That we could extend health care to everybody if only we cared enough is the theme of an op-ed in The Washington Post today by health care consultant Michael Millenson. If only that were true! Unfortunately, the op-ed is intellectually slipshod and not only does not make that case but, in fact, is self-refuting in the sense that the material provided in the op-ed is either internally contradictory or is sufficient to explain why we don’t do as the author wishes.
So, for example, from near the beginning of the op-ed:
[a music video on Youtube] expresses the frustration felt by those trying to end the United States’s status as the only industrialized nation whose citizens don’t have universal access to health care.
There’s so much wrong with that little snippet that I hardly know where to begin in criticizing it, indeed, I could get past it only with the greatest difficulty. For one thing universal coverage’s most ardent advocates would almost certainly reject the formulation above. Would universal access only to American citizens be acceptable? By defining universal coverage that way the number of the uninsured could be reduced literally at the stroke of a pen. Even a casual glimpse at the states with large numbers of uninsured people tells you that immigrants, particularly immigrants from Mexico are a key part of the problem of the uninsured.
The U. S.’s circumstances are distinctive: we’re the only major industrialized country I can think of that shares a long, largely unsecured land border with a country whose per capita GDP is a quarter its own. Britain and Japan are islands. France, Germany, Belgium, and Spain all have per capita GDP’s within 10% of one another ($33,800, $34,400, $36,500, and $33,700, respectively). There’s not much incentive for illegal immigration among those countries. Mr. Millenson hints at the explanation in his article here:
Only 13 percent of non-Hispanic white Americans is uninsured, compared with 36 percent of Hispanics, 33 percent of Native Americans, 22 percent of blacks and 17 percent of Asians/Pacific Islanders.
There is one country I can think of that has a situation similar to ours: China. It doesn’t have universal health coverage or universal access, either.
There’s another problem with the statement above. Universal coverage and universal access are not synonymous.
I know of no plans currently on the table for providing universal access. If we were to enact such a plan, it would constitute a powerful inducement for the sickest people in the world to get here by whatever means possible to them and claim their share of the universal access pie.
It might just barely actually be within our means to extend basic health care to the entire world. We are, after all, a very rich country. It is not possible, even with the U. S.’s great wealth to extend basic health care to the entire world here. The cost per person is just too high and it would simply be prohibitively expensive—an amount greater than our total GDP.
Mr. Millenson has little use for either political party. Republicans are racists:
The unofficial Republican attitude toward universal health care can be boiled down to the three “nots”: not our voters, not our kind of solution and not our priority. None of the Republican presidential candidates even pretended to present a serious plan for universal coverage, nor did Republican primary voters demand one.
Democrats are insincere phonies:
Meanwhile, Democrats play their own “us vs. them” games. Although high-profile party leaders are loudly calling for universal coverage — recall the Barack Obama-Hillary Clinton slugfest over their respective plans — they reassure the middle class that the cost of compassion will be covered by repealing tax cuts for the wealthy. This “free lunch” approach may tax credulity, but it does avoid the need for discussing other taxes.
Old people via their advocacy groups are selfish hypocrites:
AARP, one of the most powerful consumer groups, is running a high-profile ad campaign advocating a vague health care “reform.” But imagine the revolt if the organization’s leaders had asked its elderly membership to insist that those with no health insurance, including 9 million children, should be guaranteed basic care before Congress spent hundreds of billions of dollars adding a Medicare pharmaceutical benefit.
Meanwhile, he describes the effects of universal access glowingly:
The Commonwealth Fund recently tallied the ways in which universal health care would save hundreds of millions of dollars, most of which were related to lowering the societal costs exacted by the greater burden of illness among the uninsured.
Two can play at that game. For example, imagine how wonderful a perpetual motion machine would be. It could easily be converted into a generator and would produce energy forever at no cost. For that matter how about a universal cure that could be produced easily and inexpensively? That would be sure to keep costs down!
How much would we have to care, who is “we”, and, most importantly, what would we have to do merely to improve access to health care for the people living here now who don’t have adequate access to health care?
•members of the AMA would need to care enough to increase the number of physicians we graduate here annually. Most of the new graduates would have to be in family practice.
•medical educators would need to care enough to produce all of these new doctors without increasing the cost. To do this they’d need to drag medical education into the 21st century.
•physicians would need to care enough to practice where pay rates are lower and they’re far from the social and other amenities that big cities and their surroundings provide.
•legislators would need to care enough to change the work rules so that nurse-practitioners, other health care professionals, and just plain folks could do more legally. Legalizing telemedicine would help, too.
•we’d need to educate a lot more nurses and nurse-practitioners
•we’d need to care enough to close the borders so that the entire system would remain affordable
I’m just scratching the surface here. It would take a heckuva lot of caring.
