The Democrats’ ObamaCare Quagmire
这篇文章批评民主党人提出的最新医保改革方案，认为这些方案实际上是奥巴马医改失败政策的重演，或旨在进一步加强政府对医疗市场的控制。作者指出，民主党人承认奥巴马医改的不足，却承诺在未来执政时走得更远。他们提出的“一站式服务”和“标准化计划”等措施，在奥巴马医改中已导致保费飙升。民主党还试图通过“消费者保护”之名，消除短期或灾难性保险等替代方案，以阻止人们脱离奥巴马医改困境。此外，他们承诺解决“企业贪婪”问题，例如医疗损失率的漏洞，但这正是奥巴马医改本身造成的。文章强调，奥巴马医改未能降低医疗成本，而新的提案，如恢复高额补贴或提供“医保式选择”，也无法解决这一问题。作者总结道，尽管政府主导的医疗保健已失败16年，民主党人仍旧鼓吹更多的开支、监管和政府控制，这只会加剧现有问题。
One has to admire Democrats’ chutzpah. In a recent letter, Ron Wyden, ranking Democrat on the Senate Finance Committee, and 11 of his Democratic colleagues outlined a series of healthcare principles, so the Senate is ready “to take action on these issues the next time” Democrats are governing. The letter amounts to a simultaneous admission of ObamaCare’s failures and promise to go even further the next time Democrats have power.
“Chutzpah”是一个源自意第绪语的词汇，通常指一种大胆、无礼、厚颜无耻的自信或勇气，有时带有褒贬参半的意味。在政治语境中，它常用来形容政客在面对明显失败或争议时，仍能理直气壮地推行其议程的行为。
To “make health care simpler for families,” the lawmakers would “make sure people can get the insurance they are eligible for through a one-stop shop,” and “simplify and standardize plans and benefits.” ObamaCare already created government-run exchanges to shop for coverage—years after private companies had created comparison-shopping tools online. The law also standardized benefits, imposing new coverage requirements that more than doubled individual insurance premiums in ObamaCare’s first four years. Why are Democrats suggesting policies they enacted in 2010?
The letter’s vow to “get rid of junk insurance plans” hints at the senators’ true motivation. Democratic lawmakers appear to want to regulate ObamaCare off-ramps like short-term limited-duration plans and catastrophic insurance out of existence. Much as the East German government created the Berlin Wall—officially known as the Anti-Fascist Protection Rampart—to “protect” people by preventing them from leaving, Democrats want to enact stronger so-called consumer protections that eliminate any exit from the ObamaCare morass.
文章将民主党限制医保选择的行为与东德政府修建柏林墙进行类比。柏林墙官方名称为“反法西斯防卫墙”，旨在“保护”公民，实则阻止他们离开。同样，民主党以“消费者保护”为名，试图消除替代性医保方案，以防止人们脱离奥巴马医改的困境。
To “take on corporate greed,” the lawmakers want to “eliminate Big Insurance gaming of the medical loss ratio that hides their profits, and ensure that those dollars are spent on providing care and lowering costs.” Democrats are pledging to fix a problem they created as part of ObamaCare. As Sen. Elizabeth Warren outlined in November 2023, insurers have bought up pharmaceutical benefit managers and other healthcare entities to shift revenue from insurance products—where ObamaCare’s medical loss ratio caps their profits—to business areas where profits remain uncapped.
医疗损失率（MLR）是奥巴马医改中的一项规定，要求保险公司将大部分保费收入用于医疗服务而非行政开支或利润。文章指出，保险公司通过收购药品福利管理公司等实体，将收入从受MLR限制的保险产品转移到利润不受限制的业务领域，从而规避了这一规定。
In 2008, Barack Obama pledged that his healthcare plan would lower premiums by $2,500 a year for the typical family. But Sen. Peter Welch, who signed the Wyden letter, conceded last fall that “we did fail to bring down the cost of healthcare.” The “solutions” the letter outlines would also fail to bring down costs. The senators propose reinstating costly enhanced subsidies that, before their expiration in January, encouraged fraudulent enrollment in exchange coverage. They also propose exploring the benefits of “giving all Americans access to Medicare-type choices for health care”—even though 94% of Medicare beneficiaries have some form of supplemental insurance to protect them from that program’s high costs.
2008年，奥巴马曾承诺其医保计划将为普通家庭每年降低2500美元的保费。然而，文章引用参议员彼得·韦尔奇的承认，指出奥巴马医改未能降低医疗成本。这揭示了该法案在核心目标上的失败，并暗示新的提案也难以解决这一问题。
After 16 years of seeing the failure of government-supervised healthcare in action, Democrats still want to convince voters that more spending, regulation, and government control will somehow solve the problems created by just those things.
Mr. Jacobs is founder and CEO of Juniper Research Group, a policy consulting firm.