attention:if you wanna talk in this part, please use englishObama Wins: What It Means for Healthcare
http://www.medscape.com/viewarticle/583108November 5, 2008 — Tuesday's election of Democrat Barack Obama ushers in a new administration that is all but certain to include some level of health care reform. Less clear is how extensive that reform will be and when it will come.
The Illinois senator has proposed sweeping changes in the health care system designed to provide health coverage to millions of uninsured Americans.
But experts tell WebMD that the current financial crisis makes sweeping change unlikely any time soon.
"I have no inside track, but I would bet that in this economic climate it is far more likely that changes will be phased in over time," says Karen Davis, president of the health policy and research group Commonwealth Fund.
University of Michigan health economist Thomas Buckmueller, PhD, agrees that the economic climate is likely to slow reform. "I am not extremely optimistic that major reform will happen, but this seems to be the best chance we have had in a long time."
Obama's Health Plan
Obama spoke often during the campaign about his mother's battle with ovarian cancer to illustrate his commitment to changing the health care system.
He told of her final days, spent battling insurance company bureaucrats who did not want to pay for her cancer treatments. "I know what it's like to see a loved one suffer, not just because they are sick, but because of a broken health care system," he said at a rally last week and at countless campaign stops before that.
His plan would extend health coverage by expanding existing private and public programs with the help of federal subsidies and mandates.
He has repeatedly claimed the reforms will lower the average family's health insurance premiums by about $2,500 a year.
These reforms include:
Requiring employers, except small businesses, to provide health insurance to their employees or contribute to the cost.
Requiring that all children have health insurance.
Expanding Medicaid and the State Children's Health Insurance Program (SCHIP).
Creating a National Health Insurance Exchange to pool risk and give people the choice of competing private or public health plans.
According to the Tax Policy Center, a nonpartisan tax analysis group, the president-elect's plan, if fully implemented, would reduce the number of uninsured Americans from a projected 67 million to 33 million over the next decade at a cost of $1.6 trillion.
Obama has said he would pay for his plan by rolling back President Bush's tax cuts on people making more than $250,000 a year and keeping the estate tax at 2009 levels, but he has not been more specific. He has not provided a timetable for seeking his proposed reforms and has not said if he would present a comprehensive health care reform package or try for incremental change.
Expansion Likely for State Children's Health Insurance Program
Experts interviewed by WebMD agreed that expansion of the children's insurance program SCHIP is likely to be the first of the proposed reforms to be considered.
Last December, Democrats in Congress lost a yearlong fight to boost federal spending that would have expanded the program after two separate vetoes by Bush.
The program will be up for congressional review next March, and experts say it will probably be the Obama administration's first chance to make good on a health care promise.
"SCHIP is one of the big success stories in health policy over the last 20 years," Buckmueller says. "It has succeeded in getting kids the preventive care they need to keep them out of the ERs."
Medicare Reform More Problematic
Many of Obama's other proposals -- from the expansion of Medicare to his National Health Insurance Exchange -- will be much harder to win support for, even with a largely friendly Congress behind him.
Buckmueller believes the best chance for major reform lies in seeking bipartisan support for his proposals.
He says a key reason for the failure of President Clinton's 1993 health care reform effort is that his administration did not reach across the aisle. "Assuming that Obama has learned from the Clinton debacle, I think he would be wise to say, 'Here are the basic principles of my plan. You work out the details, get bipartisan support, and I'll sign it.'"
Health Spending 'Not Sustainable'
While sweeping reform may not come soon, experts contacted by WebMD agreed that the nation's broken health care system must be addressed and that this must happen sooner rather than later.
The statistics bear this out:
45 million Americans have no health insurance.
25 million more have health plans but are considered underinsured because their policies offer only minimal coverage, according to the Commonwealth Fund.
42% of U.S. adults under age 65 are uninsured or underinsured, up from 33% in 2003.
Total spending on health care represented around 16% of the gross domestic product in 2007, and the Congressional Budget Office says spending will rise to a quarter of gross domestic product by 2025.
"We are not going to reduce health care spending," says former Congressional Budget Office Director Alice Rivlin, PhD, who is now a scholar with the Brookings Institution. "The best we can do is reduce the rate of health care spending growth. That should be the No. 1 priority of any health care reform."
If jobs are the next thing to go in the current economic crisis, as many economists are predicting, the number of Americans without health insurance will quickly increase beyond projections.
"Something has to happen over the next few years, because the cost of doing nothing is too great," Rivlin says.
Davis echoes the thought. "We can't afford to stay on the path we are on with regard to total health spending," she says. "Employers can't afford it, the government can't afford it, and individuals can't afford it. It is just not sustainable."
