奧巴馬的醫療改革是在「養懶人」？

給我的一位美國朋友的信：

我是在 2000 年才來美國的，之前在香港，看國際新聞時有聽聞過克林頓的醫療改革（後來無法獲得通過）。當時我的反應是，西方社會真不同，政府連這種「小事」也要管。其實，我是身在福中不知福。香港一直都有公立醫療制度。我那時從未聽說過有人會因生病而破產的。

後來我在 1996 年到美國當了一年的訪問學者。來美之前，有熟悉美國情況的朋友閒談中提醒我，「你到美國記得要有醫療保險啊！」我唯唯諾諾，但心想這也是對的，我在美國是外國人，政府自然不會有任何保險給我－－我當時並不知道美國作為一個全球最富裕的國家，是有幾千萬人國民（超過十分一）是沒有任何醫療保險的。（幸好我的僱主 CMU 大學，的確有為所有僱員購買醫保，包括訪問學者。所以我很輕鬆地解決了這個問題。）

後來奧巴馬推動醫療改革，我有留意到有關的辯論，才開始了解克林頓和奧巴馬想解決的，並不是「小事」。要明白並判斷這場改革是否合理和合宜，要明白很多數據，也要比較美國和其他先進社會（如英、日、德、加拿大、甚至台灣）對這問題的處理方法。但當時令我印象最深刻的，是這一個有血有肉的故事，是在這個電台對談節目（十四分鐘）中聽到的：

The Under-Insured: 'Health-Care Crisis Hits Home'

其中的主人翁（被訪者的弟弟），是否人們心目中的「懶人」、「窮人」、或者「不負責任的人」，諸位可以自行判斷。

March 11, 2009

When Karen Tumulty's brother Patrick was diagnosed with kidney disease, the Time magazine correspondent thought her 15 years of experience covering health policy would enable her to solve his insurance problems. But Tumulty soon realized that the health care crisis is more complicated — and severe — than she thought.

As Tumulty notes in her Mar. 5, 2009 Time article, "The Health-Care Crisis Hits Home," her brother had subscribed for six years to a short-term health insurance policy, which he renewed every six months. But, she writes, the short-term policy meant that "each successive policy treated him as a brand-new customer." When he was diagnosed with kidney disease, the insurance company labeled his illness a "preexisting condition" and refused to pay for the costly diagnosis and treatment.

Tumulty explains that many Americans are under-insured, and they may not even know it: Health policies that seem generous for healthy people may actually be unable to cover costs if a serious illness arises. She writes that "just about anyone could be one bad diagnosis away from financial ruin."