看奥巴马推动美国医疗制度改革的高明之处 (1) 自上而下，自下而上的改革 (图)

美国医疗制度的弊病目前已是众所周知了，美国人均医疗保险支付费用是发达国家中
最高的，占GDP 的百分之十以上。

过去10年内，医疗保险费用翻了一番，

且每年增长的幅度比一般人的收入增长幅度快3倍；

同时，美国没有医疗保险的人数比例也是发达国家中最高的，3亿美国人中有近4千万
人没有医疗保险(当然，这里面有各种不同的情况)。由于美国的医疗保险是和工作有
关联的，目前近10%的高失业率将会继续使更多的人失去医疗保险。美国2/3的个人破
产原因和医疗费用有关。尽管有这些问题，几乎美国所有的医疗保险公司年年都有巨
额的利润。

以往，曾有多位美国总统试图改革医疗保险制度(象小布什这种不学无术+祸国殃民
的败家子自然不算)，但要么力不从心，要么功亏一篑。克林顿夫妇在1993年的尝试，
为奥巴马政府提供了极好的教科书，除了有良好的愿望，也要有谋略，讲策略，上
下左右配合，既要借东风，也须防暗箭。

克林顿夫妇当年可以说是有点心高气傲，趾高气扬，高估了美国国会的智商(这些议
员们实际上是如果城门没有失火，就安坐家中，高谈阔论的)，低估了美国医疗保险
行业的险恶伎俩，忽略了争取医务界的支持，调动医疗改革的受益者-一般老百姓参
与的必要性。结果落得个旗开不得胜，四处碰壁，只能掩鼓息旗 ，退下阵去。但事
实证明克林顿夫妇的预言是对的，不进行医疗改革，美国政府总有一天会不堪医疗
费用的重负，而老百姓的健康状况也会受到极大影响。

奥巴马在竞选总统时就把医疗保险制度的改革作为施政纲领的重要部分，和那位连
自己有几所房子都搞不清楚的共和党老军头不一样，强调享有医疗保险是公民权利
的一部分，实现全民医疗保险计划时不可待。这种竞选纲领，是他得到低收入阶层
和上年纪选民支持的重要原因。

在奥巴马入主白宫后，因为美国经济的急剧恶化，曾有推测，他鼓吹的医疗制度改
革计划会被束之高阁。但奥巴马明智地认识到，不尽早控制医疗费用的开支，美国
经济的复苏，与人民生活的实际改善将面临巨大的挑战。

到目前为止，分析家们认为虽然奥巴马期待的医疗制度改革的最终蓝图尚不能确定，
但他的保证全体人民都有可承受的医疗保险的原则，及所采取的相应策略实在是空
前未有的，包括自上而下，自下而上；打草惊蛇，请君入瓮；明修栈道，暗渡陈仓；
避重就轻，争取多数等。先看第一招，自上而下，自下而上地推动改革。

接受当年克林顿夫妇的失败教训，放手让国会两院的数个委员会参与医疗制度改革
的讨论与立法，除了那些一筹莫展，吃不到葡萄说葡萄酸的共和党人外，谁不想在
这种百年一遇的历史时刻给自己名下增添些光彩，更别说报效选民、国家了。奥巴
马及其智囊团谙熟国会的运作方式，不耽心功高盖主，关键时刻，还得总统说了算。
在上周的记者招待会中，奥巴马说的十分明确，不会在不符合他提出的基本原则的
医疗制度改革法案上签字。

与此同时，奥巴马也在运用他独有的，在总统竞选过程中被证明行之有效的发动群
众运动的策略，通过由总统竞选积极分子参与的 Organizing for America (OFA)的基层
组织，自下而上地推动医疗制度改革。去年，整个共和党及民主党总统候选人希拉
里就是低估了奥巴马的这种草根组织的力量，而让“没有经验”的奥巴马改写了美
国总统竞选的历史。

自6月份以来，OFA 和Health Care for America Now 等组织在紧锣密鼓地多方运作，
一方面在公开场合大造声势，如6月25日在华盛顿国会山举行的推动医疗制度改革的
集会

做电视广告；一方面在基层举行讨论会，打电话，征集支持医疗制度改革的签名，
给少数尚举棋不定的民主党议员背上击上几掌。这就是美国民主政治体制的一个组
成部分，选民的呼声还是有相当作用的。

与当地的几个团体在6月25日乘车去华盛顿，参加有数千人的国会山聚会。

口号是“High quality, affordable health care for all， this year”。

有来自美国各州的工会团体和组织，Acorn, the AFL-CIO, American Federation
of State, County and Municipal Employees, the American Federation of Teachers,
 Communications Workers of America, SEIU, and UAW 等，




五颜六色的T恤衫代表不同的组织。.




