Masingazenzisi, naphezu kwayo yonke inkulumo mayelana nezinguquko zokunakekelwa kwempilo eminyakeni embalwa edlule, ukugula eMelika kuseyingozi kakhulu.
Kunabantu abayizigidi ezingama-25 abanomshwalense ngo-2010 abasadonsa kanzima ukukhokha izikweletu zezokwelapha ngokwesilinganiso esiqinile seCommonwealth Fund. Eqinisweni, cishe izingxenye ezimbili kwezintathu zakho konke ukuqothuka komuntu zisaxhunyaniswa nalezo zikweletu.
Phakathi naleso sikhathi, labo abangenawo umshwalense wezempilo balinganiselwa ezigidini ezingu-48 ngo-2011 ne-Congressional Budget Office ilinganisela ukuthi ngisho nangemva kokuba uMthetho Wokunakekelwa Onganakekelwayo ususetshenziswe ngokugcwele eminyakeni eyisikhombisa kusukela manje, okungenani abantu abayizigidi ezingu-29 bazohlala bengaqinisekisiwe ngokuphelele.
Sekukonke, akuyona inkontileka enhle kangaka yezenhlalo yabantu abaningi baseMelika.
Kodwa-ke, kubonakala kuyisivumelwano esihle kakhulu kubatshalizimali abacebile. Imuphi umthombo ongcono ongabonisana naye kune-Bain & Company. Yebo, leyo Bain & Company. Ngokuka-Bain, ukutshalwa kwezimali kwamabhizinisi azimele emhlabeni wonke ekunakekelweni kwezempilo kuphindeke kabili onyakeni owodwa - kusuka ku-$15 billion ngo-2010 kuya ku-$30 billion ngo-2011.
Lokho kutshalwa kwezimali okugxilwe ngokuphawulekayo kumelela amaphesenti angu-15 azo zonke izivumelwano ezizimele emhlabeni wonke ngonyaka odlule futhi kwazuza inzuzo emangalisayo yezigidigidi ezingu-500 zamaRandi. Umbuzo uphakanyiswa - imuphi umthelela, ngaphandle kwenzuzo enkulu eshiwo ngenhla yabambalwa, ingabe lokho kutshalwa kwezimali ekunakekelweni kwezempilo okuzimele kunakho kithi sonke?
Bengifuna ukubuza lokhu kanye neminye imibuzo yothile onguchwepheshe ngokulinganayo ekuhlinzekeni ukunakekelwa kweziguli njengoba u-Bain enza imali ngeziguli. Ngakho-ke, ngavakashela udokotela osebenzayo owayethamele inkomfa kazwelonke yangomhla zingama-27 ka-Okthoba Yodokotela Wohlelo Lwezempilo Lukazwelonke (i-PNHP) eyayibanjelwe e-San Francisco.
U-Andy Coates, MD, ungumongameli okhethiwe we-PNHP, udokotela onakekela abagulayo esibhedlela somphakathi esisenyakatho yeTroy, eNew York, umqondisi wezokwelapha ekhaya lasebekhulile lesifunda kanye nelungu lobuhlakani e-Albany Medical College. Insizwa ematasa.
