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How bad is the U.S. health insurance system? Just look at China's health insurance system. That's because the original blueprint for domestic health care reform was copied from the American one. The same director who made "Fahrenheit 9/11" released another documentary last year, "sicko," which lambasted the ills of the U.S. health-care system, and when it came out, it became the highest-grossing documentary in U.S. history. At the end of the movie, an old, middle-class American woman sobs that she has struggled her whole life to pay for medical care, which is free in Cuba. In the United States, the health insurance system is a major "sticking point" and has become the most criticized problem in recent years. The main problem is that the cost of medical care is too high, and soaring year after year, resulting in the burden of individual health insurance is getting heavier and heavier. At the same time, the government is investing more and more, but the effect is not proportional. Under the impetus of the Bush administration, the U.S. Congress will discuss the reform of the health care system from next month. Health care reform and immigration reform, will become this year's U.S. domestic reform of the two hot spots. Massachusetts passes universal health care bill Recently, the Massachusetts State Legislature passed a health care reform bill by almost unanimous vote, becoming the first state in the U.S. to try to establish a universal health care system. This bill mandatorily requires employers and employees to bear their own responsibilities for the purchase of health insurance: employers with more than 10 employees who do not provide health insurance for all employees will be subject to a fine of $295 per employee per year; residents who can afford to purchase but do not purchase health insurance will face tax penalties from January 1, 2007; at the same time, the government will provide subsidies for low-income residents to purchase health insurance. Massachusetts legislators said that after the implementation of this bill, it is expected that by 2009, the state's existing 500,000 residents who do not have health insurance, more than 95% will have health insurance. This bill has caused a great deal of repercussions in the United States. Unlike most Western countries, the United States does not have a universal health insurance system, and several presidents after World War II, from Truman and Johnson to Nixon and Clinton, have tried to establish some kind of universal health insurance system, but all ended in failure. Commentaries in the United States are divided on the Massachusetts bill. Supporters believe that now more and more people in the United States do not have health insurance, this bill is the first bold attempt to solve the problem of health care; opponents believe that forcing individuals to buy a certain kind of insurance products, contrary to the principles of personal choice and free economy, may lead to excessive expansion of government power. A reporter once talked to an official working in the welfare department of a local government in the U.S. Even he admitted that the U.S. health care system is getting worse and worse. He said that 20 years ago, no one had to spend his or her own money to see a doctor or buy health insurance, but over the past 20 years, one reform after another has made the burden of health insurance on individuals heavier and heavier. Statistics show that U.S. employers are more and more reluctant to buy health insurance for their employees, since 2001, the share of health care costs borne by U.S. employees has grown alarmingly: family health care, the share borne by employees has grown by 58 percent; individual health care, the share borne by employees has grown by 63 percent. Only 61.9 percent of people now have employer-provided health insurance, up from 71 percent in 1987. An estimated 46 million more people do not have any health insurance. Medical costs are too high driving premiums skyrocketing Dr. Yingying Meng, a senior researcher at the Center for Health Policy Research at the University of California, Los Angeles, who has long been involved in public **** health policy research, told reporters about the background of the reform of the U.S. health care system. The U.S. health care system is based on marketization and privatization, in which the government is only a buyer, purchasing services from private insurance companies and health care providers, and the government itself has a limited ability to intervene in the insurance companies and health care providers. In this regard, the situation in the United States is different from that in Canada. Canada has set up a universal welfare health care system, and the government holds huge market resources, so it can powerfully negotiate with insurance companies, hospitals and pharmaceutical companies to suppress prices. On the other hand, the United States Government has only two social welfare health insurance schemes, namely, the Medical Care Plan for the elderly and the Medical Assistance Plan for low-income or unemployed people. The limited number of people covered by these two programs limits the Government's bargaining power. At the same time, due to political and cultural influences, it is difficult to establish a universal health care system in the United States. Any kind of universal health care system will limit the individual's right to choose, and in the U.S., a society that prizes individual choice, allowing some citizens to sacrifice a little bit of their freedom will cause a big social backlash. The only way not to sacrifice anyone's right to choose is to maintain the current market-oriented, privatized mechanism. However, this mechanism is now experiencing more and more serious failures, and the most obvious problem is that more and more money is being invested, but the results received are not proportional. The annual medical expenses of the United States are among the highest in the developed countries, and they have been increasing rapidly in recent years. According to a survey conducted by the Public Welfare Foundation of the United States in March this year, from 1993 to 2003, the health care expenditure of the United States increased from $900 billion to $1,700 billion, and the per capita expenditure increased from $3,354 to $5,670 per annum. Both of these indicators are considered high in Western countries, but the quality of medical services is not the highest. Based on a comprehensive comparison of healthcare organizations in six countries - Germany, Canada, New Zealand, Australia, the United Kingdom, and the United States - the overall quality of healthcare in the United States ranks last. The key issue contributing to this situation is that healthcare costs are too high and have skyrocketed year after year, driving health insurance premiums to skyrocket year after year as well. Lack of constraints on drug prices Limited benefit coverage So why isn't the government taking action to curb the trend of skyrocketing healthcare costs? The reason for the price hike in medical costs is that medical technology and equipment are constantly being updated and new drugs are constantly being introduced, especially drug costs, which have increased particularly significantly. The price of medical care in the United States is largely the result of checks and balances between insurance companies and medical organizations, but lacks constraints on drug companies and medical equipment companies. Hospitals are not overcharging; it is the drug companies and medical device companies that are overcharging. There is no direct economic relationship between insurance companies and drug companies and medical equipment companies, and they cannot suppress this part of the price increase through negotiation. And the government, as the buyer of services from