?
?





从衣服上看，不知这是哪个工会的

在HBO的The Sopranos节目中出镜的女演员 Edie Falco邀请了若干位不同背景的各
界人士讲述自己的遭遇，强调医疗改革的必要性和紧迫性。



老当益壮




因为我们中的一位代表举着要求“single payer" 体系的牌子(非奥巴马的官方策略
)，引起了媒体的兴趣，对他进行采访


几代人的共同努力


高中生也不袖手傍观。

医生的支持


奥巴马的忠实支持者到处可见。

几位国会议员到场助威，鼓动大家会后去本州议员的办公室游说。




回到本地后，继续推动医疗改革活动，在当地造声势，扩大影响。

[StillH2ORunDeep]

所有跟贴:


8226; 顶！！！ -老忽- ♂ (0 bytes) (5 reads) 7/29/09
8226; Co：顶！！！ -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; 医保改革的关键是降低医保费用 -whatiswrong- ♂ (619 bytes) (75 reads) 7/29/09
8226; Clinton医改的失败就在与他对既得利益者的打击太大。 -老忽- ♂ (0 bytes) (4 reads) 7/29/09
8226; 国家没有存款，如果不增加赤字，只能打击既得利益者 --凡尔赛-- ♂ (0 bytes) (3 reads) 7/29/09
8226; 但不能太大。 -老忽- ♂ (0 bytes) (6 reads) 7/29/09
8226; the most laughable answer of the day so far -wxc39- ♂ (0 bytes) (6 reads) 7/29/09
8226; We have to spend on "sick' cure it and make it grow, but -MPSocks- (35 bytes) (9 reads) 7/29/09
8226; "sick' economy and cure it... -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; 回复：We have to spend on "sick' cure it and make it grow, but -wxc39- ♂ (248 bytes) (17 reads) 7/29/09
8226; Yes ! overall we will have to spend on proper sector to grow job -MPSocks- (202 bytes) (8 reads) 7/29/09
8226; Again, you get yourself lost -wxc39- ♂ (275 bytes) (9 reads) 7/29/09
8226; Whatever ! -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; Spending on proper sector has nothing to do with baling out WS -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; MPsocks, it was a typical case of you... -wxc39- ♂ (44 bytes) (7 reads) 7/29/09
8226; Show me URs.U don't understand not because you can't, but -MPSocks- (53 bytes) (7 reads) 7/29/09
8226; if we focus on fixing real issues like health care, close loop h -MPSocks- (19 bytes) (5 reads) 7/29/09
8226; if WS needs to rot through first (according to U),. -wxc39- ♂ (41 bytes) (5 reads) 7/29/09
8226; I meant to fix the loop holes of financial system, not WS per sa -MPSocks- (0 bytes) (4 reads) 7/29/09
8226; "rotten through" (lan4tou4) means WS has to suffer more to point -MPSocks- (203 bytes) (4 reads) 7/29/09
8226; 看着你咬着自己的手指头在那里嘴犟的劲头，想起了那谁谁。。。。。。 -wxc39- ♂ (0 bytes) (4 reads) 7/29/09
8226; Fantasizing (Yi4Yin2) too much is not good for UR health ! -MPSocks- (96 bytes) (9 reads) 7/29/09
8226; a wife, a life ... -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; 呵呵，看看你这熊样儿，犯得着气成这样吗。。。。。 -wxc39- ♂ (0 bytes) (4 reads) 7/29/09
8226; 气 ? why ? -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; I do feel a waste of time on someone clueless ! -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; i enjoy wasting my time on someone with too many clues like U... -wxc39- ♂ (0 bytes) (3 reads) 7/29/09
8226; Wrong logic! People with too many clues don't need U and UR time -MPSocks- (0 bytes) (1 reads) 7/29/09
8226; 其实指出你逻辑上存在的重大偏差也是对你的爱护。。。 -wxc39- ♂ (34 bytes) (8 reads) 7/29/09
8226; 逻辑? Only law prof can talk about law, economics prof -MPSocks- (127 bytes) (10 reads) 7/29/09
8226; 防止你今后到处丢人现眼不是对你的爱好吗 -wxc39- ♂ (100 bytes) (6 reads) 7/29/09
8226; Get a wife, a life whatever takes to stop UR insanity. -MPSocks -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; 看你颠三倒四地引用自己的这两句，倒真让人见识了insinity -wxc39- ♂ (0 bytes) (4 reads) 7/29/09
