医疗保险改革之我见 (图)

医疗保险要改革，要让市场来管理，政府要管保险公司而不是自己来当保险公司。这个社会要人人有保险，生得起病也看得起病，才是好社会。

1。增加竞争机会。
老百姓可以跨州买保险，淘汰小保险公司。医生最讨厌跟小保险公司打交道。　太多的小保险公司在病人最需要的时候装傻。最好全国就几家大的保险公司。目前以州界为竞争界限根本就是不合理的。


2。减少中间环节。
病人和医生之间目前有太多的中间人，医生看个病一怕被告二怕保险公司不付三怕病人赖帐。病人看病一怕看不好二怕保险公司不付, 自己交多年的保险到头来有病还得自己掏腰包。那些靠告医生和保险公司吃饭的律师必须破产。保险公司扯来扯去的PAPERWORK必须停止。保险公司不得对任何病人不保或任何合理账单不付。对医生来说，他们的劳动收入有保障。对病人来说，他们生得起病。

3。人人要有保险。
不买保险的，最后的医疗费还是有保险的人买单。象汽车保险一样，可以买基本险，多项险。所有保险的月费都该抵税，买的少抵的少，买的多抵的也多。非法移民自己掏腰包买保险这个问题比较敏感。不让他们买不人道。让他们买，账单来的时候他们不付你也找不到他们。目前穷人和非法移民都去MEDICARE医生那里或急诊室看病，基本法都是不付钱的。这部分人的医疗费都是有保险人和纳税人买单的。这不合理。奥巴马说他不会给他们保险，国会里唯一通过的佩罗西的提案却没说要不给他们买，威而逊说奥巴马撒慌，没说错。如果奥巴马政府出来给非法移民买单，就是拿耐税人的钱给自己拉票。这是共和党反对奥巴马政府保险计划的主要原因之一。问题是这些人的保险不解决，早晚还是我们大家买单。　怎么解决？的确是个麻烦事儿。

4。政府保险不能有。
首先，美国政府没钱。奥巴马要他的改革不会增加赤字，说的好听，根本办不到。他的所谓省钱方案也是很难完成的。如果政府有盈余，大家都有保险是个好事。问题是目前以后美国政府都是靠借钱过日子，如果政府不控制开支，继续象奥巴马这样扩大社会福利计划和浪费纳税人的钱，这个无底洞会把美国彻底拖垮。

此外，政府保险保费低，是因为给医生的钱少，有些病付不起就不能保。什么能保什么不能保，这个决定将由政府说了算。一个8旬老人得了癌症和一个青年人得了癌症要救哪个？政府保险部门当然要救年轻人，那老年人就该等死吗？这是共和党反对政府保险的另一个主要原因。奥巴马在这个问题上态度很暧昧，从来没个明确答案。按国会里唯一通过的佩罗西的提案所规定，当政府保险出台的时候，私人保险公司不得接纳新的投保人。所有没有保险的和因失业要失去保险的人都必须投政府保险。这无疑就是让私人保险公司灭亡的另一种说发。奥巴马说他的保险会给老百姓更多的选择，这样怎么可能？

还有，当政府保险出台的时候，所有目前给员工提供私人保险的公司都会为了省钱把员工私人保险转成政府保险。奥巴马在没有扩大医生来源的前提下，突然增加将近四千万病人和潜在病人，会给医生增加更多的压力。而目前奥巴马已经提出要限制专科医生的收入，又让马儿跑，又让马儿不吃草，奥巴马脑子里老是觉得自己是总统老百姓都会也都必须听他的，也有点儿太高估自己的能力了吧！医生没钱赚，干多干少都一样，全民医疗保健质量肯定是一落千丈。老百姓不反对才怪那。

5。天下没有免费的午餐
医疗保险是一个商品，你用的多你就得多掏钱。你不掏钱，就的别人给你出。你要是认为别人该你的，只要你自己不出就行，那如果大家都这样，最后是谁来买单？还不是羊毛出在羊身上？有人问那人生了病政府该不该管？如果你觉得生病政府要管，工作没了政府要管，房子小了政府也要管，买不起房子政府也要管，先别说连我们伟大的社会主义祖国都不会管你，您居然还要求美国政府来挑起这负重担是异想天开! 更重要的是，政府的钱还不是拿税人的钱，政府借的债还不得你我老百姓来还，印钱造成的通货膨胀还不是老百姓遭殃？！所以，美国保守派老百姓到华盛顿游行要奥巴政府不要乱花老百姓的钱，要对老百姓要负责，是错是对，只有白痴才看不明白。

这次游行有一个大标语说的最好：

我们人民
将不会被忽略
将不会被解散
将不会被沉默
停止在美国搞大政府
停止在美国搞社会主义
为了美国
民主党和共和党联合起来!

