醫療保險改革之我見 (圖)

醫療保險要改革，要讓市場來管理，政府要管保險公司而不是自己來當保險公司。這個社會要人人有保險，生得起病也看得起病，才是好社會。

1。增加競爭機會。
老百姓可以跨州買保險，淘汰小保險公司。醫生最討厭跟小保險公司打交道。　太多的小保險公司在病人最需要的時候裝傻。最好全國就幾家大的保險公司。目前以州界為競爭界限根本就是不合理的。


2。減少中間環節。
病人和醫生之間目前有太多的中間人，醫生看個病一怕被告二怕保險公司不付三怕病人賴帳。病人看病一怕看不好二怕保險公司不付, 自己交多年的保險到頭來有病還得自己掏腰包。那些靠告醫生和保險公司吃飯的律師必須破產。保險公司扯來扯去的PAPERWORK必須停止。保險公司不得對任何病人不保或任何合理賬單不付。對醫生來說，他們的勞動收入有保障。對病人來說，他們生得起病。

3。人人要有保險。
不買保險的，最後的醫療費還是有保險的人買單。象汽車保險一樣，可以買基本險，多項險。所有保險的月費都該抵稅，買的少抵的少，買的多抵的也多。非法移民自己掏腰包買保險這個問題比較敏感。不讓他們買不人道。讓他們買，賬單來的時候他們不付你也找不到他們。目前窮人和非法移民都去MEDICARE醫生那裏或急診室看病，基本法都是不付錢的。這部分人的醫療費都是有保險人和納稅人買單的。這不合理。奧巴馬說他不會給他們保險，國會裏唯一通過的佩羅西的提案卻沒說要不給他們買，威而遜說奧巴馬撒慌，沒說錯。如果奧巴馬政府出來給非法移民買單，就是拿耐稅人的錢給自己拉票。這是共和黨反對奧巴馬政府保險計劃的主要原因之一。問題是這些人的保險不解決，早晚還是我們大家買單。　怎麽解決？的確是個麻煩事兒。

4。政府保險不能有。
首先，美國政府沒錢。奧巴馬要他的改革不會增加赤字，說的好聽，根本辦不到。他的所謂省錢方案也是很難完成的。如果政府有盈餘，大家都有保險是個好事。問題是目前以後美國政府都是靠借錢過日子，如果政府不控製開支，繼續象奧巴馬這樣擴大社會福利計劃和浪費納稅人的錢，這個無底洞會把美國徹底拖垮。

此外，政府保險保費低，是因為給醫生的錢少，有些病付不起就不能保。什麽能保什麽不能保，這個決定將由政府說了算。一個8旬老人得了癌症和一個青年人得了癌症要救哪個？政府保險部門當然要救年輕人，那老年人就該等死嗎？這是共和黨反對政府保險的另一個主要原因。奧巴馬在這個問題上態度很曖昧，從來沒個明確答案。按國會裏唯一通過的佩羅西的提案所規定，當政府保險出台的時候，私人保險公司不得接納新的投保人。所有沒有保險的和因失業要失去保險的人都必須投政府保險。這無疑就是讓私人保險公司滅亡的另一種說發。奧巴馬說他的保險會給老百姓更多的選擇，這樣怎麽可能？

還有，當政府保險出台的時候，所有目前給員工提供私人保險的公司都會為了省錢把員工私人保險轉成政府保險。奧巴馬在沒有擴大醫生來源的前提下，突然增加將近四千萬病人和潛在病人，會給醫生增加更多的壓力。而目前奧巴馬已經提出要限製專科醫生的收入，又讓馬兒跑，又讓馬兒不吃草，奧巴馬腦子裏老是覺得自己是總統老百姓都會也都必須聽他的，也有點兒太高估自己的能力了吧！醫生沒錢賺，幹多幹少都一樣，全民醫療保健質量肯定是一落千丈。老百姓不反對才怪那。