Ecelwa ukuba aveze inkinga yokuqala ekunakekelweni kwezempilo e-United States, uDkt. Coates waphendula: โNgilingeka kakhulu ukuthi โinzuzo iyinkinga,โ ukuphela kwendaba.โ
Kodwa kukhona okwengeziwe. Wachaza kabanzi: โUhlelo lwaseMelika lunenqwaba yokusaphazwa kweziphathimandla ngokungadingekile.โ โUmthwalo omkhulu wemizamo yokuphatha edla isikhathi, ehloselwe ukukhipha inzuzo ekunakekeleni izingane, uyasisinda. Izindleko eziningi zokunakekelwa kwezempilo azihlangene nalokho okwenzeka eduze nombhede. Ukufuna inzuzo yebhizinisi kubukela phansi umzamo wokuhlinzeka ngosizo lwezokwelapha kubantu. "
Ukunakekelwa Kwezempilo KuyiBhizinisi Elikhulu Lixhaswa Izintela Zethu
Abanye bangase bamangale ukuthi uhlelo lokunakekelwa kwezempilo lwenzuzo uDkt. Coates alugxeka kakhulu lukhokhelwa kakhulu ngamadola ethu entela. Ngosizo lwentela lomshwalense wezempilo ozimele kanye nezinzuzo zezempilo zezisebenzi zikahulumeni, ngoxhaso oluqondile lukahulumeni lwe-Medicare ne-Medicaid nangezinye izindlela eziningi, izintela zethu zikhokha cishe amaphesenti angu-60 ezindleko zethu zezempilo zamanje, noma njengabaholi be-PNHP uDkt. USteffie Woolhandler noDavid U. Himmelstein bathi, โsikhokhela umshwalense wezempilo kazwelonke futhi asiwutholi.โ
UWoolhandler, MD, unguprofesa wezempilo yomphakathi e-City University of New York, uprofesa wezokwelapha ovakashele e-Harvard Medical School kanye nomkhulumeli we-PNHP. Wangitshela ukuthi โiningi lezimali zokunakekelwa kwempilo kwamanye amazwe asethuthukile nazo zikhokhwa ngezintela kodwa esimweni ngasinye izindleko ziphansi kakhulu futhi uthola okwengeziwe.โ
Ngokumangalisayo, ukusetshenziswa kwezempilo kufinyelela cishe ku-$9000 ngomuntu ngamunye kuleli kanti amanye amazwe athuthukile achitha cishe uhhafu waleyo mali ngenxa yokuthi anenguqulo ethile yohlelo lukazwelonke lokunakekelwa kwezempilo olungenzi nzuzo.
Okunye ukuphawula okudabukisayo ukuthi idatha iphinde iveze ngokucacile ukuthi "isistimu yethu ayenzi kangcono," kusho u-Woolhandler, njengokuthi, ngokwesibonelo, esikhathini sokuphila lapho sisele ngeminyaka emibili noma emithathu kwamanye amazwe athuthukile.
Empeleni, akudingekile ukuba sihambe kakhulu ukuze sithole ukuqhathanisa okwengeziwe phakathi kwezinhlobo ezizimele nezikahulumeni zokulethwa kokunakekelwa kwezempilo. Singabheka khona lapha kuleli zwe.
Isibonelo, uhulumeni ngokuphelele owakhokhela futhi wasebenzisa I-Veterans Health Administration (VA), eyaziwa kabanzi ngamasevisi ayo ezokwelapha aphakeme, uthenga ngobuningi bemithi kadokotela ngezindleko ezinciphe kakhulu.
Ngokuphambene, uhulumeni unqatshelwe umthetho ekwenzeni lokhu kuthenga ngobuningi obufanayo emakethe evulekile egameni leziguli ze-Medicare kanye ne-Medicaid ngoba kuzokwehlisa inzuzo ye-monopoly yezikhulu zemithi.
Esinye isiqhathaniso yizinzuzo zezindleko zalezi zinhlelo ezimbili. Iphephabhuku i-Fortune libize i-VA engenzi nzuzo i-VA ngokuthi โuhlelo lwezempilo olunezintambo kakhulu futhi olungabizi kakhulu ezweniโ kuyilapho umkhakha ozimele umosha cishe amaphesenti angama-31 esabelomali sawo ngezindleko zokuphatha ezingahlobene nokwelashwa. Lezi zibalo aziyona imfihlo. Eqinisweni, ziyaziwa ngokujwayelekile.
Njengoba uWalter Tsou, MD, ilungu le-PNHP kanye nomongameli odlule we-American Public Health Association etshela inkundla yomphakathi yaseSan Francisco ngo-Okthoba 29, "Siyazi ukuthi yini esebenzayo, okumele sikwenze ukunaka idatha yesayensi yezenhlalakahle."