[marge]

医疗和医疗保险是个悬在头上的达摩克斯剑。现在我们有工作有保险，一旦失业短期内又找不到工作的话，怎么办？要应付房贷、生活费，可能连个感冒都会看不起。关键还是医疗费要降低。
国内现在强制医保，只包住院，门诊自理。这是建立在国内医疗费低，门诊费对一般人来说都不要紧的基础上。只要不住院，一般都几十、1、2百就够了。
我上网查了一下，去年广州市公布的医保给付的住院费上限是38万多人民币/年。以国内的医疗价格计，我觉得这个数不能治好也就算了。
国内的医疗价格低肯定和它不收治不付费的病人有关。我觉得美国能不能解决免费求治的问题？真正无能力支付的由政府买单，很多非法移民其实并非没钱支付，当然以现在的价格可能够呛，但解决了免费治疗的问题，医疗费降下来了以后呢？
医疗费降不下来的话，什么改革也是空谈。

[totf]

对不起，我漏了一点，是"每年平均增长3.6%".
我的论点是，所有发达国家在控制医疗花销增幅上，做得都不够出色，无论是否是国营还是私营。

回复xz1980的评论:
I agree health care reforem is due to "医疗花销在迅速增长." But are you kidding "如果比较人均医疗花销的增幅，会发现所有发达国家从1990年到2003年相差不大。美国增加了3.6%." Only 3.6%, are you kidding? If you go any website, e.g., www.kff.org, you will see from 1990 to 2003, healthcare spending per person in US increase more than 100% from $2700/person to $5700/person.

[xz1980]

回复totf的评论:
I agree health care reforem is due to "医疗花销在迅速增长." But are you kidding "如果比较人均医疗花销的增幅，会发现所有发达国家从1990年到2003年相差不大。美国增加了3.6%." Only 3.6%, are you kidding? If you go any website, e.g., www.kff.org, you will see from 1990 to 2003, healthcare spending per person in US increase more than 100% from $2700/person to $5700/person.

"美国GDP医疗占的比重大，是因为医疗系统为美国的经济增长做出了"重要贡献"，和美国其他行业相继外包服务后的结果." This GDP is due to inflated Drs' salary by AMA (american medical association) artificially limit the number of Drs allowed to practice in US. The medical service cannot be outsource or in other words, Drs are protected. But inflated medical cost are transferred into other industry make them less competitative in global market. They drag or will down auto, Boeing, IBM...., the every industry can possibly bring money into US except weapon industry in which price is the 2nd factor. Until then, there will be no way to pay the imported products from other countries unless the US Drs can magically force foreigners to come to see Drs in US.

I agree "生理基础到临床研究" is the real reason for advancement of medicine, but ironically, all PHD or MD doing "生理基础到临床研究" get fraction of money earned by practice Drs because doing research are not protected by AMA. I know some MD in Harvard earns only $100k a year because they see patients only half day a week, doing research most of time. However, those really produece nothing but practice got the inflated money.

[XZ1980]

回复noso的评论:
Do you mean because firefighters send saved people to Drs, Drs are elligible to artificially inflate their price by limiting the number of Drs allowed to practice in US?

I never say price for Drs in LA should be the same in AL or AK, my point is that they all should earn money in free market, but they inflated their price by artificially making shortage in supply of Drs. Do you know Murphy's 20-80 law, 20% shortage could cause 80% price inflation. In fact, I was told that price of Drs in South are higher than in Boston because there is relatively more shortage of Drs in South.

