[克魯曼專欄]雪上加霜 (原文載於10/02/25)

If we’re lucky, Thursday’s summit will turn out to have been the last act in the great health reform debate, the prologue to passage of an imperfect but nonetheless history-making bill. If so, the debate will have ended as it began: with Democrats offering moderate plans that draw heavily on past Republican ideas, and Republicans responding with slander and misdirection.


幸運的話，星期四的會議會是這場重要健保改革辯論的終幕，也會是開始立法的序曲。雖然這方案不完美，卻也締造了歷史。若一切成真，那麼最終結果有辯論跟沒辯論一樣：民主黨提出修正的健保法，其內容大量取自過去共和黨的構想，但共和黨還是不停誹謗法案和誤導民眾。


Nobody really expected anything different. But what was nonetheless revealing about the meeting was the
fact that Republicans — who had weeks to prepare for this particular event, and have been campaigning
against reform for a year — didn’t bother making a case that could withstand even minimal fact-checking.


其實沒人對此期待過什麼，不過還是揭露了會議的一些真相。共和黨幾個星期來都在為了這會議而準備，而這反對健保改革的戰役也已經打了一年。可是共和黨的主張，即便在最無力的驗證前都站不住腳。


It was obvious how things would go as soon as the first Republican speaker, Senator Lamar Alexander,
delivered his remarks. He was presumably chosen because he’s folksy and likable and could make his
party’s position sound reasonable. But right off the bat he delivered a whopper, asserting that under the
Democratic plan, “for millions of Americans, premiums will go up.”


這件事從首席共和黨發言人，參議員亞歷山大的發言就可馬上看出端倪。會挑選他為發言人，大概是此君質樸忠厚，人見人愛，在這職務上如魚得水。然而他毫不遲疑的撒了個彌天大謊，聲稱若通過民主黨的方案，「數百萬美國人民的保費將水漲船高。」


Wow. I guess you could say that he wasn’t technically lying, since the Congressional Budget Office
analysis of the Senate Democrats’ plan does say that average payments for insurance would go up. But it
also makes it clear that this would happen only because people would buy more and better coverage. The
“price of a given amount of insurance coverage” would fall, not rise — and the actual cost to many
Americans would fall sharply thanks to federal aid.


真是哇哩咧。不過我猜讀者可能不認為他撒了點技術性的謊言，畢竟國會預算局分析了民主黨的方案後，的確認為平均保費會因此上漲。可是要澄清的是就算保費上漲，也是因為民眾擴大了保險範圍及可以買更好的保險之故。保費本身是下降而不是上揚，而且對絕大多數美國人來說，由於聯邦補助，實際負擔更是下降許多。


His fib on premiums was quickly followed by a fib on process. Democrats, having already passed a health
bill with 60 votes in the Senate, now plan to use a simple majority vote to modify some of the numbers, a
process known as reconciliation. Mr. Alexander declared that reconciliation has “never been used for
something like this.” Well, I don’t know what “like this” means, but reconciliation has, in fact, been used for
previous health reforms — and was used to push through both of the Bush tax cuts at a budget cost of
$1.8 trillion, twice the bill for health reform.


在保費相關問題所說了個小謊後，他很快又講了一個。先前民主黨已經在參議院以60票通過健保法案，現在打算以簡單多數決來調整法案的一些數據，這個過程就叫做朝野協商。可是亞歷山大先生卻聲稱朝野協商「從來不是用在這種碗糕上。」好吧，我不清楚該用在什麼「碗糕」上，但先前健保改革以此方法協商過一次，推動布希的減稅時也用過一次，而且減稅那次花了1.8兆的預算，足足是健保改革的兩倍呢。


What really struck me about the meeting, however, was the inability of Republicans to explain how they
propose dealing with the issue that, rightly, is at the emotional center of much health care debate: the
plight of Americans who suffer from pre-existing medical conditions. In other advanced countries,
everyone gets essential care whatever their medical history. But in America, a bout of cancer, an inherited
genetic disorder, or even, in some states, having been a victim of domestic violence can make you
uninsurable, and thus make adequate health care unaffordable.


