奥巴马医改与崇拜

Madebywilliam王如伟Thereformationofthemedicaltreatmentfaceslotsofobstacles.HowdidObamasucceedinbreakingoutofthecrisis?

2数十年来美国历任总统推行医改都铩羽而归，皆因反对声四起。奥氏也遇到同样难题。旨在让全民都得到医保的医改计划为何遭遇重重阻挠？既然拦阻甚多，这次怎么又能顺利过关?Americanformerpresidentshadtriedtocarryouthealthreformsinthepastyearsbuttheyfailed.Somanypeopleatalllevelsrejectthehealthreforms.Obamafacedthesamedifficulties.WhydidthehealthreformswereobstructedheavilyevenitisgoodtoAmerican?WhyObamagotapprovalthistimewithsolidopposition?Wait！5ThedifficultyofthehealthcarereforminU.Sisencounteringwithopposition美国医改难难在遭遇重重反对

团结民主党巧用程序阻击共和党Obamastrategyisproperlytoavoidmakingthesamemistakes奥巴马策略得当避免重蹈覆辙

United

DemocraticPartyattack

RepublicanPartybyusingproceduressmartly团结民主党巧用程序狙击共和党6美国医改难难在遭遇重重反对医改与美国传统价值观相悖HealthcarereformcontradictswiththeAmerican'straditionalvalues多数人反对建立公共保险机构Mostpeopleobjecttoestablishthepublicinsuranceorganization共和党极力阻挠医改

TheRepublicanPartyobstructsthehealthcarereformvigorously.保险业坚决抵制医改Theinsurancebusinessfirmresistingmedicinechanges

医药行业反对医改

ThemedicineopposetheHealthcarereform中产阶级、富人忧心忡忡Themiddleclassandtherichpersonareheavy-hearted医改与美国传统价值观相悖HealthcarereformcontradictswiththeAmerican'straditionalvalues民调显示48%的美国人反对医改。反对根本原因在于，医改与美国传统价值观相悖。美国人对政府干预市场、国家控制社会的戒心根深蒂固，对政府主导医疗和国家控制医保的措施保持高度警惕性.Pollsshow48%ofAmericansopposedtomedicalreform.AgainstthefundamentalreasonisthathealthcarereformwiththeUnitedStates,contrarytotraditionalvalues.U.S.governmentinterventioninthemarket,state-controlleddeep-rootedwarinessofsociety,onthegovernment-ledcontrolofhealthcareandnationalhealthinsurancepolicytomaintainthehighdegreeofvigilance奥巴马原想建立非营利公共保险机构，通过与私营保险机构展开竞争有效降低保险费。但大多数人坚决反对，他们认为这是在破坏美国的自由价值观念，他们青睐市场主导的医保，要"把政府的手拿开"。多数人反对建立公共保险机构MostpeopleobjecttoestablishthepublicinsuranceorganizationObamaoriginallywantedtobuildnon-profitpublicinsuranceinstitutions,bymeansofcompetingwiththeprivateinsurancesectortoreduceinsurancepremiumsmoreeffectively.Butmostpeoplefirmlyopposed,theythinkthisisunderminingtheAmericanvaluesoffreedom,theyfavoramarket-drivenhealthcare,to"putthegovernment'shandaway."共和党极力阻挠医改，有党派思维作祟，但更因执政理念不同。共和党人一直主张"小政府大市场"，而医改将形成强势政府，对社会生活和经济产生过分干涉，违背资本主义自由市场经济的原则共和党极力阻挠医改

TheRepublicanPartyobstructsthehealthcarereformvigorously.Republicansobstructmedicalreformwiththethoughtofpartymischief,butmorebecauseoftherulingideaisdifferent.Republicanshavebeenadvocating"smallgovernment,bigmarket",whilethemedicalreformwillformastronggovernment,sociallifeandtheeconomytoomuchinterference,whichiscontrarytotheprinciplesofcapitalistfreemarketeconomy保险业坚决抵制医改Theinsurancebusinessfirmresistingmedicinechanges

受医改冲击最大的将是保险业。在美国医保体系中，保险企业是既得利益者，对医改持抵制态度。投票前，保险利益集团游说议员，斥巨资投放广告号召反对医改。Hardesthitbymedicalreformwillbetheinsuranceindustry.IntheUnitedStatesmedicalinsurancesystem,insurancecompanieswhohavevestedinterestsresistedonmedicalreform.Beforethevote,theinsuranceinterestgroupslobbythemembersandcostlotsofmoneyinadvertising,calledagainstthemedicalreform.医药行业反对医改

