Health-care reform

　　醫(yī)療改革

　　POLITICIANSwant to lowerspending, or at least they say they do. But in all the to-and-fro over raising the debt ceiling, little sensible has beensaid about lowering spending in the long term. Nothingilluminates this more clearly than health care.

　　政客們想要減少支出，或者至少他們嘴上是這么說(shuō)的。然而在總體上，債務(wù)限額一次又一次的爭(zhēng)論增加了債務(wù)限額，而沒(méi)有意識(shí)到減少支出這一長(zhǎng)期要求。沒(méi)有比醫(yī)療保健更能清楚地解釋這。

　　A new report, published in Health Affairs on July 28th, paintsa daunting picture. Health spending will rise by 5.8% eachyear from 2010 to the end of 2023, according to actuariesat the Centres for Medicare and Medicaid Services . In2023 health care will account for one-fifth of Americaseconomy. The federal government will pay for a greatershare than ever before.

　　發(fā)表在7月28日《衛(wèi)生事務(wù)》上的一個(gè)最新報(bào)告，描繪了一個(gè)令人望而生畏的畫(huà)面。根據(jù)醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助服務(wù)中心的精算師的預(yù)測(cè)，從2010年到2023年，醫(yī)療支出每年都將增加5.8%。到2023年，醫(yī)療保健將會(huì)占到美國(guó)經(jīng)濟(jì)的五分之一。聯(lián)邦政府將會(huì)支付比以往更多的份額。

　　Hawks have long warned that it would be impossible to curb government spending withoutcurtailing spending on health. Democrats claimed that their health law would lower costs. BarackObama assembled grey-haired sages to recommend changes to entitlement programmes. PaulRyan, the Republican chairman of the House Budget Committee, offered his own reforms. Andyet spending on health care continues to climb.

　　赤字鷹派早已警告說(shuō)，不縮減醫(yī)療支出而抑制住政府支出將是不可能的。民主黨聲稱(chēng)他們的衛(wèi)生法會(huì)減少花費(fèi)。奧巴馬綜合了灰白頭發(fā)的專(zhuān)家們的意見(jiàn)，建議改變福利計(jì)劃。眾議院預(yù)算委員會(huì)主席共和黨人保羅?瑞安提出了他自己的改革?？墒轻t(yī)療保健支出繼續(xù)攀升。

　　Last year the actuaries at CMS projected that healthreform would not lower spending, as Democratshoped. From 2009 to 2023 average annual growthfor health spending would be 0.2 percentage pointshigher with Mr Obamas health reform than withoutit. This slight net rise would mask dramatic shifts,the actuaries said. For example, reforms efforts tocontain costs for Medicare, the governmentprogramme for the old, would be dwarfed by theexpansion of Medicaid, the government programmefor the poor.

　　正如民主黨希望的那樣，去年CMS的精算師預(yù)計(jì)醫(yī)療改革支出不會(huì)減少。和沒(méi)有奧巴馬的醫(yī)療改革相比，從2009年到 2023年醫(yī)療支出平均每年增加高出0.2個(gè)百分點(diǎn)。精算師說(shuō)，這種輕微的凈增加掩飾了戲劇性的轉(zhuǎn)變。例如，政府針對(duì)窮人的醫(yī)療補(bǔ)助費(fèi)用大幅增加,使得政府為控制老年人醫(yī)療保險(xiǎn)成本所作的努力大打折扣。

　　The actuaries newest study estimates that health spending grew little last year, mostly becauseof the weak economy. The next decade, however, will bring rapid growth. Governmentspending will be the main driver. Ageing baby-boomers will enroll in Medicare; Medicaid coveragewill swell; Washington will subsidise many of those on the new state exchanges. CMS expectsWashingtons share of health spending to grow from 27% in 2009 to 31% by 2023. Togetherwith spending by states and cities, the public sector will pay for nearly half of Americas healthcare.

