評論
打印
What about single-payer systems such as those in Canada, the U.K., France and elsewhere?
加大拿、英國、法國和其他國家的單一支付制度怎么樣呢？
Flynn bluntly shows how they control expenses: by rationing. You wait and wait to visit a specialist and,
弗林直白地展示了他們是如何控制開支的：通過限額配給。你等了很久才等到專科醫(yī)師
depending on your age and condition, you may not be treated at all.
而根據(jù)你的年齡和狀況，你或許根本得不到治療。
Could a free-market health-care approach work in the U.S.? Of course.
自由市場衛(wèi)生保健方法在美國行得通嗎？當(dāng)然。
Two examples where this is already being used are elective cosmetic surgeries and LASIK eye surgeries, which aren't covered by insurance.
已經(jīng)在使用的兩個例子是選擇性整容手術(shù)以及鐳射視力矯正手術(shù)，這兩項都不包括在醫(yī)保里。
Nonetheless, demand for both has zoomed. Results? Outcomes have improved, and prices, adjusted for inflation,
盡管如此，對這兩項手術(shù)的需求都大幅上升。結(jié)果呢？在過去20年里，手術(shù)效果得到提升，
have dropped by almost 50% for LASIK operations and 25% for cosmetic procedures over the past 20 years.
受通脹影響，鐳射視力矯正手術(shù)價格下降僅50%，整容手術(shù)下降25%。
The state of Indiana provides another example.
印第安納州提供了另一個例子。
Back in 2007 it offered state employees the option of taking a high-deductible policy with a health savings account (HSA).
回到2007年，其為州員工提供了一種高免賠額的健康儲蓄賬戶（HSA）選擇。
The deductible was $2,750, with Indiana putting that amount each year into the employee's HSA,
免賠額是2750美元，印第安納州每年都把這筆錢存入員工的HSA，
which became the employee's personal property. The worker would pay 20% of costs above that, up to $8,000; anything above that was covered 100%.
成為員工的個人財產(chǎn)。超出免賠額的部分，員工需要支付20%，可高達(dá)8000美元；超出部分全由保險公司支付。
The total out-of-pocket expense in a year was thus capped at a bit more than $1,000.
因此，一年的自付費用總額上限為1000美元多一點。
Employees in this plan reduced their spending 35%, because they suddenly had an incentive to get value for their health-care dollars,
參與該計劃的員工減少了35%的支出，因為他們突然有了讓醫(yī)療費用有價值的動力，
such as choosing generic drugs over the more expensive brand names
比如選擇仿制藥而非更加昂貴的品牌藥
and visiting acute-care clinics instead of rushing to a more costly hospital emergency room.
以及去急性病治療診所看病，而不是急著去昂貴的醫(yī)院急診室。
Flynn's irrefutable bottom line: We should vigorously pursue high-deductible health insurance policies with HSAs
弗林無可辯駁的底線：我們應(yīng)該大力推行HSAs這種高免賠額健康保險政策，
that would cover the deductible and be paid for by the employer, combined with posted prices for everything offered by providers.
由雇主支付免賠額，且醫(yī)療提供方要公布一切開支的價格。
Conditions may be ripe for such a profound change. Employers are already going for high-deductible policies,
進(jìn)行這種深刻變革的條件或許已經(jīng)成熟。雇主們已經(jīng)在爭取高免賠額的政策，
but many are not attaching them to robust HSAs. In addition, HSAs are hobbled by unnecessary restrictions,
但許多人并沒有把它們納入到強(qiáng)有力的HSAs中。此外，不必要的限制使HSAs的實施并不順利，
such as a ban on using them for over-the-counter medicines.
比如禁止使用HSAs購買非處方藥。
As a start, Washington should require insurers to offer such policies in addition to their traditional ones and should remove those HSA constraints.
首先，華盛頓應(yīng)該要求保險公司在提供傳統(tǒng)保險的基礎(chǔ)上再提供這樣的保險，并且應(yīng)該取消那些HSA的限制。
By the way, Indiana is also successfully pioneering a Singapore-like approach for its Medicaid program.
此外，印第安納州也為其醫(yī)療補(bǔ)助計劃成功開創(chuàng)了一種新加坡式的方法。
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