【经济学人】收拾一下奥巴马留下的烂摊子|2017.2.23|总第822期

AS REPUBLICAN congressmen were berated by constituents this week for their desire to repeal the Affordable Care Act (see Lexington), wonks in Washington continued to work on a replacement. Paul Ryan, the Speaker of the House, has promised a health-care bill soon after politicians return from their districts on February 27th. If they are to cool the protesters’ zeal, Republicans must keep health insurance affordable for everyone who already has it. That means deciding what to do about the subsidies Obamacare gives to 10m low- and middle-earners who buy coverage through government-run websites. Mr Ryan promises to replace the law’s means-tested tax credits with a discount for everyone, varying not with income but with age. Would such a switch work?

当希望废除平价医保法案的共和党议员在本周饱受选民责备时，华盛顿的政策专家们仍在致力于拟定一项替代方案。众议院议长保罗·瑞恩(Paul Ryan)承诺政客们2月27日从选区返回后不久就会推出新的医疗保健法案。要想平息众怒，共和党人必须使每一个已经拥有健康保险的人负担得起。这意味着要妥善处理一千万中低收入者从奥巴马医改计划中获得的补贴，他们之前从政府网站购买了保险。瑞恩先生承诺用给予个人的优惠——其额度不随收入而随年龄有所变化，来替换基于收入的税收抵免政策。这样的转变会有效果吗？

• Berated 严厉责备，痛斥

• Constituents 选民

• Wonk 书呆子，政策专家

• the House 众议院(美)

• Zeal 热情

• means-tested（补助金等）经过收入调查的

• tax credits 税收抵免

Paul Ryan

Republicans have always hated the ACA’s handouts. Because they shrink if people earn more, they discourage toil. The Congressional Budget Office has estimated that Obamacare reduces the total number of hours worked by 1.5-2%, which is equivalent to 2.5m full-time jobs by 2024. Making tax credits universal would lessen that number. And because the old pay more for health insurance than the young—a gap that will widen if the Republicans loosen restrictive pricing regulations—increasing subsidies with age makes some sense.

共和党人一贯讨厌ACA的政府拨款。因为如果人们收入越多，拨款就越少，他们不鼓励辛勤的劳动。国会预算办公室估计，奥巴马医改计划使总工作小时数减少1.5-2%，相当于250万份做到2024年的全职工作。推行税收抵免会减小此数字。而且和年轻人相比，老年人会花更多钱买医疗保险，如果共和党人放宽对价格规定的限制，差距还会扩大，因此根据年龄增加补贴就显得合理。

Such a tax credit, though, would not be generous enough for all buyers. The average Obamacare subsidy adds up to about $3,600 per person. Many receive much more. Two non-smoking 55-year-olds together earning $56,500, the median household income, get $4,800 each just to help pay for premiums, according to the Kaiser Family Foundation, a think-tank. According to The Economist’s calculations, if Mr Ryan spread the cash around all 22m Americans who buy health insurance directly, rather than through their employer, it would average only about $2,000 each.

然而，这样的税收抵免对所有投保人来说都不够慷概。奥巴马医疗计划的人均补助是3600美元。许多人可以拿到更多。根据凯瑟家庭基金会——一个智囊机构所说，两个55岁的非吸烟者，其总工资按中等家庭收入56500美元来算，每人可以获得4800美元以支付保险费。根据经济学人的计算，如果瑞恩先生不通过雇主，而是直接给2200万购买过医疗保险的人发放现金的话，人均只能得到2000美元。

• Kaiser Family Foundation 凯瑟家庭基金会
  

• Subsidy 补贴

• Premium 保险费

That is close to what Tom Price, the new health secretary, proposed in 2015 for 35-to 49-year-olds (older folk would have got $3,000). Republicans say it is enough, because costs will fall once insurance is deregulated. But unless prices fall dramatically, many low-earners would probably have to downgrade to insurance covering only catastrophes.（读者试译）After deregulation, such plans might include chilling limitations, such as caps on how much insurance will pay if a person becomes chronically ill.

