakers change the current rules to let individuals and businesses purchase insurance plans across state lines, and “foster the creation of a market” for multiyear and even lifetime insurance contracts that would enable people to protect themselves, at least somewhat, from the financial ravages of a serious illness years down the line. At the same time, we should significantly raise the contribution caps on pre-tax health savings accounts and broaden the scope of what they can be used for (including, quite obviously, paying for insurance premiums or membership fees for primary care group plans). And importantly, we should rewrite the current statutes that largely prevent the expansion of telemedicine offerings across state lines. (Here’s some background reading on that.)

As leaders in Congress take up healthcare legislation anew (as they have recently teased they will), they might consider these options—along with the sobering fact that healthcare, as we know it, is a long way from a free-market system now. And any “reforms” that try to instill this ethos by simply changing who pays for insurance and how is likely to be even less embraced by freedom-loving Americans than the flawed system we have now.

掃描二維碼下載財富APP
最新国产成人精品区在线观看| 日韩欧美视频在线播放| 人人超碰人人超级碰国| 亚洲爆乳AAA无码专区| 亚洲精品无码专区在线观看| 色欧美亚洲欧美黄色成人| 无码人妻精品一区二区蜜桃老年人| 亚洲国产成人精品一区二区三区自拍| 国产狂喷水潮免费网站www| 久久国产劲暴∨内射新川| 欧美日韩国产成人高清视频 | 国产精品黄网站免费进入| 最新国产美女菊爆在线播放| 国产又粗又黄又猛又爽| 一级黄色 片免费网站| 国产精品日本亚洲777| 99精品国产在热久久无码| 久久久精品波多野结衣?v| 亚洲欧美人成综合在线在线a | 无码人妻一区二区三区蜜桃手机版| 国产另类ts人妖一区二区| 愛妃影视?无码国产精品一区二区| 亚洲国产AV一区二区三区| 精品人妻无码区二区三区| 日韩一区二区三区在线免费播放| 成人亚洲欧美在线电影www色| 日文字体乱码一二三四最新| 古装A级野外爱做片视频| 欧美日韩第一区二区三区| 在线看黄av免费网站| 东京无码熟妇人妻AV在线网址| 久久国产乱子伦免费无码| 人人妻人人玩人人澡人人爽| 亚洲夜夜性夜综合久久| 日本免费一区二区三区| 国产裸拍裸体视频在线观看| 色狠狠色狠狠综合天天| 久久久久久国产精品免费免| 亚洲日韩精品欧美一区二区a| 精品国精品国产自在久国产应用| 国产精品揄拍100视频|