Uma I-Medicare Yabo Bonke uma uke usayinwe waba umthetho, lokho okwaziwa โnjengomlando wezomthethoโ kuzohlehlela emuva ngo-Ephreli 30, 2019, futhi igama lokuqala elazwiwa yiCongress ngalo mbuzo lizobe livela kusishoshovu u-Ady Barkan.
Umlando wezomthetho uzophinde udalule inkomba eyindida yokungezwani okuyisisekelo sokulwela ukunakekelwa kwezempilo komkhokhi oyedwa: Ukulalelwa kokuqala kwe-Medicare for All akuzange kubanjwe ngaphambi kwanoma yimaphi amakomiti amakhulu anegunya phezu komthetho, kodwa esikhundleni salokho izingxenye eziminyene zeKomidi Lemithetho, ngokuvamile elibeka kuphela imigomo lapho izikweletu zizocatshangelwa khona esitezi seNdlu.
U-Rep. Tom Cole wase-Oklahoma, iRiphabhulikhi ephezulu ekomitini, uphawule indawo engacacile ngokungavamile yocezu lomthetho omkhulu kangaka. โKunesizathu,โ esho, ephakamisa ukuthi ubuholi beDemokhrasi kanye nosihlalo bamakomiti afanele bebemanqikanqika ukubhekana nalolu daba. "Lokho kungenxa yokuthi lo ngumthethosivivinywa ongajwayelekile."
USihlalo weKomidi leMithetho uJim McGovern wahleka: โNgithanda ukucabanga ukuthi usihlalo okhanyiselweโ ogqugquzele ubuholi ukuthi bukhethe isigungu sakhe esizolalela umlando.
Ukungqubuzana phakathi kukaCole noMcGovern kuphinde kwakhombisa ukuthi umthethosivivinywa kusafanele uhambe kangakanani.
Ukulalelwa kwangoLwesibili kuphawula iphuzu eliphakeme kunawo wonke okwamanje emgudwini wokunakekelwa kwezempilo okhokha oyedwa, osekukhulunywe ngakho kusukela kwasungulwa i-New Deal. Imele isigaba esisha kule nqubo, eza ngemuva kokuthi umzamo wokuhlela ukhulise ukwesekwa komphakathi komkhokhi oyedwa eminyakeni embalwa edlule, edonsa amandla emkhankasweni kamongameli wezi-2016 kaSen. Bernie Sanders, I-Vt.. Lokho kuhlelwa kwaholela ekwethulweni zeziphakamiso zomthetho ezinemininingwane eminingi eNdlu naseSenethini okwamanje, okulandelwa ukulalelwa kokuqala ngoLwesibili.
Ukungqubuzana phakathi kukaCole noMcGovern kuphinde kwakhombisa ukuthi umthethosivivinywa kusafanele uhambe kangakanani. Amakomiti amabili anezimangalo ezibaluleke kakhulu zokulawula umthethosivivinywa Izindlela Nezindlela naMandla kanye Nezohwebo. UFrank Pallone, DN.J., usihlalo Wezamandla Nezohwebo, akakavumi ukulalelwa kwecala, kodwa ngoLwesibili, uJayapal utshele izintatheli ukuthi uSihlalo we-Ways and Means uRichard Neal, D-Mass., uvumile ukubamba eyodwa. U-Neal umemezele ukweseka kwakhe ukulalelwa kwecala embuthanweni wangasese we-Congressional Progressive Caucus owahlangana njengoba ukulalelwa kweKomidi Lemithetho kwakuqhubeka.
USihlalo weKomidi Lesabelomali u-John Yarmuth, u-D-Ky., uthe uzophinde abambe ukulalelwa kwecala nge-Medicare for All, nakuba engakakuhleli ukulalelwa okuphelele nofakazi abahlukahlukene. Ucele ukuthi i-Congressional Budget Office ihlaziye izingxenye zalo mthethosivivinywa, umbiko okulindeleke ukhishwe ngoLwesithathu ntambama. Uhlela ukulandela ngokumema i-CBO ukuthi izofakaza ngemiphumela. I-Oversight and Government Reform Committee nayo inegunya futhi usihlalo wayo, u-Rep. Elijah Cummings, D-Md., ungumsekeli, nakuba lelo komiti lingazange likuhlele ukulalelwa.
