Tuesday’s Republican victory in the Massachusetts special election means that
Democrats can’t send a modified health care bill back to the Senate. That’s a
shame because the bill that would have emerged from House-Senate negotiations would have been better than the bill the Senate
has already passed. But the Senate bill is much, much better than nothing.
And all that has to happen to make it law is for the House to pass the same bill,
and send it to President Obama’s desk.
星期二共和黨在麻州補選的勝利，意味著民主黨無法將修正過的健保法案送回參議院。這實在是相當可恥，因為參眾兩院協商過的版本，要比參議院之前通過的版本好的多。但再怎麼樣，參議院的版本也好過什麼都沒有。而要立法就需要眾議院通過，然後交由歐巴馬總統簽署。
Right now, Nancy Pelosi, the speaker of the House, says that she doesn’t have the
votes to pass the Senate bill. But there is no good alternative.
而現在，眾議院議長南西‧佩洛西表示，她不會表決通過參議院的版本，可是現行並沒有一個比較好的替代方案。
Some are urging Democrats to scale back their proposals in the hope of gaining
Republican support. But anyone who thinks that would work must have spent the
past year living on another planet.
有些人主張民主黨要縮小健保提議的規模，希望能以此獲得共和黨人的支持。若這些人相信這招會有用，肯定過去一年都住在潘朵拉星上。
The fact is that the Senate bill is a centrist document, which moderate Republicans
should find entirely acceptable. In fact, it’s very similar to the plan Mitt Romney
introduced in Massachusetts just a few years ago. Yet it has faced lock-step
opposition from the G.O.P., which is determined to prevent Democrats from
achieving any successes. Why would this change now that Republicans think
they’re on a roll?
事實就是參議院版本已經是走中間路線，溫和派共和黨人應該可以欣然接受。事實上，這跟密特‧朗尼(前共和黨籍麻州州長參選人)在幾年前推銷給麻州人民的方案十分相似。但共和黨還是一致的反對，決心阻止民主黨取得任何成功。憑什麼覺得共和黨在這氣勢如虹的時刻變心呢？
Alternatively, some call for breaking the health care plan into pieces so that the
Senate can vote the popular pieces into law. But anyone who thinks that would
work hasn’t paid attention to the actual policy issues.
又或者有人建議把整個健保計畫拆成數個小部分，參議院就可以把最受民眾支持的部分通過並立法。但認為此方法可行的人，沒有注意政策的實際面。
Think of health care reform as being like a three-legged stool. You would, rightly, ridicule anyone who proposed saving money
by leaving off one or two of the legs. Well, those who propose doing only the popular
pieces of health care reform deserve the same kind of ridicule. Reform won’t work
unless all the essential pieces are in place.
把健保改革想像成三腳板凳。對於那些覺得為了省錢，決定捨棄三腳改買一腳或兩腳板凳的人，我們會很快的嘲笑他。那些支持只保留健保改革內受歡迎部分的人，也是犯了一樣的錯誤。除非所有必須部份都就緒，否則改革不會成功。
Suppose, for example, that Congress took the advice of those who want to ban
insurance discrimination on the basis of medical history, and stopped there. What
would happen next? The answer, as any health care economist will tell you, is that
if Congress didn’t simultaneously require that healthy people buy insurance, there
would be a “death spiral”: healthier Americans would choose not to buy insurance,
leading to high premiums for those who remain, driving out more people, and so on.
舉例來說，假設國會採納建議，禁止基於被保人醫療背景的保險歧視，然後就不再有後續動作，那麼會發生什麼事？任何健保經濟學者都會都會回答說，若國會沒有同時規定健康民眾必須買保險，就會產生一個「死亡螺旋」：較健康的美國民眾選擇不買保險，導致剩下的人保費升高，造成更多人不買保險等諸如此類的事。
And if Congress tried to avoid the death spiral by requiring that healthy Americans
buy insurance, it would have to offer financial aid to lower-income families to make that insurance affordable — aid at least as generous as
that in the Senate bill. There just isn’t any way to do reform on a smaller scale.
