潇湘渌水 @ 2007-06-13 21:49 Your Money or Your Life: Tackling Rising Costs of Health Care January 19, 1984 New York Tribune Americans spend more than 10 percent of the yearly gross national product on health care—nearly ,500 for every U.S. resident. Since 1975, total health care spending has more than doubled. The cost rose 11.9 percent in 1982, three times faster than the rate of inflation. While life itself may be priceless, it is possible to assign a cost to its upkeep—and that cost is rising rapidly. It is possible in theory to spend nearly all of society’s resources on health care. As societies become wealthier and people live longer, it is logical to expect an increase in the total demand for health care. But it does not follow that individual services should radically rise in price. Increased Elements Two main factors have contributed to skyrocketing medical prices. The first is regulation of the medical industry, probably the most regulated business in America. For the most part, however, the regulation was written and supported by the medical establishment, which is the main beneficiary of those laws. For instance, laws prohibit the treatment of relatively simple ailments, such as hangnails, by nurse practitioners at much lower rates; similarly, technicians who fit dentures have had great difficulty gaining the right to perform those chores; and midwives, who charge less than obstetricians, are often prohibited from delivering babies. The number of American medical schools, and therefore the number of doctors, is legally controlled through licensing laws supervised in each state by the American Medical Association. Those who favor limitations on the number of doctors do so because they fear an “oversupply,” which would presumably lower the income and power of individual doctors. These restrictions to entry and other factors, such as the lengthy and expensive testing procedures required by the Food and Drug Administration, have pushed up costs. Consumers, pressured to make quick decisions because of pain or threat of death, often do not have the time or inclination to shop around and those who would are stymied by the lack of available information. Until recently, even minimal advertising was illegal. The health-care business has enjoyed the unique privilege of calculating the bill after the services have been performed. Third-party Payments But the last 40 years have seen the rise of another factor that has caused the dramatic and continuing acceleration of costs—third-party payments. Today, nearly 95 percent of the national hospital bill is paid by third parties. Medicare and Medicaid expenditures, which cover about 22 percent of the population, have grown from .9 billion in 1967 to billion in 1982. Combined with private insurance, 86 percent of the population has been separated from the direct billing process. It is an observable economic law that when any commodity is free, more is consumed. Those who directly bear none of the costs of medical services uniformly demand more than those who pay part of the costs. Government agencies have recently begun to question medical bills presented for services rendered, but many hospitals simply shift the difference to paying patients. Group insurance plans have contributed to the problem. During World War