First of all, the American medical system is the most expensive in the world. The total health expenditure in the United States accounts for 17% of its GDP, and the annual medical expenditure has reached 2 trillion US dollars, far higher than other countries in the world, but the United States is also the only developed country that has not achieved universal medical security. At present, there are still 50 million people in the United States who do not have medical insurance (mainly under the age of 65 who do not meet the standard of medical reimbursement for the poor and do not have commercial medical insurance provided by employers). They still face three major problems: the quality of medical services with low satisfaction and the medical performance disproportionate to the high cost, that is, the low coverage, inefficiency and high cost of the medical system.
Secondly, the expensive medical expenses in the United States make it unaffordable for patients with commercial insurance or medical insurance for the elderly and the poor, because even if there is insurance, individuals have to pay a certain proportion. Health economics has long proved that having insurance will push up medical expenses. With the increase of medical expenses, insurance companies either increase the premium or reduce the insured amount and increase self-funded items. In short, the burden on patients will be heavier. The American media called it a spiral of medical expenses. Taking his mother as an example, Obama said that even though many patients have insurance, at the end of their lives, they are worried that insurance companies will refuse to pay for various reasons, and they are even more worried that many medical items cannot be reimbursed and cannot be paid.
The inefficiency is mainly reflected in the level of doctors and medical institutions. At present, doctors in the United States spend a lot of time and energy dealing with medical insurance, medical authorization and medical litigation. However, the defects of the current medical insurance reimbursement system and the fear of possible litigation often prompt doctors to carry out many unnecessary examinations and treatments.
More seriously, the medical burden in the United States has become a constraint to the stable and sustainable development of the American economy. At present, medical care is the largest item in the US government's fiscal expenditure, which is higher than education and national defense expenditure. The medical insurance for the elderly and the medical insurance for the poor have become the biggest burden of American finance, which has caused headaches for successive governments. Medical insurance in the United States is mainly paid by employers for employees according to law, which has also become a heavy burden for American enterprises and is considered as one of the culprits that damage the competitiveness of American enterprises.
Before the financial crisis, Ford, General Motors and other big American companies were unsustainable because of the burden of medical insurance. Obama called for the failure of the reform of the American health care system, which would bring down the whole United States. Therefore, he positioned the goal of medical reform as: to establish a brand-new foundation for the future sustainable development of the United States. This shows that the Obama administration attaches great importance to medical reform and the strategic height of American medical reform.
What should be changed in American medical reform?
Wide coverage and low cost not only means expanding the population covered by insurance, but also means expanding the medical projects covered by insurance. At the same time, it is necessary to control the spiraling cost of the overall medical system in the United States through information technology and other means.
Obama pointed out that the reform will establish a brand-new medical system, provide a good professional environment for doctors and provide the best medical services for all Americans at the lowest cost. Such a system can reduce the pressure on enterprises, release economic vitality, create jobs, raise real wages, bring tens of billions of dollars of extra growth to the American economy every year, and make the medical system and the overall economy more stable.
At present, the specific contents of the medical reform drafted by the Obama administration include several aspects. For example, the government should strictly control the behavior of commercial insurance companies and not allow insurance companies to "skim cream"-the original meaning of this word is skimming cream from milk, which means that insurance companies always tend to sell insurance to healthy, young and high-income people, while setting harsh conditions for the old, weak and low-income people. In view of this situation, Obama's health care reform plan requires insurance companies to accept all applicants and not to charge higher premiums according to their medical history and disease status. Moreover, the insurance plan also proposes that insurance companies must provide the "minimum welfare package" determined by the federal government to prevent insurance companies from reducing reimbursement items.
The federal government should provide subsidies to help low-income people buy insurance. For low-income people, there should be medical insurance for the poor.
In order to reduce the huge cost burden of medical insurance for the elderly, Obama proposed to reform the payment method and replace the traditional payment method with value-based payment method.
Although the medical reform in the United States seems to have found an excellent opportunity, the real progress is still difficult and controversial. Since June, Obama has lobbied and debated his new health care reform policy on many occasions. According to The New York Times's analysis, the focus of the debate is on two issues: one is how much this huge medical reform plan will cost; The second is to establish a government-run medical insurance plan to cover all the uninsured people at present, and whether it will change the "free market" values in the United States.
The US Congressional Budget Office initially estimated that the medical reform plan would cost 1 trillion dollars, which inevitably touched the nerves of taxpayers in the economic crisis and caused great resistance. Because it means that employers will pay more premiums or increase taxes. Later, it was planned to adjust and slim down to 200 billion US dollars. However, opponents of the party and the American Medical Association still refused to buy it. The bigger difference is that Obama's universal health insurance will be implemented through the establishment of a government-run medical insurance plan, because it touches the value concept of the "free market" in the United States and also touches the interests of special interest groups, especially the insurance industry. These will be fatal obstacles for the United States to promote medical reform, and this is not the only obstacle at present.
A most developed country has spent the most expensive medical expenses, but it is the only developed country that has not achieved universal medical security.
Although the United States is considered as the most liberal and open country in the world, it is also a country with a very clear value orientation. For specific political and cultural reasons, the United States has a neurotic fear of "socialism".
It is special interest groups that play a greater and more realistic role than ideology. Every social group can have its own legitimate interests, not called "special interest groups". The so-called "special interest group" refers to a group that accounts for a very small proportion of the population, but has far greater influence on policies than its population size, and uses its policy influence to vigorously safeguard policies that are beneficial to itself but contrary to social welfare.
Which interest groups oppose medical reform? It depends on which groups are hurt by medical reform. In order to achieve "low cost and wide coverage" in American medical reform, there are mainly three interest groups that suffer:
First, commercial insurance companies, because commercial insurance relies on "skimming cream" to make profits, only pick out people with high income and good health to sell insurance, which damages the function of medical insurance itself to spread risks and adjust income distribution, and realizing "universal medical insurance" is bound to squeeze the wishful thinking of commercial insurance companies;
Second, in order to control costs, pharmaceutical companies will inevitably use more cheap and effective applicable drugs and technologies, so that the profit margin of pharmaceutical companies will be greatly reduced;
Third, doctors' associations, which are different from those in China, have low remuneration. In the United States, doctors are the most respected profession, and doctors' associations are also worried that medical reform will harm the interests of doctors.
Throughout American history, the abortion of medical insurance plan is the result of the joint action of commercial insurance, pharmaceutical companies and medical associations. In order to safeguard their vested interests, they formed a powerful lobbying group outside the hospital, and through the agents in Congress and the government, they made repeated medical reform efforts go up in smoke.