　　精算師最新的研究估計(jì)，去年醫(yī)療支出沒(méi)怎么增加主要是因?yàn)榻?jīng)濟(jì)的疲軟。然而，接下來(lái)的十年，醫(yī)療支出會(huì)迅速增加。政府支出將會(huì)是主要的驅(qū)動(dòng)力量。嬰兒潮時(shí)出生的人正在變老，并將加入到醫(yī)療保險(xiǎn)的行列;醫(yī)療補(bǔ)助覆蓋范圍將會(huì)擴(kuò)大;華盛頓將會(huì)資助許多新建的州醫(yī)療保險(xiǎn)交易所。CMS預(yù)計(jì)華盛頓醫(yī)療支出份額將會(huì)從2009年的27%增加到2023年時(shí)的31%。和州以及市的支出一起，公共部門(mén)支出幾乎達(dá)到美國(guó)醫(yī)療保健的一半。

　　This is a sobering prediction. However, even this may be an underestimate. The actuaries atCMS assume that only 2m people who now have employer-sponsored insurance will lose it, ascompanies drop coverage and workers move to exchanges or to Medicaid. But more may makethe switch. In June McKinsey, a consultancy, found in a survey that 30% of firms woulddefinitely or probably stop offering insurance after 2023, when the exchanges are in place. OnJuly 25th the National Federation of Independent Business, which represents small firms,published its own survey. If some workers begin to move to exchanges, the report found, 57%of companies would consider dropping insurance completely. If these surveys are borne out infirms actions, government spending will be even higher than CMS expects. The debt disasteron August 2nd may be averted. The bigger problem remains.

　　這是一個(gè)觸目驚心的預(yù)測(cè)。然而，即使是這樣，也許是低估。由于企業(yè)降低覆蓋面以及工人轉(zhuǎn)向醫(yī)療保險(xiǎn)交易所或醫(yī)療補(bǔ)助，CMS的精算師假設(shè)只有200萬(wàn)人將會(huì)失去了雇主提供的保險(xiǎn)。然而也許更多人遭遇了此種情況。6月份咨詢(xún)公司麥肯錫調(diào)查發(fā)現(xiàn)2023年后，醫(yī)療保險(xiǎn)交易所到位后，30%的公司肯定或也許會(huì)停止提供保險(xiǎn)。7月25日代表小公司的美國(guó)獨(dú)立企業(yè)聯(lián)合會(huì)發(fā)表了它自己的調(diào)查報(bào)告。報(bào)告指出，如果一些工人開(kāi)始轉(zhuǎn)向醫(yī)療保險(xiǎn)交易所，57%的公司會(huì)考慮完全取消保險(xiǎn)。如果這些調(diào)查刺激了公司的實(shí)際行動(dòng)，政府支出甚至將會(huì)超過(guò) CMS的預(yù)期。8月2日的債務(wù)危機(jī)也許會(huì)避免。但是更大的問(wèn)題仍然存在。

　　Health-care reform

　　醫(yī)療改革

　　POLITICIANSwant to lowerspending, or at least they say they do. But in all the to-and-fro over raising the debt ceiling, little sensible has beensaid about lowering spending in the long term. Nothingilluminates this more clearly than health care.

　　政客們想要減少支出，或者至少他們嘴上是這么說(shuō)的。然而在總體上，債務(wù)限額一次又一次的爭(zhēng)論增加了債務(wù)限額，而沒(méi)有意識(shí)到減少支出這一長(zhǎng)期要求。沒(méi)有比醫(yī)療保健更能清楚地解釋這。

　　A new report, published in Health Affairs on July 28th, paintsa daunting picture. Health spending will rise by 5.8% eachyear from 2010 to the end of 2023, according to actuariesat the Centres for Medicare and Medicaid Services . In2023 health care will account for one-fifth of Americaseconomy. The federal government will pay for a greatershare than ever before.

　　發(fā)表在7月28日《衛(wèi)生事務(wù)》上的一個(gè)最新報(bào)告，描繪了一個(gè)令人望而生畏的畫(huà)面。根據(jù)醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助服務(wù)中心的精算師的預(yù)測(cè)，從2010年到2023年，醫(yī)療支出每年都將增加5.8%。到2023年，醫(yī)療保健將會(huì)占到美國(guó)經(jīng)濟(jì)的五分之一。聯(lián)邦政府將會(huì)支付比以往更多的份額。

　　Hawks have long warned that it would be impossible to curb government spending withoutcurtailing spending on health. Democrats claimed that their health law would lower costs. BarackObama assembled grey-haired sages to recommend changes to entitlement programmes. PaulRyan, the Republican chairman of the House Budget Committee, offered his own reforms. Andyet spending on health care continues to climb.

