Katswiri wanga wamankhwala ku California adachita mantha nditamuuza kuti ONSE omwe tsopano ali pa Medicare ndi Medicaid akakamizidwa kulowa pulogalamu yatsopano yamankhwala a Medicare (Part D). "Medicaid idzalipira mankhwala ambiri omwe anthu amafunikira," adatero. "Medicare idzakhala yopindulitsa kwambiri."
Ndi kuzunzidwa kwa maulamuliro a Bush kusachita bwino komanso mfundo zochepa zaboma zomwe zimabweretsa kusasamala m'dziko lathu komanso kunja, nthawi zina zovuta zamalingaliro monga momwe mankhwala amakhudzira anthu omwe ali pachiwopsezo amagwera pansi pa makwerero. t kupeza chidwi.
Ndikhala ndi nthawi pa nkhani yamankhwala yomwe ikuwoneka ngati yaying'ono ya Medicare yomwe idzakhala ndi zotsatira zoyipa kwa anthu pafupifupi 6 miliyoni pa Medicare ndi Medicaid, m'mabungwe olankhula otchedwa "oyenerera awiri" - DEs mwachidule.
Kuti ayenerere Medicaid munthu ayenera kukhala wosauka kwambiri wopanda katundu, kotero gulu ili ndilosauka kwambiri pakati pa opindula ndi Medicare. Sangakwanitse kulipirira mankhwala awo komanso kulandira mankhwala aulere ku boma.
Kulembetsa sikoyenera ku pulogalamu yatsopano ya mankhwala a Medicare kwa akuluakulu kuti ayambe pa January 1, 2005. Komabe Congress ndi Bush awona kuti ndizofunikira kuti DEs alembetse pulogalamuyi.
Ndiye vuto ndi chiyani ngati mapulogalamu onse a boma amapereka chithandizo chamankhwala? Ndiko kukhazikitsidwa kwa mabungwe a inshuwaransi omwe aziyang'anira pulogalamu ya mankhwala a Medicare.
Tsopano, Medicaid amalipira mwachindunji mankhwala operekedwa kwa DEs - palibe wapakati. Koma pansi pa dongosolo latsopano la mankhwala la Medicare mabungwe a inshuwaransi - msika - aziwongolera pulogalamu ya "gulu". Dongosolo la mankhwala a Medicare PRIVATIZES phindu lamankhwala.
Kusinthaku kumatanthauza kusintha kwakukulu kwa momwe anthu a DE amapezera mankhwala. Ndi ma inshuwaransi apadera omwe amayang'anira nkhawa yoyamba idzakhala kupanga phindu kwa omwe adalembetsa.
Anthu omwe kale anali olumala komanso odwala matenda osachiritsika adasamutsidwa kumapulogalamu aboma monga Medicaid chifukwa ndalama zawo zamankhwala nthawi zambiri zimakhala zokwera komanso ma inshuwaransi apadera amakonda kuwatsitsa mwachangu chifukwa alibe phindu. Opanga ma inshuwaransi akutsogolo amasankha ndipo safuna kuti anthuwa azikhala pamalingaliro awo achinsinsi. Olemba ntchito ambiri akalemala amafunitsitsa kusintha antchito kuchokera kumakampani omwe amalipidwa ndi mapulani achinsinsi kupita ku Medicare monga omwe amawathandizira. Izi zikutanthauza kuti ngati cholinga ndikupereka dongosolo lomwe lidzakwaniritse zosowa za DEs, sikumveka kuti boma likakamize gulu ili ku mapulani achinsinsi a capitalist. Ndiyenera kunena kuti boma lolamulidwa ndi Republican ndilofanananso - monga momwe linachitira ndi mapulani ake a Medicare HMO - lidzapereka chakudya kwa mabungwe a inshuwalansi pamene DEs akuvutika kuti apeze njira zopulumutsira kusintha kwakukulu kumeneku. Mwachitsanzo, dongosolo la mankhwala a Medicare limaphatikizapo ma inshuwaransi osiyanasiyana, zolipiritsa, zolipirira limodzi ndi mankhwala ophimbidwa. Imakhazikitsidwa kuti ikhale ntchito yosokoneza.
