Kutheni sifuna ukuThuthukiswa kwezeMpilo
Iindleko eziphakamileyo zenza inkqubo yokunakekelwa kwezempilo yase-US ixabise ngokuphindwe kabini ngomntu ngamnye xa kuthelekiswa nakwamanye amazwe aphuhlisiwe.
Ngenxa yoko, ukunakekelwa kwempilo kuncedise i-$ 3.2 trillion, okanye i-17.8 ekhulwini, kwimveliso emveliso yasekhaya . Leyo ipesenti ephezulu kwihlabathi eliphuhlisiwe.
Kukho izizathu ezintathu zokuba kutheni iindleko ziphezulu. Enye, ininzi yeendleko zivela ekuphatheni abantu kwiintsuku ezilishumi zokuqala kunye neentsuku ezilishumi zokugqibela zobomi babo. Inkqubela eninzi eyenziwe ngokweenkqubo zonyango ezingalondoloza iintsana zangaphambi kwangoko kwaye zandisa ixesha lokuphila kwabantu abadala. Kodwa ezi nkqubo zinexabiso zibiza kakhulu. Amanye amazwe amaninzi afaka umda kumntu onokufumana unonophelo olunjalo. Ukuba amathuba okuphumelela kwinkqubo aphantsi, ngoko ke ayinakunikwa. EUnited States, unonophelo olunjalo lunikezelwa nangona ukuba ukugxekwa kuswelekile.
Isizathu sesibini seendleko zokunakekelwa kwempilo ephakamileyo kukunyuka kwamacala okusesikweni. Ngenxa yoko, oogqirha badla ngokuvavanya, balela i-MRIs eyi-R1 000 kunye ne-colonioscopies eyi-$ 1,500.
Benza oku nangona bengacingi ukuba bafuna. Iyabakhusela ukuba bangaboshwa ngenxa yokuba abazange balayishe uvavanyo oluthile.
Isizathu sesithathu kukuba kukho ukuncintisana kwamanani entle kwiinkonzo zempilo kunamanye amashishini, njengabasebenzisi bekhompyutha. Kungenxa yokuba abaninzi abantu abahlawuli mali ngemali yokunakekelwa kwempilo.
Iindleko zifihliwe. Izigulane zihlawula kuphela umrhumo othethiweyo (uhlawule ngokukhawuleza) ngelixa inkampani yomshuwalense ihlawula lonke ixesha. Ngenxa yoko, izigulane azizithengi ngexabiso loogqirha, iimvavanyo zelabhu okanye iinkqubo njengoko ziza kubakho iikhomputha okanye i-TV. Ukufumana iinkcukacha ezithe vetshe, jonga izizathu zokuNyuka kweNdleko zoLondolozo lwezeMpilo .
Uhlaziyo olukhawulezayo lweNtshuwalense yeMpilo
Ekubeni unyango lwempilo lubiza kakhulu, abaninzi abantu bathenga i-inshorensi. Yingakho iingxoxo ezininzi malunga nokuguqulwa kwezempilo zijolise ekwenzeni i-inshurensi efumanekayo. Ininshurensi isebenza ngokuhlawula intlawulo yenyanga. Oku kubizwa ngokuba yi-premium. Ngenjongo yokubuyisela, iqinisekisa umgcini-mali ukuba umrhumo wokuba kukho nayiphi na ingozi yezokwelapha.
Iinkampani ze- inshurensi yezempilo zentlalo zinenzuzo xa imali efunyenwe kuma-premiums kunokuba ihlawulwe kumabango. Uninzi lwabantu base-US bafumana i-inshorensi yezempilo yeqela kumqeshi wabo, ohlawula inxalenye ye-premium. Iinkampani zinokubonelela nge-inshurensi yempilo njengenzuzo engabonakaliyo. Ngendlela, iipolisi zerhafu zenkxaso-mali zinika inkxaso yenkqubo ye-inshurensi yeqela elinikezelwa ngumqeshi. Abo bangenalo icebo elixhaswe ngumqeshi kufuneka bathenge i-inshurensi yempilo nganye. Kubiza. Kwixesha elidlulileyo, iinkampani zinokukhanyela ukuba unobungozi ukuba unesifo okanye imeko .
Ngenye indlela, unokuzibandakanya kunye neqela, njenge-AARP okanye i-COSTCO. Banikeza amaxabiso aphantsi ngenxa yokuba banomdla wokuba nabantu abanempilo.
Urhulumente wephondo unika inkxaso ngononophelo lwempilo kulabo abangaphezu kwama-65 ukuya kwi-Medicare. Icandelo le-Medicare, iSahlulo se-Intshumo ye-Intshuwalense yezibhedlele, ihlawula ngokwayo kwiirhafu zerhafu.