　　赤字鷹派早已警告說(shuō)，不縮減醫(yī)療支出而抑制住政府支出將是不可能的。民主黨聲稱(chēng)他們的衛(wèi)生法會(huì)減少花費(fèi)。奧巴馬綜合了灰白頭發(fā)的專(zhuān)家們的意見(jiàn)，建議改變福利計(jì)劃。眾議院預(yù)算委員會(huì)主席共和黨人保羅?瑞安提出了他自己的改革。可是醫(yī)療保健支出繼續(xù)攀升。

　　Last year the actuaries at CMS projected that healthreform would not lower spending, as Democratshoped. From 2009 to 2023 average annual growthfor health spending would be 0.2 percentage pointshigher with Mr Obamas health reform than withoutit. This slight net rise would mask dramatic shifts,the actuaries said. For example, reforms efforts tocontain costs for Medicare, the governmentprogramme for the old, would be dwarfed by theexpansion of Medicaid, the government programmefor the poor.

　　正如民主黨希望的那樣，去年CMS的精算師預(yù)計(jì)醫(yī)療改革支出不會(huì)減少。和沒(méi)有奧巴馬的醫(yī)療改革相比，從2009年到 2023年醫(yī)療支出平均每年增加高出0.2個(gè)百分點(diǎn)。精算師說(shuō)，這種輕微的凈增加掩飾了戲劇性的轉(zhuǎn)變。例如，政府針對(duì)窮人的醫(yī)療補(bǔ)助費(fèi)用大幅增加,使得政府為控制老年人醫(yī)療保險(xiǎn)成本所作的努力大打折扣。

　　The actuaries newest study estimates that health spending grew little last year, mostly becauseof the weak economy. The next decade, however, will bring rapid growth. Governmentspending will be the main driver. Ageing baby-boomers will enroll in Medicare; Medicaid coveragewill swell; Washington will subsidise many of those on the new state exchanges. CMS expectsWashingtons share of health spending to grow from 27% in 2009 to 31% by 2023. Togetherwith spending by states and cities, the public sector will pay for nearly half of Americas healthcare.

　　精算師最新的研究估計(jì)，去年醫(yī)療支出沒(méi)怎么增加主要是因?yàn)榻?jīng)濟(jì)的疲軟。然而，接下來(lái)的十年，醫(yī)療支出會(huì)迅速增加。政府支出將會(huì)是主要的驅(qū)動(dòng)力量。嬰兒潮時(shí)出生的人正在變老，并將加入到醫(yī)療保險(xiǎn)的行列;醫(yī)療補(bǔ)助覆蓋范圍將會(huì)擴(kuò)大;華盛頓將會(huì)資助許多新建的州醫(yī)療保險(xiǎn)交易所。CMS預(yù)計(jì)華盛頓醫(yī)療支出份額將會(huì)從2009年的27%增加到2023年時(shí)的31%。和州以及市的支出一起，公共部門(mén)支出幾乎達(dá)到美國(guó)醫(yī)療保健的一半。

　　This is a sobering prediction. However, even this may be an underestimate. The actuaries atCMS assume that only 2m people who now have employer-sponsored insurance will lose it, ascompanies drop coverage and workers move to exchanges or to Medicaid. But more may makethe switch. In June McKinsey, a consultancy, found in a survey that 30% of firms woulddefinitely or probably stop offering insurance after 2023, when the exchanges are in place. OnJuly 25th the National Federation of Independent Business, which represents small firms,published its own survey. If some workers begin to move to exchanges, the report found, 57%of companies would consider dropping insurance completely. If these surveys are borne out infirms actions, government spending will be even higher than CMS expects. The debt disasteron August 2nd may be averted. The bigger problem remains.

　　這是一個(gè)觸目驚心的預(yù)測(cè)。然而，即使是這樣，也許是低估。由于企業(yè)降低覆蓋面以及工人轉(zhuǎn)向醫(yī)療保險(xiǎn)交易所或醫(yī)療補(bǔ)助，CMS的精算師假設(shè)只有200萬(wàn)人將會(huì)失去了雇主提供的保險(xiǎn)。然而也許更多人遭遇了此種情況。6月份咨詢(xún)公司麥肯錫調(diào)查發(fā)現(xiàn)2023年后，醫(yī)療保險(xiǎn)交易所到位后，30%的公司肯定或也許會(huì)停止提供保險(xiǎn)。7月25日代表小公司的美國(guó)獨(dú)立企業(yè)聯(lián)合會(huì)發(fā)表了它自己的調(diào)查報(bào)告。報(bào)告指出，如果一些工人開(kāi)始轉(zhuǎn)向醫(yī)療保險(xiǎn)交易所，57%的公司會(huì)考慮完全取消保險(xiǎn)。如果這些調(diào)查刺激了公司的實(shí)際行動(dòng)，政府支出甚至將會(huì)超過(guò) CMS的預(yù)期。8月2日的債務(wù)危機(jī)也許會(huì)避免。但是更大的問(wèn)題仍然存在。