II, government established maximum wage and salary laws that encouraged the use of fringe benefits to attract employees. Barred from offering money to employees, employers offered more health insurance than would have been purchased by people who control their own spending. Insurance Preferred The trend was encouraged as taxes reached new heights. Employers and employees prefer health insurance to direct compensation because insurance can be written off as a tax-deductible business expense. For low-income individuals, a dollar spent by an employer to purchase health insurance is worth nearly 50 percent more than if it were paid directly to an employee for purchase of insurance. For higher-income individuals, the difference is drastic. H. E. Frech, economics professor at the University of California, Santa Barbara [and contributing author of The Independent Institute’s book, American Health Care: Government, Market Processes and the Public Interest], believes elimination of the tax-deductible status of insurance expenditures would do away with most over-insurance while real general reductions in corporate and individual taxes would offset reduced benefits. Wholesale deregulation and privatization reforms of Medicare and Medicaid, according to Frech, would complete most of the task. Ironically, considering the magnitude of those programs, they offer complete coverage only for initial services but have limited catastrophic coverage. Co-payment plans, which require consumers to pay part of the medical costs up to a certain point, encourage wise use of services without discouraging legitimate uses. Individuals can encourage their companies to shop for the best plans. Options have risen in response to high medical costs, such as health maintenance organizations that provide all medical care at a competitive fixed cost. Some firms offer several plans to employees, differing in the amount of co-payment and rewarding employees who do not unnecessarily use medical services. Comparison shopping for services such as standard physicals or prescription drugs helps if everybody in a group plan makes that effort. Companies can and have significantly lowered their insurance costs. The ultimate solution to overpriced health-care services is deregulation and tax reform that would foster competition in the health-care industry. Competition is the only real ally we have in the fight against the high cost of living—and the high cost of staying alive. 要钱要命：如何应对彪升的医疗费用 1984年1月19日 David J. Theroux 纽约讲坛 美国人每年要花费10%以上的GNP在医疗卫生上－差不多每个美国居民1500美元。自从1975年以来，全国的医疗卫生总费用已经翻了一倍。而在1982年增长率更是达到了11.9%，是同期通货膨胀率的三倍。虽然生命是无价的，但给生命安排一个合理的维护费用还是可能的－尽管这个维护的成本不断的彪升。 理论上整个社会的资源用于医疗卫生都是可能的。当社会越来越富有且国民寿命越来越长，我们期待国家医疗卫生总费用的提高是很正常的。但这并不意味着接下来我们取得这些医疗卫生服务的花费就要根本提高。 费用增长的原因 对 于飞涨的医疗价格有两个“罪魁祸首”。第一是医疗产业的管理，医疗产业大概是美国最受管制的产业了。卫生管制的大部分内容都是由卫生机构制订和维持的法规 制度，而这些卫生机构却是其法规制度的主要受益者。例如，法律禁止护士以低得多的价格进行一些相对简单的治疗，如治疗指甲倒拉刺；还有装假牙的技师也几乎 没有权利干一些这样简单的灵活；甚至比产科医生廉价得多的助产士还经常被禁止抱送婴儿。 另外，美国医科学校和医生的数目也是被American Medical Association在各州的监督许可法规所控制的。那些人因为害怕所谓“供大于求”而限制医生的数量，大概是那样会降低了每个医生的收入和权力把。正是这些准入措施和其它一些因素，如FDA要求的漫长而昂贵的检测过程一起推动了我们的医疗费用。 而出于疼痛和死亡威胁必须做出迅速决定的患者们却因为没有可靠的信息经常没有时间和兴趣去周围寻找更好的医疗机构。直到最近，连最低限度的医疗广告都是非法的。就这样在所有措施都安排好以后，医疗机构们就可以愉快的在那里享受清点钞票的特权拉。 第三方偿付医疗费用 但是还有第二个被视为近40年来促使医疗费用急剧持续上升的因素－第三方偿付（保险）。今天近95%的国立医院费用是由第三方支付的。