Umthethosivivinywa obekuyisihloko sokulalelwa kwecala ngoLwesibili ugunyazwe nguMmeli uPramila Jayapal, oweDemocrat waseWashington state kanye nosihlalo weCongressal Progressive Caucus. Kungathuthukisa izinzuzo ze-Medicare; susa ama-copay, imali ebanjwayo, nama-premium; futhi wandise ukusabalala kubo bonke abahlali baseMelika. Inqubekelaphambili yomthetho womthethosivivinywa iqala emuva ekulweni kukaRep. Nancy Pelosi wokuba nguSomlomo weNdlu futhi aphasise iphakethe lemithetho eguquliwe, lapho uJayapal ekhipha khona uchungechunge lwezivumelwano zokuqulwa kwecala.
Kodwa ngaphandle kokulalelwa kwecala noma ivoti kumakomiti amakhulu, mancane amathuba okuthi kuvotelwe phansi eNdlu kuleli hlandla. Kusenethi, ngakolunye uhlangothi, uMholi Omkhulu uMitch McConnell, uR-Ky., Uphakamise ukuthi angabamba uhlobo lwevoti, kodwa njengendlela yokuzama ukubeka amaDemocrat amaphakathi endaweni enzima.
Uma kubhekwa ukuthi i-Medicare for All ayilona usongo lokuba umthetho ngenkathi u-Donald Trump ese-White House futhi amaRiphabhlikhi alawula iSenethi, ukulalelwa kwaba nomuzwa ohlangene. "Kungumgomo omuhle futhi ofanele nonke enihlanganyelayo," u-Cole utshele abasekeli be-Medicare for All - ngenkathi eqhubeka nokubiza izindlela eziholela kulokho "njengesiphakamiso sezenhlalakahle" kanye "neMedicare for None."
Ukulalelwa kwecala kwanikeza amaDemocrats ithuba lokuba nenkulumo-mpikiswano ejulile ngenqubomgomo, njengoba bebeka isisekelo sokuthi bazobusa kanjani uma bengase bawine i-White House ngo-2020. Abaningi abanethemba likamongameli basekela i-Medicare for All, nakuba benemibono ehlukene. mayelana nokuthi kuzoba njani. Ukwesekwa komphakathi kwe-Medicare for All kunyukile eminyakeni yamuva nje, iningi labantu baseMelika belisekela ngombono, nakuba i-Kaiser Family Foundation yakamuva. i-poll uthole ukuthi ukwesekwa kuyehla lapho abantu bebuzwa ngemininingwane yohlelo.
Lapho ufakazi Uhlu luxazululiwe ukuze kuqulwe icala ngoLwesibili, abameli bakhungathekile ukuthola ukuthi abanye babasekeli abavelele be-Medicare For All babengamenywanga, okuphakamisa okunye ukushuba kwesimo: Lapho lo mthethosivivinywa ucutshungulwa ngokungathi sรญna, kulapho usuka khona kakhulu. kusukela kumkhakha wayo wabasekeli bangempela. UMcGovern uthe ngemuva kwalokho akafuni ukufaka leli thimba nabameli abamele abakhokha oyedwa, kodwa ufuna ukuxubana ngemibono eyahlukene. Ingcindezi yehle ngasekupheleni kwesonto eledlule ngesikhathi kumenyezelwa ukuthi uBarkan, ohlonishwa umhlaba wonke kwiDemocratic Party, naye uzobamba iqhaza.
Efa nge-ALS, uBarkan wakhuluma ngezwi elenziwe ngekhompyutha, ukuthembela ku-software elandelela ukunyakaza kwamehlo akhe ukuze akwazi ukuthayipha esikrinini. Utshele ikomiti ukuthi ukuphikisa okuhlobene nezindleko zomkhokhi oyedwa kungokwezombangazwe, hhayi kwezomnotho, nokuthi โizwe elicebe kakhulu emhlabeniโ lingakwazi ukuhlinzeka ngomshuwalense wezempilo kubantu balo. Wabuye wakhuluma ngokuhlangenwe nakho kwakhe siqu kokunqatshelwa ukunakekelwa yizinkampani zomshwalense nokudinga ukuchitha isikhathi sakhe esiyigugu esisele elwa nazo. Izindleko zokunakekelwa kwezempilo ekhaya zisebenza ku-$9,000 ngenyanga, uthe.
