Pakati pezvivimbiso zvakawanda zvemushandirapamwe wesarudzo waBarack Obama wemuna 2008 yaive shanduko yakakwana yehutano hweUS. Kusashanda kwakanyanya kwehurongwa huripo hwakanga huri pachena: kunyange zvazvo mari yehutano hwehutano hwakaenzana nekaviri kudarika kune dzimwe nyika dzakabudirira, vanhu vanosvika mamiriyoni e46 vachiri vasina inishuwarenzi yehutano uye 45,000 vakafa gore negore semugumisiro [1].
Iyo 2010 Patient Dziviriro uye Affordable Care Act ("Obamacare") haigadzirise matambudziko aya. Shanduko iyi ine zvimwe zvakanaka, kunyanya rubatsiro rwayo kune vanhu vane mari shoma, kuwedzerwa kweinishuwarenzi yevana kusvika pamakore makumi maviri nematanhatu (sechifunga kuti vabereki vavo vatove neinishuwarenzi), uye kurambidzwa kwemakambani einishuwarenzi achiramba kuvharwa zvichienderana nemamiriro akange aripo. Asi kuvandudzwa uku kwakaiswa muchimiro chinochengetedza nekubatanidza hurongwa hwakakanganisika hunotungamirwa nemakambani einishuwarenzi akazvimirira uye inogarwa nevasina kunyoreswa vanopa purofiti.
Mhedzisiro yeshanduko ndeye "simba remunhu" rinoda kuti munhu wese atenge inishuwarenzi kubva kumakambani akazvimirira kana kubhadhara faindi, modhi iri kure nehurongwa hwekutarisira hutano hwepasirese hunoita kuti mutero unofambira mberi unopa inishuwarenzi inotungamirwa nehurumende, inobhadhara mumwechete. plan. Iyi sarudzo yekupedzisira, inowanzonzi "Medicare for All," haina kumbobvira yakatariswa neCongress kana manejimendi, kunyangwe ichinyanya kushanda uye nehunhu kupfuura dzimwe nzira [2]. Kunyangwe isiri yekumanikidza hurumende-inomhanya chirongwa cheinishuwarenzi (iyo "sarudzo yeruzhinji") haina kumbovaraidzwa zvakanyanya muSeneti.
Pano tinoongorora shanduko yehutano semufananidzo wekumisikidzwa kwemakambani makuru muU.S. Maindasitiri akakanganisika aive nechepakati pechirongwa ichi kubva pakutanga, achivimbisa kuti zvido zvawo zvaizoiswa pamberi, ukuwo maonero everuzhinji uye kutariswa kwekodzero dzevanhu. Kusikwa kweObamacare kunopa lenzi yekuti unganzwisisa sei uye nei hurumende ichimbundira zvido zvekirasi zvevakuru vemakambani [3]. Zvakadaro nyika haingori mudziyo wekutonga; inzvimbowo yekutamburira. Mushure mekuongorora maitiro ekugadzirisa, tinopa mamwe mazano ehurongwa hweMedicare for All movement.
Ruzhinji Ruzivo
Kuwanda kwemapepanhau kuburitswa kweObamacare kwakaratidza kusawirirana kwakadzama pakati peruzhinji rweUS. Zvakadaro vatauri vakarerekera kufuratira zvikonzero nekuda kwekusafarira kwevanhu. Muongororo yakaitwa muna Ndira 2010 CBS, semuenzaniso, 54 muzana vakaramba "kubata kwaObama kwekuvandudzwa kwehutano," asi vazhinji vakati mutemo hauna kuenda "kure zvakakwana" mu "kuvhara vanhu vekuAmerica" โโ(35 muzana), "kutonga mari. โ (39 muzana), uye โkuronga makambani einishuwarenzi ehutanoโ (43 muzana). Vashoma kwazvo (32, 24, uye 27 muzana, zvichiteerana) vakafunga kuti shanduko "yakanyanya." Kubvumidzwa kuyera kweCongressal Republicans, vasina kuvanza kushora kwavo vanhu vanoshanda uye vasina kuchengetedzwa, kwakatodzika pane kwaObama nemaDemocrats [4].
Vanhu vazhinji vaingwarira mutemo waVaObama vangadai vakatsigira mubhadharo mumwe chete, chirongwa cheinishuwarenzi yehutano hwepasi rose, kunyanya dai chakapihwa se "Medicare for All." Musarudzo dzakatora makumi emakore, ruzhinji rwevanhu vemuUS vakaramba vachiratidza kufarira chirongwa cherudzi urwu, vaine guru vazhinji vanobvumirana kuti hurumende inofanirwa kuvimbisa kuwana hutano kune wese munhu munyika [5]. Muongororo yakaitwa sarudzo dzemuna 2008 dzisati dzaitwa, 77 muzana yevanhu vose (uye kunyange 57 muzana yeavo vakaronga kuvhotera Republican John McCain) vakabvumirana kuti hurumende โinofanira kuva nebasa rekuonaโ kuti munhu wose โanonyanya kuda utanoโ. kusangana [6]. Mune mamwe mazwi, ruzhinji rwevanhu rwakanga rwakanyanya kufambira mberi kupfuura zvese Republican Party uye ruzhinji rweDemocratic Party.
Huwandu uhu hunoramba chirevo chakajairika chekuti veruzhinji vanofambisa mutemo wehutano [7]. Nepo maonero everuzhinji angave akaita chimwe chikamu mukuwana shanduko yezvehutano pagwaro chinangwa, yakanga iri pamucheto wekugadzirisa mitemo pachayo [8].
Kuumbwa Kwekuchinja
Zvinhu zvakati wandei zvakakonzera danho rehutongi hwaObama rekutsvaga shanduko yezvehutano mukutanga kwa2009: kushushikana kwezvikamu zvebhizinesi pamusoro pekukwira kuri kuramba kuchikwira kwemitengo yehutano, kushushikana kweveinishuwarenzi nezvehutano nezvedambudziko rakakura remari, kushushikana kwakanyanya kweveruzhinji nezvehutano, uye chishuwo chaObama chekuda. kuunza vimbiso yakakosha yemushandirapamwe (uye nokudaro anosimbisa mikana yake yekusarudzwa patsva uye nhaka) [9]. Huremu chaihwo hwechimwe nechimwe chezvinhu izvi muchisarudzo chekutanga chehutungamiri hahuna kunyatsojeka.
