看奧巴馬推動美國醫療製度改革的高明之處 (1) 自上而下，自下而上的改革 (圖)

美國醫療製度的弊病目前已是眾所周知了，美國人均醫療保險支付費用是發達國家中
最高的，占GDP 的百分之十以上。

過去10年內，醫療保險費用翻了一番，

且每年增長的幅度比一般人的收入增長幅度快3倍；

同時，美國沒有醫療保險的人數比例也是發達國家中最高的，3億美國人中有近4千萬
人沒有醫療保險(當然，這裏麵有各種不同的情況)。由於美國的醫療保險是和工作有
關聯的，目前近10%的高失業率將會繼續使更多的人失去醫療保險。美國2/3的個人破
產原因和醫療費用有關。盡管有這些問題，幾乎美國所有的醫療保險公司年年都有巨
額的利潤。

以往，曾有多位美國總統試圖改革醫療保險製度(象小布什這種不學無術+禍國殃民
的敗家子自然不算)，但要麽力不從心，要麽功虧一簣。克林頓夫婦在1993年的嚐試，
為奧巴馬政府提供了極好的教科書，除了有良好的願望，也要有謀略，講策略，上
下左右配合，既要借東風，也須防暗箭。

克林頓夫婦當年可以說是有點心高氣傲，趾高氣揚，高估了美國國會的智商(這些議
員們實際上是如果城門沒有失火，就安坐家中，高談闊論的)，低估了美國醫療保險
行業的險惡伎倆，忽略了爭取醫務界的支持，調動醫療改革的受益者-一般老百姓參
與的必要性。結果落得個旗開不得勝，四處碰壁，隻能掩鼓息旗 ，退下陣去。但事
實證明克林頓夫婦的預言是對的，不進行醫療改革，美國政府總有一天會不堪醫療
費用的重負，而老百姓的健康狀況也會受到極大影響。

奧巴馬在競選總統時就把醫療保險製度的改革作為施政綱領的重要部分，和那位連
自己有幾所房子都搞不清楚的共和黨老軍頭不一樣，強調享有醫療保險是公民權利
的一部分，實現全民醫療保險計劃時不可待。這種競選綱領，是他得到低收入階層
和上年紀選民支持的重要原因。

在奧巴馬入主白宮後，因為美國經濟的急劇惡化，曾有推測，他鼓吹的醫療製度改
革計劃會被束之高閣。但奧巴馬明智地認識到，不盡早控製醫療費用的開支，美國
經濟的複蘇，與人民生活的實際改善將麵臨巨大的挑戰。

到目前為止，分析家們認為雖然奧巴馬期待的醫療製度改革的最終藍圖尚不能確定，
但他的保證全體人民都有可承受的醫療保險的原則，及所采取的相應策略實在是空
前未有的，包括自上而下，自下而上；打草驚蛇，請君入甕；明修棧道，暗渡陳倉；
避重就輕，爭取多數等。先看第一招，自上而下，自下而上地推動改革。

接受當年克林頓夫婦的失敗教訓，放手讓國會兩院的數個委員會參與醫療製度改革
的討論與立法，除了那些一籌莫展，吃不到葡萄說葡萄酸的共和黨人外，誰不想在
這種百年一遇的曆史時刻給自己名下增添些光彩，更別說報效選民、國家了。奧巴
馬及其智囊團諳熟國會的運作方式，不耽心功高蓋主，關鍵時刻，還得總統說了算。
在上周的記者招待會中，奧巴馬說的十分明確，不會在不符合他提出的基本原則的
醫療製度改革法案上簽字。

與此同時，奧巴馬也在運用他獨有的，在總統競選過程中被證明行之有效的發動群
眾運動的策略，通過由總統競選積極分子參與的 Organizing for America (OFA)的基層
組織，自下而上地推動醫療製度改革。去年，整個共和黨及民主黨總統候選人希拉
裏就是低估了奧巴馬的這種草根組織的力量，而讓“沒有經驗”的奧巴馬改寫了美
國總統競選的曆史。

自6月份以來，OFA 和Health Care for America Now 等組織在緊鑼密鼓地多方運作，
一方麵在公開場合大造聲勢，如6月25日在華盛頓國會山舉行的推動醫療製度改革的
集會

做電視廣告；一方麵在基層舉行討論會，打電話，征集支持醫療製度改革的簽名，
給少數尚舉棋不定的民主黨議員背上擊上幾掌。這就是美國民主政治體製的一個組
成部分，選民的呼聲還是有相當作用的。

與當地的幾個團體在6月25日乘車去華盛頓，參加有數千人的國會山聚會。

口號是“High quality, affordable health care for all， this year”。

有來自美國各州的工會團體和組織，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，




五顏六色的T恤衫代表不同的組織。.