Malipiro adzaperekedwa ndi ndondomeko ya mankhwala a Medicare a DEs, koma iwo omwe akupatsidwa mankhwala awo mwachindunji ndi Medicaid tsopano akuyenera kudalira ndondomeko zachinsinsi za mankhwala zomwe zingathe kapena sizingathetsere mankhwala onse omwe akugwiritsa ntchito panopa. Mwachitsanzo, Center for Medicare and Medicaid Services (CMS) yapanga malamulo omwe ma inshuwaransi payekha ayenera kutsatira. CMS yanena kale kuti mankhwala ena omwe mayiko ambiri amagwiritsa ntchito mapulogalamu awo a Medicaid-monga benzodiazepines-sadzaperekedwa ndi dongosolo la mankhwala a Medicare.
CMS ikulola mapulani achinsinsi kuti atuluke pagulu lonse la benzodiazepines - mankhwala omwe nthawi zambiri amagwiritsidwa ntchito pochiza spasticity, nkhawa, mantha ndi zovuta zina.
CMS ikukakamiza ma DE kuti alowe mu dongosolo la mankhwala a Medicare koma sizikakamiza mabungwe a inshuwaransi kuti apitilize kugwiritsa ntchito mankhwala omwe alipo. Aliyense wa inshuwaransi payekha atha kubwera ndi njira yakeyake ndipo ndizotheka kuti palibe dongosolo lomwe lingapereke ndalama zenizeni zomwe munthu atha kumwa (ndipo ayenera kumwa chifukwa amamugwirira ntchito payekha).
Nthawi zambiri ma DE akhala akugwira ntchito ndi madokotala awo kwa zaka zambiri kuti apeze mankhwala omwe amawathandiza. Pansi pa pulogalamu ya mankhwala a Medicare DEs akuyembekezeka kusintha kukhala mankhwala otsika mtengo komanso/kapena kusintha zina zomwe sizingagwire ntchito mogwirizana ndi mikhalidwe yawo. Ambiri mwa gululi sangathe kuchita popanda mankhwala omwe akuyenera kumwa komabe akhoza kukumana ndi zovuta izi zomwe sangathe kulipira m'thumba kuti apeze mankhwala ofunikira. Anthu zikwizikwi m'dziko lonselo adzakhudzidwa, chifukwa amafunikira mankhwala enieni (osati olowa m'malo) pamikhalidwe yawo. Kupitilira apo, CMS imalola wa inshuwaransi aliyense payekha kuti athetse mankhwala nthawi iliyonse yomwe angafune kutero. Kulipira limodzi ndi gawo lamasewera. Popeza mapulani sakupezekabe kuti afufuze palibe amene akudziwa kuti ndi zingati. Ndalama zilizonse zitha kubweretsa zovuta zambiri kwa ma DE omwe amakhala pansi kapena paumphawi wokhazikika. Privatization ya Medicare inalephera m'mbuyomu. Mwachitsanzo, pamene makampani azinsinsi adalowa nawo kulembetsa akuluakulu pa Medicare muzoyang'anira zaumoyo, mitengo idakwera kwambiri. HMOS pamapeto pake idayamba kutaya opindula ndi Medicare pamalingaliro awo. Chifukwa chiyani zikuyenera kuchita bwino nthawi ino ndi mankhwala olembedwa? Mapulani achinsinsi a mankhwala amapanga ma formula kutengera zomwe zingawapangitse ndalama zambiri. Pakhoza kukhala kukwera kwamitengo komwe makampani azinsinsi amapindula pomwe nzika zimasokonekera koma pakapita nthawi ma DE sawoneka ngati opangira phindu kumakampani a inshuwaransi. Purezidenti Bush wapanga tsoka chifukwa cha mankhwalawa "phindu" posankha kuyika ma DE pa chifundo chomwe sichinachitike pamsika ndi malingaliro ake achitetezo kuti ateteze inshuwaransi ndi malonda ogulitsa mankhwala.
Zimenezo si zosayembekezereka.
Chomwe sichimayembekezereka ndikuti mabungwe amtundu wa anthu olumala sanagwirizane kuti aletse kuลตeta kwa DEs mu ndondomeko ya mankhwala osokoneza bongo a Medicare.
Kuyang'ana m'maso mwa dokotala wanga kunauza zonse - zinali zochititsa mantha poganizira zomwe zingachitike pa Januware 1. Malingaliro ake: "Uzani aliyense kuti alandire mankhwala omwe amamwa kwa miyezi itatu kumapeto kwa Disembala. akadali pa Medicaid."
Limenelo ndilo lamulo lamakono. Dongosolo labwino lingakhale kupanga maboma kuphimba mankhwala omwe makampani a inshuwaransi ayi. Mwina ndiye chitetezo chenicheni chidzakhala lamulo.
Russell ndi mlembi wa "Beyond Ramps: Disability at the End of Social Contract" (Common Courage Press).
http://www.martarussell.com