5。天下沒有免費的午餐
醫療保險是一個商品，你用的多你就得多掏錢。你不掏錢，就的別人給你出。你要是認為別人該你的，隻要你自己不出就行，那如果大家都這樣，最後是誰來買單？還不是羊毛出在羊身上？有人問那人生了病政府該不該管？如果你覺得生病政府要管，工作沒了政府要管，房子小了政府也要管，買不起房子政府也要管，先別說連我們偉大的社會主義祖國都不會管你，您居然還要求美國政府來挑起這負重擔是異想天開! 更重要的是，政府的錢還不是拿稅人的錢，政府借的債還不得你我老百姓來還，印錢造成的通貨膨脹還不是老百姓遭殃？！所以，美國保守派老百姓到華盛頓遊行要奧巴政府不要亂花老百姓的錢，要對老百姓要負責，是錯是對，隻有白癡才看不明白。

這次遊行有一個大標語說的最好：

我們人民
將不會被忽略
將不會被解散
將不會被沉默
停止在美國搞大政府
停止在美國搞社會主義
為了美國
民主黨和共和黨聯合起來!

[marge]

醫療和醫療保險是個懸在頭上的達摩克斯劍。現在我們有工作有保險，一旦失業短期內又找不到工作的話，怎麽辦？要應付房貸、生活費，可能連個感冒都會看不起。關鍵還是醫療費要降低。
國內現在強製醫保，隻包住院，門診自理。這是建立在國內醫療費低，門診費對一般人來說都不要緊的基礎上。隻要不住院，一般都幾十、1、2百就夠了。
我上網查了一下，去年廣州市公布的醫保給付的住院費上限是38萬多人民幣/年。以國內的醫療價格計，我覺得這個數不能治好也就算了。
國內的醫療價格低肯定和它不收治不付費的病人有關。我覺得美國能不能解決免費求治的問題？真正無能力支付的由政府買單，很多非法移民其實並非沒錢支付，當然以現在的價格可能夠嗆，但解決了免費治療的問題，醫療費降下來了以後呢？
醫療費降不下來的話，什麽改革也是空談。

[totf]

對不起，我漏了一點，是"每年平均增長3.6%".
我的論點是，所有發達國家在控製醫療花銷增幅上，做得都不夠出色，無論是否是國營還是私營。

回複xz1980的評論:
I agree health care reforem is due to "醫療花銷在迅速增長." But are you kidding "如果比較人均醫療花銷的增幅，會發現所有發達國家從1990年到2003年相差不大。美國增加了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]

回複totf的評論:
I agree health care reforem is due to "醫療花銷在迅速增長." But are you kidding "如果比較人均醫療花銷的增幅，會發現所有發達國家從1990年到2003年相差不大。美國增加了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.

"美國GDP醫療占的比重大，是因為醫療係統為美國的經濟增長做出了"重要貢獻"，和美國其他行業相繼外包服務後的結果." 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 "生理基礎到臨床研究" is the real reason for advancement of medicine, but ironically, all PHD or MD doing "生理基礎到臨床研究" 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]

回複noso的評論:
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]

醫改的起因並非是現在大肆渲染的"美國有不到15%的人沒有醫保"，而是醫療花銷在迅速增長。但是，那些醫療係統國家化的發達國家在這方麵做得也不盡如人意。可以說，很多都比美國差。

如果比較人均醫療花銷的增幅，會發現所有發達國家從1990年到2003年相差不大。美國增加了3.6%，要低於醫療國家化的愛爾蘭7.1%，盧森堡亞4.0%等；和日本3.3%，英國4.2%相近。

美國GDP醫療占的比重大，是因為醫療係統為美國的經濟增長做出了"重要貢獻"，和美國其他行業相繼外包服務後的結果；也從另一個側麵反映出美國從生理基礎到臨床研究的領先地位。

[noso]

回複XZ1980的評論:

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]

回複XZ1980的評論:
Some good points there!

Obama claims that AMA supports his healthcare plan.

[XZ1980]

回複noso的評論:

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]

回複XZ1980的評論:

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]

回複tristateMD的評論:

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

[tristateMD]

支持，支持，支持。