美国选民周二明确传达了一个信息：医疗费用太高。民主党面临的挑战是，如何就最快缓解这一问题的途径达成一致。
Americans made it very clear on Tuesday that health care is too expensive. The challenge for Democrats is to agree on the quickest way to deliver some relief.
为何重要：选民无法等到2029年才看到生活成本下降——但任何能在短期内切实降低医疗成本的行动，都将要求民主党与特朗普总统达成交易。
Why it matters: Voters can't wait until 2029 for life to get cheaper — but any short-term action to meaningfully lower health costs will require Democrats to make deals with President Trump.
大局观：关于民主党团结的医疗保健议程会是什么样子，以及进步派在中期选举中的成功对“全民医保”意味着什么，已经有各种猜测。
The big picture: There's already speculation about what a Democratic unity health care agenda would look like, and what progressives' midterms success means for Medicare for All.
- 但这些讨论主要是针对2028年总统大选或可能出现的民主党政府。
• But that's largely geared toward the 2028 presidential race or a possible Democratic administration.
- 短期现实是，任何大幅扩大政府在医疗保健中作用的雄心勃勃的政策，几乎注定会撞上特朗普的否决大笔。
• The short-term reality is that any ambitious policies that significantly expand the government's role in health care are almost certain to collide with Trump's veto pen.
- 战略家们表示，民主党最现实的选择是明年寻找零散的负担得起的修补方案，而在重塑医疗体系方面则打持久战。
• Strategists say the Democrats' most realistic option is to find piecemeal affordability fixes next year and play the long game when it comes to reshaping the health system. "If you read history,
“如果你读历史，人们在获胜时最容易犯最大的错误。那时他们会松懈大意，不做正确的事，”奥巴马白宫前顾问、宾夕法尼亚大学医学伦理与卫生政策教授泽克·埃马纽埃尔说。
people make the biggest mistakes when they win. That's when they take their eye off the ball and they don't do the right thing," said Zeke Emanuel, an adviser in the Obama White House and a professor of medical ethics and health policy at the University of Pennsylvania.
- “这是一场关于负担能力的选举。我们需要解决负担能力问题，但我确实同意这是一个两步走的过程，”他补充道。“将不得不进行长期改革。”
• "This is an affordability election. We need to do affordability, but I do agree with the idea that this is a two-step process," he added. "There's going to have to be longer-term reforms."
- “对于那些在辩论新一届国会是该考虑大刀阔斧的改革，还是立即通过切实帮助民众的法案的人来说，答案是肯定的。选民能够而且应该期待在多个战线上采取行动，”“美国家庭”组织执行主任安东尼·赖特在一份声明中说。
• "For those debating whether the new Congress should consider big and bold reforms or pass practical help for people right away, the answer is yes. Voters can and should expect action on multiple fronts," Families USA executive director Anthony Wright said in a statement.
深层含义：民主党下一届国会的首要任务是恢复《平价医疗法案》的增强补贴，并扭转去年共和党和解法案中的医疗补助资金削减。
Between the lines: Democrats' top priorities for the next Congress are restoring enhanced Affordable Care Act subsidies and reversing the Medicaid funding cuts in last year's GOP reconciliation law.
他们在两院意外获得的巨大多数席位将赋予他们筹码，但如果与特朗普陷入僵局，并不能保证取得胜利。
• Their unexpectedly large majorities in each chamber will give them leverage, but no guarantee of a victory, if there's a standoff with Trump.
即使他们获胜，也无法帮助那1.57亿拥有职场医保的美国人，他们正承受着保费、免赔额及其他自付费用上涨的压力。
• Even if they prevail, it won't help the 157 million Americans with workplace coverage who are feeling the strain of higher premiums, deductibles and other out-of-pocket costs.
“国会考虑的是医疗保险、医疗补助，以及一定程度上的交易所（保险市场）。但他们必须记住，一半美国人口以及许多抱怨负担不起的人都在私营部门，”埃马努埃尔说。
• "Congress thinks of Medicare, Medicaid, and to some extent the exchanges. But they have to remember half the American population and a lot of people complaining about affordability are in the private sector," Emanuel said.
他们怎么说：参议院民主党领袖舒默昨天告诉“MS NOW”，医疗成本将成为民主党的重点关注领域。
What they're saying: Senate Democratic Leader Chuck Schumer told MS NOW yesterday that health costs will be a top focus for Democrats.
- 新任参议院财政委员会主席罗恩·怀登（民主党-俄勒冈州）表示，他的委员会“将为美国医疗体系建立新基础，确保全民医疗，让美国人获得更廉价、更优质的医疗服务，并终结企业对国家医疗体系的垄断控制”。
• Incoming Senate Finance Committee Chair Ron Wyden (D-Ore.) said his committee "will create a new foundation for America's health care system that guarantees health care for all, gives Americans cheaper and better health care, and ends the corporate chokehold on our nation's health care system."
- 众议院能源与商务委员会资深民主党人、新泽西州的弗兰克·帕洛内呼吁制定“一个以工薪阶层为先、专注于解决离谱涨价问题的议程”。
• And House Energy and Commerce Committee senior Democrat Frank Pallone of New Jersey called for "an agenda that puts working people first and focuses on resolving the outrageous price increases."
耐人寻味的是：药品定价可能是一个有望达成协议的领域，鉴于特朗普政府曾努力推动共和党主导的国会将其与主要制造商达成的“最惠国”协议写入法律。
The intrigue: Drug pricing could be one area ripe for a deal, considering the Trump administration's efforts to get the Republican Congress to write into law the "most favored nation" deals it struck with major manufacturers.
- “当公众听到民主党人和总统都表示关心这一问题，却找不到办法……为他们的药品提供更大的费用减免时，这很难让公众接受，”民主党医疗顾问克里斯·詹宁斯说。
• "It's very hard for the public to hear both Democrats and the president say they care about this issue and fail to find a way to ... provide greater cost relief for their medications," said Democratic health care consultant Chris Jennings.
- 埃马努埃尔表示，民主党还应推动医院按服务地点中性支付的政策、医院费用上限，以及取消医疗保险和《平价医疗法案》市场中仿制药的共付额和免赔额。
• Emanuel said Democrats should also push for site-neutral hospital payment policies, caps on hospital costs and an end to copays and deductibles for generic drugs in Medicare and ACA markets.
问题在于，有多少民主党人愿意为了与一位实力削弱的总统达成协议，而缩减自己的雄心。其中许多政策选项都能产生预算结余，这些资金可以转而用于帮助支付全面扩大医保覆盖范围的费用。归根结底：选民们再清楚不过地表明，他们正受到医疗负担能力危机的挤压。民主党人必须设法应对要求立即采取行动的压力。
• The question is whether many Democrats are willing to scale back their ambitions for the sake of striking a deal with a weakened president. Many of those policy options would generate budgetary savings that could instead be used to help pay for sweeping coverage expansions. The bottom line: Voters couldn't have been clearer about how they're being squeezed by the health affordability crisis. Democrats have to figure out how to respond to pressure to act now.