Nzira yakazotevera iyo shanduko yakaumbwa yakanyatsojeka: manejimendi akakoka vabati vemasimba makuru muhurongwa hwekugadzira mitemo kubva pakutanga. Mumashoko eWhite House director director Dan Pfeiffer, zano raObama raive "kuunza munhu wese ane chekuita patafura" [10]. Mutori wenhau Ryan Lizza anojekesa kuti "mutori wenhau" akataura nezvezvido zvecapitalist uye kwete ruzhinji rwevanhu, achicherekedza, semuenzaniso, kuti VaObama "vakatumira vezvematongerwo enyika vakaomesesa - saRahm Emanuel naJim Messina - kuti vaderedze madhiri neindasitiri yemishonga nezvipatara" [11].
Chimwe chibvumirano chikuru chakabva mumuitiro uyu wenhaurirano chakavimbisa indasitiri yeinishuwarenzi yehutano makumi emamiriyoni evatengi vatsva, vaizomanikidzwa nemutemo kutenga zvirongwa kubva kune veinishuwarenzi yakazvimirira. Mukutsinhana, iyo indasitiri yakabvumirana kupa ruzivo kune varwere vane pre-ivapo mamiriro [12]. Mune imwe nhaurirano huru, vatungamiri vehurumende pamwe naSeneta weDemocratic Alliance, Max Baucus (Sachigaro weSeneti Finance Committee) vakawana mvumo kubva kuPharmaceutical Research and Manufacturers of America (PhRMA) kumutemo wakarongwa nekuramba simba rehurumende rekutaurirana mitengo yezvinodhaka uye kupinza kunze kwenyika. zvinodhaka zvinodhura [13].
Chigadzirwa chekupedzisira chaiwanzoonekwa se "chibvumirano chakanaka" nevemukati meindasitiri (pfungwa yemutevedzeri wemutungamiri wePhRMA, iyo yakatenga chaizvo zviziviso zvinotsigira bhiri) [14]. Kunze kwevashanu vakuru veinishuwarenzi vakazvimiririra (Aetna, Cigna, Humana, UnitedHealth, uye WellPoint), vazhinji vatambi vakuru muindasitiri yehutano vakatsigira shanduko kana kuti havana kuipikisa. Mvumo iyi kubva kuindasitiri - kudzoserwa kwemakumi emakore ekupikisa kwakasimba - kwakabva mukuumbwa kweiyo shanduko kuita yakajairika nzira yehutano hwemakambani: "jekiseni guru rerubatsiro rweveruzhinji kuwedzera saizi yese yemusika wehutano weUS," se. the Financial Times zvakaonekwa [15].
Mamiriro ehutano emakambani ebhiri anogona kuoneka zvakajeka munhaurirano neAmerica's Health Insurance Plans (AHIP), iro rinokurudzira veinishuwarenzi vehutano. Kunyangwe hazvo AHIP isina kumbobvira yatsigira bhiri iri, yakabvumirana nehurongwa hwayo uye haina kuunganidza huremu hwayo hwemutemo kupokana naro. Chikamu chepakati chemutemo - simba remunhu mukutsinhana "pasina mamiriro akange aripo asati abatanidzwa" - ndizvo chaizvo izvo AHIP nebato rekurudyi Heritage Foundation zvakange zvambotaurwa, uye izvo zvakange zvaitwa (nemvumo yavo) muMassachusetts pasi peRepublican Gavhuna. Mitt Romney [16]. Urongwa uhwu, hwakabatana nerubatsiro rwehurumende kune vatengi vanotambira mari shoma, hwaizovimbisa kuwedzera kukuru kwepurofiti muindasitiri yeinishuwarenzi yehutano, kunyanya sezvo vatengi vasina kupihwa "sarudzo yeruzhinji" yakasimba. Kutsiva sarudzo yeruzhinji, imwezve rubatsiro rwehurumende rwakawedzerwa kumutemo: kusikwa kwekutsinhana kwemari yehurumende kwaitungamira vatengi kuinishuwarenzi yakazvimirira, pasina mainishuwarenzi anobhadhara sevhisi [17].
Indasitiri yeinishuwarenzi yakaumbawo zvimwe zvakawanda zvemutemo. Vachishandisa simba ravo mukati meSeneti Finance Committee, vatsigiri veinishuwarenzi vakaderedza chikamu chemari yekurapa iyo vangadai vakafanirwa kuvhara pasi pezvirongwa zvekare [18]. Chinhu chekupedzisira cheObamacare chakataurirana neAHIP kwaive kusiiwa kwemutemo wehuwandu hwehurumende, izvo zvinowanzoenderana nemabasa anotsigirwa nehurumende. Mitemo yemitengo yakasununguka mumutemo wekupedzisira-mutengo wekutakura uchave waka "kuzvidira" -yaive imwe mhedzisiro yehurongwa hwekuunza "wese [wekambani] ane chekuita patafura" [19].