Kodwa noma ngabe lokhu kugcinwa kubhalwe ngokucacile, uhlelo lwenzuzo lugxilile kangangokuthi izimali zentela zikahulumeni ze-Medicare kanye ne-Medicaid ziyaqhubeka nokugeleza kubahlinzeki abazimele kanye nezinkampani zomshuwalense ezifana nezinhlelo ezikhulayo ze-Medicare Advantage. Futhi lapha yilapho, ngokusho kwe-PNHP, umkhakha ozimele uphinda kabuhlungu iphethini yawo yokweqisa kanye nomhobholo.
Amaqiniso Amaqiniso kodwa Imali Inamandla
Ngokocwaningo oluzovela maduze kuyi-International Journal of Health Services olwenziwa iqembu lochwepheshe bezinqubomgomo, kuhlanganise noDkt. Woolhandler, kwanqunywa ukuthi inani lamadola entela i-Medicare โelikhokhele ngokweqile izinkampani zomshwalense ezizimele ngaphansi kohlelo lwe-Medicare Advantage kanye nabanduleli balo. kule minyaka engu-27 edlule isibalo esishaqisayo samaRandi ayizigidi eziyizinkulungwane ezingu-282.6 ezinkokhelweni ezeqile, eziningi zazo kule minyaka eyisishiyagalombili edlule.โ
Leyo yimali emoshiwe obekumele isetshenziselwe ukuthuthukisa ukunakekelwa kweziguli, ukuqinisa isikhwama se-Medicare's trust noma ukunciphisa ukusilela kukahulumeni, kusho abacwaningi.
Ngakho-ke, lapha sinokwehluka okuphawulekayo kwamanani amakhulu amadola omphakathi aya kubahlinzeki abazimele bokunakekelwa kwezempilo, ngokuvamile abatshalizimali be-Wall Street abanganeliseki abasebenza ngaphandle kokulawula noma abakhokhi bentela okufanele bakulindele. Ingabe zikhona izindleko ezimangazayo ezikhuphukayo?
Thina njengomphakathi sizokhokha inani njengoba izigidi zabangenamshwalense zigwema ukwelashwa, izigidi zihlupheka ngenxa yobunzima bezomnotho ngenxa yokukhuphuka kwezindleko zokukhokhelwa kanye nezindleko ezidonswayo futhi izigidi zithole sekwephuzile kakhulu umshwalense wazo ongenamali ngeke uhlanganise uhlelo lwazo lokubuyisela olunconywe ngokwezempilo.
"Kudingeka sibambe iqhaza kulezi zinkinga," kusho isishoshovu sokukhokha oyedwa eSan Francisco uDon Bechler engqungqutheleni ye-PNHP.
โUma sesikwazi ukuthola umbhobho, siyazinqoba lezi zinkulumompikiswano. Ngakho-ke, ukuhlela umkhankaso wokunakekelwa kwezempilo emhlabeni wonke kususwe izinkampani zomshwalense, kubalulekile ukuthi abantu baye kuwo singlepayernow.net or healthcare-now.org futhi sisekele 'Umthetho Wezokwelapha Othuthukisiwe Nonwetshiwe Wabo Bonke' kuCongress (HR 676)."
Impela kokubili ucwaningo nobushoshovu kuyizingxenye ezidingekayo zenkulumompikiswano evuselelwe futhi evuselelwe kabusha yokunakekelwa kwezempilo kazwelonke esiyidinga kakhulu. Kodwa, ukuze le nkulumo-mpikiswano ikhiqize, ngeke, ngokungafani nezingxoxo zikaKhongolose esizibonile, ukuthinta umdanso ozungeza ukuhaha nokungasebenzi kahle kwabenzi benzuzo abagcwele futhi babukela phansi uhlelo lwethu lwezokwelapha.
Imithombo etholakalayo uma uyicela.
UCarl Finamore uyisithunywa seMachinist Lodge 1781 kuMkhandlu Wezabasebenzi waseSan Francisco. Angafinyelelwa ku [i-imeyili ivikelwe]
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