若國會藉由強制健康民眾買保險的方式來避開死亡螺旋，就一定要提供低收入戶補助讓他們買的起保險，其援助資金量至少要像參議院版本一樣大，這就是為何沒有什麼可以縮小改革規模的方法。
So reaching out to Republicans won’t work, and neither will trying to pass only the
crowd-pleasing pieces of reform. What about the suggestion that Democrats use
reconciliation — the Senate procedure for finalizing budget legislation, which
bypasses the filibuster — to enact health reform?
因此對共和黨伸出友誼之手沒什麼用，只通過民眾欣喜支持的改革部分也沒有效果。那麼民主黨人使出朝野協商，讓參院直接完成預算的立法程序，避開拖延策略，通過健保改革的建議如何？
That’s a real option, which may become necessary (and could be used to improve
the Senate bill after the fact). But reconciliation, which is basically limited to matters
of taxing and spending, probably can’t be used to enact many important aspects of
reform. In fact, it’s not even clear if it could be used to ban discrimination based on
medical history.
這是真誠的意見，也許會成為必要手段(在通過後亦可拿來改進參院版本)。可是朝野協商基本上只限於稅收與支出，可能無法用來通過許多地方都十分重要的改革。實際上，連是否能用這方法禁止對醫療歷史的歧視都不清楚。
Finally, some Democrats want to just give up on the whole thing.
最後，有些民主黨人打算全盤放棄了。
That would be an act of utter political folly. It wouldn’t protect Democrats from charges
that they voted for “socialist” health care — remember, both houses of Congress
have already passed reform. All it would do is solidify the public perception of
Democrats as hapless and ineffectual.
這是政治上最蠢的行動，放棄無法讓民主黨免於指控，說民主黨支持「社會主義式的健保」。請記住，參眾兩院都已經通過了改革案。現在放棄只會鞏固民眾認為民主黨軟弱無能，倒楣不幸的看法。
And anyway, politics is supposed to be about achieving something more than your
own re-election. America desperately needs health care reform; it would be a betrayal
of trust if Democrats fold simply because they hope (wrongly) that this would slightly
reduce their losses in the midterm elections.
無論如何，所謂政治應該是要達成某些比個人改選更重要的事。美國極切需要健保改革，假使民主黨人只是因為(錯誤的)希望在期中選舉少輸一些，就輕易的放棄健保改革，便是背叛民眾的信任。
Now, part of Democrats’ problem since Tuesday’s special election has been that
they have been waiting in vain for leadership from the White House, where
Mr. Obama has conspicuously failed to rise to the occasion.
目前民主黨有部分問題是自星期二補選以來，無謂的等待來自白宮的領導。相當引人注意的，歐巴馬先生這次沒能拉抬選舉氣勢。
But members of Congress, who were sent to Washington to serve the public,
don’t have the right to hide behind the president’s passivity.
但國會議員是被送到華盛頓來為大眾服務的，沒有權利躲在總統消極的背影裡。
Bear in mind that the horrors of health insurance — outrageous premiums, coverage
denied to those who need it most and dropped when you actually get sick — will get
only worse if reform fails, and insurance companies know that they’re off the hook.
And voters will blame politicians who, when they had a chance to do something,
made excuses instead.
記住健康保險的可怕之處：天價般的保費，拒保那些最需要保險的人，真正生病時卻終止保險，倘若健保改革沒有通過，這些問題只會更糟，而保險公司會知道他們又逃過了一劫。選民會責怪這些政客，因為他們明明可以做些什麼，卻用藉口敷衍卸責。
Ladies and gentlemen, the nation is waiting. Stop whining, and do what needs to be
done.
告位先生女士，整個國家都在觀望著。不要再嘀咕抱怨，該做的事，就必須去完成。
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[克魯曼專欄] 做正確的事 (原文載於10/01/21)
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