2017年10月17日 星期二

川普有意淘空「奧巴馬醫保」多州起訴;2 Senators Have Deal on Health Subsidies That Trump Cut Off

川普有意淘空「奧巴馬醫保」多州起訴

在國會中未能過關的美國總統川普現在試圖通過單方行動達到目的:廢除「奧巴馬醫保」。然而,他已遭遇強烈抵抗。

(德國之聲中文網)多個美國聯邦州狀告總統對"奧巴馬醫保""釜底抽薪"的決定。共有18個州向加利福尼亞的一個聯邦法院提交了訴狀,反對擬議中的聯邦政府停止支付相關巨款,以阻止川普"危害美國人民健康生活" 的企圖。
迄今,聯邦政府向保險企業直接撥款,以尤其給低收入公民減負。今年,支付總額有可能達到70億美元。白宮本週四(10月12日)稱,這一補貼缺乏法律基礎。此前,共和黨議員就已起訴這一補貼政策,理由是,川普的前任奧巴馬由此超越了自己的權限,因為,只有國會才有權批准此類開支。相關訴訟程序尚在進行。
川普本人表示,補貼的唯一獲益方是保險企業,而非受保人。獨立專家們指出,若取消補貼,保費會大幅上升。包括紐約、加利福尼亞和馬薩諸塞等在內的起訴州稱川普的決定"肆無忌憚"。紐約州司法部長施奈德曼(Eric Schneiderman)表示,川普總統"意欲炸燬這整個體系"。
6個醫界組織也譴責了停止付款的決定,呼籲國會確保這一補貼,以避免"醫保費急遽、以致災難性暴漲"。它們擔心,成百萬美國人有可能因此失去醫保。這6個組織代表了56萬名大夫和醫科學生。
雖然擁有多數席位,共和黨在眾議院通過廢除 "奧巴馬醫保"法案的努力多次受挫。廢除"奧巴馬醫保"是川普的中心選戰承諾之一。川普現在顯然是要試圖逐步淘空"奧巴馬醫保"。
川普此前還走出了另一步,以總統行政令形式,放寬對醫療保險企業的限制,允許它們提供廉價保單。批評者們擔心,這一規定最終會導致慢性病患者和老年人的保費變得昂貴。
凝煉/任琛(路透社、美聯社)


2 Senators Have Deal on Health Subsidies That Trump Cut Off

  • The plan by the two senators, Lamar Alexander of Tennessee and Patty Murray of Washington, would fund the subsidies that President Trump said he would cut off.
  • It remains to be seen whether conservative-leaning Republicans will get on board with the agreement, and whether the House will entertain it.

2017年10月12日 星期四

法國的【美國季刊】/【知美季刊】

The magazine’s tagline is “America like you’ve never read it.”
In Paris, a team of editors have created a publication that examines the…
NEWYORKER.COM









Paris Postcard
October 16, 2017 Issue
A Magazine to Help French Readers Make Sense of the U.S.
In Paris, a team of editors have created a publication that examines the Trump Presidency and what led to it.



By Lauren Collins


On a recent Monday night in the First Arrondissement of Paris, a crowd of cowboys, Native Americans, Uncle Sams, and federal agents packed the terrace of a restaurant. They drank Bloody Marys and draft beers. They ate popcorn and wore buckskin vests—this was a faintly ironic theme party, thrown by the editors of America, a new magazine that, since launching in the spring, has sold nearly a hundred thousand copies in France.

The magazine’s tagline is “America like you’ve never read it.” A trimonthly that will be published until the fall of 2020, America was conceived to help French readers make sense of its namesake in the age of Trump. The editorial mix comprises long interviews with American novelists (Toni Morrison, Don DeLillo, James Ellroy); essays and excerpts in translation (Ta-Nehisi Coates’s “My President Was Black”); and original reported pieces by famous French writers set loose among the Republicans of the Rust Belt or the bears of Yellowstone Park (“Mon point de départ est Denver, dans le Colorado”). “We’re trying to say to French readers that America is a more complex country than we thought,” François Busnel, the editor-in-chief, said the other day. “There are fantastic parts, there are nightmares, but let’s try to understand.”