Nemutengo chaiwo wakasiiwa, kukakavara panguva yekutonga kwemutemo kwakasvika pakati pekuti ndiani aizobhadhara mari yekuwedzera (iyo inonyanya kukosha. batsiro kuwedzera kweindasitiri yezvehutano). Paive mumamiriro ezvinhu aya apo Obama manejimendi vezvematongerwo enyika vakatsvaga kupindura zvaidiwa nevashandirwi vemakambani makuru ekudzora mari yeinishuwarenzi yehutano. Zvinhu zviviri zviri mumutemo zvakagadzirirwa kuendesa mari yemushandirwi kuvashandi vavo. Chekutanga, hurongwa hweinishuwarenzi husina purofiti, hune vashandi vakawanda huri kuvharisa vashandi vemubatanidzwa vane mamiriyoni makumi maviri (vazhinji vavo vari venguva pfupi kana mwaka) vacharambidzwa kuwana rubatsiro runowanikwa kune vasiri mubatanidzwa vashandirwi pakuchinjana kwehutano hutsva; Obamacare nekudaro inogadzira kukurudzira kwevashandirwi kuti vabve pazvirongwa zvisiri zvepurofiti uye kumanikidza vashandi vavo kuita purofiti zvirongwa zvinofambiswa nemakambani einishuwarenzi akazvimirira, ayo anobatsira. ndivo iripo. Zvirongwa zvisina purofiti zvingangove zvakawedzerwa kuvhara huwandu hwese zvinodzikiswa neObamacare [20]. Chechipiri, mutemo uchabhadharisa mutero wepamusoro-soro (uye kazhinji yepamusoro-yemhando yepamusoro) zvirongwa zveinishuwarenzi zvinoshoropodzwa se "Cadillac" zvirongwa nevezvematongerwo enyika. Kutanga muna 2018, mutero wakawedzerwa uchapa vashandirwi chikonzero "chekucheka [mukuvharirwa] kwavaida kuita zvakadaro" pamwe nekukurudzira kwakasimba "kurasira mari yakawanda kuvashandi nekupa yakaderera-premium, yepamusoro-inobviswa" (uye yakakwirira co-pay) zvirongwa, anonyora mutori wenhau webasa Jenny Brown [21]. Obama pachake akapindira kuchengetedza mutero uyu muna Ndira 2010, achizviona seimwe nzira yekuwedzera mutero kune vapfumi [22].
Munguva yese yekuumbwa kwemutemo, hutongi hwaObama nevatungamiriri veCongress vakatsvaga kuvaka mutemo waipindura zvinodikanwa zvevakakosha "vane vatori vechikamu," zvichireva zvido zvekambani zvinobatanidzwa kana zvine chekuita nehutano. Yakatarisana nekukakavadzana kukuru pakati peveinishuwarenzi yehutano, vemishonga, zvipatara, maindasitiri asiri ehutano, uye vamwe vatambi vakakosha, hutongi hwaObama hwakatsvaga kupindura zvinonetsa zvemumwe nemumwe, vachisvika, pakupedzisira, nemutemo waishandira kufarira kwemubatanidzwa we capitalist. class.
Kuitwa seKurwisa Kwekirasi
Chikamu chekushandisa chekugadzirisa mitemo chinowanzokosha sechikamu chemutemo. Sarudzo neBazi reMutungamiriri (uye mune dzimwe nguva Congress) inosarudza kushanda-pasi kwemutemo uye kubatsira kusarudza kuti ndiani achabhadhara mari dziri kukwira dzehutano. Kubva 2010 nyika yemubatanidzwa yakakwanisa kushandisa kunyudzwa kwayo mukati mehurumende kuhwina mazhinji ehondo idzi [23]. Funga, semuenzaniso, kutadza kwekukurudzira kubva kuvashandi vakarongeka uye vamwe vatsigiri kuti vadzorerwe kwenguva pfupi kubva pazvirango zveObamacare, izvo zvinosiyana zvakanyanya nekugara kwakawanda kune zvichemo zvevakuru vekambani. Mienzaniso inocherekedza yerusaruro rwekirasi iyi yaisanganisira kupihwa kwekunonoka kwegore rimwe chete kune vashandirwi vakuru kuti vachengetedze vashandi vavo vese - chibvumirano chemadhora mabhiriyoni gumi kumakambani akakanganisika - uye kunonoka kwemakore maviri mushonga wedialysis Sensipar usati waiswa pasi peMedicare. mitengo inodzora, iyo ichaendesa madhora mazana mashanu emamiriyoni kune biotechnology hofori yeAmgen [10].
Iyi nzira yepekugara inosimbisa kukosha kwechikamu chekugadzirisa kwekuita mitemo senhandare yekurwira kusingaperi kwekirasi, ine "vane vatori vechikamu" vane simba vanowanzokunda hondo pamusoro pekushandiswa kwemitemo yakapihwa neCongress. Vaya vane chekuita kazhinji vanga vari vemakambani epamusoro, asi vanhuwo zvavo vanogona kuve vanobatanidzwawo - nzvimbo yatinodzokera pazasi.
Nzira dzeKufurira Kwekambani
Muenzaniso wekuvandudzwa kwehutano hunonetsa dzidziso dzinosimbisa kuterera kwehurumende yeUS kune vagari vayo [25] pamwe nemakakatanwa anobvunza kugona kwevakuru vemakambani kushanda pamwe chete kuti vape mutemo [26]. Maitiro acho anojekesa nzira dzinoshandiswa nevatambi vemakambani vane simba kuumba mutemo wenyika. Pesvedzero yekambani inotorwa kubva kune dzakawanda nzira, dzakawanda dzadzo dzinozivikanwa:
- Zvemari yemushandirapamwe: Vatambi vakakosha mukugadzira kweObamacare vainyanya kutsamira pamakambani eindasitiri yehutano musarudzo nekusarudzwa patsva. Barack Obama akagamuchira madhora 22.4 miriyoni muna 2008, uye bazi rezvehutano rakanga riri rake rechitatu-akakosha-tsime revanopa vemakambani (mipiro yeindasitiri yehutano yega yaive yakakura zvakapetwa ka32 kupfuura. zvose mipiro yemubatanidzwa wevashandi kuna Obama). Nhengo makumi maviri nenhatu dzedare reSenate Finance Committee (SFC) dzakagamuchira mari inosvika mamiriyoni gumi nematanhatu emadhora muna 23 uye madhora mamirioni makumi maviri muna 16. Kubva 2008 Sachigaro weKomiti, Max Baucus, akanga agamuchira mamiriyoni matatu nemazana mana emadhora, kana kuti 20 muzana yezvipo zvake zvose zvomushandirapamwe; mutungamiri wevashoma, Republican Charles Grassley, akanga awana mamiriyoni maviri emadhora. Kupokana kwenhengo dzekomiti kune "sarudzo yeruzhinji" yaizokwikwidza nemainshurensi akazvimirira aiwanzoenderana nezvipo kubva kuindasitiri yehutano mumakore makumi maviri apfuura [2010]. Chimiro chemaitiro esarudzo saka chakavimbisa kuvepo kwevakavimbika indasitiri yehutano mumahofisi makuru eCongress.