8226; Only to U "insinity" ? LMAO ! -MPSocks- (0 bytes) (1 reads) 7/29/09
8226; Agrred ! It can and will be. We have to start first ! -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; If 90% or more people use Gov's health plan, doctors -wxc1204- ♂ (316 bytes) (34 reads) 7/29/09
8226; contrary to what GOP predicted/promised, free market did not sol -老忽- ♂ (150 bytes) (20 reads) 7/29/09
8226; health care is more than just a service,it is basic rights. -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; Yes, it is part of basic human rights. -老忽- ♂ (77 bytes) (9 reads) 7/29/09
8226; 奥说绝对不通过增加财政赤字来为医疗改革买单 --凡尔赛-- ♂ (231 bytes) (42 reads) 7/29/09
8226; Have you read the news, he is going to cut $$ from -WXC1204- ♂ (122 bytes) (37 reads) 7/29/09
8226; 也许这可以节省一部分 --凡尔赛-- ♂ (0 bytes) (5 reads) 7/29/09
8226; Then he should refund part of the money to the people -WXC1204- ♂ (52 bytes) (8 reads) 7/29/09
8226; why? -老忽- ♂ (62 bytes) (7 reads) 7/29/09
8226; because they get less benifit due to the cut -WXC1204- ♂ (0 bytes) (7 reads) 7/29/09
8226; do u know medicare will bankrupt if we don't do anything? -老忽- ♂ (70 bytes) (6 reads) 7/29/09
8226; Are you sure OB's new plan won't bankrupt? -WXC1204- ♂ (0 bytes) (3 reads) 7/29/09
8226; Are you sure OB's new plan will bankrupt? -老忽- ♂ (0 bytes) (5 reads) 7/29/09
8226; The reason why I applaud 08 for guts to even tackle this issue -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; The country will be bankrupt -WXC1204- ♂ (0 bytes) (3 reads) 7/29/09
8226; Yes, if we don't reform health care system. -老忽- ♂ (0 bytes) (3 reads) 7/29/09
8226; 这次集中在“全民”享有，不是“全面”享有 --凡尔赛-- ♂ (0 bytes) (3 reads) 7/29/09
8226; 总结的精彩，会借用此点。 -Stillh2orundeep- ♂ (0 bytes) (2 reads) 7/29/09
8226; 咱们拭目以待，看他有没有这个操控能力 --凡尔赛-- ♂ (0 bytes) (3 reads) 7/29/09
8226; otherwise, medicare is just like a Ponzi Scheme -WXC1204- ♂ (0 bytes) (4 reads) 7/29/09
8226; Sorry, u do need to know the basics of a Ponzi Scheme. -老忽- ♂ (0 bytes) (2 reads) 7/29/09
8226; 从中国引进3亿年轻人Ponzi Scheme 就可以暂时循环了 --凡尔赛-- ♂ (6 bytes) (5 reads) 7/29/09
8226; Hahaha ! Ding ! -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; 我个人不太确信这张dollar分配的真实性 --凡尔赛-- ♂ (0 bytes) (6 reads) 7/29/09
8226; If things come so easy, it would have been done already. -老忽- ♂ (111 bytes) (17 reads) 7/29/09
8226; 老忽哲理名言 --凡尔赛-- ♂ (0 bytes) (4 reads) 7/29/09
8226; Co：老忽哲理名言 -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; 的确如此。这种CHANGE从来不是易事，但共和党无法让人再信任。 -Stillh2orundeep- ♂ (0 bytes) (1 reads) 7/29/09
8226; If thing is difficult to do, it usually is diffcult to do it rig -用户名被占用了- ♂ (0 bytes) (6 reads) 7/29/09

[julia42163]

回复jennifer123ee的评论:
I know what it takes to be a good doctor and what it takes to be a rich doctor(both in China and US). I know the difference between treating a patient, cure a patient and to prevent a human from being a patient. I know how much weight a doctor's intellegence carries in the whole health care delivery system. This debate is not about whether you want the top 10% or bottom 10% students to be doctors.
Actually it's a very good question for politicians to think about: whether they want a system to encourage top 10% students to be medical doctors.

