在过去15年里，共和党的医疗保健政策一直非常简单：他们认为奥巴马医改（ObamaCare）糟糕至极，因此应该彻底废除这项政策。然而，这种做法不仅没有解决问题，反而给他们在2026年中期选举中的处境带来了更多麻烦。
For the past 15 years, Republican health care policy has been simple: ObamaCare stinks (end of policy). But that’s not just working, and it’s adding to their troubles in the 2026 midterms. Health insurance premiums for 2027 are rocketing, and the announcements are arriving right before the November elections.
2027年的医疗保险费用正在急剧上涨，而这些相关公告正好在11月大选前夕发布。企业面临的保费涨幅高达8%，远超通货膨胀率。其中一部分费用最终会转嫁给员工；通过市场平台购买医疗保险的个人所支付的保费也同样在上升——宾夕法尼亚州平均涨幅为16%，俄亥俄州为15%，爱荷华州则在12%到16%之间。所有人都将因此受到负面影响。
Businesses are looking at an 8 percent hike, well above inflation. And some of that cost will be passed on to employees. Premiums for individuals through the marketplace are going up, too — an average of 16 percent in Pennsylvania, 15 percent in Ohio, and between 12 and 16 percent in Iowa. Everyone is going to feel the pain.
当然，特朗普总统确实通过一些协议为医疗补助计划（Medicaid）争取到了更便宜的药品，并提供了相应的折扣优惠（如“Trump Rx优惠券”）。但这些措施对降低医疗保健成本的作用微乎其微。虽然劳工统计局声称医疗保健领域的通胀率有所下降，但问题在于：消费者价格指数（Consumer Price Index）实际上只统计了部分医疗保险费用。对特朗普和共和党人来说，不幸的是，人们仍然必须全额支付这些保费，而且保费还在持续上涨。
Sure, President Trump cut some deals for cheaper drugs for Medicaid and discounts via Trump Rx coupons. But those deals have barely dented the real cost. Yes, the Bureau of Labor Statistics claims health care inflation is down. Conveniently, the Consumer Price Index includes only a portion of health insurance premiums. Inconveniently for Trump and the Republicans, people still have to pay those premiums in full — and they are going up.
这一切让人不禁联想到拜登政府时期的情况。拜登团队曾顽固地坚称通胀根本不是问题，只是右翼宣传者的虚假言论。但他们忽略了一个关键事实：消费者价格指数并未包含利率的变化（利率实际上已经翻了一番多）。这意味着购房或任何其他需要贷款的消费项目的实际支出增加了80%以上。
This is all reminiscent of the Biden administration. Recall Team Biden stubbornly insisting inflation was not a problem — just fake news by right-wing propagandists. What the non-geniuses on Team Biden forgot was that the consumer price index doesn’t include interest rates, which more than doubled. That means out-of-pocket costs for buying and financing a house — or anything else financed — went up more than 80 percent.
然而，消费者并不关心政府的报告或枯燥的统计数据。他们关心的是自己的银行账户和每月的开支。如果他们的经济状况正在恶化，任何形式的威胁或否认都无法改变这一现实。
But consumers don’t care about government reports or dry statistical releases. They look at their bank accounts and their monthly expenses. If they are falling behind, no amount of blustering and denial is going to convince them otherwise.
对特朗普和共和党来说，更令人担忧的是2023年秋季拜登所遭遇的情况。正如我之前指出的，拜登在关键摇摆州的支持率大幅下降；我认为这主要是由于哈马斯对以色列的袭击以及日益严重的移民危机所致。不过，2024年的医疗保险费用上调也在那时被宣布了，而且涨幅相当可观。
Even more ominously for Trump and the Republican Party is what happened to Biden in the fall of 2023. As I once noted, Biden’s polling against Trump took a huge hit in key swing states. I attributed that to the Hamas attacks against Israel and an intensifying immigration crisis. But the health care premium increases for 2024 were announced at that time, too. And those hikes were big.
拜登和卡玛拉·哈里斯试图通过否认问题的存在或指责企业贪婪来挽救自己的政治处境，但这些手段显然没有起到任何作用；对特朗普和共和党来说，这些策略也同样无效。
Denial and accusations of corporate greed didn’t save Biden or Kamala Harris. They’re not going to work for Trump and the Republicans, either.
