主题：【原创】谈谈对美国医疗改革的一点看法 -- 海外俗人

河里到底是牛人多啊。本来一个帖子，确是无法面面俱到，多有疏漏，但众位网友的评论，补充了很多不足之处。如山青青网友提到的Baby Boomer的因素，确是医疗成本高速膨胀的重大原因。

说到上文中提到的交易，今天ABC News的一篇报道，值得一看。

A Complicated Enemy: Obama Seeks to Vilify Health Insurers, Give Them $336 Billion Check

复杂的敌人－奥巴马一边寻机抹黑保险业，一边开出$336Billion的支票给他们。

http://blogs.abcnews.com/thenote/2010/03/a-complicated-enemy-obama-seeks-to-vilify-health-insurers-give-them-336-billion-check.html

“Neither mentioned that the Senate health reform bill, which is the basis for Democrats' last best chance at comprehensive reform, would give the insurance companies millions of new customers required by law to buy health insurance. It would also require insurers to cover everyone, regardless of age, gender or pre-existing condition.

To help pay for the new insurance requirements the government would give to people money to buy insurance - $336 billion over the next ten years. That money, ultimately, would have to go to... drum roll... insurance companies.

People without employer-sponsored insurance who make too much money to qualify for Medicaid and less than about $88,000 for a family of four, would get tax credits to help them buy insurance on the open market. But the payment of the tax credits would be made, point out Republican researchers, directly to insurance companies. See page 37 here of the Senate Finance Committee's exhaustive explanation of the plan: ”

参议院通过的议案中，将以法律形式带给保险业几百万的新客户。没有公司集体保险计划，收入高于低保而不能纳入政府低保医疗计划，却又不足四人家庭收入$88,000的个人，必须直接向保险公司买保险。为让这些新客户付得起保费，政府会在将来十年内，补贴他们$336 billion，而这些钱，将直接划到保险业的账户上。

但为什么保险公司得了便宜还要反对医改呢？因为别人得益得更多。

He argued that health insurers should not be targeted by the President and their profits are lower by margin than other sectors in the health industry.

"For every dollar spent on health care in America, less than one penny goes towards health plan profits. The focus needs to be on the other 99 cents," he said.

别人之中，不得不提到药品行业的交易。HuffingtonPost的一则消息。

http://www.huffingtonpost.com/2009/08/13/internal-memo-confirms-bi_n_258285.html

白宫的内部记录：

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Commitment of up to $80 billion, but not more than $80 billion.

1. Agree to increase of Medicaid rebate from 15.1 - 23.1% ($34 billion)

2. Agree to get FOBs done (but no agreement on details -- express disagreement on data exclusivity which both sides say does not affect the score of the legislation.) ($9 billion)

3. Sell drugs to patients in the donut hole at 50% discount ($25 billion)

This totals $68 billion

4. Companies will be assessed a tax or fee that will score at $12 billion. There was no agreement as to how or on what this tax/fee will be based.

Total: $80 billion

In exchange for these items, the White House agreed to:

1. Oppose importation

2. Oppose rebates in Medicare Part D

3. Oppose repeal of non-interference

4. Oppose opening Medicare Part B

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主要内容是药品行业愿意以出让十年间$80B的代价，换取政府保证一不会利用政府的大主顾优势讨价还价和进口竞价（同样药品在加拿大往往只有一半价格），二是放弃政府低保医疗计划中对药品行业的近$65Billion的回扣要求，三是延长生物药品的产权保护期限至12年（比原先多5年）从而阻止低价的仿制药品对其过早的竞争。

其实，同保险业一样，药品行业本身也将享受由强制的新增用户所带来的更高销售额。

至于医院和医疗服务人员及工会的利益块，以后有时间再唠叨。