Yana da wuya a gaskanta shekaru biyar kenan tun lokacin da Majalisa ta zartar da Dokar Kulawa mai araha (ACA) a ranar 23 ga Maris, 2010. Ƙwallon hannun dama mai tasowa, jijiya mai faɗowa har yanzu yana ci gaba da faɗin kalmar Obamacare.
Duk da haka, ajiye ɓangarorin da ba su da ma'ana da diatribes, ba da yawa daga cikinmu suna da dalilin bikin sai dai watakila manyan masana'antun kiwon lafiya na 1300 ko kuma masu zaman kansu masu zaman kansu waɗanda ke samun riba mai yawa - hannun jari na kiwon lafiya ya karu da kusan kashi 40 a cikin 2013. mafi girman kowane bangare a cikin S&P 500.
Duk da haka, a matsayin tunatarwa, dokar da ke da gardama tana ƙunshe da wasu abubuwa masu mahimmanci ga mutane na yau da kullun. Misali, yana ba da garantin ɗaukar hoto ga kowa da kowa ba tare da biyan kuɗi mafi girma ba saboda yanayin kiwon lafiya da aka rigaya ya kasance kuma yana buƙatar duba lafiyar rigakafin kulawa kyauta na shekara-shekara ga waɗanda ke kan Medicare.
Amma, shekaru biyar a cikin, kamar yadda masu sukar suka ci gaba da jaddadawa, ACA har yanzu tana aiki da farko a matsayin babbar kamfen ɗin tallan gwamnati don kamfanonin inshora masu zaman kansu, suna ba da miliyoyin sabbin abokan ciniki tare da kaɗan idan duk wani hani kan hauhawar farashi.
"ACA ta gina kan kurakuran tsarin kasuwancinmu kuma, a zahiri, yana kasawa don ƙunsar farashi da ba da dama ga mai araha, ingantaccen kula da lafiya. Bukatun kamfanoni har yanzu suna haifar da kyakkyawan sakamako a cikin kula da lafiyar Amurka, ”a cewar wani kima na shekaru biyar na ACA wanda ya bayyana a cikin Fabrairu 10, 2015. Jaridar International Journal of Health Services, MD John P. Geyman ne ya rubuta.
Dr. Geyman ba shi kaɗai ba. Sauran mashahuran malamai da masu kulawa sun yarda cewa dogaro da ACA ga masu inshorar masu zaman kansu shine faɗuwar sa.
Alal misali, mai haɓaka na'urar na'urar bugun zuciya, Dokta Bernard Lown, gaba ɗaya ya yi watsi da rawar da suke takawa wajen ba da kulawa mai kyau don sauƙi cewa "kamar duk kasuwancin, burinsu shine samun kuɗi."
Sami Abin da kuke Biyan & Babu wani abu
A zahiri, har yanzu muna samun kulawar da za mu iya bayarwa dangane da wane dubunnan tsare-tsaren da muke biyan kuɗi. Iya biyan kuɗi har yanzu babbar matsala ce.
Sakamakon haka, lissafin likita ya kasance dalili na ɗaya na fatarar mutum ko da yake yawancin masu koke suna da inshorar lafiya. Ga sauran mu, bai fi kyau ba.
Abin ban tsoro, a hankali 40 kashi na Amurkawa suna da matsala wajen biyan kuɗin likita kamar yadda aka gani (a shafi na 44) ta wani cikakken cikakken ma'auni na ƙasa na 2011 akan Ayyukan Tsarin Kiwon Lafiyar Amurka wanda Asusun Commonwealth ya ba da izini.
Kuma, ko da yake mutane da yawa sun sami manufofi tare da kuɗi masu araha, rahoton ya kuma nuna cewa manya sun fi na sauran ƙasashen da suka ci gaba su yi watsi da kulawa saboda tsada.
Ƙididdiga na da ban tsoro.
A cikin shekaru biyar da suka gabata, bisa ga cikakken 2015 Bloomberg bita zan kawo da yawa, matsakaicin farashin ganin likita na farko ya karu da kashi 20 cikin dari. Ga ƙwararren ya haura kashi 29 cikin ɗari kuma ga aikin tiyatar marasa lafiya ya haura kashi 43 cikin ɗari.
Ba abin mamaki bane, labarin ya bayyana, kashi 22 cikin dari na mutane yanzu sun ce farashin samun kulawa ya sa su jinkirta jinya don wani mummunan yanayi. Wannan shi ne kaso mafi girma tun lokacin da Gallup ya fara tambaya a shekara ta 2001. Wani binciken jin ra'ayin jama'a da aka yi nuni da cewa manya da suka kai miliyan 16 da ke fama da rashin lafiya sun guje wa likitan saboda tsadar aljihu.
Matsala a Takaice
SinglePayer Yanzu! Mai shirya taron San Francisco Don Bechler, ya bayyana mani cewa yawancin tsare-tsaren inshora an tsara su azaman "hanyoyin talla don haɗa ƙarin abokan ciniki." Shirye-shiryen suna tweaked, daidaikun mutane kuma an daidaita su don takamaiman adadin kuɗin gaba kowane kasuwanci yana son sanya wa ma'aikata.
Don haka, Bechler ya bayyana, don rufe yarjejeniyar da kuma ci gaba da samun kuɗi, masu insurer sun kafa tsare-tsaren kamfanoni masu yawa waɗanda ke ɗaukar nauyi iri-iri ga ma'aikata don raba farashi mai ƙima, haɗin kai da kuma cirewa.