insurance companies and medical organizations, has no direct economic leverage to intervene directly with the drug companies and medical device companies. And since drug companies and medical device companies are the largest financial contributors to bipartisan politics in the U.S., with powerful out-of-hospital activism, any move to suppress prices is bound to meet with unimaginable resistance. This creates an interesting phenomenon: drugs produced by U.S. companies that are expensive to sell in the U.S. are sold in Canada at a price that is kept low by the Canadian government. So there are countless Americans flocking to Canada to buy drugs. Beyond the issue of cost, health insurance coverage is also a key issue. Dr. Yingying Meng explained that because the United States does not have universal health care, the entire system is based on marketization and privatization, resulting in a segmented and disorganized health care system. Government and corporate benefits do not cover everyone, and a significant portion of the population is in a three-way embarrassment. Dr. Meng Yingying, who has worked in Shanghai Municipal Health Bureau, believes that the U.S. health insurance system follows the market-oriented path and lacks social coordination, which does cause certain problems; however, this system also has advantages, i.e., the insurance companies and medical institutions hold each other back under the market mechanism, the insurance companies have to control the costs and at the same time ensure the quality of service, and the medical institutions have to fight for customers and at the same time provide good service. The ideal health insurance system is an organic combination of marketization and social co-ordination, but this is not an easy thing to do, and there are certain contradictions between the two. It is difficult to get to the root of the problem when reforms are carried out in different directions. President Bush's approach to reform is still free-market and privatization. The centerpiece of his recently proposed "personal health account" program is that individuals will deposit a portion of their pre-tax wages into a tax-free "personal health account," which can be rolled over from year to year, and individuals will use the money in this account to pay for health care while purchasing a "high-deductible" health plan. The individual uses the money to pay for medical expenses while purchasing a "high-deductible" insurance plan. A "high deductible" means that the insurance company pays for medical expenses only when they reach a significant amount, but of course, the premiums are fairly inexpensive. The advantage of this plan is that individuals will be more careful about how they spend their money on medical care, and because of the equal tax breaks offered to all, some of those who don't have health insurance will enroll in the plan, and the problem of the uninsured is expected to be partially solved. But the disadvantage is that it favors the young, in better health, and with more stable incomes; for those who need to see a doctor more often, the program does not pay for itself, and those with lower incomes simply don't have enough money to put into an Individual Health Account. Therefore, critics say, the consequences of this plan is that the healthy people are enrolled in the "individual health account" program, leaving the old and sick and low-income people to stay in the government welfare system, the government health care account income is reduced, but the expenditure is more, the collapse of the welfare system will be faster. Many U.S. states have considered bypassing the federal government and going it alone. Massachusetts reform program is one of the earliest introduced, Maryland and other 20 states to consider legislation to force large businesses to buy insurance for their employees, Kansas, Maine, Minnesota and other states want to design a program to allow small businesses to buy insurance for their employees, Florida last year began to turn health benefits into cash to the hands of individuals, South Carolina would like to put the "Medicaid program "South Carolina wants to privatize Medicaid. It can be seen that the direction of the current U.S. health care reform, from the federal level, is to further marketization and privatization, from the level of local governments, is to go their own way, which will inevitably deepen the trend of the U.S. health care system fragmentation. And all the reforms have not touched the most fundamental problem, namely, to suppress drug prices and control medical costs, so it is difficult to expect a complete solution to the existing problems. Our U.S. correspondent Xu Yipeng related links to the health care system, many problems "Los Angeles Times" April 3 issue of a special report, citing a part of the Americans because of health care issues and face a variety of dilemmas: some people want to get a divorce, but in order to pay for health care premiums, more than a decade can not do the divorce procedure; some people struggle all their lives, from the poor class into the middle class, a serious illness and fell back into the poor class, can only rely on the government's benefits Health insurance life; some immigrants from Mexico to the United States, working for more than 20 years, still can not afford to pay the United States of America's family health insurance, can only buy Mexico's health insurance, medical care still have to go back to Mexico. Government health care in trouble medical cost growth makes it difficult for the government to support, the U.S. government's two health care programs are facing a financial crisis. "Medical care program" mainly for retirees, after 2011, "baby boom" a group of people will gradually retire, will bring great pressure to the program. In addition, in January of this year, President Bush as a performance project, launched for the retirees to buy prescription drug insurance program. Forecasts say that by 2013, the prescription drug program alone will cost $558 billion, by then, "medical care plan" account may go bankrupt. The "Medical Assistance Program" is aimed at low-income and unemployed people for medical assistance, the number of people increased by more than 8 million in the past three years. The U.S. Treasury Department's annual foreign debt, a significant portion of the program to fill the gap. In addition, the U.S. government has to bear the cost of emergency care in all public hospitals. U.S. law provides that all public hospitals encounter emergency patients, regardless of whether the patient has insurance or not, and even regardless of whether he is a legal resident of the United States, must be unconditionally and immediately save the medical costs are finally hanging on the government bill. Every year, this expense is also very powerful, a few years ago, the U.S. public hospital system had to be greatly compressed, closed dozens of hospitals, layoffs of tens of thousands of people. "Managed care plans" in the face of various contradictions, the U.S. insurance industry is also constantly reforming, but all it can do is to negotiate with the medical institutions, *** with the lower costs. For example, "managed care plan", by the insurance company and medical institutions to enter into a contractual nature of the contract, medical institutions contracted a certain number of people's medical services, the insurance company according to the number of people to pay a fixed fee each month, regardless of whether these people have to see a doctor, see how sick. This can effectively control medical costs and make medical institutions pay more attention to disease prevention. This program is now becoming more and more popular, but it does not solve the fundamental problem of rising medical costs. U.S. health care costs have risen year after year, and it is becoming more expensive to treat illnesses