Ona Uri Wega Kana Obamacare Inowedzera Utano Hwakawanda Mari
Utano hwezvoutano hwakapedza 4 muzana yemari inowanikwa muna 1960 yakaenzaniswa ne6 muzana muna 2013.
Paiva nezvikonzero zviviri zvekuwedzera uku kukuru: hurumende yehurumende uye mararamiro ehupenyu. Chokutanga, United States inotsigira kambani-inotsigirwa nehutano yehutano inshuwarisi . Hurumende yakagadzira mapurogiramu akaita seMedareid and Medicaid kubatsira avo vasina inshuwarisi. Aya mapurogiramu akaita kuti chido chekuchengetwa kwehutano chiwedzere. Izvo zvakapa vatsigiri kukwanisa kukwidza mitengo. Purogiramu yePrinceton University yakawana kuti vanhu veAmerica vanoshandisa huwandu hwehutano hwakanaka sevagari vemamwe marudzi. Vanongoripa zvakawanda. Somuenzaniso, nhamba dzezvipatara zvekuUnited States dzakapfuura makumi matanhatu kubva muzana kupfuura dzeEurope. Hurumende yekuedza kuchinja mararamiro ehutano nekudhura mari yakavamutsira panzvimbo.
Chechipiri, zvirwere zvisingaperi, zvakadai sechirwere chetachiona uye chirwere chemwoyo, zvakawedzera. Ivo ndivo vanokwana 85 muzana yehutano hwekutarisira mari. Inenge hafu yevose veAmerica vane imwe yadzo.
Zvinodhura uye zvakaoma kubata.
Somugumisiro, varwere vanopfuura 5 kubva muzana vevanhu vanoparadza 50 muzana yehutano hwekutarisira hutano. Iko inopa 50 muzana chete inopedza 3 muzana yemari yekuchengetedza kwehutano yenyika.
Vazhinji vevarwere ava vane chirwere cheMedare. Basa rezvehutano reUnited States rinoita basa rinotyisa rokuponesa upenyu.
Asi zvinouya pamutengo. Medicare kushandisa mari kuvarwere mugore rekupedzisira rehupenyu kunopetwa kasitanhatu kudarika mavhareji. Kuchengetedza varwere ava kunotora chikamu chechina chebhadhiro yeMedare.
Mumwedzi yavo yekupedzisira yemwedzi mitanhatu, varwere ava vanoenda kuhofisi yechiremba makumi maviri nemakumi maviri pamusana. Mumwedzi wavo wokupedzisira wehupenyu, hafu inopinda mukamuri rinokurumidza. Chimwe chetatu mhepo inopinda muimba huru yekuchengetedza. Mumwe wechishanu anovhiyiwa.
Government Policy
Pakati pa1960 na1955, kushandiswa kweutano hwehutano kwakawedzera nekusvika kwe8,9 muzana pagore. Ndiyokuti inshuwarisi yehutano yakawedzerwa. Sezvazvaifukidza vanhu vakawanda, kudiwa kwehutano hwehutano hwakasimuka. Pakazosvika 1965, mhuri dzakabhadhara kunze kwehomwe ye 44 muzana yezvose zvekurapa mari. Inishuwarenzi yehutano yakabhadhara 24 muzana
Kubvira muna 1966 kusvikira muna 1973, kushandiswa kweutano hwehutano kwakasimuka nekusvika kwe11,9 muzana pagore. Medicare uye Medicaid yakavhara vanhu vakawanda uye vakavabvumira kushandisa masangano ekurapa akawanda. Medicaid yaibvumira vanhu vakuru kuti vagare kupinda mudzimba dzinodhura dzekuyamwisa. Sezvo zvinoda kuwedzera, ndizvo zvakaitawo matengo. Vashandi vezvoutano vanoisa mari yakawanda mukutsvakurudza. Yakagadzira zvimwe zvitsva, asi zvinodhura, teknolojia.
Medicare yakabatsira kusimbisa kudzvinyirira kuchipatara kuchengetwa.
