公營與私有
美國醫療保險改革的辯論，今夏進入白熱狀態。返鄉述職的參眾議員，做夢也想不到要面對指著自己鼻子大罵的憤怒選民。這種媒體最愛的火爆場面，點綴上「歐巴瑪是納粹」、「老祖母被判死」等聳人聽聞的政治標語，使美國終於有了自己的政暴嘉年華會，不讓台灣打打鬧鬧的議會專美於前。
暴風中心直指歐巴瑪健保改革裡的「公營選擇」(public option)方案 。顧名思義，「公營選擇」，就是由政府提供「公營」的健康保險，以做為民眾在私有保險公司之外的「選擇」。
目前所有先進國家的醫療保險，多少都有政府的涉入，「公營選擇」也算不上是激進的公共政策，卻為何引起如此強烈的反彈？除了政黨政治與特殊集團的因素之外，這更和美國篤信資本主義的國情有關。許多人對市場經濟的自由競爭，有著類似宗教的狂熱信仰。政府「染指」任何企業，他們都將激烈反對，並習慣性地用「社會主義」的大帽一以叩之。「社會主義」的名目一出，各種想像的慘狀亦應運而生：人們排著長隊等待醫療服務、政府官僚決定誰生誰死、無用的老年人不得醫治等等。
在政策辯論中，隨便把「主義」的大帽子加在對方身上的陣營，通常缺乏理性辯論的誠意，因為「主義」的標籤，是不給理由就想證明對方全錯的捷徑。歐巴瑪提出的「公營選擇」是否能解決美國目前的醫療危機，本應被激烈地辯論，但是反「公營選擇」(下文以「反公」稱之) 人士，在「恐社會主義」的歇斯底里中所提出的論證，卻沒有一項能通得過理性的檢查。
我說「歇斯底里」，主要因為「反公」人士情願用想像力的渲染來刻劃公保的恐怖， 卻不願以近在身邊的例子，做實事求是的驗證。美國並不是沒有「公營」健保，目前65歲以上老人享有的「聯邦醫療保險計劃」(Medicare)，就完全是由政府經營的健康保險。公保如果真是那樣恐怖， 以Medicare的實際經驗舉例說明，不是最有說服力嗎？ 奇怪的是，「反公」人士很少提及Medicare ，提到它的人，表現出的卻竟然是對Medicare誓死也要護衛的滿意與喜愛。
南卡羅萊納州參議員的聽政會上，就有一名男子大叫 ：「混蛋政府，不准碰我的Medicare！」白宮也接到類似的信件：「拒絕政府提供醫療保險，拒絕社會主義的醫療制度，更拒絕政府打Medicare的主意！」這些不分青紅皂白地反對政府捲入健保的民眾，竟然沒搞清楚，為他們提供完善健保的，正是極惡不赦的政府。
當然，「反公」陣營中亦不乏誠心保衛市場自由競爭的人士，他們擔心政府的介入，將不公平地摧毀私有保險公司。 這種假設，卻非必然。現今市場中亦有反證存在。美國郵政局與私有郵遞業 (UPS， FedEx，DHL)之間的競爭即為一例。美國郵局並沒有以公營的優勢，打敗私有企業，反而居於下風，並在與私有企業競爭的壓力下，被迫增加效率。這正是自由競爭為消費者帶來的福利，公營健保又為何不能有相同的結果呢？
就算私有保險公司最終真的被公營健保淘汱，那也是市場力量運作的結果，一向信仰自由競爭的「反公」人士，卻為何突然自相矛盾地認為私有保險公司需要受到保護？
最令我困惑的「反公」言論，卻是政府官僚將成為醫療仲裁者的可怕。在現行的健保制度中，私有保險公司不正是所有醫療配給的仲裁者？他們決定個人可以看什麼醫生，可以住什麼醫院，可以動什麼手術。私有保險公司的官僚可以介入個人的醫療決定，政府的官僚卻不可以，這又是什麼樣的邏輯呢？
市場競爭雖是推動社會進步的動力，但是某些必要的社會功能，因為不應以營利為目的，所以必須仰賴政府提供，教育、國防、社會安全 (警察與消防隊等) 都是這樣的例子，醫療保健可能也是。
(世界周刊, 2009-9-6)
[[蘇友貞 said; "75% people want a public option,.."]]
and here is the poll stats that i found;
-------------------------------------------------
HART/McINTURFF Study #6095--page 21
June 2009 NBC/Wall Street Journal Survey
34a. In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance––extremely important, quite important, not that important, or not at all important?