Yin la'akari da lissafin kuɗi ga kowane majiyyaci, ga kowane likita da kowane wurin kulawa a cikin ɗimbin tsare-tsaren tsare-tsare, Bechler ya ƙara da cewa, "ya zama mafarki mai ban tsoro mai cike da jinkiri da rudani."
An tabbatar da wannan ta hanyar binciken kwanan nan na shirye-shiryen Amfani na Medicare masu zaman kansu wanda ya gano an yi wa marasa lafiya caji kusan rabin lokaci.
Don haka, a bayyane yake, kumburi na tsarin mulki da ke gurgunta harkokin kiwon lafiyarmu yana zaune ne a kamfanoni masu zaman kansu, ba a cikin gwamnati ba.
Almubazzaranci Ne
Bugu da kari, da sarkakiya na tsare-tsare, kowanne da nasa tallace-tallace, takardun aiki, rajista, premium, ka'idoji da ka'idoji, suma suna ba da gudummawa ga babban farashin gudanarwa.
Na yi magana game da wannan tare da James G. Kahn, MD, MPH, wanda mai bincike ne a Cibiyar Harkokin Kiwon Lafiya ta Philip R. Lee a Jami'ar. na Cal., SF, kuma babban marubucin a nazarin kwanan nan nazarin tsadar tafiyar da kamfanonin inshora da kuma yadda take karkatar da biliyoyin daloli da yawa a duk shekara daga ainihin aikin jiyya.
Abin da ya bayyana a matsayin almubazzaranci ga mutum na yau da kullun kamar tarin albarkatun da aka sadaukar don yin lissafin kuɗi mai rikitarwa da sauran ayyukan inshora (BIR), kamar yadda Dr.Kahn ya rubuta, ana ɗaukarsa a matsayin kudin shiga da kudaden shiga ta kamfanonin inshora saboda suna cajin waɗannan wuce gona da iri.
Don haka, almubazzaranci da almubazzaranci da almubazzaranci ya zama ruwan dare ga tsarin kasuwanci na kamfanonin inshora kuma daidai da abin da ya kara musu kwarin gwiwa, babu wani abin da zai sa a kawar da rugujewar hukuma.
Masanin tattalin arziki na kiwon lafiya Uwe Reinhardt ya bayyana bacin ransa tun a gaban ACA a cikin shaidarsa na ranar 19 ga Nuwamba, 2008 ga kwamitin kudi na Majalisar Dattijan Amurka: “Masu lissafin kudi 900 a Duke tare da gadaje 900. Ba mu da tabbacin muna da ma'aikaciyar jinya ga kowane gadon asibiti amma muna da ma'aikacin lissafin kuɗi. Batsa ne.”
Wannan matsala na yau da kullum ta girma tare da ACA.
Dokta Kahn ya gaya mani cewa bincikensa ya auna lissafin lissafin kuɗi da sauran kuɗin da ya shafi inshora a kan $ 375B mai ban mamaki a kowace shekara. Tsarin kiwon lafiya na ƙasa wanda zai ba da cikakkiyar kulawa iri ɗaya ga kowa da kowa ba tare da raba kulawa cikin dubban tsare-tsare daban-daban ba "zai cece mu biliyoyin," in ji shi.
Ya yi nuni ga Ostiraliya da Kanada, inda kuɗaɗen kula da inshorar likita na gwamnati ke ƙasa da kashi 3%, kama da na mu na Medicare.
Kahn ya kuma nuna a cikin hirarmu cewa waɗannan ƙananan kuɗaɗen sun bambanta sosai da kashi 33% na gudanarwa na kulawa da aka samu ta hannun masu inshorar riba ta Amurka - duk abin da muke biya.
Waɗannan alkaluma suna da gaske.
"Ba shi da ma'ana," in ji Kahn, "a kashe abin da ya kai dala 1200 a kowace shekara ga kowane namiji, mace da yaro a Amurka don kawai tura takarda" a matsayin wani ɓangare na lissafin kuɗi da ayyukan tallace-tallace na kamfanonin inshora.
Dole ne mu koma ga "mayar da hankali kan ingantacciyar kulawar asibiti inda masu haƙuri da masu ba da lafiya da kansu suke tuntuɓar kai tsaye game da mafi kyawun kulawar da ake samu," in ji Kahn, ba tare da tsalle-tsalle ba ta hanyar ƙayyadaddun ƙayyadaddun tsare-tsare na kuɗi da aka sanya a cikin kowace manufa.
Masu fafutuka kamar Bechler suna fatan cewa gogewa tare da ACA za ta kara tada don tallafawa Dokar Kula da Kiwon Lafiya ta Kasa ta HR 676 wacce ke ba da Medicare ga Duk ko Biyan Kuɗi ɗaya kamar yadda Dokta Kahn da Dr. Geyman suka goyi bayan.
A zahiri, duk da haka, ya ce ƙarfin tattalin arziki da na siyasa na kamfanonin inshora yana nufin cewa muna da tushen ciyawa da yawa da suke shirin yi.
Dole ne mu fara gane lahani a cikin ACA sannan mu yi aiki don samun wani abu mafi kyau, Bechler ya ba da shawara, ta hanyar yin rajista don ayyuka a http://www.singlepayernow.net/ a California ko na ƙasa a https://www.healthcare-now.org
Carl Finamore shi ne wakilin Machinist Lodge 1781 zuwa Majalisar Ma'aikata ta San Francisco, AFL-CIO. Yana fatan za a faɗaɗa Medicare kuma a faɗaɗa don haɗa kowa da kowa. A halin yanzu, yana fatan kyawawan kwayoyin halittarsa su samu shi. Ana iya samun sa a [email kariya]
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