ThemedicineopposetheHealthcarereformsomemedeineenterprisesrefusehealthreform,forthereformsincreasecosts.itwillusecheapeffectivemedeineandtechnology,whichwillcutdowntheprofitsofmedicineenterpriseheavily.whatismore,doctorassociationworryaboutthereformsmaycoursedamagetodoctors'interests.药品企业也反对医改，因为医改要控制成本，必然将更多地使用便宜而有效的适宜药品、适宜技术，医药企业的盈利空间将会大大缩小；三是医生协会，也担心医改会损害医生的利益。除不得不缴纳更多税收来为穷人享受医保“埋单”外，中产阶级、富裕阶层还担心，大量穷人在获保后涌入医疗服务市场，而医疗资源相对有限，富人们曾经享受的VIP式服务将可能不复存在Inadditiontohavetopaymoretaxestoenjoymedicalinsuranceforthepoor,"paysthebill",themiddleclassandwealthyclassisalsoconcernedthatalargenumberofpoorbytheinfluxofmedicalservicesaftertheinsurancemarket,whilerelativelylimitedmedicalresources,therichpeoplewhoenjoytheVIP-styleservicesmaynolongerexist中产阶级、富人忧心忡忡Themiddleclassandtherichpersonareheavy-hearted13

奥巴马策略得当避免重蹈覆辙雷厉风行动用舆论压力Vigorousandresoluteuseofpublicpressure

先易后难逐个击破Theeasieronebyonebreak抢在中期选举前推动改革

Rushtopromotetherevolutionbeforethemid-termelections顶住压力坚持信念Withstandthepressureofitsconvictions

吸取教训只提纲领Lessonsprovidedonlyprogram

懂得妥协和放弃Knowhowtocompromiseandgiveup

奥巴马在6月9日民主党参议院公布医改方案之后，次日即在全国动员全美200万草根支持者在50个州展开宣传，掀起一场全国性的大讨论。这实际上也是借助公众舆论的力量迫使既得利益集团低头。OnJune9,ObamaannouncedtheSenateDemocratichealthcarereformproposal,thenextdayinnationalgrassrootsmobilizationofthenation'stwomillionsupportersin50statestohaveapublicity,whichsetoffabignationaldiscussion.Thisisactuallyusingthepowerofpublicopinionforcedthebowofvestedinterests.雷厉风行动用舆论压力Vigorousandresoluteuseofpublicpressure

Obamahasthefullsupportofhigh-profilemedicalreformprogram,andthenhefacedtheproblemsfromtheinterferenceofCongressandinterestgroups,andevenmanyvotersbegantowaveronhissupport.ButObamahasnotmanipulatedbythem,insteadoftakingamoreactiveengagementsituationtofaceit,evenifsuchcontactisnothappy.顶住压力坚持信念Withstandthepressureofitsconvictions

奥巴马高调全面支持医改方案之后，面临了来自国会和利益集团的干扰，甚至众多选民也开始动摇对他的支持。但奥巴马并未因此受制于人，而是采取了更积极的接触态势，哪怕这样的接触并不愉快先易后难逐个击破Theeasieronebyonetobreak奥巴马针对各个利益集团，按难易程度采取分别谈判、各个击破的战略。奥巴马积极游说此前一直被称为“医改禁区”的美国医学协会，与全美医院体系达成共识，并得到了全美护士协会的支持ObamahaveaactivelobbywiththeAmericanMedicalAssociation,whichisreferredtoas"restrictedmedicalreform".Thenreachaconsensuswiththenation'shospitalsystemandhasbeensupportedbytheNationalNursesAssociation.吸取教训只提纲领Lessonsprovidedonlyprogram

克林顿也曾力推医改，拿出长达数百页的报告，却连国会投票也没争取到。有了前车之鉴，奥巴马没有推出几百页方案，让议员在看懂之前就失去耐心，而是推出一些纲领和方针，交由国会自行拟订方案。ClintonhaspressedformedicalreformwithhundredsofpagesofreportsbutitfailedtogetanyvotesfromtheCongress.Withthislesson,ObamadidnotreleasehundredsofpagesoftheprogramwhichwillmaketheMemberslosepatiencebeforeunderstand,buttointroduceprogramsandpolicieswhichisdraftedbyCongress.抢在中期选举前推动改革

Rushtopromotetherevolutionbeforethemid-termelections奥巴马他在上任后第一年就开始大刀阔斧推行这一改革，争取在中期选举季节到来之前取得成果，以免因改革努力受到政治需求限制

懂得妥协和放弃Knowhowtocompromiseandgiveup

奥巴马作出了让步，有关设立公共保险机构的构想在参议院的最终版本医改议案中消失了。这不仅平息了巨大争议，也将大大降低政府开支。ObamamadeaconcessionthattherelevantideaofsettinguppublicinsuranceinstitutionswasdieoutinthefinalMedicalreform.Thisnotonlyputdownahugecontroversy,butalsowillgreatlyreducegovernmentexpenditure.Toavoidethereformswillbelimitedbypoliticaldemand19团结民主党巧用程序阻击共和党

共和党想用“阻碍议事程序”拖延改法案Republicanswanttoimpedetheproceedingsinordertodelayhealthcareref