译文:
关心是不够的
要是我们足够关注医疗顾问MichaelMilenson今天在华盛顿公告网站The Washington Post发起的一个以医疗为主题的社评,我们便能把医疗展向所有人.只要那是千真万确的.不幸的是,这个社评自作聪明的欲盖弥彰,不但没有摆明此间的道理,而且在社论中提供的材料不是内部矛盾就是不足矣服众,大有自吹自擂之嫌.
举个例子，选自接近社论开头的部分：
［Youtube的一个音乐录象带］表达了一些人的沮丧情绪，美国公民没有享用全民医疗，因此这些人试图去终止美国作为唯一工业国的地位．
这个小片段有太多的错误以至于我不知道该从哪开始谴责它，我实在很难认同它．一方面全世界全民医疗保险最忠实的拥护者肯定会拒绝以上方案．能接受只有美国公民才能全民享用医疗保险么？以这种方式定义全民医疗保险,口诛笔伐,不受保的人数将真的减少.甚至随意的看一眼这个有大量未受保人口数量的国家,它会告诉你,那些移民,特别是来自墨西哥的移民是未受保问题的主要原因.
美国的情况是很明显的：我们是唯一以工业为主的国家，我可以考虑和一个人均国内生产总值是其本身四倍的国家分享狭长的大部分地区存在安全隐患的疆土.英国和日本是岛国，法国，德国，比利时和西班牙全的人均国内生产总值都只在其他国的10%以内(分别是$33,800,$34,400,$36,500,和$33,700)这些国家的非法移民没有多少动机.Millenson先生在他文章的解释中给予以下的提示:
只有13%的非拉丁美洲的美国白种人未保险，成对比的是36%的拉丁美洲人,33%的美国人,22%的黑人和17%的亚洲人/太平洋群岛人.
我想到有个国家和我们有着相似的情况:中国,他们也没有全民医疗保险或全民医疗享用.
以上的论述还有另一个问题.全民医疗保险和全民医疗享用不是同义词．
我知道目前没有要提供全民医疗享用的计划,如果我们把这样一个计划付诸以实际,这会构成患病群体达到目的最有力的动机，竭其所能，索求享受全民医疗享用派．
实际上，以我们的方法不太可能将基本医疗扩展到全世界．我们总归是一个富有的国家.即使是拥有巨大财产的美国也不可能将基本医疗传播到全世界这里.平均人口的花费太高了,望而却步的昂贵__总额高于我们国内生产总值的总数
Millenson先生不为政治党派所用，共和党是激进主义：
非官方的民主党对全民医疗的态度可以被归结为三个＂不＂字，不是我们的选民，不是一种解决措施，不是我们的优先考虑．甚至没有一个民主党的总统候选人提出一个关于全民医疗保险的严肃计划，共和党预选投票也没这要求．
民主党是不诚实的伪君子：
同时,民主党玩他们的"我们对抗他们"的游戏.即使高调的党派领导人大声呼吁全民医疗保险___回想奥巴马和希拉里互相斥责各自的计划__他们让中等阶层安心,以取消减少富人的税款来弥补补济的损失.这个免费"午餐"的提出使人轻信税收,但不能避免讨论其他税款的需要.
老年人取道倡议团体是自私伪君子.
APPR,最权威的消费者机构之一,正在发动一个高调的广告游行,提倡大意模糊的医疗"改革".但如果组织领导要求老龄成员支持那些没有医保的人,包括900万儿童,想象下那造反场面吧.在议会耗资千万增加到对老人的医疗药物津贴费之前基本医疗需要得到保证.
同时,他描述了进一步全民医疗享用的作用:
联邦基金会最近夸大造次，说全民医疗将节省千万美金,大部分的资金用于降低未受保患者的巨大负荷所强求的社会费用.
两个人可以玩这样的游戏.举个例子,想象下这是一个多么奇妙的永恒运转的机器.它可以很容易的转变成一个创造能量的机器,不需要花费,会永远产生能量.就此而言,如何使全民医疗低价的简单的运行呢?减少花费是肯定的!
有多少我们不得不关心.谁是"我们",最重要的是,只不过是为了那些没有正当享用医疗的人提高医疗的享用权,有什么又是我们不得不做的呢?
•AMA的成员需要足够关注,增加医生的数量.我们毕业生每年在此.多数的新毕业生不得不在家实践.
•医疗教育者需要足够关注,在不增加花费的情况下培养出新医生.为了做到这个,他们需要把医疗教育硬拉进21世纪.
•医生需要足够关注,大城市和他们周边提供的薪水低下,他们得远离社会和其他愉快事物到别处行医.
•立法者需要足够关注,改变工作条例,使执业护士,其他医疗专家和一些平民就能做的很合法.并且使远 程医疗合法化．
•我们需要教育更多的护士和执业护士．
•我们需要足够关注，边境更加紧密，以能够支付得起整个系统．
我仅仅是略点毫毛．全民医疗保险需要更多的关注．