Emergency room treatment inodhura zvikuru, zvichiita chikamu chetatu chemari yese yeutano muAmerica. Pakazosvika gore ra2011, pakange paine 136 mamiriyoni echipinda chekutsvaga. Mumwe anoshamisa kubva kuvakuru vashanu vanoshandisa imba yepamusoro gore rose.
Muna 1971, Mutungamiri Nixon akashandisa mubhadharo wekutengesa mari kuti asiye kugadzikana kwezvishoma . Kudzora pamatambudziko ekuchengetwa kwehutano kwakagadzira kudiwa kwakanyanya. Muna 1973, Nixon akarayira masangano ekugadzirisa hutano kugura mari. Izvi zvirongwa zvekubhadharwa zvakabhadharwa vashandisi kune rimwe boka rezvechiremba. Mutemo weHMO WA193 wakapa mamiriyoni emadhora ekutanga kushandiswa kwemari yeHMOs. Izvo zvaidawo vashandi kuti vazvipe iyo kana zviripo.
Muna 1973, Nixon akasiya zvachose chiyero chegoridhe . Sezvo kukosha kwedhora kwakapera, kwakabudisa kuwandisa kwechipiri . Mari yekuchengetwa kwehutano yakasimuka yakafanana.
Kubva muna 1974 kusvikira muna 1982, mutengo wekutarisira utano hwakasimuka nekusvika kwe14.1% pagore nekuda kwezvikonzero zvitatu. Kutanga, mutengo wakasimbiswa mushure mekunge mubhadharo wekutengesa mubairo wakapera muna 1974. Chechipiri, Congress yakagadza Employee Retirement Income Security Act muna 1974. Yakabudisa makambani kubva kumitemo yehurumende nemitero kana ivo vanozvipira. Makambani akashandisa zvidzidzo izvi zvakaderera uye zvakajeka. Chechitatu, kutarisira kwoutano hwemusha kwakabviswa, kukura ne 32.5 muzana pagore.
Pakazosvika 1983 na1992, mari yekuchengetwa kwehutano yakasimuka nemavhareji 9,9 muzana gore negore. Congress yakakura Medicaid kuti iiswe nevashambadzi vemutemo, vana (kuburikidza neCIP), uye vakadzi vane pamuviri. Chirwere chemishonga chinodhaka chakakwira ne12.1 muzana pagore. Imba yekutarisira utano hwekumba yakawedzerwa ne18.3 muzana pagore.
Pakazosvika 1993 kusvika 2010, mutengo wakasimuka nehuwandu hwe6,4 muzana pagore. Mukutanga kwema1990, makambani ehutano inshuwarano akaedza kudzora mari nekuparadzira kushandiswa kweHMO zvakare zvakare. Congress yakabva iedza kudzora mari neE Balanced Budget Act muna 1997. Pane kudaro, yakamanikidza vashandi vakawanda vehutano vachiita bhizinesi. Nokuda kweizvi, Congress yakarambidza mitsara yekubhadhara mu Bal Balanced Refinement Act muna 1999 uye Benefits Improvement and Protection Act ye2000.
Mushure megore ra1998, vanhu vakapandukira uye vakakumbira zvakasarudzwa kune vanotarisira. Sezvo kuda kunowedzera zvakare, ndizvo zvakaitawo matengo. Panguva ino, makambani ekurapa mishonga akagadzira mishonga mishonga yemishonga. Vakaparidzira zvakananga kune vatengi ndokugadzira zvimwe zvaidiwa.
Muna 2003, Medicare Modernization Act yakawedzera Medicare Part D kuti inyore mishonga yemishonga inoshandiswa. Yakashandurawo zita reMedareti C C kune chirongwa cheMedare Advantage . Nhamba yevanhu vanoshandisa zvirongwa izvi zvakapetwa katatu kusvika mamiriyoni 17.6 muna 2016. Izvo zvikwereti zvakasimuka nokukurumidza kupfuura mari yaMedare pachayo.
