美国医改的政治经济分析——历史视角兼论对中国医改的启示

The Political Economy of Health Reform in the United States:A Historical Review and Lessons for China

美国医疗体系表现为医疗费用高、医保覆盖低、健康指标差的特征。问题的根源在于美国独特的由雇主为雇员提供商业医保——而非由政府向全民提供医保——的医疗体制。这种区别于所有其他发达国家的制度之所以在美国得以巩固和发展,是因为它满足了美国各方资本势力(包括大雇主、商业保险公司、医院、医生、医药公司等)的利益诉求,而且,这些资本势力具有异常强大的政治经济力量,足以使过去近百年来美国工人组织推动的、为实现政府全民医保而进行的数次政治努力皆归于失败。虽然奥巴马医改在理论上接近了全民医保,但由于它并不改变美国医疗体制的逐利机制,不触动既有利益格局,导致美国巨大的医疗费用在奥巴马医改后继续攀升。美国的教训对走在十字路口的中国医改具有警示作用。

Despite its superb economic strength, the health system of the United States is characterized by astronomical spending on the one hand, while low insurance coverage and disappointing health indicators on the other. The root cause for the inefficiency lies in that, different from all other developed countries that have a national health pro- gram, the United States has a private system driven by commercial objectives. It responds primarily to the interests of large employers, private insurance companies, hospitals, medical professionals, and pharmaceutical companies. During the past sever- al decades, these interests groups have been powerful enough to defeat every political effort--largely promoted by workers and unions--striving for a universal, government- sponsored health system. Although the recently-launched Obamacare has played an important role in reducing the uninsured population, it keeps intact the for-profit nature of the American health system and further empowers the interest groups. Consequent- ly, the escalation of health care spending in the United States has continued. China is currently experiencing major health reforms. Some of the lessons learned may be helpful for China＇s health policy-makers.