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Business Health insurance in America The doctor octopus
商業 美國的健康保險 章魚博士
Obamacare is making health insurers bigger
奧巴馬的保健計劃正在使健康保險公司變得更加龐大
THE future of Barack Obama's health law is uncertain.
奧巴馬健康法案的前景還不明朗。
Its main provisions will not come into effect until 2014; the Supreme Court may strike it down before then.
其主要條款要到2014年以后才會生效；并且在生效之前也可能會被最高法院槍斃。
But America's insurers are already transforming.
盡管如此，美國的各大保險公司已經隨機而動了。
They were big before; now they are growing bigger.
過去，它們很龐大，現在則正在變得更大。
On October 24th Cigna, an insurer based in Connecticut, said it would pay $3.8 billion for HealthSpring, which offers services and insurance to the elderly.
十月二十四日，坐落在康涅狄格州的保險公司Cigna聲明，它將為收購HealthSpring支付38億美元，后者的主要業務是為老年人提供服務和保險。
It is the latest deal to extend insurers' tentacles into new areas of health care.
這是Cigna公司拓展健康保險新領域的最新舉動。
The question is whether they might actually improve it.
問題是它會不會真的去提高該領域的服務質量。
Good, cheap health care has long eluded America.
長期以來，美國都沒有既好又便宜的衛生保健項目。
Doctors are paid for each service, so they deliver as many as possible, necessary or not.
醫生的每項服務都是付費的，因此，不管有沒有必要，他們都會推銷盡可能多的服務項目。
Insurers protect margins by micromanaging claims and hiking premiums.
保險公司靠權利的細微調控和額外費用的大幅提高來保障利潤。
These perverse incentives are addressed, faintly, by Obamacare.
奧巴馬健康法案中模糊地提到要改革這些不當的動機。
For example, there are pilots to reward hospitals for the quality rather than the quantity of their care.
比如，法案中的一些導則規定，獎勵那些致力于提高服務質量而不是服務數量的醫院。
Mostly, however, the reform deals with the symptoms of muddled incentives: high premiums and poor access.
但是，大部分的改革內容則是針對那些讓人不解的怪癥，即高額的額外費用同時又難以得到的健康保健服務。
For insurers, reform holds opportunity and peril.
對于保險公司來說，改革即潤育著機會同時也存在風險。
From 2014 the law will require everyone to buy health insurance and offer subsidies to those who cannot afford it.
法律規定，從2014年開始每個公民都要買健康保險，同時對于那些支付不起保險費用的公民給與補貼。
As more people buy insurance, firms' revenues will more than double to $1.2 trillion by 2019, predicts the Boston Consulting Group.
波士頓咨詢公司預計，截止到2019年，當更多的人買保險之后，保險公司的收益會達到一萬兩千億美元，是現在的兩倍多。
However, profits will be squeezed, thanks to a new tax, a minimum standard for benefits and new scrutiny of increases in premiums.
但是，由于新稅法，利潤上限制度和新的監管酬金增長制度的實施，保險公司的利潤將會縮減。
Faced with all this, insurers are keen to diversify.
面對這些新變化，保險公司都熱衷于多樣化的經營。
Many are hedging against a volatile private market by turning to the public one.
為了預防私營市場的不穩定性，許多公司轉向了國營（政府經營的）市場。
More states are asking insurers to run Medicaid, the programme for the poor.
更多的州政府要求保險公司經營管理針對窮人的醫療補助項目。
HealthSpring will help Cigna tap the market for Medicare Advantage, private plans that use public money to cover the old.
HealthSpring幫助Cigna叩響了公共市場醫療保險優越性的大門，即通過私企的計劃方案，來達到利用公共資金服務老年人市場的目的。
Humana, already a leader in public health programmes, has bought two Medicare firms this year (so far) and WellPoint has bought one.