UMcGovern uthe uPelosi nguyena ophakamise ukuthi kumenywe uBarkan. Wahlangana naye kafushane ngaphambi kokuqulwa kwecala ekamelweni eliseduze, lapho amkhombisa khona indlela yakhe yokuxhumana eqhutshwa yisoftware. Ngesikhathi sekhefu, u-Rep. John Lewis, D-Ga., isithonjana samalungelo omphakathi, naye wakhomba inhlonipho.
Inqwaba yezishoshovu, abasebenzi, kanye nabenzi bomthetho bahambele ukulalelwa kwecala, nokubonisa ukubaluleka kwakho. Abasebenzi beSen. Bernie Sanders, I-Vt., bahambele futhi basiza ukuhlela ukulalelwa; Umxhasi walo mthethosivivinywa, uJayapal, ubekhona, naphezu kokuba wayengekho ekomitini, futhi wahlala eduze kukaBarkan. Ummeli u-Ilhan Omar, D-Minn., wadlula ukuze anga u-Barkan futhi wahlala eceleni kwakhe kafushane njengoba efakaza. ULinda Sarsour, ongomunye wabasunguli beMashi Yabesifazane, kanye noWinnie Wong, umeluleki omkhulu womkhankaso kaSanders ka-2020, babekhona, kanye noJennifer Epps-Addison kanye no-Ana Maria Archila, abaqondisi ababambe iqhaza beCentre for Popular Democracy, lapho uBarkan esebenza khona.
Ngemuva kobufakazi obunyakazayo bukaBarkan, iphaneli yaphendukela kuCharles Blahous, isazi sezomnotho esikhungweni esixhaswe yi-Koch Mercatus Centre. Wakhuluma mayelana nokuhlaziya kwakhe waphakamisa ukuthi izindleko ezihlongozwayo zenguqulo ka-2017 ye-Medicare for All bill, ayifake ku-$32 trillion eminyakeni eyi-10 - ebiza kakhulu, waphakamisa.
โIngabe osomnotho bahlale beqinisile?โ kubuza uMcGovern encokola. Ube esebuza uBlahous ukuthi ngabe bekulungile yini ukuchaza ukuhlaziya kwakhe ngokuthi โI-Medicare for All izobiza imali engaphezulu noma engaphansi kunaleyo esiyikhokhayo njengamanje, akunjalo?โ
โNgicabanga ukuthi lokho kulungile,โ kusho uBlahous.
"Sinazo zonke lezi zixwayiso mayelana nezindleko eziphezulu," kusho uMcGovern, ebhekisela kwesinye sezici ezivame kakhulu zokunakekelwa kwezempilo komkhokhi oyedwa. "Ngiqonde ukuthi, sisebenzisa imali eningi ekunakekelweni kwezempilo njengamanje."
Ukugcizelela kukaBlahous ezindlekweni akunaki umkhondo wesistimu yamanje.
Ukugcizelela kukaBlahous ezindlekweni akunaki umkhondo wesistimu yamanje. Ukuqagela kwakamuva kusukela ku-Centers for Medicare and Medicaid Services ilindele ukusetshenziswa kwemali kokunakekelwa kwezempilo kuzwelonke kuzofinyelela ku-$6 trillion ngonyaka wezi-2027, kukhule ngesilinganiso esingamaphesenti angu-5.5 kule minyaka eyishumi ezayo. Izindleko zizodinga ukubekwa phansi, kungaba ngendlela yamanje yokunakekelwa kwesilinganiso ngokukwenza kubize kakhulu kwabanye, noma ngomkhokhi oyedwa oxoxisana ngamanani aphansi kuyo yonke imboni.
