人们之所以对社会主义萌生好感，纯粹是因为医疗和住房成本太高，而国会却没有解决这个问题。当权者因此受到了指责。随着美国民主社会主义者对民主党内部似乎完成了接管，通过惩罚富有的大公司来提供快速解决办法的承诺似乎变得顺理成章，并伴随着像“全民医保”这样的吸引人的口号。医疗保健正日益成为选民最关注的首要问题。医院和保险企业卡特尔对医疗领域形成了死死把持，这些卡特尔得到了政府裙带资本主义的补贴，而奥巴马医改（讽刺地被称为《平价医疗法案》）使这一情况严重恶化。如果当选官员不采取行动，选民现在愿意尝试别的方法。
The reason people are flirting with the idea of socialism is simply that the costs of healthcare and housing are too high and Congress is not solving it. Those in power get the blame. With the seeming internal take-over of the Democratic Party by the Democratic Socialists of America, the promises of quick fixes by punishing the rich corporations are seemingly plausible, with catch phrases like “Medicare-for-All.” Healthcare is increasingly the No. 1 issue for voters. There is a stranglehold by both hospital and insurance corporate cartels subsidized by government cronyism, profoundly worsened by ObamaCare (the ironically named Affordable Care Act). Voters are now willing to try something else if elected officials won’t act.
另一方面，承诺“全民医保”的政客们是在做一个无法兑现的承诺。医疗保险本身是由保险公司管理的，其利润是保费的一个百分比，而且保险公司和医院都存在过度收费的情况。最终，政府运营的医疗保健不得不提高税收或配给医疗服务。或者，就像加拿大和英国的情况一样，他们两者兼施。
Politicians promising “Medicare-for-All,” on the other hand, is a promise they cannot keep. Medicare itself is managed by insurance companies, whose profits are a percentage of premiums, and over-billed by both insurance and hospitals. Eventually, government-run healthcare has to raise taxes or ration medical care. Or, as in the case of Canada and the U.K., they do both.
医疗改革是共和党中期会议的重中之重，我们有机会在选举前或新一届国会会议开始前，通过预算协调程序大幅改善医疗保健。中间商会因为改革而损失巨额财富，但他们并没有做任何事情来帮助实际的医疗服务或降低成本。是时候绕过他们了。现行的联邦规则正在造成危害并助长卡特尔。通过理性的改革和为需要帮助的人提供安全网，将患者和医生的主导权还给他们，这份改革清单可以将成本降低百分之五十。
Healthcare reform was forefront at the Republican Midterm Convention, and there is the opportunity to dramatically improve healthcare through reconciliation before the election or before the new congressional session. The middlemen will lose fortunes with reform, but they are not doing anything to help actual medical care or lower the costs. It is time to bypass them. Current federal rules are causing harm and feeding the cartels. This list of reforms can lower costs 50 percent, by restoring patient and physician control with commonsense reform and a safety net for those who need it.
关键改革措施：
Healthcare reform was forefront at the Republican Midterm Convention, and there is the opportunity to dramatically improve healthcare through reconciliation before the election or before the new congressional session. The middlemen will lose fortunes with reform, but they are not doing anything to help actual medical care or lower the costs. It is time to bypass them. Current federal rules are causing harm and feeding the cartels. This list of reforms can lower costs 50 percent, by restoring patient and physician control with commonsense reform and a safety net for those who need it.
1. 将“灾难性医疗计划”（Catastrophic Medical Plans）的覆盖范围扩展到所有年龄段和收入水平的民众。“灾难性医疗计划”本质上就是为应对重大、高成本的医疗事件而设计的保险产品。保险不应被用于那些价格远低于保险费用的商品或服务。特朗普政府已通过修改《医疗保险与医疗补助服务中心》（Centers for Medicare and Medicaid Services）的相关法规，提出了将这些计划推广至2027年的建议；但左派势力正在通过法律诉讼试图阻止这一改革，以维持奥巴马医改政策的原貌。如果这些改革能够被纳入立法程序并正式成为法律，那么左派将无法再对其进行反对，民众也将拥有更多的选择。
1. Expand Catastrophic Plans to all ages and incomes.Catastrophic or major medical plans are just that: plans for major high-cost events for which insurance was originally designed. Insurance should not be used for items that are wholesale 90 percent cheaper than insurance rates. The Trump administration has made these recommendations for 2027 with Centers for Medicare and Medicaid Services rule changes, but the left is already litigating to block it and keep ObamaCare unchanged. Putting it into reconciliation would make it a law they could not attack and people would have options.
2. 为所有人及所有类型的医疗保险计划（包括医疗保险）设立“健康储蓄账户”（Health Savings Accounts, HSA）。健康储蓄账户为个人提供了与企业享受的相同税收优惠，有助于个人为医疗保险未覆盖的医疗费用进行长期储蓄。患者可以自行控制医疗费用的支出，从而在药品、门诊就诊和影像检查（如X光检查）等方面节省50%至90%的费用。
2. Health Savings Accounts for everyone and all plans, including Medicare.HSAs offer individuals the same tax benefits businesses have for healthcare costs. It also gives people lifetime savings for healthcare Medicare does not cover. Cash prices controlled by patients are 50-90 percent cheaper for medications, clinic visits and imaging (x-rays).
3. 废除奥巴马医改中对医生拥有医院的限制。这或许是奥巴马在2010年签署的医疗改革法案中最“疯狂”或最具垄断色彩的条款。多项研究表明，医生自有的医院在提供医疗服务方面表现更佳，运营效率也更高。令人惊讶的是，医院利益集团一直在积极阻止竞争者的出现；许多州（如北卡罗来纳州）甚至允许医院否决竞争对手开设新医院。
3. End ObamaCare-Affordable Care Act restrictions on physicians owning hospitals.This is perhaps the craziest or most cartel-like part of the healthcare law Obama signed in 2010. Research consistently shows physician-owned hospitals are better at providing medical care and better run. Most people are stunned to learn the hospital lobby works hard to prevent competition. Many states, such as North Carolina, allow hospitals to veto competition hospitals from opening.
