“让政治远离金钱！把钱留在你们的口袋里！实现‘全民医保’！”这是阿卜杜勒·埃尔-赛义德（Abdul El-Sayed）在竞选时喊出的口号；他在今年8月赢得了密歇根州民主党参议院初选。
“Money out of politics! Money in your pocket! Medicare for All!”That’s the rally chant of Abdul El-Sayed, who won Michigan’s Democratic Senate primary in August.
这个口号确实很朗朗上口，另一句口号“如果你喜欢现有的医疗保险计划，就可以继续使用它”也同样如此。不过，PolitiFact将这句话评为2013年的“年度谎言”——因为在奥巴马医改（ObamaCare）政策实施后，约有400万美国人收到了医疗保险取消的通知。
It’s catchy. So was “If you like your health care plan, you can keep it.”PolitiFact named that line its 2013 Lie of the Year, but only after roughly 4 million Americans received cancellation notices due to ObamaCare.
埃尔-赛义德并非个例：明尼苏达州的参议院候选人佩吉·弗拉纳根（Peggy Flanagan）也在积极倡导“全民医保”政策；此外，还有102名众议院议员与普拉米拉·贾亚帕尔（Pramila Jayapal，民主党，华盛顿州）共同提出了这项法案。他们的主张是：为所有居住在该州的人提供免费医疗服务，无论其移民身份如何；而相关的税收负担则由其他人来承担。
El-Sayed has company. Minnesota’s Senate nominee, Lt. Gov. Peggy Flanagan, is campaigning on Medicare for All, and 102 House members joined Rep. Pramila Jayapal (D-Wash.) as cosponsors of her bill. The pitch goes like this: free care, coverage for everyone living here regardless of immigration status, and the tax bill gets mailed to somebody else.
我在私募股权、私人信贷及家族企业领域工作了30多年，深知：任何只考虑收入增长而忽视成本因素的预测都注定会失败——最终，总是中产阶级来承担这些额外的费用。
I have spent more than 30 years in private equity, private credit and family offices reading pro formas. A projection that only works if you ignore the expense line is a dud — the middle class always ends up writing the check.
以最后一个承诺为例：巴拉克·奥巴马总统曾表示，他的医改计划能让普通家庭的医疗保险费用每年减少2500美元。但根据PolitiFact的评估，这一承诺早已被打破。事实上，医疗保险费用持续上涨；为了缓解民众的负担，国会不得不在疫情期间额外提供补贴。然而当这些补贴在2025年底到期后，平均每月的医疗保险费用反而增加了58%，平均免赔额也达到了创纪录的3786美元。十六年过去了，《平价医疗法案》（Affordable Care Act）依然未能实现其最初的承诺。
Start with that last promise. President Barack Obama said his plan would cut a typical family’s premium “by up to $2,500 a year.”PolitiFact has since rated it “Promise Broken.”Premiums rose so far that Congress had to tack on “enhanced” subsidies to them during COVID — one subsidy added on top of the original subsidy, just to make premiums slightly less intolerable. When those credits expired at the end of 2025, the average monthly net premium jumped by 58 percent and the average deductible hit a record $3,786. Sixteen years in, the Affordable Care Act still can’t live up to its own name.
民主党人希望将临时补贴永久化——国会预算办公室估算，此举十年将耗资3500亿美元。这意味着什么？医院收取的费用将与现在完全相同（价格随时间上涨）。你的保费账单每个月看起来会更友好。差额将落在已经背负超过40.3万亿美元债务的财政部头上。这叫做用一笔更大的坏账来为坏账再融资——财政上在愚蠢之上加倍下注。
Democrats want the temporary credits made permanent — a move the Congressional Budget Office priced at $350 billion over a decade. What would that mean? Hospitals would charge exactly what they charge now (with prices rising over time). Your premium statement would look friendlier each month. The difference would land on a Treasury already carrying more than $40.3 trillion in debt. That is called refinancing a bad loan with a bigger bad loan — a fiscal doubling down on stupid.
接下来是重头戏。2025年《全民医保法案》规定，“每一位美国居民”都有权享受福利。该法案禁止基于“公民身份”的歧视。同一法案还规定，私人保险公司销售与政府计划重复的保险为非法。所以你可以保留你的保险计划，直到它变成违禁品。你那份扎实的福利套餐——也许还是你的工会为了替代加薪而谈下来的——将变成非法。
Then comes the main event. The Medicare for All Act of 2025 says that “every individual who is a resident of the United States” is entitled to benefits. It bars discrimination based on “citizenship status.”The same bill makes it unlawful for a private insurer to sell coverage that duplicates the government plan. So you can keep your plan, right up until it becomes contraband. Your solid benefits package — perhaps even negotiated by your union in lieu of higher pay — would become illegal.
全民医保的代价每年高达数万亿美元。国会预算办公室研究了五种示意性的单一支付方设计方案，发现仅2030年一年，联邦医疗补贴就将增加1.5万亿至3万亿美元。其后续研究发现，若通过所得税或工资税来为其买单，到2030年GDP将降低1%至10%。它还警告说，需求将超过供给，导致“拥堵加剧”。毕竟，没有人能靠在保险卡上印“免费”二字就变出一张多余的病床或一名夜班护士。
The price of Medicare for All runs into the trillions each year. The Congressional Budget Office studied five illustrative single-payer designs and found federal health subsidies would rise by $1.5 trillion to $3 trillion in 2030 alone. Its follow-up work found that paying for it with income or payroll taxes would leave GDP between 1 percent and 10 percent lower by 2030. It also warned that demand would outrun supply and produce “increased congestion.”After all, nobody conjures an extra hospital bed or a night-shift nurse by printing “free” on an insurance card.