Njengoba izingxoxo ezimayelana nokunakekelwa kwezempilo zivame ukwenza, ukuzwa kwangoLwesibili kuphendukele kufilosofi. Umqondo wesikhathi, okungukuthi phakathi nendawo yokucabanga okukhona, kwavela njalo. โIsikhathi sami sokwethula lobu bufakazi siyaphela. Futhi, ngomqondo ojulile, isikhathi sami sokwethula lo mlayezo kubantu baseMelika siyaphela, โkusho uBarkan ngesikhathi evula isitatimende. โIsikhathi sethu kulo mhlaba siwumthombo oyigugu kunawo wonke esinawo. Uhlelo lwe-Medicare for All luzosongela sonke isikhathi esikhulu. Kodokotela nabahlengikazi nabahlinzeki, kuzosho isikhathi esengeziwe sokunikeza ukunakekelwa kwekhwalithi ephezulu. Futhi ezigulini nasemindenini yethu, kuzosho isikhathi esincane sokubhekana nesistimu yokunakekelwa kwezempilo ephukile kanye nesikhathi esengeziwe sokwenza izinto esizithandayo, ndawonye. Abanye abantu baphikisana ngokuthi nakuba i-Medicare for All ingumqondo omuhle, sidinga ukuhamba kancane ukuze sifike lapho. Kodwa bengidinga i-Medicare yabo bonke izolo. Izigidi zabantu ziyasidinga namuhla. Isikhathi sokuphasisa lo mthetho manje.โ
Ummeli u-Ed Perlmutter, D-Colo., ugqamise ukumosha nokungasebenzi kahle kohlelo. "Isikhathi siyingxenye ebalulekile yakho konke lokhu," esho.
Ngesikhathi ephekwa ngemibuzo, uBarkan utshele amalungu ethimba ukuthi uyalijabulela ithuba lokuba lapho, kodwa bekungeyona lapho ebefuna ukuba khona. Ngokuhamba kwesikhathi, angathanda ukuba sekhaya eCalifornia, esho, edlala nendodana yakhe uCarl, kunokuba abe seCapitol Hill ezama ukuvusa onembeza babameleli.
U-Rep. Jamie Raskin, D-Md., waphakamisa isihloko futhi wabhekisela kwisingathekiso esenziwe umlobi uSusan Sontag: โUkugula kuwuhlangothi lwasebusuku lokuphila, ukuba isakhamuzi esinzima kakhulu. Wonke umuntu ozelwe unobuzwe obubili, embusweni womthombo nasembusweni wabagulayo. Nakuba sonke sikhetha ukusebenzisa i-passport ekahle, ngokushesha noma kamuva ngamunye wethu ubophekile, okungenani ukuze alotshwe, aziveze njengezakhamuzi zaleyo ndawo.โ
Umqondo oyisisekelo wobumbano lwentando yeningi, kusho uRaskin, usho ukuthi labo abakuyo yomibili imibuso kufanele banakekelane. UBarkan, ngomshini wakhe owenziwe ngekhompyutha, utshele uRaskin ukuthi eminyakeni engu-10 edlule, wabona ummeleli ekhuluma. โNginqume ukuthi uwuhlobo lommeli nesisebenzi sikahulumeni engifuna ukuba yiso,โ kusho uBarkan.
Ukufakazela i idlanzana, uGrace-Marie Turner, umongameli we-Galen Institute, inhlangano ekhuthaza ucwaningo lwenqubomgomo yomphakathi mayelana nemibono yemakethe yamahhala yokunakekelwa kwezempilo, uphakamise ukukhathazeka mayelana nesilinganiso sokunakekelwa kwezempilo kanye nezikhathi zokulinda ngokweqile zezakhamuzi emazweni asevele anezinhlelo zokukhokha oyedwa. , njengeFrance noma i-United Kingdom. Kodwa amanye alawo mazwe asevele ekhulume nezikhathi zokulinda isikhathi eside, kusho uSara Collins weCommonwealth Fund, obizwe ukuthi azofakaza yiningi, waveza. โAkusho ukuthi uhlelo lomkhokhi oyedwa kuzoba nohlelo lomkhokha oyedwa lapha,โ kusho uCollins. Iqiniso lokuthi abantu abafakwe umshwalense e-US namanje abakakwazi ukuthola usizo abaludingayo, noma bakhethe ukuhamba ngaphandle kokunakekelwa ngokukhokha izindleko ezimba eqolo, kusho ukuthi nathi, sinokunakekelwa kwesilinganiso, uFarzon Nahvi, udokotela wegumbi lezimo eziphuthumayo e-NYU Langone Health. , kwengezwe. UBarkan usebenzise leli thuba ukuphinda aveze iphuzu elibalulekile ebufakazini bakhe. "Ngaphandle kwama-anecdotes, siyazi ukuthi izinhlelo zokukhokha oyedwa kwamanye amazwe zinemiphumela engcono kunathi," esho.