[totf]

医改的起因并非是现在大肆渲染的"美国有不到15%的人没有医保"，而是医疗花销在迅速增长。但是，那些医疗系统国家化的发达国家在这方面做得也不尽如人意。可以说，很多都比美国差。

如果比较人均医疗花销的增幅，会发现所有发达国家从1990年到2003年相差不大。美国增加了3.6%，要低于医疗国家化的爱尔兰7.1%，卢森堡亚4.0%等；和日本3.3%，英国4.2%相近。

美国GDP医疗占的比重大，是因为医疗系统为美国的经济增长做出了"重要贡献"，和美国其他行业相继外包服务后的结果；也从另一个侧面反映出美国从生理基础到临床研究的领先地位。

[noso]

回复XZ1980的评论:

After the policemen and firefighters saved someone's life, what do they do next? Go to talk to some professors at some universities? I rest my case.

Doctors can charge whatever they want to, they have to consider too things: who will pay them, and how much other doctors are charging.

I don't think AMA has too much to say here. In LAX, you can charge whatever level, different doctors have different patients with different financial backgrounds. In AK or AL,doctors fees' have be reasonable to get paid, because the fincial backgrounds of the patients are about the same.

There is no single market for doctors, you see. It all depends on where you live and what you do. Inflated fees can get away in Beverly Hills, CA but not in Mobil, AL. This is the way how market works.

[mehaa]

回复XZ1980的评论:
Some good points there!

Obama claims that AMA supports his healthcare plan.

[XZ1980]

回复noso的评论:

They should make whatever they can make. The problem is that they make inflated money by manually limiting Dr supply. It is like that you open a store, then you limit the stores of this kind can be opened. This is monoply.

Drs not for money, why not they go practice in Africa, or other country?

Talk about saving life, firefighters, police and airplane pilots they all save lives how much money they make? They are priced by free market.

Long training, how many years of training need to become a professor or Ph.D? How much they make. They can only earn at free market price.

I do not mind how much money Drs can make, but they have to make money in free market, not by manually limiting numbersof Drs allowed to practice in US. Drs are protected by AMA for now, but they will damage every production industry, auto, Boeing,....

Frankly, good Drs should make good money (Harvard, John Hopkins, ....). The problems all Drs make good money in this monoply system by AMA. This will bankrupt the country.
Another bad effects is that they do not need to do good work to stay in the business because they manually limiting the new comers.

[noso]

回复XZ1980的评论:

I know many doctors,and I can tell you none of them are greedy person, they wanted to be doctors to save lifes, making a lot of money is not a crime if lifes have been saved.

I agree with you on the free market rules, however, since it takes 10 years to be a doctor, I don't mind they make a good living after investing so much of their time and money to be in the profession. Besides, they have to buy the equipments and update their knowledge, go for master class and learn knew skills. Those cost their time and money, someone has to pay for. I don't mind to pay if my life can be saved for that.

The malpractice tiral lawyers, on the other hands, must go broke. They are making money by harrasing insurance companies and doctors.

[XZ1980]

There are a lot of debates on the high healthcare cost in US. The root reason of high health cost is the artificially inflated Dr's salary.

This problem primarily attributes to the AMA (American Medical Association), an institution which effectively enforces a chronic supply shortage of Drs. The production system of Dr is strangled by the withholding nature of the AMA, which requires every Dr practices in US to have residency in US (even for well experienced foreign Drs). On the other hand, the AMA restricted number of residency slots available. This environment prevents equilibrium of supply-demand od Drs from occurring, or the AMA effectively enforces a chronic supply shortage of Dr to the increasing demand. By eliminating competition, Drs can maintain high salary.

AMA’s monopoly on the production of Drs has to be removed. Let the free market decide the price. Capitalism is best at determining fair value when you don't have unions controlling supply of labor or politicians picking winners or greedy monopolies eliminating competition. In the free market environment, the Drs have to provide good service at reasonable price to stay in the market in which the consumer will benefit.

Without free market in the production of Dr, the country will be dragged deep to the sea. Any reform without changing current monopoly in production of Drs will not work &

[noso]

回复tristateMD的评论:

Thanks. I do believe people should understand what's at the stake.

[tristateMD]

支持，支持，支持。