已經是公共健康項目領頭羊的Humana公司，今年（截至目前）已經收購了兩家醫療保險公司；WellPoint公司也收購了一個。
For these insurers, Medicare Advantage gives access to baby-boomers.
對于這些保險公司來說，醫療保險優越性給它們打開了面向嬰兒潮時期出生的人群。
It is also a testing ground for Mr Obama's new health "exchanges", where consumers will be able to buy health insurance from 2014.
同時，這也是奧巴馬新健康"契約"的試驗場，新契約規定從2014年開始消費者都將能夠購買健康保險。
Both are highly regulated markets that court consumers directly.
兩個業已高度規范化的市場將同時直接服務于消費者。
Insurers are spreading into new businesses. Last year Aetna bought a health information technology (IT) company.
保險公司也正在將其業務擴展的新的領域。去年Aetna公司收購了一個健康信息科技公司。
Humana recently bought a chain of clinics. Its new Medicare plans both provide care and pay for it.
Humana最近也收購了一個連鎖經營的診所，它的新型醫療保險計劃是即提供健康服務項目，同時也提供支付服務費用的項目。
The thinking is that this will give Humana the means to keep more of its customers healthy.
思考一下可知，這將給Humana公司更多的手段，去保證其客戶得到更多的健康服務。
Others are doing the same.
其他公司也正在做和Humana公司一樣的事情。
UnitedHealth Group, the biggest health insurer, has been extending its reach for some time.
美國最大的健康保險公司，聯合健康集團（UnitedHealth Group）拓展其業務已經有一段時間了。
Two non-insurance subsidiaries already account for 20% of its $94 billion annual revenue:
其兩家非保險業務的子公司的營業收入已經占了其年度營業額940億美元的20%，
OptumInsight, an IT business, and OptumHealth, which owns doctors' groups and provides services to help hospitals improve care.
這兩家公司分別是OptumInsight，一家IT公司，和OptumHealth，一家擁有醫生團隊并且為醫院提高健康服務提供支持的公司。
These ventures do not just create new revenue streams, argues Sheryl Skolnick of CRT Capital, a broker-dealer. They strengthen United's main business.
經紀公司CRT Capital的Sheryl Skolnick說，這些風投不僅僅創造了新的公司收入，它們鞏固了聯合健康集團的主營業務。
This is most obvious when OptumHealth buys a doctors' group.
最明顯的例子是OptumHealth收購了一個醫生組織。
In August it announced that it would acquire Monarch HealthCare, in California.
今年八月份，OptumHealth宣布它將收購位于加州的Monarch HealthCare。
Bart Asner, Monarch's chief executive, predicts that Optum will help his doctors be more efficient, monitor patients' conditions and keep them healthier.
Monarch的首席執行官Bart Asner預計，OptumHealth公司將會幫助他的醫生更加高效，并協助醫生監護病人，使病人變得更健康。
United will enjoy revenue from owning Monarch.
聯合健康公司將會很高興分享擁有Monarch公司而帶來的收益。
But as one of six insurers that contracts with Monarch, it will also benefit from patients' lower costs.
但是作為與Monarch公司簽訂合約的六個保險公司之一，它也將會從更低的病人服務價格中"受益"。
This virtuous circle extends to hospitals that United does not own.
這種良性循環擴展到了不屬于聯合健康集團的醫院。
Historically insurers have fought with hospitals over payments.
歷史上保險公司總是在支付費用的多少上與醫院開戰。
But now insurers are testing pay-for-performance contracts.
但是現在，保險公司正在實驗按績效付酬的合約。
Hospitals can use Optum's services to improve their operations, creating new revenue for Optum and new savings for United's insurance business.
醫院能夠利用Optum的服務來提高它們自己的服務質量，這樣在為Optum創造效益的同時也為聯合健康集團的保險業務節省了開支。
This strategy might begin to align the insurer's interests with those of its former adversaries.
這項策略可能會開始將以前互為對手的醫院的利益與保險公司的利益拉到同一條船上。