?
?





從衣服上看，不知這是哪個工會的

在HBO的The Sopranos節目中出鏡的女演員 Edie Falco邀請了若幹位不同背景的各
界人士講述自己的遭遇，強調醫療改革的必要性和緊迫性。



老當益壯




因為我們中的一位代表舉著要求“single payer" 體係的牌子(非奧巴馬的官方策略
)，引起了媒體的興趣，對他進行采訪


幾代人的共同努力


高中生也不袖手傍觀。

醫生的支持


奧巴馬的忠實支持者到處可見。

幾位國會議員到場助威，鼓動大家會後去本州議員的辦公室遊說。




回到本地後，繼續推動醫療改革活動，在當地造聲勢，擴大影響。

[StillH2ORunDeep]

所有跟貼:


8226; 頂！！！ -老忽- ♂ (0 bytes) (5 reads) 7/29/09
8226; Co：頂！！！ -MPSocks- (0 bytes) (3 reads) 7/29/09
8226; 醫保改革的關鍵是降低醫保費用 -whatiswrong- ♂ (619 bytes) (75 reads) 7/29/09
8226; Clinton醫改的失敗就在與他對既得利益者的打擊太大。 -老忽- ♂ (0 bytes) (4 reads) 7/29/09
8226; 國家沒有存款，如果不增加赤字，隻能打擊既得利益者 --凡爾賽-- ♂ (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; 回複：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; 看著你咬著自己的手指頭在那裏嘴強的勁頭，想起了那誰誰。。。。。。 -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; 嗬嗬，看看你這熊樣兒，犯得著氣成這樣嗎。。。。。 -wxc39- ♂ (0 bytes) (4 reads) 7/29/09
8226; 氣 ? 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; 其實指出你邏輯上存在的重大偏差也是對你的愛護。。。 -wxc39- ♂ (34 bytes) (8 reads) 7/29/09
8226; 邏輯? Only law prof can talk about law, economics prof -MPSocks- (127 bytes) (10 reads) 7/29/09
8226; 防止你今後到處丟人現眼不是對你的愛好嗎 -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; 看你顛三倒四地引用自己的這兩句，倒真讓人見識了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; 奧說絕對不通過增加財政赤字來為醫療改革買單 --凡爾賽-- ♂ (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; 也許這可以節省一部分 --凡爾賽-- ♂ (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; 這次集中在“全民”享有，不是“全麵”享有 --凡爾賽-- ♂ (0 bytes) (3 reads) 7/29/09
8226; 總結的精彩，會借用此點。 -Stillh2orundeep- ♂ (0 bytes) (2 reads) 7/29/09
8226; 咱們拭目以待，看他有沒有這個操控能力 --凡爾賽-- ♂ (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; 從中國引進3億年輕人Ponzi Scheme 就可以暫時循環了 --凡爾賽-- ♂ (6 bytes) (5 reads) 7/29/09
8226; Hahaha ! Ding ! -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; 我個人不太確信這張dollar分配的真實性 --凡爾賽-- ♂ (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 --凡爾賽-- ♂ (0 bytes) (4 reads) 7/29/09
8226; Co：老忽哲理名言 -MPSocks- (0 bytes) (2 reads) 7/29/09
8226; 的確如此。這種CHANGE從來不是易事，但共和黨無法讓人再信任。 -Stillh2orundeep- ♂ (0 bytes) (1 reads) 7/29/09
8226; If thing is difficult to do, it usually is diffcult to do it rig -用戶名被占用了- ♂ (0 bytes) (6 reads) 7/29/09

[julia42163]

回複jennifer123ee的評論:
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]

回複julia42163的評論:
就說嘛，真正的聰明人是做聰明事的。醫生掛牌子隻是為了治病救人。

[julia42163]

回複jennifer123ee的評論:
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]

回複julia42163的評論:
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]

回複StillH2ORunDeep的評論:
If you havn't not heard of this, I suggest you read more!

