爲奧巴馬醫改歡呼 Hooray for Obamacare

Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.

我是坐在椅子邊翹首等待最高法院針對奧巴馬醫改補貼的裁決結果嗎？不——我當時在屋子裏走來走去，緊張地坐不下來，擔心法院一個措辭潦草的判決會令數百萬人無法享受醫療保險，使數萬人陷入經濟困境，數千人因病早逝。

It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?

它沒有做出這樣的裁決。這意味着一些大的干擾——早期出現的網站技術問題、一些客觀講比較荒唐可笑、但仍是用心險惡的、通過法律途徑發起的破壞活動——已經過去，我們可以專注於醫改現實層面的東西了。《平價醫療費用法案》(Affordable Care Act)已經實施一年多，情況到底如何呢？

The answer is, better than even many supporters realize.

答案是，好得甚至超乎很多支持者的想象。

Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance.

先來看法案最基本的目標，即覆蓋之前沒有保險的人羣。該法案的反對者堅持認爲它會減少參保人數；事實是1500萬美國人已經因之獲得醫療保險。

But isn’t that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.

但還有數百萬人沒有覆蓋，是不是就只能說不算完全成功呢？呃，那些依然沒有享受醫療保險的人中，有很多是由於當地州政府拒絕聯邦政府把他們納入聯邦醫療補助(Medicaid)。

Beyond that, you need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.

除此以外，你還要知道這項法案從來沒有準備或指望覆蓋到所有人。無證移民沒有享受醫保的合法身份，而且任何一個不能實現自動註冊的系統都會有所遺漏。馬薩諸塞州承諾醫保全覆蓋已經十年了，但依然有5%的非老年人口沒有參保。

Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there. Most of the way with the A.C.A.!

如果以5%的未參保人口比例爲基準。我們已經取得多大進步？美國城市研究院(Urban Institute)的數據顯示，在全面施行該法案和擴大聯邦醫療補助的州，未參保人口比例從高於16%降低到只有7.5%——也就是說，在醫保改革實施第二年，我們就達到了目標的80%。《合理醫療費用法案》的目標已經接近實現！

But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.

但這些覆蓋成效如何？這個法案帶來的一些低價保單的確包含較多的免賠項目，這讓受保人需要自行支付不少的費用。但此類情況還是比沒有保險要好得多，也強過法案中列爲非法的那些過於基礎的保險計劃。新參保人員所承受的與健康相關的財務壓力急劇降低，而且對自己的醫保的滿意度也比較高。

What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.

那保險的費用怎麼樣呢？2013年曾經出現“保費大漲”趨勢隱現的驚悚言論；結果保費卻低於預期。2014年，還是那一撮人又宣稱2015年保費會出現大幅增長；結果只增長了2%。今年早些時候，又一輪保費高漲的恐怖預言再度甚囂塵上。隨着更多消息顯現，看起來2016年的保費增長似乎會比今年的增幅要大，但參照歷史標準依然不算高——也就是說保險費還是會比人們預期的低很多。

And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.

而且，整體醫療支出的增幅也出現了大幅放緩，這可能和政府採取的一些成本控制措施有關，這些措施主要針對聯邦醫療保險(Medicare)，也是醫改的重要部分。

What about economic side effects? One of the many, many Republican votes against Obamacare involved passing something called the Repealing the Job-Killing Health Care Law Act, and opponents have consistently warned that helping Americans afford health care would lead to economic doom. But there’s no job-killing in the data: The U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.

醫改會不會對經濟發展產生副作用呢？很多反對奧巴馬醫改法案的共和黨人士都曾經嘗試通過一項名爲“撤銷抑制就業的醫改法案”的議案，反對者不斷警告，幫助更多美國人負擔醫保會引發經濟災難。這是許多這方面擔心的其中一例。但數據顯示法案並沒有抑制就業：自奧巴馬醫改實行以來，美國經濟每月新增24萬多個就業機會，這是自1990年代以來增長最多的時期。

Finally, what about claims that health reform would cause the budget deficit to explode? In reality, the deficit has continued to decline, and the Congressional Budget Office recently reaffirmed its conclusion that repealing Obamacare would increase, not reduce, the deficit.

最後，那些聲稱醫療改革會令財政赤字規模擴大的言論是否成真了呢？實際上，赤字規模已經在不斷下降，國會預算辦公室(Congressional Budget Office)最近再次確認，撤銷奧巴馬醫改法案只會增加，而非減少財政赤字。

Put all these things together, and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure.

所有這些放在一起，我們看到的是一項政策取得勝利的圖景——儘管反對者想盡辦法從中破壞，它還是實現了許多預定目標，以比預期更低的成本改善了數以百萬計的美國人的生活，給予他們更多保障。

Now, you might wonder why a law that works so well and does so much good is the object of so much political venom — venom that is, by the way, on full display in Justice Antonin Scalia’s dissenting opinion, with its rants against “interpretive jiggery-pokery.” But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.

現在，你可能會納悶，爲何成效如此好、利好如此多的一項法案會召來那麼多惡毒的政治攻擊——順便說一句，這種攻擊在安東寧·斯卡利亞大法官(Justice Antonin Scalia)最近對“詭辯解釋(interpretive jiggery-pokery)”發出的激烈反對意見中體現得淋漓盡致。保守派一直擔心的是，醫改可能會成功，並由此提醒選民，有時候政府行爲的確能提高普通美國人的生活水平。

That’s why the right went all out to destroy the Clinton health plan in 1993, and tried to do the same to the Affordable Care Act. But Obamacare has survived, it’s here, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.

這是爲什麼右派人士會在1993年不遺餘力地破壞克林頓的醫保改革計劃，之後又對《合理醫療費用法案》極盡詆譭之能事。但奧巴馬醫改撐了下來，它就在我們眼前，正在發揮作用。保守派的噩夢成真了。這真是太美妙了。