โSimnqabele u-$300, kodwa manje sesikhokha izinkulungwane zamaRandi ngalokho.โ
UNahvi wabelane ngenani lezindaba ezigqamisa ukuthi uhlelo lwamanje alulona nje unya, kodwa futhi alusebenzi futhi aluzuzisi lutho. Wakhuluma ngesiguli esisodwa esenqaba ukwelashelwa i-appendicitis ngenxa yokuthi sasingakwazi ukukhokhela i-CT scan kanye nokwelashwa okwalandela. Omunye wesifazane osemusha weza ukuzolashelwa isifo somgudu womchamo, kodwa inkampani yakhe yomshwalense yasichitha isicelo sakhe sokuthola ama-antibiotics, futhi wayengakwazi ukuthenga umuthi ongu-$300, kusho uNahvi. Kunalokho, wathenga ijusi ye-cranberry. Ezinsukwini ezimbili kamuva, wayesebuyele egumbini lezimo eziphuthumayo ene-sepsis nomkhuhlane omkhulu. Kwadingeka angeniswe esibhedlela. โSimnqabele u-$300, kodwa manje sesikhokha izinkulungwane zamaRandi ngalokho.โ
Esinye seziguli zika-Nahvi sasingakwazi ukukhokhela ama-antibiotics emfiva, futhi sanquma ukuthi kungcono aye esitolo sezilwane sendawo futhi athenge ama-antibiotic enzelwe izinhlanzi. Uphuze ngokweqile futhi wagcina esegunjini labezimo eziphuthumayo ezinsukwini kamuva waba nemiphumela emibi kakhulu ethinte ubuchopho bakhe nesimiso sezinzwa esimaphakathi. Ngokuhamba kwesikhathi kudingeke ukuthi angeniswe egunjini labagula kakhulu.
โNgikhathazekile ngokuthi kuningi okutholakalayo ngezinkinga ngesixazululo, kunokuthi kutholakale izixazululo kule nkinga,โ kusho uNahvi. "Angifuni ukubona esinye isiguli esicabanga ukuthi indlela engcono kakhulu yokunakekelwa kwezempilo ukuya esitolo sezilwane sasendaweni."
Enye indikimba ekulalelweni kwecala kwaba ukuhlukana kwezinhlanga okukhona ohlelweni lwamanje lokunakekelwa kwezempilo. UDkt. Doris Browne, owayengumongameli weNational Medical Association, emele odokotela abangaphezu kuka-30,000 base-Afrika-baseMelika kanye neziguli zabo, uthe uMthetho Wokunakekelwa Onganakekelwayo awuhambanga ngokwanele ekuxazululeni izindlela ukunakekelwa kwezempilo kwamanje. uhlelo lwehluleka abantu base-Afrika baseMelika.
