经济学人下载:废除奥巴马医改 成本分摊令人关注(1)

United States
美国

Replacing Obamacare: Cost-sharing is caring
废除奥巴马医改：成本分摊令人关注

The paroles of replacing Obamacare's subsidies for the poor.
替换奥巴马医改法案对穷人补贴的口号。

As republican congressmen were berated by constituents this week for their desire to repeal the Affordable Care Act , wonks in Washington continued to work on a replacement.
当希望废除平价医保法案的共和党议员在本周饱受选民责备时，华盛顿的政策专家们仍在致力于拟定一项替代方案。

Paul Ryan, the Speaker of the House, has promised a health-care bill soon after politicians return from their districts on February 27th.
众议院议长保罗·瑞恩(Paul Ryan)承诺政客们2月27日从选区返回后不久就会推出新的医疗保健法案。

If they are to cool the protesters' zeal, Republicans must keep health insurance affordable for everyone who already has it.
要想平息众怒，共和党人必须使每一个已经拥有健康保险的人负担得起。

That means deciding what to do about the subsidies Obamacare gives to 10m low- and middle-earners who buy coverage through government-run websites.
这意味着要妥善处理一千万中低收入者从奥巴马医改计划中获得的补贴，他们之前从政府网站购买了保险。

Mr Ryan promises to replace the law's means-tested tax credits with a discount for everyone, varying not with income but with age.
瑞恩先生承诺用给予个人的优惠——其额度不随收入而随年龄有所变化，来替换基于收入的税收抵免政策。

Would such a switch work?
这样的转变会有效果吗？

Republicans have always hated the ACA's handouts.
共和党人一贯讨厌ACA的政府拨款。

Because they shrink if people earn more, they discourage toil.
因为如果人们收入越多，拨款就越少，他们不鼓励辛勤的劳动。

The Congressional Budget Office has estimated that Obamacare reduces the total number of hours worked by 1.5-2%, which is equivalent to 2.5m full-time jobs by 2024.
国会预算办公室估计，奥巴马医改计划使总工作小时数减少1.5-2%，相当于250万份做到2024年的全职工作。

Making tax credits universal would lessen that number.
推行税收抵免会减小此数字。

And because the old pay more for health insurance than the young—a gap that will widen if the Republicans loosen restrictive pricing regulations—increasing subsidies with age makes some sense.
而且和年轻人相比，老年人会花更多钱买医疗保险，如果共和党人放宽对价格规定的限制，差距还会扩大，因此根据年龄增加补贴就显得合理。

Such a tax credit, though, would not be generous enough for all buyers.
然而，这样的税收抵免对所有投保人来说都不够慷概。

The average Obamacare subsidy adds up to about $3,600 per person.
奥巴马医疗计划的人均补助是3600美元。

Many receive much more.
许多人可以拿到更多。

Two non-smoking 55-year-olds together earning $56,500, the median household income, get $4,800 each just to help pay for premiums, according to the Kaiser Family Foundation, a think-tank.
根据凯瑟家庭基金会——一个智囊机构所说，两个55岁的非吸烟者，其总工资按中等家庭收入56500美元来算，每人可以获得4800美元以支付保险费。

According to The Economist's calculations, if Mr Ryan spread the cash around all 22m Americans who buy health insurance directly, rather than through their employer, it would average only about $2,000 each.
根据经济学人的计算，如果瑞恩先生不通过雇主，而是直接给2200万购买过医疗保险的人发放现金的话，人均只能得到2000美元。

That is close to what Tom Price, the new health secretary, proposed in 2015 for 35-to 49-year-olds (older folk would have got $3,000).
这接近于汤姆·普莱斯(Tom Price)——新的卫生部长在2015年提出的为35到49岁人群提供的补贴水平(年纪更大的人本来可以得到3000美元)。

Republicans say it is enough, because costs will fall once insurance is deregulated.
共和党人说这就足够了，因为一旦保险放松管制，成本便会下降。