I-Medicare Ingxenye B (iNkqubo yoNyango ye-Assurance Medical Supplementary) kunye neCandelo D (Inkqubo yokuLawulwa kweziDakamizwa) ayikho ipesenti eziyi-100 ezigqitywe ngeentlawulo ze-premium. Ngokubanzi, iirhafu zokuhlawula iiMediare nee-premium zifihla kuphela iipesenti ezingama-57 zeenzuzo zangoku. Iipesenti ezingama-43 eziseleyo zixhaswa ngemali evela kwingeniso jikelele. Urhulumente wesigqeba unika inkxaso ukunakekelwa kwempilo kwiintsapho ezingaphantsi kwinqanaba elithile lemali engenayo ngokusebenzisa iMedicaid. Ixhaswa ngemali yenkxaso-mali kunye nekarhulumente jikelele.
Ngako oko longeza kwiindleko zombuso kunye neyephondo. Ukuze ubone ezinye i- Inshurensi yezeMpilo njani?
Izizathu ezine zokuguqula ukunakekelwa kwempilo
Ukuguqulwa kwezempilo kuyafuneka ngenxa yezizathu ezine. Okokuqala, iindleko zokunakekelwa kwezempilo ziye zaphazamiseka. Ngo-2011, iindleko eziqhelekileyo zentsapho yesine zenyuka ngamaphesenti angama-7.3, ukuya kuma-19,393. Iphantse iphindwe kabini kwento ebiza ngayo nje iminyaka engama-9 ngaphambi kokuba. Ngo-2030, kuqikelelwa ukuba iirhafu zerhafu ziza kuhlawula iipesenti ezingama-38 zeendleko ze-Medicare. Bonke abanye baya kuncedisa kwi- budget budget .
Okwesibini, ukuguqulwa kwezempilo kuya kuphucula umgangatho wokunyamekela. Abaninzi baseMerika bayamangaliswa ukufumana ukuba ilizwe labo linonophelo olubi kakhulu kwilizwe eliphuhlisiweyo. Izifo ezingapheliyo zibangela iipesenti ezingama-70 zazo zonke i-US zokufa kwaye zichaphazele ama-45 ekhulwini lawo onke amaMerika. Njengabantu abadala, iziganeko zezi zifo ziya kukhula ngokukhawuleza.
Ngo-2023, umhlaza kunye nesifo sikashukela kuya kunyuka ngamaphesenti ama-50, ngelixa izifo zentliziyo ziya kunyuka ngama-40 ekhulwini. Ngelo xesha, i-hypertension kunye nesifo somphunga kuya kuba ngamaphesenti angama-30 kwaye izibetho ziya kubakho ama-25 ekhulwini ngokuphindaphindiweyo. Unyaka ngamnye, iindleko zonyango zizonke i-$ 1.7 trillion, ezimele iipesenti ezingama-75 zazo zonke iinkonzo zemali ezichitha imali. Le ndleko inganciphisa ngokukhuselwa kwezifo kunye neenkqubo zokuphila kakuhle. (Umthombo: Ulwalamano lokulwa nezifo ezingapheliyo.)
Okwesithathu, ukulungiswa kwezempilo kwakudingekile kuba phantse ama-25 e-America ayinayo inshuwalense okanye i-inshorensi yezempilo. Abantu abangama-101 000 baseMerika bafa ngonyaka ngamnye ngenxa yokuba babengenayo inshorensi. Ngokomzekelo, ukutyelela kwegumbi loxakeka kwindleko kubiza i-$ 1,265. Ukuba ufumanisa ukuba unomdlavuza, ixabiso eliqhelekileyo le-chemotherapy laliyi $ 7,000. Iyakwazi ukugijima iphezulu njengama-30,000.
Ezi ndleko ziyakunceda ukusindisa abantu okanye kubangele baphumele ekhaya. Okubi nakakhulu, abantu abaninzi babeza kufuneka bayeke unyango ngenxa yokuba babengenakukwazi ukuwufumana. Akukuphela nje oku kubi kubo, kubi nakwiimeko zoqoqosho. Umzekelo, isiqingatha sazo zonke iziphumo zebhanki zivela kwiindleko zonyango eziphezulu.
Okwesine, ukulungiswa kwezempilo kuyafuneka ukuze kuhlulwe iindleko zezoqoqosho zonyango lobuqhetseba . Phakathi kwama-3-10 ekhulwini (i-$ 60 billion ukuya kwii-200 ezigidigidi zeebhiliyoni) ilahlekelwa ngubuqhetseba ngamnye ngonyaka. Ukuba ezo zepesenti ezifanayo zisetyenziselwa iprogram ye-Medicare yeeRandi ezingama-436 yezigidi, iindleko zobuqhetseba zi-$ 14 billion ukuya kwii-30 ezigidigidi zama-dollar.
