为奥巴马医改欢呼 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.

我是坐在椅子边翘首等待最高法院针对奥巴马医改补贴的裁决结果吗？不——我当时在屋子里走来走去，紧张地坐不下来，担心法院一个措辞潦草的判决会令数百万人无法享受医疗保险，使数万人陷入经济困境，数千人因病早逝。

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?

它没有做出这样的裁决。这意味着一些大的干扰——早期出现的网站技术问题、一些客观讲比较荒唐可笑、但仍是用心险恶的、通过法律途径发起的破坏活动——已经过去，我们可以专注于医改现实层面的东西了。《平价医疗费用法案》(Affordable Care Act)已经实施一年多，情况到底如何呢？

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.

先来看法案最基本的目标，即覆盖之前没有保险的人群。该法案的反对者坚持认为它会减少参保人数；事实是1500万美国人已经因之获得医疗保险。

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.

但还有数百万人没有覆盖，是不是就只能说不算完全成功呢？呃，那些依然没有享受医疗保险的人中，有很多是由于当地州政府拒绝联邦政府把他们纳入联邦医疗补助(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，你还要知道这项法案从来没有准备或指望覆盖到所有人。无证移民没有享受医保的合法身份，而且任何一个不能实现自动注册的系统都会有所遗漏。马萨诸塞州承诺医保全覆盖已经十年了，但依然有5%的非老年人口没有参保。

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%的未参保人口比例为基准。我们已经取得多大进步？美国城市研究院(Urban Institute)的数据显示，在全面施行该法案和扩大联邦医疗补助的州，未参保人口比例从高于16%降低到只有7.5%——也就是说，在医保改革实施第二年，我们就达到了目标的80%。《合理医疗费用法案》的目标已经接近实现！

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.

但这些覆盖成效如何？这个法案带来的一些低价保单的确包含较多的免赔项目，这让受保人需要自行支付不少的费用。但此类情况还是比没有保险要好得多，也强过法案中列为非法的那些过于基础的保险计划。新参保人员所承受的与健康相关的财务压力急剧降低，而且对自己的医保的满意度也比较高。

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.

那保险的费用怎么样呢？2013年曾经出现“保费大涨”趋势隐现的惊悚言论；结果保费却低于预期。2014年，还是那一撮人又宣称2015年保费会出现大幅增长；结果只增长了2%。今年早些时候，又一轮保费高涨的恐怖预言再度甚嚣尘上。随着更多消息显现，看起来2016年的保费增长似乎会比今年的增幅要大，但参照历史标准依然不算高——也就是说保险费还是会比人们预期的低很多。

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，整体医疗支出的增幅也出现了大幅放缓，这可能和政府采取的一些成本控制措施有关，这些措施主要针对联邦医疗保险(Medicare)，也是医改的重要部分。

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.

医改会不会对经济发展产生副作用呢？很多反对奥巴马医改法案的共和党人士都曾经尝试通过一项名为“撤销抑制就业的医改法案”的议案，反对者不断警告，帮助更多美国人负担医保会引发经济灾难。这是许多这方面担心的其中一例。但数据显示法案并没有抑制就业：自奥巴马医改实行以来，美国经济每月新增24万多个就业机会，这是自1990年代以来增长最多的时期。

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.

最后，那些声称医疗改革会令财政赤字规模扩大的言论是否成真了呢？实际上，赤字规模已经在不断下降，国会预算办公室(Congressional Budget Office)最近再次确认，撤销奥巴马医改法案只会增加，而非减少财政赤字。

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.

所有这些放在一起，我们看到的是一项政策取得胜利的图景——尽管反对者想尽办法从中破坏，它还是实现了许多预定目标，以比预期更低的成本改善了数以百万计的美国人的生活，给予他们更多保障。

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.

现在，你可能会纳闷，为何成效如此好、利好如此多的一项法案会召来那么多恶毒的政治攻击——顺便说一句，这种攻击在安东宁·斯卡利亚大法官(Justice Antonin Scalia)最近对“诡辩解释(interpretive jiggery-pokery)”发出的激烈反对意见中体现得淋漓尽致。保守派一直担心的是，医改可能会成功，并由此提醒选民，有时候政府行为的确能提高普通美国人的生活水平。

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.

这是为什么右派人士会在1993年不遗余力地破坏克林顿的医保改革计划，之后又对《合理医疗费用法案》极尽诋毁之能事。但奥巴马医改撑了下来，它就在我们眼前，正在发挥作用。保守派的噩梦成真了。这真是太美妙了。