Why the U.S. never got universal health care

One big thing you should know about the U.S. healthcare system: it’s barely a system at all.
關於美國醫療保健系統你應該知道的一件大事：它根本就不是一個系統。

It’s a patchwork.
只是東拼西湊而成的。

A bunch of different systems crammed together.
一堆不同的系統擠在一起。

That’s why it’s so expensive and why it can be such a pain to use.
這就是為甚麼它這麼貴，這麼難使用。

We’ve never really decided what we want to prioritize, and that’s part of the reason we don’t have universal health care, like so many other countries do.
我們從來沒有思考優先順序，這就是我們沒有其他許多國家都有的全民健保的部分原因。

So why doesn’t the U.S. have universal health care?
所以為何美國沒有全民健保？

There have been lots of calls for it, dating back to Theodore Roosevelt, who proposed national health insurance in 1912.
有很多人要求過，最早可以追溯到1912年提出國家健康保險的Theodore Roosevelt。

But a national system of government-run health insurance never happened.
但是在體制內由政府主導的健康保險從來沒有發生過。

Instead, employers started offering health insurance in World War II as a benefit to attract workers, since everyone’s wages were frozen.
相反，雇主開始在第二次世界大戰中提供健康保險，作為吸引員工的好處，因為每個人的工資都被凍結了。

That’s how we got the employer-based health insurance system we have today.
這就是我們今天得以擁有由雇主支付的健康保險制度的原因。

Instead of creating one program to cover everyone else, the U.S. decided to add onto it piece by piece.
比起創造一個讓全體人民受惠的全新程序，美國政府決定將各種舊有程序整合起來。

* Medicare for seniors.
*老年人醫療保險
* Medicaid for low-income people.
*低收入戶醫療保險
* CHIP for kids.
*-兒童醫療保險
* And each one of those programs is a patchwork within itself.
而每個醫療保險也是拼湊而成的。

Then there’s the Affordable Care Act, another complex marketplace for people who don’t have another source of health coverage.
然後是“平價醫療法案”（Affordable Care Act），這是給那些沒有其他健康保險的民眾的複雜市場。

The catch is - that still leaves about 28 million people uninsured, including low-income adults and non-citizens.
問題是 - 仍然有大約2800萬人沒有保險，包括低收入成年人和非公民。

Many of those who haven’t signed up say it’s because they can’t afford the coverage.
那些尚未簽屬保險的原因，大多是他們無法負擔保險費用。

By contrast:
相比之下：

* Canada has had national health care since 1968.
加拿大自1968年起就有全國保險。

* Britain has had it since 1948.
英國也從1948年就有。

* Germany requires everyone to be insured by a “sickness fund” — a system that started in 1883.
德國要求每位國民加入"疾病基金"，一個自1883年開始的系統。

* Switzerland has required everyone to buy health insurance since 1996.
瑞士也自1996年開始要求國民購買健保。

The bottom line: Unlike other countries, the U.S. has never reached a consensus on whether health care is a right, or whether universal health care should be a goal.
結語: 底線：與其他國家不同，美國從未就醫療保健是否為基本人權，或全民醫療保健是否應成為主要目標而達成共識。

Unless that happens, the U.S. isn’t going to have the kind of health care safety net, that other country have.
除非這兩個問題釐清，否則美國不可能像其他國家一樣，擁有一個完善的健保系統。

 

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