Kuvimba kwehurumende kune inshuwarisi yehutano yehutano yega yega yakasiya vanhu vazhinji vasina chiremba wekutanga. Pakazosvika 2009, hafu yevanhu (46,3 muzana) avo vakashandisa chipatara vakati vaenda nekuti vakange vasina imwe nzvimbo yekuenda nayo yehutano. IThe Emergency Medical Treatment uye Active Labor Act yaida kuti zvipatara zvirape ani zvake akazviratidza muimba yepamhanho. Ava varwere vasina kuvimbiswa vanodhura zvipatara zvinodhura $ 10 mabhiriyoni pagore. Zvipatara zvakapfuura izvi mari kune Medicaid.
Chronic Diseases
Chikonzero chechipiri chekuwedzera kweutano hwekutengesa ndechirwere chezvirwere zvinodzivirirwa. Zvimwe zvikonzero zvina zvinokonzera rufu ndiyo chirwere chepfungwa, kenza, chronic obstructive pulmonary disorder, uye chirwere. Zvirwere zvisingaperi zvinokonzera vose. Zvinogona kudzivirirwa kana kuti zvingadhura zvishoma kudarika kana zvakabatwa munguva. Njodzi dzinokonzera chirwere chepfungwa uye kurohwa ndezvokudya zvakashata uye kuneta. Kusvuta chinhu chinokonzerwa nekenza yemapapu (inowanzozivikanwa) uye COPD. Kuwedzera muviri kunowedzerawo mungozi kune dzimwe nzira dzakawanda dzekenza.
Zvirwere izvi zvinodhura $ 7 900 imwe neimwe. Iko kanomwe kupfuura mumwe munhu ane hutano. Ivhareji mari yekurapa chirwere cheshuga, semuenzaniso, iine $ 26,971 pamhuri. Zvirwere izvi zvakaoma kugadzirisa nokuti varwere vanoneta nokutora mishonga yakasiyana-siyana. Vaya vanocheka vanozviwana vari muimba yekukurumidzira nekurwadziwa kwemwoyo, kurohwa uye zvimwe zvinetso. (Mhedziso: "The Impact of Chronic Diseases on Health Care," Pamusoro Pokurarama America, 2014.)
Kuti ACA Yakaderedza Sei Kuwedzera Kwehutano Hupenyu?
Pakazosvika 2009, kuwedzera kwehutano hwekutarisira kwakadya federal budget. Medicare neMedicaid inodhura madhora 676 mabhiriyoni. Ndiyo 10,4 muzana yebhajheti yose. Mamiro emitero chete anopa hafu ye Medicare uye hapana yeMedicaid. Izvi zvinonzi zvinoshandiswa kushandiswa zvakare zvaisanganisira federal uye veterans 'pensions, hurumende uye kufarira kune chikwereti. Yakapedza 60 muzana yebhadharo yehurumende .
Zvinotonyanya kuipa, kubvisa vana Bhoomers zvinodarika kaviri Medicare neMedicaid mari inotanga muna 2020. Sezvo kutarisira kwehutano kuchiwedzera nokukurumidza kudarika hupfumi, Medicare mitero uye Trust Trust ichavhara zvishoma nezvishoma. Pakazosvika 2030, Trust Trust ichave yakashata, uye mitero ichabhadhara chete 48 muzana yemari.
Mari yehutano yehutano inotora chikamu chebhadharo inotarisirwa . Izvozvo zvinoreva kuti vanofanira kubhadharwa. Somugumisiro, vari kudya kudya mari ye discretionary zvinhu, zvakadai sokudzivirira , dzidzo kana Dhipatimendi reRuramisiro.
Ndiyo imwe chikonzero nei Congress yakagamuchira Obamacare . Yakaida makambani einishuwarenzi kuti ape hutano hwekudzivirira pasina. Yakatarisa zvirwere zvisingaperi vasati vaida kurapwa mune zvipatara zvinodhura. Izvo zvakaderedzawo mari kune Murengeti weVhizinesi.
Kubvira muna 2010, apo Affordable Care Act yakasayirwa, mari yekuchengetwa kwehutano yakasimuka ne4.3 muzana pagore. Yakazadzikisa chinangwa chekuderedza kuwedzera kwehutano hwemari yekushandisa mari.