[StillH2ORunDeep]

回复julia42163的评论:
就说嘛，真正的聪明人是做聪明事的。医生挂牌子只是为了治病救人。

[julia42163]

回复jennifer123ee的评论:
hehe, I went to the best medical school and I am not only top 10%, but may be top 1%......
But I don't use my smartness as a ticket to insult people who have different point of views or to look down people who are less blessed.

[StillH2ORunDeep]

See no point to argue with self-assured assumption. Better check with ALL Harvard professors who support Obama, his economic plan AND health care reform.

[jennifer123ee]

回复julia42163的评论:
Your comments proves you probably are not at top 10% of your class. Only top 10% or even less students in this country can go to medical school.
However, if you are at bottom 10% of the class, I don't blame you supporting the ObamaCare

[jennifer123ee]

回复StillH2ORunDeep的评论:
If you havn't not heard of this, I suggest you read more!

[StillH2ORunDeep]

回复好望角骆驼的评论:
研究表明，“垃圾快餐”不是造成肥胖的唯一因素，甚至主要因素，尽管麦当劳向其
它国家输出汉堡包时，也连带有美国的不健康生活方式，但人们也得对自己的健康
负责，毕竟不是吃“垃圾快餐”的人都肥胖啊。综合因素，综合治理。

[StillH2ORunDeep]

回复jennifer123ee的评论:
“most of european countries are trying to privatize their medicine program.
They have experienced it, they want to be like us. ”，这倒是第一次听说，没见过这样的文章。总不至于在美国吃够了苦头，寻求变革的时候，有人会愿意试试至少10%的人没有医疗保险的“特点”。

[StillH2ORunDeep]

回复julia42163的评论:
贴标签是吓唬人的做法，社会/资本主义都无所谓，能为全体人民提供可承担的医疗
保险才行。记得当年好像是胡适先生说的，少谈点主义，多谈点问题。谈论问题，
最让人鄙视的就是扣帽子那一套。信任是得有制度的核查相辅才成，是呀，这年头
儿，让别人相信自己的人倒恰恰值得核查。谢谢分享见解。

[julia42163]

回复tortfeasor的评论:
The problem with the current situation (healthcare) is it gets the worst of both socialism(medcare, medcare and gov subsidize to hospitals, very inefficient and wasteful) and capitalism (denial of pre-existing conditions, doctors are profit driven and not result driven).
The only solution is to create competition to bring out the best of socialism and capitalism. I don't think 100% free-market work well in health care.

[julia42163]

回复jennifer123ee的评论:
Only doctors should be and can be trusted in this country?
how about police? How about politician? Are they from the top 10% of the class? Even with the 'smart' doctors now, can they be trusted now?

[jennifer123ee]

Here are my concerns for socialize medicine.
1. Doctors will be compensate much less. Very soon, the only students want to become doctors are the bottom 10% of the class, not the top 10 %. will you continue trust your doctors?
2. medicaid and medicare patients will have to settle with the less benefits. Because there are so many more people need to be covered by government, people who already benefit will have less coverage.
3. Quality of the care. Our doctors will not have options to choose what care to provide to patients, the government does. The government will tell us what treatment will be cover, what will not!
4. all government social programs have cost more than projected, this will efffect whole country's economy. has any government run program work better than private inductry? NO, they all fail.
5. Last but not at least. Talking to some friends from Europe, most of european countries are trying to privatize their medicine program. They have experienced it, they want to be like us.

[shangweng]

这种文章最好别再登了,实在没什么内容.

[whatandhow]

回复tortfeasor的评论:
Sorry, I am one of the "average Chinese living in the US" who is below the "average intelligence" and think the same as the author. By the way, I do not see so many "average Chinese" you mentioned around here.

[好望角骆驼]

先把那些垃圾快餐整治一下吧，看把人都喂成啥样了。

[bivan]

OB是压倒米国的最后一根稻草。蜀中无大将，廖化当先锋。米国来日无多了。人民公社不早就完蛋了吗？

[小鸿]

回复new^new的评论:So you think Bush is pretty smart? what is you IQ?

