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In some alternate America imagined by Pixar the health-care system could simply be reinvented.
在皮克斯設想的另一個美國，醫療保健系統可以簡簡單單重建。
In the real world it would be unworkable—and political suicide.
但在現實世界中，這將是一場難以實現的政治自殺。
Because American health-care costs are so high, making the government assume them all would require a huge increase in taxation.
因為美國的醫療成本如此之高，讓政府認為所有這些都需要大幅增加稅收。
Voters in Colorado, California and Vermont, all relatively friendly territory for Democrats, rejected single-payer systems when they realised how much they cost.
科羅拉多州、加利福尼亞州和佛蒙特州的選民都對民主黨相對友好，但當意識到單一支付系統的成本時，都拒絕了這一提案。
The rebellion that would follow an attempt to remove jobs-based health insurance from the 55% of Americans who have it, putting medical-insurance companies out of business in the process, would make the politics of Obamacare look like a church picnic.
在此之前，55%的美國人都有基于工作的醫療保險，在移除保險的過程中，保險公司會破產，這會讓奧巴馬醫改的政治看起來像一場教堂野餐。
A better approach would be to continue changing the health-care system in small steps, frustrating though that might be.
更好的辦法是繼續逐步改變健康醫療系統，盡管這可能會令人失望。
In states that expanded Medicaid, the health-care programme for low-income Americans, the proportion of people without health insurance halved.
在擴大醫療補助計劃的州，即擴大低收入群體的醫保項目，沒有醫療保險的人數已經減半。
If Democrats can win power in states that rejected the federal government's offer to pay for Medicaid expansion, they will be able to bring down the number of uninsured further.
有些州拒絕為擴展聯邦政府醫療補助計劃買單，如果民主黨人能夠在這些州贏得權力，那么民主黨將能夠進一步減少沒有醫保的人數。
The markets where individuals can buy insurance should be shored up.
個人可以購買保險的市場應該得到支持。
Finally, individuals could be offered the option to buy Medicare, paying an annual premium to the government just as they would to any other provider of health insurance.
最終，個人可以選擇購買醫療保險，每年向政府支付保險費，就像他們向任何其他醫療保險公司支付費用一樣。
Since Medicare has more pricing power than individual insurers do, this option ought to bring costs down eventually.
由于醫療保險比單個保險公司有更多的定價權，這個選擇最終應該會降低成本。
It would also provide choice for those living in the many rural areas where there is currently no competition in insurance markets.
它還將為生活在許多農村地區的人提供選擇，這些地區目前在保險市場上沒有競爭。
Senators Michael Bennet and Tim Kaine have a proposal along these lines.
參議員麥克·班尼和蒂姆·凱恩也提出了類似的建議。
It is not perfect.
它并不完美。
If premiums were not set high enough, the government’s liabilities would increase.
如果保費設置不夠高，政府的債務就會增加。
It would leave much of America’s frustrating health-care system unreformed.
這將使美國許多令人沮喪的醫保系統得不到改革。
But unlike most other versions of Medicare for all, it might actually happen.
但與大部分其他版本的全民醫保不同，這項改革可能真的會發生。
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