[StillH2ORunDeep]

回複好望角駱駝的評論:
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，盡管麥當勞向其
它國家輸出漢堡包時，也連帶有美國的不健康生活方式，但人們也得對自己的健康
負責，畢竟不是吃“垃圾快餐”的人都肥胖啊。綜合因素，綜合治理。

[StillH2ORunDeep]

回複jennifer123ee的評論:
“most of european countries are trying to privatize their medicine program.
They have experienced it, they want to be like us. ”，這倒是第一次聽說，沒見過這樣的文章。總不至於在美國吃夠了苦頭，尋求變革的時候，有人會願意試試至少10%的人沒有醫療保險的“特點”。

[StillH2ORunDeep]

回複julia42163的評論:
貼標簽是嚇唬人的做法，社會/資本主義都無所謂，能為全體人民提供可承擔的醫療
保險才行。記得當年好像是胡適先生說的，少談點主義，多談點問題。談論問題，
最讓人鄙視的就是扣帽子那一套。信任是得有製度的核查相輔才成，是呀，這年頭
兒，讓別人相信自己的人倒恰恰值得核查。謝謝分享見解。

[julia42163]

回複tortfeasor的評論:
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]

回複jennifer123ee的評論:
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]

這種文章最好別再登了,實在沒什麽內容.

[whatandhow]

回複tortfeasor的評論:
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.

[好望角駱駝]

先把那些垃圾快餐整治一下吧，看把人都喂成啥樣了。

[bivan]

OB是壓倒米國的最後一根稻草。蜀中無大將，廖化當先鋒。米國來日無多了。人民公社不早就完蛋了嗎？

[小鴻]

回複new^new的評論: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]

就一句話：錢從哪來？

[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，就知道你是為奧巴的 health care 叫好，估計你也是沒有醫療保險的，就指望奧巴的health care 和 加稅（當然別人的稅）了，錢從哪兒來？

[new^new]

小布什不學無術+禍國殃民？真的不敢苟同

[bpc2001]

不想砸，不過沒看懂到底什麽地方高明了？發動群眾？就這種文章也能放頭版，文學城沒人寫中國字了啊。

[如星如沙]

此文的題目太現眼，作者的政治傾向太坦白偏激，而真正內容又缺乏，隻有靜候眾多磚砸了。

ObamaCare 肯定是幾家歡喜幾家愁。憑感覺，大概懶人與老人及非法移民者受益較多。就看諸位屬哪類人。

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]

推動醫療改革的錢呢？ 繼續借？

[上海老油條]

醫療改革雖是個急迫問題但決不是單靠口號就能解決筆者的政治傾向太重不適合作非政治性評論

[RobHe]

閱讀本文, 讓我想起大字報時代豪氣衝天, 而缺欠理智的風格. 畫餅容易造餅難啊, 朋友.

[qszheng]

奧巴馬是個慎密的思想家，否則也不能執教於著名大學，這一點比那位沒頭腦的佩林強。他也是個講實際的行動家，這一點要比麥坎強（從麥坎堅持不提就可看出他的固執和務虛）。總之奧巴馬的當選是美國民眾的福氣。

[落花飄零]

暈，什麽都沒寫。。。這種文章也拿到首頁，有沒有搞錯阿。。。

[人心很古]

看了半天，你也沒能說明 OB 的醫療改革到底是什麽。 你意味地謾罵共和黨，歌頌民主黨，給人的感覺是：

（1）你是政治衝昏頭腦的人（似乎在為黨派叫喊）
（2）你不懂醫療問題的症結所在，也不知道醫療改革的實質內容

多學習學習，少輕易發表（自己也搞不懂的）意見。

[ncpga]

so far from your article, I don't see any "奧巴馬推動美國醫療製度改革的高明之處".

[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?)

[無良娛記]

奧是美國的罪人。下一代美國人會認為懶惰足以持家，愚蠢也可享福。