伯尼·桑德斯参议员于2017年首次提出了“全民医保”（Medicare for All）法案。尽管该提案多次被重新提出，但它至今仍未在国会任何一院获得正式的投票表决。在本次选举季中，“全民医保”已成为进步派的口号；最近的民意调查显示，公众对该提案的支持率大幅上升。然而，选民们在表达自己的诉求时应当格外谨慎。
Sen. Bernie Sanders first introduced his Medicare for All legislation in 2017. Despite multiple reintroductions, the proposal has never received a floor vote in either congressional chamber. Medicare for All has become a rallying cry for progressives this election season, and recent polling suggests public support has surged. Voters should be careful what they wish for.
根据KFF的最新民意调查，三分之二的美国人支持“全民医保”计划——这一比例较2020年大幅上升（2020年时仅有约一半的受访者表示支持）。但大多数美国人并不了解该提案的具体内容及其可能产生的影响。“全民医保”计划会取消医疗保健领域的竞争与选择机制，限制人们的就医渠道，并最终导致税收增加。
Two-thirds of Americans favor Medicare for All, according to a new KFF poll—a substantial increase from 2020, when roughly half of respondents were in favor. But most Americans don’t understand the proposal or its likely effects. Medicare for All would eliminate competition and choice in medical care, limit access, and inevitably lead to tax increases.
“全民医保”并非对现行医疗保险制度的简单扩展。目前的医疗保险制度结合了公共保险与私人保险两种方式，从而保障了竞争与消费者的选择权：符合条件的受益人可以选择由联邦政府管理的传统医疗保险计划、私人经营的医疗保险附加计划（Medicare Advantage），以及私人经营的医疗保险D部分（Medicare Part D，用于药品费用报销）。
Medicare for All isn’t an expansion of the current Medicare program. Medicare as we know it combines public and private insurance options, allowing competition and choice. Eligible beneficiaries can choose from a traditional Medicare plan run by the federal government, privately-run Medicare Advantage plans, and privately-run Medicare Part D drug plans.
“全民医保”计划将取代现有的公私结合的医疗保健融资体系，转而由联邦政府统一运营一个全民性的医疗保险计划。该计划将禁止所有私人医疗保险的存在（包括雇主为员工提供的团体保险）；如果私人保险提供的福利与“全民医保”计划重复，那么这些私人保险也将被取消。此外，“全民医保”计划还会废除针对低收入家庭的医疗补助计划（Medicaid）、针对老年人和残疾人的现行医疗保险制度，以及基于《平价医疗法案》（Affordable Care Act）建立的个体医疗保险市场。
Medicare for All would replace the existing public-private system for financing healthcare with a single, universal insurance program operated by the federal government. It would ban private insurance, including the employer-sponsored group insurance that half of Americans have, if the insurance duplicates any Medicare for All benefits. It would eliminate Medicaid for low-income households, Medicare as it now exists for the elderly and disabled, and the Affordable Care Act exchange-based individual insurance market.
该提案还规定：整个医疗体系的报销标准将低于私人保险的报销水平。对于那些对政府垄断提供的医疗服务质量不满意的患者来说，他们将不再有其他保险选择。
The proposal includes systemwide decreases of reimbursement levels below private insurance rates. Patients who don’t like the quality of care provided by the government monopoly would have no other insurance options.
对桑德斯最初提案的研究估计，它将在10年内增加联邦支出32万亿美元。根据白宫经济顾问委员会最近的估计，预计的10年成本现在为47万亿美元。这种增加的支出可能通过赤字支出、项目削减和税收的组合来融资——最可能的是税收负担会很重。
Studies of Mr. Sanders’s original proposal estimated it would increase federal spending by $32 trillion over 10 years. The projected 10-year cost is now $47 trillion, according to a recent White House Council of Economic Advisers estimate. That increased spending could be financed through a combination of deficit spending, program cuts and taxes—most likely heavy on the last.