最令人愤慨的是：共和党其实拥有解决问题的机会，但他们却什么都不做。虽然他们总是用“民众负担不起医疗费用”这样的借口来为自己开脱，但实际上《平价医疗法案》本身就根本无法真正实现“平价医疗”的目标。前总统巴拉克·奥巴马对医疗费用问题明显漠不关心；该法案的推行时间恰好安排在2012年他连任竞选之后，而在过去的14年里，它丝毫未能遏制医疗费用和保险费的增长趋势。
The disgrace of it all is that Republicans had their opportunities — they just don’t do anything. It is a cheap line, but nothing is “affordable” about the Affordable Care Act. Former President Barack Obama was notably disinterested in the price side of the equation. Suspiciously timed to commence after his 2012 re-election campaign, ObamaCare has done nothing in the last 14 years to arrest the rise in health care costs and insurance premiums.
尽管生产力的提高与技术创新推动了经济增长（至少在2020年之前是这样），但医疗行业却完全无视这些积极因素，依然保持着官僚主义、浪费资源且缺乏竞争力的现状。《平价医疗法案》丝毫没有缓解美国民众对医疗体系的担忧。
Although productivity and innovation led to gains and low inflation in the economy (at least through 2020), healthcare has stood out as totally resistant to these trends everywhere else. It is just as bureaucratic, wasteful and non-competitive as ever. ObamaCare has done nothing to assuage Americans’ concerns over health care.
选民们一直将医疗问题视为最重要的议题。YouGov在9月14日进行的调查显示，医疗问题位列第三大重要议题（与六个月前的排名相同）；但这些数据其实掩盖了民众真实的担忧程度。实际上，医疗问题与通货膨胀压力密切相关。YouGov的调查结果显示，通货膨胀才是最受关注的问题，其重要性是“就业与经济”（第二大重要议题）的两倍半；而在六个月前，通货膨胀还是最受关注的问题，其重要性则是“就业与经济”的两倍。另一项民意调查显示，59%的受访者支持实施医疗费用上限制度。
Voters have consistently cited health care as a top issue. In its Sept. 14 benchmark, YouGov found health care to be the third most important issue — exactly where it was six months ago. And these results mask the true level of concern. Health care concerns are tied up with cost pressures, that is to say, inflation. YouGov has inflation as the top issue by far, two and a half times higher than “jobs and the economy,” the second most important issue. Six months ago, inflation was on top, twice as important as “jobs and the economy.”
共和党的回应要么显得可悲，要么显得无知至极。这个政党甚至连一项关于价格透明度的法案都无法通过。在美国，几乎所有商品和服务在销售时都会明确标明价格；只有医疗服务的价格会在消费者使用服务之后才会被披露。即使对于那些主张最小政府干预、支持自由市场经济的共和党人来说，这种情况也是不可接受的。价格透明化是任何正常运作的市场体系的基本前提。
A Center Square poll has 59 percent of respondents favoring price caps. The Republican response has bounced between pathetic and ignorant. The party cannot even pass a price transparency bill. Practically every other product and service in America comes with a price tag up front. Only medical care routinely hides prices until after the consumer uses it. Even for the most non-interventionist free marketer, this should be unacceptable. Price discovery is a fundamental underpinning of any functioning market.
价格透明化虽然不能直接降低成本，但至少是朝着正确方向迈出的一步。然而，共和党国会连这一步都迈不出来，而特朗普对此似乎完全漠不关心。这项关于价格透明度的法案本应在去年就获得通过，这样共和党至少可以借此机会推进一些基本的行政和官僚体制改革。
Price discovery is not a magic bullet for reducing costs, but it is a step in the right direction. Yet the Republican Congress cannot even take that one step, and Trump seems totally uninterested. Price transparency should have passed last year, allowing Republicans to move forward with at least some basic administrative and bureaucratic reforms.
然而他们什么都没做。共和党已经沦为一个只会抱怨、却从不解决问题的政党。如果中期选举中民主党大获全胜，那只能怪他们自己。
Instead, they have done nothing. The Republican Party has degenerated into a party focused on moaning rather than solving problems. If the midterms are a rout for the Democrats, they have only themselves to blame.
基思·诺顿（Keith Naughton）曾担任竞选顾问，同时也是公共事务公司“Silent Majority Strategies”的联合创始人。你可以在他的 Substack 订阅账号“Betting On Politics”上找到他的更多文章。
Keith Naughton is a former campaign consultant and co-founder of the public affairs firm Silent Majority Strategies. Find him on his Substack, “Betting On Politics.”