話說回來，真正讓我訝異的是共和黨在解釋如何處理此議題時，是那麼的無力與無能。因為精確的說，他們根本是用感情中樞來處理健保辯論。目前的醫療狀況，讓美國人飽受折磨。其他先進國家的民眾，不管過去有什麼醫療歷史，都可以得到必要的醫療照顧。然而在美國，癌症也好，遺傳性疾病也好，甚至在某些州連家庭暴力的受害者都無法承保，因此付不起需要的健保。


One of the great virtues of the Democratic plan is that it would finally put an end to this unacceptable case
of American exceptionalism. But what’s the Republican answer? Mr. Alexander was strangely inarticulate
on the matter, saying only that “House Republicans have some ideas about how my friend in Tullahoma
can continue to afford insurance for his wife who has had breast cancer.” He offered no clue about what
those ideas might be.


民主黨的方案有個最大的優點，就是終結在這方面無法讓人接受的美國例外主義。那共和黨的答案呢？亞歷山大先生這時很奇怪的結巴了起來，只籠統的說什麼「共和黨有些想法，像我有位在圖拉荷馬的朋友的妻子得了乳癌，可是他有能力繼續付保費。」什麼想法？他說不出個所以然來。


In reality, House Republicans don’t have anything to offer to Americans with troubled medical histories. On
the contrary, their big idea — allowing unrestricted competition across state lines — would lead to a race
to the bottom. The states with the weakest regulations — for example, those that allow insurance
companies to deny coverage to victims of domestic violence — would set the standards for the nation as
a whole. The result would be to afflict the afflicted, to make the lives of Americans with pre-existing
conditions even harder.


事實上除了差勁又麻煩的醫療歷史外，共和黨根本沒提過什麼東西。相反的，他們的大構想──讓不受限制的競爭跨越州界，會導致競爭惡化到谷底。在管制上最鬆的州──比方說，允許保險公司不受理家暴受害者的州，會把這標準擴張到全國。結果就是對美國民眾的磨難落井下石，對現存醫療狀況雪上加霜。


Don’t take my word for it. Look at the Congressional Budget Office analysis of the House G.O.P. plan.
That analysis is discreetly worded, with the budget office declaring somewhat obscurely that while the
number of uninsured Americans wouldn’t change much, “the pool of people without health insurance
would end up being less healthy, on average, than under current law.” But here’s the translation: While
some people would gain insurance, the people losing insurance would be those who need it most. Under
the Republican plan, the American health care system would become even more brutal than it is now.


也別只是聽我譙，看看國會預算局分析共和黨方案的結果。分析結果的用字遣辭相當謹慎，晦澀難懂的稱儘管沒有保險的美國人人數不會有太大變動，「在現行法制下平均來看，沒有健保的民眾會變的沒那麼健康。」我來翻譯好了，「儘管有些人可以有保險，但失去保險的人其實最需要保險。共和黨的方案一但實施，美國的健保體系會變的比現在更加野蠻無理。」


So what did we learn from the summit? What I took away was the arrogance that the success of things
like the death-panel smear has obviously engendered in Republican politicians. At this point they obviously
believe that they can blandly make utterly misleading assertions, saying things that can be easily refuted,
and pay no price. And they may well be right.


好啦，我們從這會議學到什麼呢？我認為明顯是共和黨政客的烏賊戰術，如奪命小組等成功所引起的自大傲慢。透過這論點，他們顯然自認可以不動聲色的徹底誤導健保主張，讓他們得以輕鬆反駁亦不需負任何代價，而且他們大概是對的。


But Democrats can have the last laugh. All they have to do — and they have the power to do it — is finish
the job, and enact health reform.


不過民主黨可望笑到最後，他們唯一要做的事，而且有能力做的事，就是完成工作，啟動這場健保改革。