- Lobbying: Indasitiri yezvehutano inoshandisa mari yakawanda mukubiridzira kupfuura chero ipi zvayo, kusanganisira inenge miriyoni imwe yemadhora pazuva pakutsvaga uye mipiro yemushandirapamwe panguva yegakava ra2009 [28]. Zvinhu zvakawanda zvemutemo zvakanyorwa zvakananga nevamiriri.
- Politicians' stock Holdings: Sekureva kwemushumo wa2009, "Vanoda kusvika makumi matatu evatongi vemitemo" vane chekuita nekunyora mutemo "vane mari muindasitiri, inosvika madhora zviuru gumi nerimwe zvekudyara." Zvadaro-SFC nhengo John Kerry (D-MA) nemudzimai wake vakabata "inenge $30 mamiriyoni mumakambani akadai saMerck naEli Lilly" [11]. Kufarirwa kwemunhu kwevagadziri vemitemo kwakarara mukuchengetedza nekuwedzera purofiti yemakambani ehutano.
- Kuendeswa kwevashandi: Iyo SFC, uye hofisi yaMax Baucus kunyanya, yakaratidza kutamiswa kwevashandi kana "musuwo unotenderera" pakati pehurumende neindasitiri (Tafura 1). Muenzaniso wakajeka waiva Elizabeth Fowler-uyo, seMukuru Mukuru kuKomiti, akanga ari nyanzvi inokosha inobatanidzwa kudivi rehurumende. Fowler aimbove Mutevedzeri weMutungamiri paWellPoint, rimwe remakambani makuru einishuwarenzi ehutano munyika. Mushure mekunge shanduko yave mutemo, akagadzwa neMutungamiri Obama kuti atarisire kuitwa kwayo. Basa raFowler-uye nevamwe vazhinji vatambi vakakosha-raisanganisira kuenda nekudzoka pakati pebasa rehurumende neindasitiri yehutano.
Pamusoro peidzi nzira dzinozivikanwa dzekupesvedzera kwemakambani, kune zvakare kushoma-kutaurwa-pamusoro kurongeka chikonzero chekutevedzera hurumende nezvido zvecapitalist. Pesvedzero yemakambani haidi nguva dzose kudzorwa nehurumende kana kuti chiokomuhomwe semipiro yemushandirapamwe; macapitalist anoshandisawo simba kuburikidza nekutonga kwavo kwemaitiro pamusoro pehupfumi hunotsamira nyika uye kuburikidza nezvimisikidzo zvinoiswa nemasangano ehurumende pachawo, izvo zvakaumbwa nefurirano yemakambani apfuura nenzira dzinodzikamisa rusununguko rwevezvematongerwo enyika vega. Inosanganisira 18 muzana yeGDP yenyika, uye yakabatana nemamwe maindasitiri kuburikidza nekubatanidza mabhodhi evatungamiriri uye zvimwe zvisungo, makambani eindasitiri yehutano anopa chikamu chakakura chebhesi remutero iro hurumende inotsamira pamihoro yayo. Vanoshandisawo matunhu akawanda uye vanotora mitero kubva kuvashandi vavo vakamirira hurumende. Muchokwadi, saka, nyika inotsamira pane ese ari maviri purofiti nhanho uye nehupfumi trajectory yenyika yemakambani. Vezvematongerwo enyika vanofanira kutevera mitemo inovimbisa purofiti, kunyange kana mitemo yakadai ichikanganisa kugara zvakanaka kweruzhinji rwevanhu kana hupfumi hwakazara. Mafemu ezvehutano eUS anoshandisa simba risingadaviriki rakasiyana nemaitiro anooneka esimba anoonekwa pamusoro [30].
Zvese izvi zvinhu zvakakonzera nzira yekugara (kune zvido zvemakambani) yehutongi hwaObama uye DRM Democrats. Vezvematongerwo enyika vane hungwaru hwemunhu mumwe nemumwe, uye kazhinji kacho zvido zvavo uye zvisungo zvinovatungamira kuti vafarire zvido zvecapitalist. Kunyangwe ivo vakazvipira ivo pachavo kune inofambira mberi kana inopokana nemasangano, zvisinei, chimiro chezvematongerwo enyika nemaitiro zvinogona kurambidza zvirongwa zvakadaro. Kuve nevezvematongerwo enyika vakasiyana muCongress kana kuve nemutungamiri ane hukasha, anofambira mberi muWhite House kwaigona kuita mutsauko, asi kunyangwe Ralph Nader angadai akave pasi pezvipingamupinyi zvakawanda zvakafanana.
Medicare Yevose: Chii Chichatora?
Kuwanda kwekubatanidzwa kwekambani mukugadzirisa mitemo kune zvakakosha pakugadzirisa mazano. Sezvo vezvematongerwo enyika vasiri ivo vanyori vakuru vemitemo, kunangana nevezvematongerwo enyika kungave isiri iyo nzira inoshanda yekushandura mutemo wenyika. Isu panzvimbo pacho tinokurudzira kuti, tichipihwa simba rezvematongerwo enyika remakambani, zano rinonyanya kushanda rekupesvedzera mutemo wenyika kutyisidzira makambani acho zvakananga. Kuita izvi kunogona kudzikisira kushora kwavo kuvandudza, kana kunyangwe-kana kutyisidzira kwakakura zvakakwana-kuvamanikidza kuitsigira [31].