覆盖22%人口的老人医疗保险和穷人医疗辅助费用也从1967年39亿美元涨至1982年64亿美元，再加上私人保险，86%的人口已经不再直接支付医疗费用。 这 是一个显而易见的经济法则，那就是当一个商品看起来免费的时候其将会被更多的浪费。那些不直接支付医疗服务费用的人几乎都要比自己要进行部分支付的人要求 更多的医疗服务。最近政府机构已经开始质疑他们面对的高额的医疗支付费用，但是许多医院只要简单的转换一下付费病人的区别对待就可以应付政府了。 再有集体保险计划也加剧了这个问题。二战期间，政府建立了鼓励使用附加福利来吸引员工的最高工资法。因为禁止直接把福利支付给员工，所以雇主不得不支付的福利费用比员工自己控制保险购买的费用要更多。 优选的保险方式 随着税收达到新的高度那种不良的趋势也被提高。因为保险可以被当作一种可减税的支付手段，雇主和员工更愿意把健康保险作为直接补偿。对低收入者来说，雇主为其支付健康保险比雇主把钱打入工资再由员工购买健康保险要超值50%。而对高收入者来说，这点就存在很激烈的意见分歧。 H. E. Frech，UC. Santa Barbara大学经济学教授，独立研究所出版书籍《American Health Care: Government, Market Processes and the Public Interest》的副作者，都相信当公司和个人税收的实际减少可以抵消减少的收益时，取消保险抵税可以废除大部分超额保险费用。 据Frech的 看法，大批管制的撤销和医疗保险制度、医疗辅助计划的私有化改革将大部分减少医疗成本。具有讽刺意味的是，考虑到这些项目的巨大，他们只提供了初级医疗服 务的覆盖而限制了大病难的医疗覆盖。另外还有联合支付计划，它要求人们支付一定比例的费用，这样既鼓励了谨慎使用医疗服务又没有抑制其合理使用。 个人能鼓励他们的公司去选购最好的保险计划。对高医疗费用的替代选择已经被提出，如health maintenance organizations他 们就能以具有竞争性的固定价格提供所有医疗服务。一些公司同时给员工提供几种计划，可以选择不同的联合支付比例和区分那些不必要使用医疗服务的员工。如果 一个集体计划里的每个人都努力，那么比较并选择标准治疗或处方药就有益处。因此公司能够且已经大幅度的降低他们的保险费用。 最终解决高价医疗卫生服务的办法是可以给医疗卫生产业引进竞争的解除管制措施和税收改革。总之，竞争是我们在与高昂的生活费用和高昂的生存费用战斗时唯一真实的盟友。 |
潇湘渌水 @ 2007-06-04 21:01 十八年了 人生有几个十八年 十八年前我没有任何记忆 那一年唯一的记忆是海湾战争 电视上说打仗了 我怕怕的问爸爸：我们这里会打吗？ 十八年了 国家这个孩子什么时候才会长大？ |
潇湘渌水 @ 2007-06-02 12:25 http://www.nytimes.com/2007/06/02/us/02toothpaste.html?_r=1&hp&oref=slogin Toxic Toothpaste Made in China Is Found in U.S.美国FDA新没收一批中国制造的牙膏，并警告美国消费者不要使用中国制造的牙膏。 看来我是不是要考虑上网订购国外的牙膏呢～～哈哈 |
潇湘渌水 @ 2007-05-24 22:55 生命可以美丽吗？——我看“美国丽人” 林小蒸    “AMERICAN BEAUTY”实在不应该被翻译成“美国丽人”的。我相信她是花的名字。我更相信，这花是美丽而绝望的。 不止是中产阶级的迷惘，也不止是中年的迷惘。那是——关于生命的迷惘。 我们都是失败者。在时间面前，所有的生命都是天生的注定的失败者。那么我们能做什么呢？ LESTER努力地做了。他不甘于庸常的生活。他要做自己的心真正要做的事。他换了自己真正喜欢的车。他炒了讨厌的老板的鱿鱼。他开始锻炼身体。他尝试吸毒。他尝试重新找回他和妻子当年的激情。他尝试重新去爱。 他爱上的是女儿的同学。这并不重要。重要的是，他还有能力去爱。 但一切都是徒劳。失败是早已注定的。生命以各种形式强调着自己的意志的权威，给所有企图反抗者以致命的打击。 妻子是命定的。在LESTER试图重寻激情时，妻子首先想到的是四千美元的沙发。怎么可以在沙发上呢？四千美元啊！…… 一切都是命定的。女儿不能容忍自己的父亲爱上同学。事实上，她又欣赏过父亲什么呢？父亲在她眼中，只是一个可怜虫而已。 还有邻居。新搬来的一家三口也是莫名的混乱。暴虐的父亲，有偷窥癖的儿子，以及略显痴呆的母亲。倒是那对同性伴侣似乎比较健康，给新来的邻居送花，每天跑步，相亲相爱。这是怎样的荒谬世界呢？ 也许，只有ANGELA，那朵娇艳的玫瑰，是他心目中的异数。他爱上的并不是ANGELA，他爱上的只是他的幻想。他幻想中的美好的影子。 我又看到了那尾鱼。那尾绝望的爱上莲的鱼。莲本不属于鱼的世界呀，鱼纵使挣扎，又如何可以挣脱命运？ 所以一切都是命定的。生命原本是一场必输的比赛。 我们只能孤注一掷。 03-30-2000 |
潇湘渌水 @ 2007-05-09 19:15 《friends》,I love you so much! 《friends》,I love you so much! 《friends》,I love you so much! You are so beatuful,wanderful, amazing! |
潇湘渌水 @ 2007-05-06 17:15 品德并不值得夸奖，它往往是缺乏恶的能量； 在这种情况下，它只是懒惰的结果。 |
潇湘渌水 @ 2007-05-06 16:54 http://www.nytimes.com/2007/05/06/world/americas/06poison.html?_r=1&hp&oref=slogin －－－文章 http://www.nytimes.com/ref/world/20070506_POISON_GRAPHIC.html －－－中国毒药世界行路图 处在资本主义原始阶段的中国，其产品或者叫“毒品”又一次上了NYTimes， 真是风光啊～～ 从中国泰兴生产的一种化学工业试剂，远渡重洋赶到巴拿马制成糖浆毒死了人。 中国成了世界最主要的假药品源头～good～well done～ |
潇湘渌水 @ 2007-04-04 12:30 选择“美德”比 “美德的后果”更为重要 |
潇湘渌水 @ 2007-04-02 11:23 http://www.bullog.cn/blogs/drunkpiano/archives/38064.aspx drunkpiano 也就是“情书”的博客上的转载周其仁的文章，我也很喜欢周的文章，当年看经济的时候看了很多他的文章。这篇转载精简后一目了然，短短的篇幅把医改的虚伪狼皮给捅破，实在经典。 而且也是“国有惨败”的经典案例，其余的有“金融”领域的惨败，“教育”领域的惨败，还有“土地市场”的惨败－也就是住房－其背后真正的黑手是所谓的“土 地国有制度”－即“土地政府私有制”，还有“能源”领域的惨败，再凑上这篇“医改”惨败，当今国民的仇恨焦点全部凑齐！当然也是不久后经济危机的起源－即 少数人对多数人的压迫！ 所有的一切无不证明了“集体主义”（包括国有、地方集体所有，这里的集体制是一个哲学范畴，反义是“个体主义”）是万恶之源，所以永远要警惕一切所谓“集体行为”，即打着冠冕堂皇的什么“国家”、”集体“、”人民“的口号的一切行为！！ |
潇湘渌水 @ 2007-03-29 20:23 隆重推荐“情书”的博客～～ 基本篇篇文章都经典～ |
潇湘渌水 @ 2007-03-28 12:52 http://www.nytimes.com/2007/03/27/world/asia/27china.html?_r=1&oref=slogin 重庆的 nail house～～ 上nytimes |
2011年2月25日
一大页