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http://www.dxy.cn/bbs/post/view?bid=116&id=13149442&sty=1&tpg=3&age=0&ticket=ST-524473-wqIeV0z7WGcUCKCc3opOA10xG39JwgWqdsv-20奥巴马胜出对医疗意味着什么？
2008年11月5号-星期二的选举中民主党奥巴马迎来一个新的政府，是否对所有政策改革，但某些包括某种程度的医疗保健改革。不太清楚广泛的改革将和什么时候会来。
伊利诺伊州参议员提出了彻底改革中的医疗保健系统旨在提供医疗保险，以保险的数以百万计的美国人。
但中央社专家说，当前的金融危机使不大可能发生翻天覆地变化在短期内。
我虽然不是圈内人士，但我打赌，在这种经济环境是远远更有可能的变化将逐步在随着时间的推移， “戴维斯，克伦族，总统的卫生政策和研究小组，英联邦基金发言人如是说。
美国密西根大学卫生经济学家托马斯Buckmueller博士认为，经济气候很可能会缓慢的改革。 “我不是非常乐观地认为，重大的改革会发生，但是这似乎是最好的机会，我们已经在很长一段时间。 ”
奥巴马的健康计划
奥巴马以常常在竞选期间用他母亲的战斗卵巢癌为例说明他的承诺，改善了卫生医疗保健系统。
他告诉她的最后几天，保险公司政府谁不想来支付她的癌症医疗费用。 “我知道这是不希望看到心爱的人受苦，不只是因为他们是生病了，而是因为打破医疗保健系统制度， ”他说。
他的计划将扩大医疗保险的扩大现有的私人和公共项目，增加联邦基金补贴是政府的任务。他一再宣称的改革将每年降低平均每个家庭的健康保险费约$ 2500。
这些改革包括：
要求雇主，除了小企业，提供健康保险的雇员或有助于节约成本。
要求所有儿童都有健康保险。扩大医疗补助和国家儿童健康保险计划（斯基普） 。
建立国民健康保险外汇集中的风险，给予人们选择的竞争性私人或公共健康计划。
根据税收政策的中心，一个无党派税收分析组，当选总统的计划，如果得到充分实施，将减少一些保险的美国人预测的6700万至3300万美元在未来10年内，耗资1.6万亿美元。
奥巴马说，他将支付他的计划的不足部分，布什总统的减税政策的人超过$ 250000每年维持遗产税在2009年水平，但他没有更具体。他没有提供一个时间表，要求他提出的改革并没有说他是否会提交一份全面的医疗保健改革方案或尝试的增量变化。
扩大国家可能儿童的健康保险计划
专家访谈中央社一致认为，扩大孩子的保险计划斯基普很可能是第一次提议的改革加以考虑。去年12月，民主党在国会否决了一个为期一年的提高联邦支出扩大计划后，布什提出的两个独立计划也被否决。
该计划将由国会将于明年3月的审查，和专家们称，它可能会成为奥巴马政府的第一次有机会取得良好的卫生保健的承诺。
斯基普是一大成功的故事在卫生政策在过去20年， “ Buckmueller说。 ”它已经成功地得到孩子们的预防保健，他们需要保持他们的环境要求。
更多的医疗改革问题
许多奥巴马的其他建议-从医疗保险扩大他的国民健康保险外汇-将更难获得支持，即使美国国会基本上达成一致以后。Buckmueller认为，最好的机会在于重大改革，寻求两党的支持是对他最好的建议。
他说，一个重要原因失败的克林顿总统1993年医疗改革的努力，他的政府没有达到整个过道。 “假设奥巴马吸取了克林顿的崩溃，我认为他将是明智的说， ''这是基本原则，我的计划。你的工作细节，是获得两党的支持，我会签署”。
保健支出'不可持续性'
4500万美国人没有医疗保险。 2500万没有的健康计划，但被认为是underinsured政策，因为他们只提供最低限度的覆盖范围，根据英联邦基金统计。
2003年，从33 ％增加到42 ％的美国成年人和未满65岁的人没有保险或保险额不足 ，总开支保健约占16 ％的国内生产总值在2007年，和美国国会预算办公室说，开支将上升到四分之一的国内生产总值到2025年。
我们不会减少医疗保健开支，说： “前国会预算办公室主任里夫林爱丽丝，博士，谁现在是一个学者的布鲁金斯学会。 ”最好我们能做的就是降低医疗保健开支的增长。这应该是优先于其他任何保健改革。
如果工作是未来的事情去在目前的经济危机，许多经济学家预测，在多的美国人没有医疗保险将迅速增加超出预期。一些已经发生在未来几年中，由于成本的什么都不做太大了， “里夫林说。
戴维斯对此产生了共鸣，他说， “我们不能永远停留在负担不起卫生总支出的地方。”。他说： “雇主负担不起，政府负担不起，个人支付不起。这是不可持续的。 ”[/post]