Mhedzisiro yakashata yekuvandudzwa kwehutano hunoratidza kuti hurongwa hwese hwemitemo nekuita hunoda kuvandudzwa, kweshanduko. Asi nekushaikwa kweshanduko yemaitiro akadai, zvikamu zvakakura zvehutungamiriri hwekambani zvinofanirwa kuuya kune pfungwa yemubhadharo mumwe chete zvisati zvaitika. Mumamiriro ezvinhu epanguva ino yeUS, chero shanduko inofambira mberi iyo inomira kukanganisa zvakaipa vane chekuita nebhizinesi yakakosha ichakundikana kunze kwekunge vatsigiri vayo vanogona kuwana nzira yekumanikidza tsigiro yekuvandudza pakati pezvikamu zvikuru zvevakuru vekambani, mungave mumaindasitiri akakanganisika kana kumwewo. Semaonero edu, masimba ekufambisa anoshandiswa zvakanyanya kunanga kwete vezvematongerwo enyika asi kuti vane masimba chaiwo mukuita kwezvematongerwo enyika: vepamusoro vemakambani, kana-zvakanyanya-boka re capitalist. Chinangwa chemubhadharo mumwe chete chinofanira kunge chiri chekuwedzera kudzvanywa kwemari kumakambani kusvika pakuenda kune vezvematongerwo enyika uye. chinodikanwa mubhadhari mumwe chete.
Iyi nzira isina kunanga yekuchinja kwemitemo yehurumende yave yakakosha kune mamwe ematambudziko akakosha ekuchinja munhoroondo yeUS. Mutemo wa1935 Wagner Act unovimbisa vashandi vemasangano akazvimirira kodzero yekubatana wakazoitwa mushure mekunge mhirizhonga yevashandi yatyisidzira vashandirwi zvekuti vakagashira kumiririrwa kwemubatanidzwa se "huipi hushoma" zvichienzaniswa nekukanganisika kubasa. Saizvozvo, kukuvadzwa kwehupfumi kwakaitwa nevarwiri vevatema kumabhizinesi akapatsanurwa yaive chinhu chinodiwa kuti zviitwe uye kuita shanduko yekodzero dzevanhu muma1960s. Muzviitiko zvese izvi, vatsigiri vezvematongerwo enyika vakashandura mutemo wehurumende kwete zvakanyanya nekunangana nevezvematongerwo enyika asi nekutarisa kune vane masimba ehupfumi, avo vakagamuchira nekuzengurira shanduko yaidiwa nevaratidziri sechisarudzo chidiki-chakaipa, ndokuzoraira vamiriri vavo vezvematongerwo enyika kuti vaite zvakafanana [32].
Nezvehutano hwehutano isu hatina mashiripiti-bullet zano rekupa, asi tingapa zano kuti sangano remubhadharo rimwechete ritarise pakuvaka mibatanidzwa yevashandi-nharaunda iyo inogona kumanikidza makambani kutora yakawanda yemitengo yehutano. Kana vakamanikidzwa kutakura mari idzi, vashandirwi vari kunze kweindasitiri yezvehutano vanogona kusarudza kushandisa simba ravo rezvematongerwo enyika pachinzvimbo cheanobhadhara mumwechete. Kune chero nhamba yezvikonzero nei vasiri vehutano-indasitiri maCEO vasati vambundira mubhadharo mumwe chete: hukama hwavo kuindasitiri yehutano, chishuwo chekuchengetedza ine simba bargaining chip vis-ร -vis vashandi vavo, chishuwo chekuwedzera kune vasingashande. , uye zvichida mune zvimwe zviitiko kusaziva kana kusava nechiono chenguva refu. Asi pane imwe nguva vashandirwi-kana mari yavo yehutano ikaramba ichikwira kumusoro-vanogona kusarudza kuti mabhenefiti emubhadhari mumwe chete anodarika mutengo. Vashandirwi nhasi vari kuwedzera kushushikana nezvemitengo yehutano, zvichireva kuti kufamba kwakashata kunovamanikidza kuti vatakure yakawanda yemitengo iyoyo kunogona kubatsira kupeta zvikero zvavo zvekubhadhara kune imwe chete-mubhadhari sarudzo [33]. Vashandi vari mukati meindasitiri yehutano - iyo ichine mwero wakakwira mubatanidzwa - vanogonawo kuita basa rakakosha. Nekuchinja mari yakawanda kune vavanoshandira (zvipatara, makiriniki, misha inochengeterwa vakwegura, zvichingodaro), vanogona kukwanisa kuita kuti zvikamu zveindasitiri izvi zvipikise makambani einishuwarenzi ehutano.
Nhoroondo kune hukama hwakasimba hwakanaka pakati pesimba rekushanda munyika yakapiwa uye iyo nyika inogadzwa yeinishuwarenzi yehutano yenyika uye mamwe maitiro ehutano hwevanhu [34]. Kunyange zvazvo asina kusimba kupfuura munyika dzakawanda dzakabudirira, masangano evashandi eU.S. ave ari simba guru rinofambisira mberi fariro dzeboka rose revashandi, kwete bedzi mitezo yawo. Dzimwe nguva vanobatsira boka revashandi rakakura kunyangwe vasina kuyedza, nekuwedzera mihoro uye mabhenefiti muhupfumi uye kukurudzira vashandirwi kuti vagamuchire zvirongwa zvehurumende zvemagariro. Vave vakanyanya kubudirira, zvisinei, apo ivo vakarwira nemaune vakamirira boka rekushanda rakafara uye vamwe vanhu vakadzvinyirirwa [35].