Muna 2010, hurumende yakafanotaura kuti Medicare mari yaizokwidza 20 muzana mumakore mashanu chete. Izvo zvinobva ku $ 12,376 pamubatsiri mugore ra2014 kusvika kune $ 14,913 ne2019. Pane kudaro, vatsvakurudzi vakashamisika kuona kuti mari yainge yadarika ne $ 1 000 pamunhu mumwe, kusvika $ 11,328 na2014. Zvakaitika nekuda kwezvikonzero zvina zvakananga:
- IAACA inobhadharwa kubhadharwa kuMedare Advantage providers. Mari yevanopa maitirwo ekugadzirisa Zvikamu A uye B zvakanga zvichikwira zvakakurumidza kudhura kwehurumende. Vatapi 'havakwanisi kururamisa mitengo yakakwirira. Pane kudaro, zvakaratidzika sokunge zviri kuwedzera hurumende.
- Medicare yakatanga kushandura masangano ekuchengetedza kuzvidavirira, kubhadhara mari uye zvikwereti zvinokosha. Kushandiswa kwekuchengetwa kwechipatara kwakagara kwakangofanana kubva muna 2011. Chikamu chechikonzero cheizvi ndechekuti kuverenga kwechipatara kunodonhedzwa ne 150 000 pagore muna 2012 uye 2013. Ndiyo imwe yezvipatara inotora chirwere kana ichidarika mitemo. Yakaguma nekuwedzera kwehutano uye hutano hwehutano hwevarwere.
- Vashandi vanobhadhara zvikuru vanowirirwa muMedarere mitero yemitero uye Chikamu B uye D premium. Zvaireva kuti Medicare Part B inotengeswa kune mumwe munhu wese inogona kuramba iri parizvino ye $ 104.90 pamwedzi. Nokuda kwezvimwe, ona Obamacare Mitero .
- Muna 2013, kuregererwa kwakaderedza Medicare zvikwereti ne 2 muzana kune vanotengesa uye zvirongwa.
Kubva pamaitiro aya matsva, mari yeMedricare yakarongedzwa kukura 5.3% chete pagore pakati pa2014 na2024.
Health Care Costs by Year
| Gore | National Health Spending (Mabhiriyoni) | Percent Growth | Mutengo Pamwe Munhu | Chiitiko |
|---|---|---|---|---|
| 1960 | $ 27.2 | NA | $ 146 | Kudzoka |
| 1961 | $ 29.1 | 7.1% | $ 154 | Kudzorera kwakaguma |
| 1962 | $ 31.8 | 9.3% | $ 166 | |
| 1963 | $ 34.6 | 8.6% | $ 178 | |
| 1964 | $ 38.4 | 11.0% | $ 194 | LBJ yakatanga Medicare neMedicaid |
| 1965 | $ 41.9 | 9.0% | $ 209 | |
| 1966 | $ 46.1 | 10.1% | $ 228 | Vietnam War |
| 1967 | $ 51.6 | 11.9% | $ 253 | |
| 1968 | $ 58.4 | 13.3% | $ 284 | |
| 1969 | $ 65.9 | 12.9% | $ 318 | |
| 1970 | $ 74.6 | 13.1% | $ 355 | Kudzoka |
| 1971 | $ 82.7 | 11.0% | $ 389 | Mutengo-mutengo wekutonga |
| 1972 | $ 92.7 | 12.0% | $ 431 | Stagflation |
| 1973 | $ 102.8 | 11.0% | $ 474 | Ndarama inogumira. HMO Mutemo |
| 1974 | $ 116.5 | 13.4% | $ 534 | ERISA. Mutengo-kutengesa kwemari wakaguma. |
| 1975 | $ 133.3 | 14.4% | $ 605 | Kutengesa kwezvinhu pa6,9% |
| 1976 | $ 152.7 | 14.6% | $ 688 | Kutengesa kwezvinhu pa4,9% |