4. 承认“直接初级保健诊所”（Direct Primary Care Clinics）属于医疗保险的覆盖范围。这类诊所能够以更低的价格为患者提供高质量的医疗服务（尤其是针对复杂病例）。医院和保险公司之所以反对这类诊所，是因为它们无法从中获利或无法控制这些诊所的运营。但医疗保险的初衷本就不是为了让企业牟取暴利。此外，应禁止医疗保险机构阻碍患者使用这些诊所的服务（包括开具药物处方或转诊）。否则，患者只能被迫选择那些处于垄断地位的医疗服务网络。
4. Allow direct primary care clinics to count as primary care for Medicare.It is far better medical care for complex medical cases at a fraction of the price. Hospitals and insurance do not like direct primary care because they do not profit from these clinics or control them. But the purpose of Medicare patients is not to make corporations rich. Also, for patients using Medicare and direct primary care, ban Medicare from blocking medical orders (medications or referrals). This serves only to force patients into monopolistic networks. 5. Clarify IRS rules for direct primary care clinics.Make them HSA-eligible for providing wholesale medications and medical supplies.
5. 明确国税局（IRS）关于直接初级保健诊所的规定。使其有资格使用健康储蓄账户（HSA）支付批发药品和医疗用品费用。
6. Expand business options.Let them offer cost-sharing plans and other options outside the Affordable Care Act marketplace with the same tax exemptions (known as ICHRA or CHOICE options).
6. 扩大商业选择。允许其提供费用分担计划及其他《平价医疗法案》市场之外的选项，并享受同等的税收豁免（即ICHRA或CHOICE选项）。
7. Expand short-term plans.Allow those between jobs or insurance plans to carry short-term plans for up to one year and to renew them for up to three years. Many states have done this —it can be extended nationally by Jan. 1, 2027.
7. 扩大短期保险计划。允处于换工作或换保险期间的人购买最长一年的短期计划，并可续保最长三年。许多州已实施此政策——可在2027年1月1日前在全国范围内推广。
8. Stop Medicare from paying higher reimbursement fees to hospitals than to independent clinics.This has encouraged acquisition of independent clinics and led to healthcare consolidation.
8. 禁止医疗保险（Medicare）向医院支付比独立诊所更高的报销费用。这鼓励了对独立诊所的收购，导致医疗行业垄断加剧。
9. End the middlemen’s control over drug prices.Pharmacy Benefit Managers have exemptions from the Anti-Kickback Act. Three of them control 80 percent of the market, and they increasingly control the market with ownership of pharmacies and now manufacturing of pharmaceuticals. Ending these market controls is basic antitrust policy. We should also end their control of access to drugs they deem “speciality” drugs.
9. 终结中间商对药价的控制。药品福利管理公司（PBM）享有《反回扣法》豁免权。其中三家控制了80%的市场份额，并通过拥有药房、甚至涉足药品制造进一步掌控市场。终结这些市场控制是基本的反垄断政策。我们还应终结它们对被认定为“专业药品”的药物准入的控制。
10. Fix business insurance.Lastly, business insurance is controlled by Federal ERISA laws. Expanding the concept of “transparency” from prices to all aspects of business contracts, disclosure of conflicts of interest, and kickbacks will restore healthcare markets.
10. 修复商业保险。最后，商业保险受联邦《雇员退休收入保障法》（ERISA）管辖。将“透明度”的概念从价格扩展到商业合同的所有方面、利益冲突披露及回扣，将恢复医疗市场机制。
Increasingly patients are held hostage by their own health, and all healthcare professionals are held captive as employees to a few corporations. Administrators determine your medical needs, rather than you and your doctor.
患者日益沦为自身健康的囚徒，所有医疗专业人员也沦为少数大公司的雇员。是行政人员而非您和您的医生在决定您的医疗需求。
Healthcare reform means middlemen lose business and vast wealth if they lose control over our health. It is like the tobacco industry in the 1980s and 1990s insisting cigarette smoking is not dangerous. Healthcare conglomerates insist they are preventing cost increases even though they are some of the most profitable businesses in the world.
医疗改革意味着，如果中间商失去对我们健康的控制权，他们将失去业务和巨额财富。这就像20世纪80年代和90年代的烟草业坚称吸烟无害一样。医疗巨头坚称他们在防止成本上涨，尽管他们是世界上最赚钱的企业之一。
Healthcare reform means middlemen lose business and vast wealth if they lose control over our health. It is like the tobacco industry in the 1980s and 1990s insisting cigarette smoking is not dangerous. Healthcare conglomerates insist they are preventing cost increases even though they are some of the most profitable businesses in the world.
这份联邦改革清单具有变革性和革命性。改革很容易，但阻力依然惊人。如果不改革，就会冒着沮丧的选民转向美国民主社会主义者虚假承诺的风险。国会有一个行动的机会 —— 就叫它“你可以找回你的医生法案”吧。
This list of federal reforms is transformational and revolutionary. Reform is easy but the resistance remains staggering. Failure to reform risks frustrated voters reaching for the false promises of the Democratic Socialists of America. Congress has an opportunity to act — just call it the “You Can Have Your Doctor Back Act.”
克利福德·波特博士是德克萨斯公共政策基金会的医疗政策高级研究员。
Dr. Clifford Porter is the Senior Fellow for Healthcare at the Texas Public Policy Foundation.