Ulungelelwaniso lweMpilo eNtsha eMva
Ngomnyaka we-1993, uMongameli uBill Clinton uqalise uMthetho woKhuseleko wezeMpilo phantsi kolawulo lukaMongameli wokuqala uHillary Clinton . Yanikezela ngononophelo lwempilo yonkqantosi kunye nokuncintisana okulawulwayo phakathi kweenkampani zomshuwalense yezempilo URhulumente uya kulawula iindleko zegqila kunye nee-premiums. Iinkampani ze-inshorensi zempilo ziza kukhuphisana ukubonelela ngeepakethe ezifanelekileyo kunye neyona nto ephantsi kwiinkampani kunye nabantu ngabanye. Oku kwahluke kwi-Medicare apho urhulumente akontraki ngqo kunye noogqirha, izibhedlele kunye nabanye ababonelela ngempilo. I-Medicare ibizwa ngokuba ngumvuzo omnye.
Uninzi lwabantu luya kufumana i-inshorensi ngokusebenzisa abaqeshi babo. Abantu abangenamisebenzi bangathenga i-inshorensi yezempilo ngokwabo kwimibutho yezempilo yesithili. Urhulumente wephondo uza kunika inkxaso kwiindleko zabantu abafumana imali encinci. Le bhili-mali yahluleka ngo-1994.
Ngo-2010, uMthetho woKhuseleko weziGulane kunye noMthetho woKhathalelo ongenakunciphisa waba ngumthetho. Kwaqala ukuphasiswa kwezibonelelo zonyango zempilo kunye neendleko zonyaka. Kwaye kwaqala nokwandisa abantu ababenemiqathango ebesele ikhona ngaphambili, abantwana kunye nalabo abakhishwe. Yanika inkxaso kumashishini amancinci , abadala kunye neendleko eziphezulu zeziyobisi kunye nemali yokunciphisa ukunqongophala koogqirha kunye nabongikazi. Iindleko zaye zahlulwa yerhafu ephezulu yokuhlawula irhafu kunye nemirhumo yeenkampani zonyango kunye neentlawulo eziphantsi kwizibhedlele.
Ngaphambi kokunyulwa kukaMongameli, uBarack Obama wakhuthaza ukuguqula unyango lwempilo . Wayefuna ukwenza inshorensi efumaneke ngakumbi kwabo bangenakufumana i-inshorensi exhaswe ngumqeshi. "Indlela akhethwa ngabantu" yafuna ukwandisa inkqubo efana ne-Medicare kunoma ubani owayeyifuna. Oku kuya kunciphisa iindleko zikaRhulumente ngokubandakanya abantu abancinci, abaphilileyo abahlawula i-premium. Kodwa ukuxhalabisa nge "intlalo yonyango" kukhokelela ekutshintsheni kwe-inshurensi yempilo.
I-ACA ivimbela abafuduki abangekho mthethweni ukuba bafumane iimali zikaRhulumente ukuhlawula i-inshurensi. Ngelo xesha, ayifuni abantu ukuba babonise ubungqina bemihlali kwaye ababoneleli ukuthotyelwa.
I-ACA idale iBhodi lezeMpilo leSizwe. Le nkonzo entsha yesigqeba iya kubeka ikhefu kwiinkcitho zokunakekelwa kwempilo kwilizwe lonke. Oko kwakuthetha ukuba ilawulwa yiimali-mali ze-inshorensi zempilo. Kubantu ngabanye, ibeka imingcele kwiindleko eziphezulu ezingaphandle kwee-pocket. Umthetho-mali awuphumelelanga ngezizathu ezahlukahlukeneyo ngo-1994.
Impembelelo yoTshintsho lwezeMpilo kwi-Economy
Ngomhla ka-2011, kubonakala sengathi uMthetho woNonophelo ongenakuncedo wawusebenza. Ukususela ngoMeyi waloo nyaka, abantu abangaphezu kwama-600,000 abatsha abatsha bafumana i-insured. Kwenzeke ngenxa yokubonelelwa kwe-ACA yokuba abantwana ukuya kwi-26 ubudala bangabhekiswa yinshurensi yabazali babo. Kwakwandisa inzuzo yeenkampani zomshuwalense. Kwiingcamango ezifanele ziguqulelwe kwiiprayimari eziphantsi. Abo batsha bahlawula i-inshorensi kwinkqubo kodwa bahlala befuna iinkonzo zezempilo ezingaphantsi. Enyanisweni, iinkampani ze-inshorensi zempilo zixela inzuzo yerekhodi kwikota yokuqala ka-2011.
Okwesibini, iipesenti ezingama-46 ezincinci zamashishini amancinci anikezela ngoncedo lwempilo ngo-2011 kunokuba ngowama-2010, ngokwe- Kaiser uphando . Abasebenzi abancinci abasemagunyeni abancinci babhekisela kumabonakaliso ambalwa, amanqaku angaphezulu kweekredithi kunye nemfuno ephezulu yabathengi. Oku kwabavumela ukuba bachithe ngaphezulu, kukhulise ukukhula koqoqosho . Enyanisweni, kwakunobuncipha obuncinane ngo-Agasti 2011 kunokuba ngexesha elifanayo kunyaka odlulileyo.