[tortfeasor]

You seem to be a very active Democrat, but, seriously, you can still try to talk with your brain for a change. This is the wrong forum for you to advocate such propaganda, because most of us came to this country to escape from socialism. Your comment is an insult to the intelligence of average Chinese living in the United States. On the other hand, if you truely believe in what you said, I feel sorry for you.

[tortfeasor]

You comment is an insult to the intelligence of average Chinese living in the United States. If you truely believe in what you said, I feel sorry for you. Don't forget that most of us came to this country to escape from socialism, which is where it is heading to right now. You seem to be a very active Democrat, but, seriously, you can still talk with your brain instead.

[freesia]

就一句话：钱从哪来？

[918918]

Which social class has more obesity? Think about all the diabetic patients picking up by Obama's new policy? Spine, knee, and shoulder surgeries... they did not take care of their bodies, now us, the tax payers need to

[包粽子]

你得文章我都不用看，就知道你是为奥巴的 health care 叫好，估计你也是没有医疗保险的，就指望奥巴的health care 和 加税（当然别人的税）了，钱从哪儿来？

[new^new]

小布什不学无术+祸国殃民？真的不敢苟同

[bpc2001]

不想砸，不过没看懂到底什么地方高明了？发动群众？就这种文章也能放头版，文学城没人写中国字了啊。

[如星如沙]

此文的题目太现眼，作者的政治倾向太坦白偏激，而真正内容又缺乏，只有静候众多砖砸了。

ObamaCare 肯定是几家欢喜几家愁。凭感觉，大概懒人与老人及非法移民者受益较多。就看诸位属哪类人。

For people who really have interest, please visit：

http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:

[Mehaa]

BO and his friends will break your leg in order to give you a crutch free. Wise up!

There are good or bad politicans on both sides, as long as they truely speak for average folks, we the people need to support them, that's the way how you make politicians work for you other than being manipulated by some vile politicians and caught up in the political game. The way that BO handled the Gates gate showed he is nothing but an empty suit. Americans need healthcare reform, but not the one BO pushs.

[wuximm]

Receiving adequate health care is everyone's responsibility not the right. Where does health care dollar go? More than half we spend on the people dying within 6 months. Without addressing the fivorous law suit, end of life care issue and prevention, Health care will cont to sky rocket. Now Obama try to cover everybody by taxing the others, is the worst idea, it soon will bankrupt America. Look at the current "universal healthcare" such as medicare ( for >65 yrs old citizens) and VA system ( for Veteran), they both run poorly on the verge of break.
The healthcare reform should address to cut down the cost, so everybody can afford. Make it illegal if you don't purchase health insurance just like car insurance.
Free health care for all is not good care and it creates more waste and abuse just like any existing public run welfare. For sure it will bankrupt country if it passes.

[scim]

推动医疗改革的钱呢？ 继续借？

[上海老油条]

医疗改革虽是个急迫问题但决不是单靠口号就能解决笔者的政治倾向太重不适合作非政治性评论

[RobHe]

阅读本文, 让我想起大字报时代豪气冲天, 而缺欠理智的风格. 画饼容易造饼难啊, 朋友.

[qszheng]

奥巴马是个慎密的思想家，否则也不能执教于著名大学，这一点比那位没头脑的佩林强。他也是个讲实际的行动家，这一点要比麦坎强（从麦坎坚持不提就可看出他的固执和务虚）。总之奥巴马的当选是美国民众的福气。

[落花飘零]

晕，什么都没写。。。这种文章也拿到首页，有没有搞错阿。。。

[人心很古]

看了半天，你也没能说明 OB 的医疗改革到底是什么。 你意味地谩骂共和党，歌颂民主党，给人的感觉是：

（1）你是政治冲昏头脑的人（似乎在为党派叫喊）
（2）你不懂医疗问题的症结所在，也不知道医疗改革的实质内容

多学习学习，少轻易发表（自己也搞不懂的）意见。

[ncpga]

so far from your article, I don't see any "奥巴马推动美国医疗制度改革的高明之处".

[jjj7]

OB is a bullshit talker. US will go down in the long run if his policy passes. Everybody will be equally poor and get equally poor quality of health care (sounds familiar?)

[无良娱记]

奥是美国的罪人。下一代美国人会认为懒惰足以持家，愚蠢也可享福。