经济学人下载:美国中期选举将至 全民医保项目何去何从?(2)

In some alternate America imagined by Pixar the health-care system could simply be reinvented.
在皮克斯设想的另一个美国，医疗保健系统可以简简单单重建。

In the real world it would be unworkable—and political suicide.
但在现实世界中，这将是一场难以实现的政治自杀。

Because American health-care costs are so high, making the government assume them all would require a huge increase in taxation.
因为美国的医疗成本如此之高，让政府认为所有这些都需要大幅增加税收。

Voters in Colorado, California and Vermont, all relatively friendly territory for Democrats, rejected single-payer systems when they realised how much they cost.
科罗拉多州、加利福尼亚州和佛蒙特州的选民都对民主党相对友好，但当意识到单一支付系统的成本时，都拒绝了这一提案。

The rebellion that would follow an attempt to remove jobs-based health insurance from the 55% of Americans who have it, putting medical-insurance companies out of business in the process, would make the politics of Obamacare look like a church picnic.
在此之前，55%的美国人都有基于工作的医疗保险，在移除保险的过程中，保险公司会破产，这会让奥巴马医改的政治看起来像一场教堂野餐。

A better approach would be to continue changing the health-care system in small steps, frustrating though that might be.
更好的办法是继续逐步改变健康医疗系统，尽管这可能会令人失望。

In states that expanded Medicaid, the health-care programme for low-income Americans, the proportion of people without health insurance halved.
在扩大医疗补助计划的州，即扩大低收入群体的医保项目，没有医疗保险的人数已经减半。

If Democrats can win power in states that rejected the federal government's offer to pay for Medicaid expansion, they will be able to bring down the number of uninsured further.
有些州拒绝为扩展联邦政府医疗补助计划买单，如果民主党人能够在这些州赢得权力，那么民主党将能够进一步减少没有医保的人数。

The markets where individuals can buy insurance should be shored up.
个人可以购买保险的市场应该得到支持。

Finally, individuals could be offered the option to buy Medicare, paying an annual premium to the government just as they would to any other provider of health insurance.
最终，个人可以选择购买医疗保险，每年向政府支付保险费，就像他们向任何其他医疗保险公司支付费用一样。

Since Medicare has more pricing power than individual insurers do, this option ought to bring costs down eventually.
由于医疗保险比单个保险公司有更多的定价权，这个选择最终应该会降低成本。

It would also provide choice for those living in the many rural areas where there is currently no competition in insurance markets.
它还将为生活在许多农村地区的人提供选择，这些地区目前在保险市场上没有竞争。

Senators Michael Bennet and Tim Kaine have a proposal along these lines.
参议员麦克·班尼和蒂姆·凯恩也提出了类似的建议。

It is not perfect.
它并不完美。

If premiums were not set high enough, the government’s liabilities would increase.
如果保费设置不够高，政府的债务就会增加。

It would leave much of America’s frustrating health-care system unreformed.
这将使美国许多令人沮丧的医保系统得不到改革。

But unlike most other versions of Medicare for all, it might actually happen.
但与大部分其他版本的全民医保不同，这项改革可能真的会发生。