由于“全民医保”的报销率将远低于私人保险的报销率，医疗服务提供者将通过提供更少的服务来作出回应。这将导致等待时间变长、获得医疗服务的机会减少。通过取消私人计划和目前医保所施加的用于限制“免费”医疗过度消费的费用分担，“全民医保”还将增加对医疗服务的需求，进一步损害获取医疗服务的机会，并可能将医疗资源从急需治疗的患者那里转移出去。
Because Medicare for All’s reimbursement rates would be substantially below private insurance rates, providers would respond by offering less service. This would lead to longer waiting times and less access to care. By eliminating the cost-sharing that private plans and Medicare currently impose to limit overconsumption of “free” healthcare, Medicare for All would also increase demand for care, further impairing access and possibly diverting care away from patients with urgent need.
从长期来看，国会预算办公室预测，较低的报销率将导致更少的人进入医疗行业，制药公司开发的新药也会减少，从而加剧获取问题并降低健康水平。
In the long term, the Congressional Budget Office predicts that lower reimbursements would cause fewer people to enter medical professions and pharmaceutical companies to develop fewer new drugs, exacerbating access problems and diminishing health.
当KFF民调的受访者被告知“全民医保”的影响时，支持率骤降。当被告知私人保险将被取消时，只有52%的人表示支持；当得知“全民医保”可能威胁到目前的医保计划时，支持率降至38%；当他们考虑到“全民医保”可能要求大多数美国人缴纳更高税款时，支持率降至35%；在得知它可能导致医学检测和治疗的延迟后，支持率进一步下降至24%。
When respondents in the KFF poll were told the effects of Medicare for All, support plunged. Only 52% were in favor when told that private insurance would be eliminated, 38% when learning Medicare for All could threaten the current Medicare program, 35% once they considered that Medicare for All could require most Americans to pay higher taxes, and 24% after learning it could lead to delays for medical tests and treatments.
只有21%的英国公众对如今世界上最著名的单一支付方医疗体系——国民医疗保健服务（NHS）表示满意。在2024年的一项调查中，十分之六的英国人表示他们对NHS“非常”或“相当”不满意，这是自该调查始于1983年以来对NHS不满程度最高的水平。在加拿大，私人医疗保险被禁止覆盖由中央财政资助的公共医疗保险所涵盖的服务，2025年有超过10.5万名加拿大人出国就医以支付非紧急医疗护理费用。
Only 21% of the British public were satisfied with what is now the most famous single-payer health system in the world, the National Health Service, in a 2024 survey. Six in 10 Britons said they were “very” or “quite” dissatisfied, the highest level of dissatisfaction with the NHS since the survey began in 1983. In Canada, where private health insurance is prohibited from covering services included in the centrally financed public health insurance, more than 105,000 Canadians traveled abroad to pay for nonemergency medical care in 2025.
寻求在本国接受治疗的加拿大人平均在看完全科医生后等待近29周才能获得治疗——去看专科医生的等待时间长达15.3周，然后再额外等待13.3周才能开始治疗。加拿大人报告的医疗服务可及性问题远多于美国人。
Canadians who sought care within the country waited an average of almost 29 weeks between seeing a primary-care provider and obtaining treatment—a 15.3-week wait to see a specialist and then 13.3 more weeks before treatment. Canadians report far more access problems than Americans.
美国人应该知道，“全民医保”（Medicare for All）将取消他们现有的医疗保障，禁止私人保险选项，大幅增加税收，并严重影响医疗服务的可及性。在这些事实摆在桌面上时，选民们很可能会得出结论：任何版本的《全民医保法案》都不应通过国会。
Americans should know that Medicare for All will eliminate their existing coverage, ban private insurance options, dramatically increase taxes and impair access to care. With those facts on the table, voters will likely conclude no version of the Medicare for All Act should ever pass Congress.
扎贝尔博士（Dr. Zberg）是帕根健康研究所公共卫生与美国幸福感倡议的主任。[视频] 《华尔街日报》评论：全民医保与中期选举
Dr. Zinberg is director of the Paragon Health Institute’s Public Health and American Well-Being Initiative. [video] WSJ Opinion: Medicare for All and the Midterms