Extremely important ..........................
41
[248]
Quite important .................................
35
Not that important .............................
12
Not at all important ...........................
8
Not sure ..........................................
4
-------------------------------------------------
76% percent agreeing it was important that health care reform include a "choice of both a public plan administered by the federal government and a private plan for their health insurance." Not only is that finding badly outdated, you can't stretch it to argue that 76 percent of the country wants "a public plan to compete with the private insurance industry, because they hate them and don't trust their health care to them,"
the example above alone indicates the misuse and the lack of understanding(ignorant?) of the data by 蘇友貞.
i'm sorry 蘇友貞, you are not up to the task!
By the way, 警察與消防隊 are governed at the state level. If a citizen and tax payer do not agree with the way police and FF are being run by his/her state, the person can easily pack up and move. There are 49 other options. But a public insurance at Federal level will leave no option for any citizen.
What I am interested in is dialogue not argument, therefore I cannot care less who wins or who loses. Declare your “victory” whichever way you want. I will not say a word more unless there is a genuine desire for engaged discussion.
By the way, please drop your over-used put-down language of Obama’s cool-aid and pill. No true discussion can go on if one side tries to portray the other side as being “duped”. It is such a cheap shot.
you? talking about "inefficiency"?
who is more inefficient? the government or the private insurance company?
if people think the insurance companys are putting their lives in danger, why is it that more than 80% of peoples surveyed said they are happy with the current health coverage?
what pill did obama give you?
>>You know very well the argument is on philosophical grounds, not administrative grounds.<<
the fact that you can't even get your facts straight tells me alot about your understanding of the situation. when you base your argument on emotions such as "[putting people’s lives in jeopardy...]" you lose.
I happen to think the more urgent need is to reform the private insurance industry whose profit hunger and operational inefficiency are putting people’s lives in jeopardy.
>>>police and FF are state regulated not federal, mind you.<<<
Oh, stop this petty nitpicking. You know very well the argument is on philosophical grounds, not administrative grounds.
>>> if you have no problem saying "capitalist", why would you have problem when being called a "socialist"? <<<
I have zero problem saying any “ism” under the sky, I just have problem with people who frame any argument in the vaguest concepts of “ism” with the sole intent of not having to substantiate their arguments.
you also mentioned 教育、國防、社會安全 (警察與消防隊等...ever since Edward Kenedy put his inprints on every education reform bill passed after 1960, the quality of education here in the US is...well, a disaster at best! we have the worst SAT score ever in 2007.
police and FF are state regulated not federal, mind you.
and pou'leeeeeeeees.... if you don't like to be labeled as a socialist, then don't act like one.
if you have no problem saying "capitalist", why would you have problem when being called a "socialist"?
By the way, Medicare and Medicaid cost tax payers $700 billion a year, more than national defense. I don't think I am alone when I say everyone LOVE paying more taxes. (Serious sarcasm in last statement)
Private sector such as UPS and FedEx controls pricing and the service they provide. They can increase their competitiveness by offering superior service, while charging more.
Private insurance companies, on the other hand, do not have such power (they don't own the hospitals nor drug companies). They would have no advantage when competing with a public institution that receive unfair advantage (subsidy by tax payers).
Most health insurance providers are public traded, if you look them up, their profit margin is only 3~5%. Meaning, their operating cost is around 95%. Without a complete system reform first, private insurers could only lower their rate by 5% at most, while public insurer will be entirely 100% funded by government. I will leave the consequence of that to everyone's imagination...