| 1977 | $ 173.9 | 13.8% | $ 777 | Kuwedzera kwepamuviri pa 6.7% |
| 1978 | $ 195.3 | 12.4% | $ 865 | Kuwedzera kwezvinhu pa9.0% |
| 1979 | $ 221.5 | 13.4% | $ 971 | Kutengesa kwezvinhu pa13.3% |
| 1980 | $ 255.3 | 15.3% | $ 1,108 | Kutengesa kwezvinhu pa12.5% |
| 1981 | $ 296.2 | 16.0% | $ 1,273 | Fed yakawedzera mitengo |
| 1982 | $ 334.0 | 12.8% | $ 1,422 | Kudzorera kwakaguma |
| 1983 | $ 367.8 | 10.1% | $ 1,550 | Kubhadhara mutero uye kushandiswa kwezvokudzivirira |
| 1984 | $ 405.0 | 10.1% | $ 1,692 | |
| 1985 | $ 442.9 | 9.4% | $ 1,833 | |
| 1986 | $ 474.7 | 7.2% | $ 1,947 | Mutero wecheka |
| 1987 | $ 516.5 | 8.8% | $ 2,099 | Black Monday |
| 1988 | $ 579.3 | 12.2% | $ 2,332 | Fed yakawedzera mutengo |
| 1989 | $ 644.8 | 11.3% | $ 2,571 | S & L nhamo |
| 1990 | $ 721.4 | 11.9% | $ 2,843 | Kudzoka |
| 1991 | $ 788.1 | 9.2% | $ 3,070 | Kudzoka |
| 1992 | $ 854.1 | 8.4% | $ 3,287 | |
| 1993 | $ 916.6 | 7.3% | $ 3,487 | HMOs |
| 1994 | $ 967.2 | 5.5% | $ 3,641 | |
| 1995 | $ 1,021.6 | 5.6% | $ 3,806 | Fed yakawedzera mutengo |
| 1996 | $ 1,074.4 | 5.2% | $ 3,964 | Welfare reform |
| 1997 | $ 1,135.5 | 5.7% | $ 4,147 | Kuenzanisa Budget Act |
| 1998 | $ 1,202.0 | 5.8% | $ 4,345 | LTCM dambudziko |
| 1999 | $ 1,278.3 | 6.4% | $ 4,576 | BBRA |
| 2000 | $ 1,369.7 | 7.1% | $ 4,857 | BIPA |
| 2001 | $ 1,486.8 | 8.5% | $ 5,220 | 9/11 kurwisa |
| 2002 | $ 1,629.2 | 9.6% | $ 5,668 | Hondo pane Kutyisa |
| 2003 | $ 1,768.2 | 8.5% | $ 6,098 | Medicare Modernization Act |
| 2004 | $ 1,896.3 | 7.2% | $ 6,481 | |
| 2005 | $ 2,024.2 | 6.7% | $ 6,855 | Bankruptcy Act |
| 2006 | $ 2,156.5 | 6.5% | $ 7 233 | |
| 2007 | $ 2,295.7 | 6.5% | $ 7,628 | |
| 2008 | $ 2,399.1 | 4.5% | $ 7,897 | Kurega kunonoka kupedza kushandisa. |
| 2009 | $ 2,495.4 | 4.0% | $ 8,143 | |
| 2010 | $ 2,598.8 | 4.1% | $ 8,412 | ACA yakasaina. |
| 2011 | $ 2,689.3 | 3.5% | $ 8,644 | Dambudziko rematambudziko |
| 2012 | $ 2,797.3 | 4.0% | $ 8,924 | Mari yematombo |
| 2013 | $ 2,879.0 | 2.9% | $ 9,121 | ACA mutero |
| 2014 | $ 3,026.2 | 5.1% | $ 9,515 | Kugoverana kunotanga . |
| 2015 | $ 3,200.8 | 5.8% | $ 9,994 | |
| 2016 | $ 3,337.2 | 4.3% | $ 10,348 |
(Kubva: "Nhepfenyuro yeZvenyika Dhepfenyuro Inosanganisira Kugoverana kweGDP, CY 1960-2016," Centers for Medicare neMedicaid Services. " Kuwedzera Kwemari Gore ," The Balance. " Nyaya Yezveutano kuUnited States, 1960-2013 , "Centres for Medicare neMedicaid Services, November 19, 2015." US Health Care Spending: Ndiani Anobata? "California Health Care Foundation, December 2015.)