โNgenxa yezingqinamba eziningi nezinganqobeki ekutholeni ukunakekelwa kwezempilo okuseqophelweni eliphezulu,โ kusho uBrowne ebufakazini bakhe bokuvula, โabantu abanemibala babona umehluko ekutholeni usizo lwezempilo, ukukwazi ukuthengeka kwalezi zinsiza, ukuchema okusobala kwabanye abahlinzeki, nokubamba iqhaza okulinganiselwe emitholampilo. ucwaningo, olunemiphumela emayelana nokwelashwa okusebenzayo.โ
U-Browne, ongudokotela futhi oyisikhulu sezempi eselathatha umhlalaphansi, ukhulume ngokulingana kwezempilo, okubhekise โesimeni lapho wonke umuntu enethuba lokuthola amandla akhe ezempilo aphelele futhi kungekho muntu oncishwe amathuba.โ Uthe ukutholakala kwendawo yonke kuyindlela yokuzuza leso simo. โInamandla okubhekana nobubha, ukungalingani nokucwasa. Ingase futhi inikeze uhlelo olusebenza kahle kakhulu nolusebenza kahle, lokonga izindleko, uhlelo lokunakekelwa kwezempilo lawo wonke umuntu. Ngenxa yokuthi ukulingana kwezempilo nethuba kuxhumene ngokungenakuhlukaniswa, lapho ukulingana kufinyelelwa, ngeke kube khona ukuhlukana kwezempilo. Kungakhathaliseki ukuthi uyibiza ngokuthi i-universal coverage, umkhokhi oyedwa, i-Medicare for All, noma enye ilebula, ilebula ayilona iphuzu elibaluleke kakhulu. Okubalulekile ukuthi ukunakekelwa kufanele kube sezingeni eliphezulu, kufinyeleleke, kungabizi kakhulu, kuphelele futhi kudidiyelwe.โ
Abanye abantu baseRiphabhlikhi ekomitini bazame ukunciphisa isidingo sokulungisa kabusha uhlelo lwezempilo olungasebenzi kahle lwaseMelika. Ummeli u-Rob Woodall, u-R-Ga., uphakamise ukuthi angakhetha uhlelo olugxile kwabagula ngempela kanye nalabo abanesidingo esikhulu, njengo-Barkan, kunokuba enze kabusha uhlelo noma adlulisele izinsiza emindenini enempilo ngenye indlela. Nokho, uBarkan wayephawule ukuthi akekho kithi ongabalekela isidingo sokunakekelwa kwezokwelapha, nokuthi asazi njalo ukuthi kuyodingeka nini.
Ummeli wase-Arizona, uDebbie Lesko, uthe akazi ukuthi kungani ikomiti libambe ukuqulwa kwamacala. Usebenzise isikhathi sakhe ukuzama ukubhoboza izimbobo ohlelweni ngokuhamba esimeni esicatshangelwayo sokuthi isibhedlela sizohamba kanjani ohlelweni lokulungisa uphahla oluvuzayo ngaphansi kohlelo lomkhokha oyedwa. Kamuva wabuza ukuthi ngabe lolu hlelo "luzohlinzeka ngosizo lwezempilo kubantu bokufika ngokungemthetho."
UNahvi uphambane ukuze aveze ukuthi i-United States isivele ihlinzeka ngosizo lwezempilo lwamahhala kubantu bokufika abangenazo izincwadi ngenxa yomthetho wango-1986 owabekwa nguRonald Reagan, i-Emergency Medical Treatment and Active Labor Act.
Ummeli waseFlorida uDonna Shalala, owayengunobhala Wezempilo Nezinsizakalo Zabantu, uthe ucabanga ukuthi ukuqulwa kwecala kuyisinyathelo esihlakaniphile. Ukubhekana nenkinga enkulu kangaka kuthatha inkulumo-mpikiswano eqinile, uthe, enqaba izimpikiswano zeRiphabhlikhi zokuthi zinzima kakhulu noma zizothatha isikhathi eside kakhulu. "ICongress ikhombise kaningi ukuthi inomgogodla wokubhekana nezinkinga ezinkulu, ibeke izingalo kuzo, futhi izame ukuthola isisombululo," kusho yena. โNgizimisele ngokuphelele ukukhuluma ngodaba lwezindleko nokuthi sizozikhokhela kanjani. Kodwa silapha ngoba uhlelo lwabasebenzi luyawohloka phambi kwamehlo ethu.โ
Umbono wokuthi uhlelo lokunakekelwa kwezempilo olusekelwe kumqashi kuseyisixazululo esibalulekile ekunakekelweni kwezempilo ufile futhi awusekho, esho.
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