这接近于汤姆·普莱斯(Tom Price）——新的卫生部长在2015年提出的为35到49岁人群提供的补贴水平（年纪更大的人本来可以得到3000美元）。共和党人说这就足够了，因为一旦保险放松管制，成本便会下降。（期待您的翻译，明天将会有针对这句话的长难句解析哟~）放松管制后，诸如此类的计划可能会包含糟糕的限制，比如，保险能报销给慢性病的金额上限。

• Cap 最高限额
  

• Deregulate 解除管制

• Catastrophes 灾祸

That would be sickening, especially as most affluent Americans benefit from subsidised health care. Fully 155m workers get health insurance from their employer without paying tax on this income-in-kind. The tax exemption cost $268bn (1.4% of GDP) in 2016, enough to pay for Obamacare’s subsidies six times over (see chart). Hated by economists, it encourages firms to give their workers more generous health benefits rather than more pay. One-third of the benefit flows to the top fifth of earners.

这很令人恶心，尤其是因为大多数富裕的美国人受益于医疗补贴。1.55亿工人全部从雇主那里得到医疗保险，而不对这种收入实行纳税。免除税额在2016年花费了2680亿美元（占GDP的1.4%），足以支付奥巴马医疗补助六次（见图表）。它鼓励公司给员工更多的健康福利，而不是更多的工资，因此被经济学家所痛恨。有三分之一的收益流向了前五分之一的收入者。

• Sickening 令人厌恶的

• Affluent 富裕的

• income-in-kind 实物收入

• exemption 免税额

Unfortunately, Mr Obama could not shrink the tax-break, having vilified John McCain, his opponent in the 2008 election, for proposing to scrap it. Instead, he created the so-called “Cadillac tax” on expensive plans, which is due to come into effect in 2020. Messrs Price and Ryan would do away with that and instead cap the exemption—a simpler approach. It would be best to get rid of it completely. Doing so could fund a universal tax credit of $1,500 without touching Obamacare’s means-tested payments, The Economist reckons. Unfortunately, killing the perk would be very unpopular. Just ask Mr McCain.

不幸的是，奥巴马不能缩减税收优惠，他诋毁2008年选举中的对手约翰·麦凯恩（John McCain），因为对方提议废除这项政策。相反，他对高成本计划制订了所谓的“凯迪拉克税”，本该于2020年生效。普莱斯和瑞恩先生会将其撤销，而不是采用一种更简单的方法——限制免税额。最好是能完全摆脱它。经济学人认为，这样做可以为1500美元的普通水平税收抵免提供资金，而不用接受奥巴马医保基于收入的保险支付制度。不幸的是，砍掉额外津贴的行为非常不受欢迎。不信去问麦凯恩先生。

• Vilified 中伤，诽谤

• Scrap 取消，废除

• do away with 废除

• cap 限制(支出)

• Perk 额外津贴

Making premiums affordable is only the first step. People must also be able to pay their medical bills up to the point where their insurance coverage kicks in. The ACA limits such payments for low-earners, and reimburses insurers accordingly. Those reimbursements, though, are currently held up in court after the House sued to stop them in 2014. On February 21st it filed to delay legal proceedings. Deciding what to do about the case—in which Mr Price is now the defendant—is yet another headache for the Republicans.

使人们负担得起保险费只是第一步。人们还必须能够支付他们的医疗费用，达到保险覆盖率的点。ACA限制了给低收入者的此类付款，并相应地偿还给保险公司。但是，自2014年众议院提起诉讼要求其停止后，这笔补偿款现在还在法院手里。2月21日，众议院提出推迟诉讼程序。该如何妥善处理这个案子——普莱斯先生现在还是被告，是另一个共和党人头痛的问题。

• Reimburses 偿还

• sued to 起诉

• filed 提出诉讼

翻译 ▍木三阳

审核 ▍ww

编辑 ▍毛毛