Mazana evagari vemuUnited States vemo, makumi maviri nevaviri vekune dzimwe nyika, uye kunyange AFL-CIO vakatsigira mubhadharo mumwe chete. Nekudaro, mwero wekuzvipira kune chikonzero unosiyana zvakanyanya pakati pavo, uye mazhinji eiyo mibatanidzwa yakafanana vaivewo vanoshingairira kusimudzira mutemo weObamacare [36]. Kusawirirana uku kunoratidza kusasimba kwechiono, kunosimbiswa pasina kupokana nekujaira kwemasangano mazhinji kuzvirongwa zvehutano zvevashandirwi. Inoratidza zvakare mibatanidzwa mizhinji 'inoenderera mberi yakanamatira kune zano rekuvaka hukama neveDemocratic vezvematongerwo enyika uye kudzivirira kunetsana nevashandirwi. Asi mibatanidzwa inogona kuchinja, zvose kuburikidza nekumutsidzira mukati uye kuburikidza nehutano hwakanaka hwekumwe kufamba kwevanhu vakawanda [37]. Masangano asingabatanidzi, masangano emunharaunda anogona kuita basa guru mukurwisana uku nekuronga vashandi vasina kubatana uye kutaura hurongwa hwakashinga, hunofambira mberi hunokwevera masangano kuruboshwe. Mapoka ehuswa ane simba seVermont Workers' Center uye Healthcare-NOW! vanga vari vatungamiriri mune izvi, kunyanya muVermont asi mune dzimwe nyika zhinji zvakare.
Pamusoro pekuwedzera kudzvanyirirwa kwemari kune vashandirwi, sangano revashandi rakamutsiridzwa rinogona kubatsira panguva imwe chete kuunganidza ruzhinji rwakatenderedza chirongwa chemubhadharo mumwe chete. Mibatanidzwa yakaita seNational Nurses United uye masangano ehunyanzvi akaita seVarapi veNational Health Program anga ari pamberi pemubhadharo mumwe chete, achibatsira kudzidzisa vashandi vemubatanidzwa nevasiri vemubatanidzwa nezve mabhenefiti emubhadharo mumwe. Kuwirirana kunofambira mberi kunopesana-kurondedzera uye kubatana kwevashandi nenharaunda zvose zvakakosha, nokuti zvinangwa zvevakuru zvemhirizhonga zvinozopindura kumanikidziro emari yakawedzerwa nekupomera vashandi nevarombo uye kutsvaga kukanganisa vasina kubatana kune avo vakabatanidzwa.
Zano rakabudirira mune iyi nyaya rinoenderana nekuvaka masimba epasi apo uchishandisa kusasimba uye kupatsanurwa kwemukati kwevemakambani makuru. Bato rekupokana rakarongeka rakatenderedza mibatanidzwa yevashandi-nharaunda uye rakanangidzirwa kune zvinodiwa neboka rose revashandi (munyika nepasi rose) rinogona kukurumidzira zvakanyanya kuderedzwa kwezvikero zvemubhadharo wevatungamiriri vemakambani uye, nekuwedzera, kubudirira kwehurongwa hwehutano hwakabudirira.
Kevin Young achangopedza Ph.D yake. munhoroondo paStony Brook University. Akashanda semurongi wezvematongerwo enyika mumamiriro ezvinhu akasiyana-siyana, kusanganisira kufamba kwevashandi uye mubhadharo mumwe chete.
Michael Schwartz ndiye purofesa wesociology paStony Brook University. Dzidzo yake inotarisa pamagariro evanhu, maitiro ezvematongerwo enyika uye maitiro ehupfumi. Bhuku rake richangoburwa, War Without End, rakaongorora kushanda kwemakore 10 kutorwa kweU.S. kweIraq pane zvematongerwo enyika, zveupfumi, nemagariro evanhu munzanga yeIraqi, uye nekuchinja kuri kuita kusawirirana kwezvizvarwa zvemo.
Ndapota tumira tsamba kune [email inodzivirirwa].
Notes:
[1] Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bohr, naDavid U. Himmelstein, โHealth Insurance and Mortality in US Adults,โ American Journal of Public Health 99, kwete. 12 (2009): 2289-95. Pamitengo ona Center for Economic and Policy Research's Health Care Budget Deficit Calculator pa http://www.cepr.net/calculators/hc/hc-calculator.html.
[2] Steffie Woolhandler, et al., "Mutengo weHealth Care Administration muUnited States neCanada," New England Journal of Medicine 349, no. 8 (2003): 768-75.
[3] Gwaro rehurumende rinopesvedzerwawo nedzimwe pfungwa dzekutonga (rusaruraganda, heterosexism, zvichingodaro), sezvo nhoroondo yeU.S. social policy inonyatsojekesa. Chatinotarisana nacho pano chiri kupesvedzero yekirasi yecapitalist, asi ongororo izere yeObamacare yaizofanira kuongorora nzira idzo mamwe aya, anopindirana mazano anobatsirawo kuona mutemo nemhedzisiro pahuwandu. Pamusoro pekukosha kwenhoroondo yedzinza uye murume kana mukadzi mukugadzira mutemo wehutano hweUS uye nharo ona Colin Gordon, Vakafa Pakusvika: Zvematongerwo enyika zvehutano hwehutano mumakumi maviri emakore ezana America (Princeton: Princeton University Press, 2003), esp. 78-82, 153-57, 172-209.
[4] Nhau dzeCBS, "Mutungamiri, Hutano Hwehutano uye Hugandanga," Ndira 11, 2010, inowanikwa http://www.cbsnews.com/htdocs/pdf/poll_obama_011110.pdf?tag=contentMain;contentBody.
[5] Ona http://www.wpasinglepayer.org/PollResults.html; Benjamin I. Peji naLawrence R. Jacobs, Hondo Yekirasi? Zvinonyatsofungwa nevanhu vekuAmerica nezve Economic Economic (Chicago: University of Chicago Press, 2009), 65-67, 83.
[6] WorldPublicOpinion.org, "Obama, Vatsigiri veMcCain Vanobvumirana neHurumende Inosungirwa Kuita Zvekuchengetedza Utano Hwakakosha, Chikafu, uye Dzidzo Inodiwa," Gumiguru 13, 2008, inowanikwa pa http://www.worldpublicopinion.org/pipa/articles/brunitedstatescanadara/553.php?lb=brusc&pnt=553&nid=&id=.
[7] Mumwe mutori wenhau anotaura nenzira isingatsananguriki kuti "chisungo kune vasina kuchengetedzwa uye vasina kuchengetedzwa hazvina kuvhota zvakanaka" -asi "zvakaremera Obama" (Jonathan Alter, Chipikirwa: Mutungamiri Obama, Gore Rokutanga [New York: Simon & Schuster, 2010], 247). Onawo Paul Starr, Kugadzirisa uye Kuita: Iyo Inoshamisa Kurwira kweAmerica pamusoro peHutano Hwehutano Reform (New Haven: Yale University Press, 2011), 1-24, 177, 180-81, 220.