候选人们坚称富人将买单。但2023年，收入最高的1%人群缴纳了38.4%的联邦所得税，而他们的调整后总收入占比仅为20.6%；收入最低的一半人群缴纳了3.3%。参议员克里斯·范霍伦（民主党-马里兰州）的百万富翁附加税十年内最多只能筹集1.5万亿美元。
Candidates insist the rich will pay. But the top 1 percent already paid 38.4 percent of federal income taxes in 2023 while earning only 20.6 percent of adjusted gross income; the bottom half paid 3.3 percent. Sen. Chris Van Hollen’s (D-Md.) millionaires surtax would raise no more than $1.5 trillion over ten years.
参议员伯尼·桑德斯的亿万富翁财富税在十年间可征收2.3万亿至4.4万亿美元，而他在纸面上已经把这笔钱花得一分不剩——用于发放3000美元的支票、撤销去年的医疗补助计划和《平价医疗法案》改革，以及新增联邦医疗保险的牙科覆盖。即便桑德斯撕毁他的愿望清单，按照国会预算办公室的高端估算，这两项法案加在一起或许也只够支付两年的单一支付者医疗体系费用。
Sen. Bernie Sanders’ billionaire wealth tax scores between $2.3 trillion and $4.4 trillion over a decade, and he has already spent every dime on paper — on $3,000 checks, a rollback of last year’s Medicaid and ACA changes and new Medicare dental coverage. Even if Sanders tore up his wish list, both bills together might cover two years of single-payer health care at the Congressional Budget Office’s high estimate.
此后，征税的手就要伸向工资单了。玛格丽特·撒切尔在1976年就看清了这一点：社会主义政府“总是把别人的钱花光”。加利福尼亚州为“全民联邦医疗保险”提供了一次预演。萨克拉门托将完整的加州医疗补助（该州的医疗补助计划）扩展至所有成年人，不论其移民身份，随后发现该州每年要从普通基金中为这一人群支出约85亿美元，成本超出预测27亿美元。
After that, the tax collector comes for payroll. Margaret Thatcher saw it in 1976: Socialist governments “always run out of other people’s money.”California offers a preview of Medicare for All. Sacramento extended full Medi-Cal (the state’s Medicaid program) to adults regardless of immigration status, then discovered it was spending about $8.5 billion a year from the general fund on that population, with costs running $2.7 billion over projections.
该州随后于2026年1月1日冻结了大多数非公民成年人的新参保，并宣布将缩减已在册人员的覆盖范围。常规牙科保险已于7月被削减，从2027年起将要求每月缴纳30美元的保费。
The state then froze new enrollments for most non-citizen adults on Jan. 1, 2026 and announced it will be scaling back coverage for those already on the program. Routine dental was cut in July, and $30 monthly premiums will be required starting in 2027.
州长加文·纽森（民主党）绝非削减赤字的鹰派。当他为一项计划猛踩刹车时，你就知道这项计划不可持续。这意味着，那些承诺在全国推行这一灾难性政策的候选人，不过是在兜售亚利桑那州的滨海地产。
Gov. Gavin Newsom (D) is hardly a deficit hawk. When he slams the brakes on a program, you know it is unsustainable. It means that candidates promising the national version of this debacle are just selling oceanfront property in Arizona.
目前，在西健康-盖洛普指数中，只有49%的成年人被评为“费用安全”，这是该指数自2021年设立以来的最低读数。这是支持者最有力的论据。但价格问题需要的是更多的供给和更多的竞争，而这恰恰是“全民联邦医疗保险”做不到的。
Currently, only 49 percent of adults rate as “cost secure” in the West Health-Gallup index, the lowest reading since it began in 2021. That is the proponents’ strongest argument. But a price problem calls for more supply and more competition, something Medicare for All cannot do.
国会今年已让青铜级和灾难性医保市场计划有资格使用健康储蓄账户，向约730万新参保者开放了免税账户。这是起点。接下来，提高缴费上限。用真正有痛感的罚款来强制执行医院价格透明度。资助更多住院医师名额，因为美国医学院协会预计到2036年医生缺口将高达8.6万人。把价格压下来，所有人的保险都会更便宜。
Congress already made bronze and catastrophic marketplace plans eligible for Health Savings Accounts this year, opening tax-free accounts to about 7.3 million new enrollees. That’s the place to start. Next, raise the contribution limits. Enforce hospital price transparency with penalties that sting. Fund more residency slots, since the American Association of Medical Colleges projects a shortfall of up to 86,000 physicians by 2036. Drive prices down, and coverage gets cheaper for everyone.
在11月3日投票之前，你应该向每一位支持全民医保的候选人提出三个问题。第一，什么税率会打到我的工资单？第二，谁有资格？第三，我看专科医生要等多久？
Before you vote on Nov. 3, you should put three questions to every candidate who supports Medicare for All. First, what tax rate hits my paycheck? Second, who is eligible? Third, how long will I wait for a specialist?
唤起你内心的杰里·马奎尔，让他们把钱亮出来。一个候选人如果回答不了这些问题，就是在给你一份没有财务数据的推介材料——这是一个巨大的危险信号，曾让我放弃过比这好得多的交易。
Channel your inner Jerry Maguire and make them show you the money. A candidate cannot answer those questions is handing you a pitch deck with no financials — a huge red flag that has prompted me to walk away from much better deals than this one.
杰伊·罗杰斯是一位金融专业人士，在私募股权、私人信贷、对冲基金和财富管理领域拥有30多年经验。
Jay Rogers is a financial professional with more than 30 years of experience in private equity, private credit, hedge funds, and wealth management.