[8] Sarudzo dzaive dzakakosha zvakanyanya pakuti dzaibatsira vezvematongerwo enyika kutengesa mitemo yavo yavakasarudza kumatunhu avo. Muongorori mukuru waObama, Joel Benenson, akataura zvakanyanya mukutaura kwa2009 pamusoro pegakava rehutano, achiti "patinoziva zvakanyanya nezve [zva] hunhu nemaitiro" eruzhinji, "patinogona kugadzirisa meseji" (yakataurwa. muMichael D. Shear, "Kuvhota Kunobatsira Obama Frame Mharidzo mune Hutano-Kutarisira Gakava," Washington Post, Chikunguru 31, 2009: A10). Onawo Lawrence R. Jacobs naRobert Y. Shapiro, Vezvematongerwo enyika havaite Pander: Kunyengedza kwezvematongerwo enyika uye kurasikirwa kweDemocratic Responsiveness. (Chicago: Yunivhesiti yeChicago Press, 2000).
[9] Obama anonzi akazvidza vamwe vanachipangamazano mukutsvaga shanduko yehutano pakutanga mukutonga kwake (Starr, Kugadzirisa uye Kuita, 196-201).
[10] Yakatorwa muna Peter Baker, "Obama Akasundidzirwa neDrug Lobby, E-mail Suggest," New York Times, Chikumi 9, 2012: A1.
[11] โSezvo Nyika Inopisa,โ The New Yorker (Gumiguru 11, 2010): 76. Onawo Starr, Kugadzirisa uye Kuita, 174-238.
[12] Sezvatinocherekedza pazasi, gadziriro yekupedzisira iyi, chimwe chezvinhu zvakanaka muObamacare, haina kumanikidzwa kune veinishuwarenzi; ivo pachavo vakanga vazvitaura. Dai vasina kubvuma kutambira varwere vane mamiriro akange aripo kare, mutemo ungadai waisanganisira "sarudzo yeruzhinji" yekuvimbisa kuti varwere vakadaro vanokwanisa kuwana inishuwarenzi yehutano, nekudaro kugadzira makwikwi eruzhinji aizopa vamwe vatengi kusa- private insurance sarudzo. Kuti sarudzo yeruzhinji ingadai yakaumba imwe nzira ine musoro inokwikwidzana nemakambani akazvimirira ingangoenderana neruzivo rwemagadzirirwo ayo; zvirokwazvo zvinogoneka kuti ingadai yakashanda senzvimbo yevamiriri veinishuwarenzi yekurasa vatengi vanorwara, zvichiita kuti ive inodhura uye isingagoneki (kunyanya kana vakatove neinishuwarenzi vasina kupihwa sarudzo yeruzhinji, sezvingangoita). Chero zvazvingava, ingadai yakave yakaderera kune imwechete-mubhadharo system. Ona VanaChiremba veNational Health Program, โThe โPublic Plan Optionโ; Ngano uye Chokwadi,โ inowanika pa http://www.pnhp.org/change/Public_Option_Myths_and_Facts.pdf.
[13] Edward Luce, "Magurovhosi Anoenda muHutano Reform Hondo," Financial Times, October 13, 2009: 7; Starr, Kugadzirisa uye Kuita, 14, 187, 204-05, 218-19.
[14] Yakatorwa muBaker, "Obama Akasundidzirwa neDrug Lobby." Onawo "Chirevo chePhRMA pamusoro peKuchinja Kwehutano Hwehutano," Kurume 25, 2010, inowanikwa http://www.phrma.org/media/releases/phrma-statement-health-care-reform-1.
[15] Luce, "Magurovhosi Anoenda muHutano Reform Hondo." Kune nhoroondo yenhoroondo yebasa reindasitiri yehutano mukuvharira inishuwarenzi yehutano yenyika ona Gordon, Wafa pa Kusvika.
[16] AHIP Board of Directors, Ino Ndiyo Nguva Yekuchinja Kwehutano Hwehutano: Chikumbiro cheKuwana Universal Coverage, Kugona, Kuvandudza Hunhu uye Kuchinja Kwemusika. (Zvita 2008), 6, inowanikwa pa http://www.ahip.org/nowisthetime-hcr.
[17] Kutsinhana kwacho kwaivewo chinhu chezvikumbiro zveRepublican zvisati zvaitika, zvakamboitwa seimwe nzira yebhizimusi kune anobhadhara mumwechete "Medicare for All." Ona Starr, Kugadzirisa uye Kuita, 202-03.
[18] Chad Terhune naKeith Epstein, "Nei Mainishuwarenzi Ehutano Ari Kukunda," Businessweek (Nyamavhuvhu 17, 2009): 39.
[19] Robert Pear, "Indasitiri Yezvehutano Inonzi Inovimbisa Kumisa Mari Nekuzvidira," New York Times, Chivabvu 11, 2009: A12; Baker, "Obama Akasundidzirwa neDrug Lobby." Kugamuchirwa kwechikumbiro ichi chekupedzisira cheAHIP kwakavimbisa kuenderera mberi kwemutengo muchikamu chehutano chiri pamusoro peiyo inflation rate, zvichiratidza kusiiwa kwechinangwa chekuchengetedza mutengo izvo zvanga zvichifungidzirwa kuti ndizvo zvakakurudzira kuseri kwekuvandudzwa. Zvakaratidzawo kumwe kudzika kweindasitiri yeinishuwarenzi mune zvekutonga uye zvekutonga zvehutano hweUS. Chaizvoizvo, makambani einishuwarenzi ndivo vatongi, nokuti vanochengetedza simba rekutaurirana nevatarisiri uye, pasinei nezvimwe zvipingamupinyi zvitsva, simba rekuona mitengo.
[20] Max Fraser, "The Affordable Care Attack," New Labor Forum 23, kwete. 1 (2014): 96-98; James McGee, "Mubatanidzwa Wehutano Zvirongwa Zvichatambura pasi peObamacare," Labor Notes (Kurume 2013): 14-15.
[21] Jenny Brown, "Obamacare Inovhura Bhizinesi, Inovhara Basa," Labor Notes (Nyamavhuvhu 2013): 3-4; Reed Abelson, "High-End Health Plans Scale Back to Dzivisa 'Cadillac Mutero,'" New York Times, Chivabvu 28, 2013: B1.
[22] David M. Herszenhorn, "Obama Anokurudzira Mutero Wemutero paInishuwarenzi Inodhura," New York Times, Ndira 7, 2010: A21; Starr, Kugadzirisa uye Kuita, 223.
[23] Chimiro chakafanana chakaratidza kushandiswa kweDodd-Frank shanduko yemari kusvika ikozvino; ona Robert Pollin, "Kurwira Wall Street Regulation: Ndiani Akati Zvaive Nyore?" New Labor Forum 22, no. 2 (2013): 88-91.
[24] Brown, "Obamacare Inovhura Bhizinesi," 1; Eric Lipton naKevin Sack, "Fiscal Footnote: Big Senate Gift to Drug Maker," New York Times, Ndira 20, 2013: A1.
[25] Semuyenzaniso Clem Brooks naJeff Manza, "Social Policy Responsiveness in Developed Democracies," American Sociological Review 71, no. 3 (2006): 474-94.
[26] E.g., Fred Block, "Kirasi Yekutonga Haitongi: Zvinyorwa zveMarxist Theory yeNyika," Socialist Revolution 33 (May-June 1977): 6-28; Mark S. Mizruchi, Kuputsika kweAmerican Corporate Elite (Cambridge, MA: Harvard University Press, 2013). Mizruchi anoziva kugona kukuru kwekubatana kukanganisa magadziridzo, zvisinei, kusiyana nekufambisira mberi kwavo.
[27] Center for Responsive Politics, http://www.opensecrets.org; Daniel Ward, "Iyo Mari Taboo muhutano Reform Coverage," Zvakawedzera! (Mbudzi 2009): 7-8.
[28] Ward, "Iyo Mari Taboo," 7.
[29] Paul Kane, "Vagadziri vemitemo Vanoratidza Hutano-Kuchengetwa Kwekudyara: Vatambi Vakakosha Vane Matanho muIndasitiri," Washington Post, Chikumi 13, 2009: A1.
[30] Bvisa, "Chikwata Chekutonga Hachitongi"; Michael Schwartz, ed., Chimiro cheSimba muAmerica: Iyo Corporate Elite seKirasi Inotonga (New York: Holmes & Meier, 1987).
[31] Isu tinokudziridza iyi nharo yedzidziso munaKevin Young naMichael Schwartz, "Yakaregeredzwa Mechanism yeSocial Movement Political Influence: Basa reAnticorporate uye Anti-Institutional Protest muKuchinja Hurumende Policy," Kukurudzira (iri kuuya, 2014).
[32] Kuti uwane rumwe ruzivo rwemienzaniso miviri iyi ona Young naSchwartz, "A Neglected Mechanism."
[33] Zano redu rakamboyedzwa, kunyanya mushure meHondo Yenyika II apo United Auto Workers (UAW) yakasundira mushandirwi-based hutano hwehutano, vachifunga kuti indasitiri yemotokari yaizopindura kukwira kwemitengo nekusundidzira muripo mumwe chete. Zano racho rakakundikana ipapo, uye kuzvipira kwemubatanidzwa kune mumwe chete anobhadhara uye mamwe nhanho dzehupfumi hwenyika "zvakatanga mureza" (Nelson Lichtenstein, Murume Ane Njodzi muDetroit: Walter Reuther uye Fate yeAmerican Labor [New York: Basic Books, 1995], 297). Asi nguva yekukwira kwemitengo yehutano uye kuwedzera kwemakwikwi epasirese yakanga isati yatanga, zvichireva kuti makambani aikwanisa kupfuudza mutengo kune vatengi. Kuverengera kwemakambani kungangove kwakasiyana nhasi.
[34] Vicente Navarro, Iyo Politics yehutano Hutano: Iyo US Reforms, 1980-1994 (Oxford: Blackwell, 1994), 135-93.
[35] Mibatanidzwa inotungamirwa nekuruboshwe yakada kuhwina zvibvumirano zvakanakisa ukuwo ichinyanya kusanganisirwa uye ine demokrasi. Ona Judith Stepan-Norris naMaurice Zeitlin, Kusiiwa Kunze: Reds uye America's Industrial Unions (Cambridge: Cambridge University Press, 2003).
[36] Kune vanotsigira ona mawebhusaiti eLabour Campaign yeMubhadhari Mumwechete (http://www.laborforsinglepayer.org/) uye maUnion for Single Payer Health Care (http://unionsforsinglepayer.org/) Alan Derickson anocherekedza kuti munguva yapashure pehondo Rutsigiro rwemubatanidzwa weU.S kumubhadharo mumwe chete rwakanga rwakapararira asi kazhinji rusina kudzika; na1950 mibatanidzwa mizhinji โyakapa inishuwarenzi yehutano yenyika chete sevhisi yemuromoโ (โHealth Security for All? Social Unionism and Universal Health Insurance, 1935-1958,โ Zvinyorwa zveAmerican Nhoroondo 80, kwete. 4 [1994]: 1351).
[37] Kim Voss naRachel Sherman, "Kutyora Mutemo Wesimbi weOligarchy: Union Revitalization muAmerican Labor Movement," American Journal of Sociology 106, kwete. 2 (2000): 303-49; Larry Isaac naLars Christiansen, "Mafambiro Akaita Sangano Rekodzero Dzevanhu Vakamutsidzira Basa reVashandi," American Sociological Review 67, no. 5 (2002): 722-46.
ZNetwork inopihwa mari chete kuburikidza nerupo rwevaverengi vayo.
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