The magazine is a side project for Busnel, who is well known in France as the host of “La Grande Librairie,” a prime-time television program devoted to the celebration of literature. (Americans might need a special periodical to get their heads around that.) When Trump was elected, Busnel realized that many of the American writers of his acquaintance had foreseen what the political experts had missed. “Everybody was saying, ‘Hillary’s going to win,’ but when I read John Irving, Donald Ray Pollock, Russell Banks, Jim Harrison, they told me the opposite: of an America that’s a little disenchanted, a little forsaken; that, since September 11th, doesn’t know anymore where it lives.” The weirder and faker the news got, the more American literature seemed the most credible vector of truth. “We’re living in a profoundly novelistic era,” Busnel said. “America’s a country that was capable of electing George W. Bush two times in a row, and then electing two times in a row his exact opposite, Barack Obama. How can you explain that?”

The magazine’s view of America is both slightly anachronistic (lots of hoboes and road trips) and exceptionally well informed. The first issue offered a sort of CliffsNotes on books that the editors deemed prescient: Sinclair Lewis’s “It Can’t Happen Here,” Bret Easton Ellis’s “American Psycho,” and “The Plot Against America,” by Philip Roth. “And if the world’s experts had taken the time to read the great American novels instead of their polls?” the headline read. “They would have discovered a country haunted by a tendency toward authoritarianism, the spectre of Fascism, the growing shadow of a blond-maned billionaire.” The second issue included a great article by the French novelist Laurent Gaudé on the inventor of barbed wire. The third issue, whose publication the party marked, was dedicated to the F.B.I., “the ruthless mirror of America’s demons.” It featured an infographic on America’s police forces. “There exist more than 18,000 police bodies in the United States, structured according to a complicated administrative architecture,” the chart read, noting that county officers were the ones in “Miami Vice” and “Longmire,” while city police could be found in “Serpico” and “The Wire.”

At the restaurant, an American took the opportunity to drink her first decent Margarita in several years. When she asked a guest wearing a sheriff’s badge what his favorite book about America was, he answered, “Rien,” but a survey of several other partygoers yielded thought-provoking results:

“Anything by Kurt Vonnegut. ‘Timequake,’ probably.”



“ ‘L’Attrape-Coeurs.’ ” (That turned out to be “The Catcher in the Rye.”)

“There was one about the suffering of the American people. It came out in July last year,” one man said, opening his Amazon app to search, unsuccessfully, for the title.

“ ‘No Country for Old Men,’ for the beauty of the landscape.”

“ ‘Tropic of Cancer,’ by Henry Miller.”

Busnel’s favorite book about America is “Travels with Charley,” by John Steinbeck. He was hoping that America, taken in its entirety, would assist not only today’s French people but also future generations in making sense of a tumultuous moment. “I’m interested in how novelists can tell history again,” he said. “If you want to understand France during the last war, I would suggest to read André Malraux or Camus. That’s what we would like to do. The sixteen issues are going to be a map of America, but also a memoir of its time.” The fourth issue comes out in January. The theme remains undecided. ♦This article appears in other versions of the October 16, 2017, issue, with the headline “In Search of America.”





Lauren Collins began working at The New Yorker in 2003 and became a staff writer in 2008. She is the author of “When in French: Love in a Second Language.”Read more »

2017年10月11日 星期三

Donald Trump just went full dictator



BREAKING


Donald Trump just went full dictator
INDEPENDENT.CO.UK


Donald Trump has threatened to shut down NBC and other American networks, saying that they peddle fake news.
"With all of the Fake News coming out of NBC and the Networks, at what point is it appropriate to challenge their License? Bad for country!" Mr Trump wrote in a tweet.
Mr Trump's tweet came in response to a story written by NBC, which said that Mr Trump had sought to increase America's nuclear arsenal tenfold after taking a look at a briefing slide that showed stead reduction of the US nuclear arsenal since the 1960s. The story cited three officials who were reportedly in the room when Mr Trump made the comments.
"Fake @NBCNews made up a story that I wanted a 'tenfold' increase in our US nuclear arsenal," Mr Trump had tweeted before his threat. "Pure fiction, mad eup to demean. NBC = CNN!"

More follows…

2017年10月3日 星期二

50 years of U.S. mass shootings: The victims, sites, killers and weapons

Since 1966, at least 939 people were killed in mass shootings in America. We will be updating this page as we find out more about the Las Vegas country music festival shooting: http://wapo.st/mass-shootings
Correction: Earlier post said "Since 1950." This graphic shows mass shootings in America since 1966.

Washington Post 和 Washington Post Visuals 都分享了 1 條連結
Mass killings in the United States are most often carried out with guns,…
WASHINGTONPOST.COM

2017年10月2日 星期一

美國不妨借鏡日本醫保體系

【即時頭條】特朗普醫改受阻 美國不妨借鏡日本醫保體系
參議員桑德斯(Bernie Sanders)提出的新醫療保健計劃,即「全民醫療補助」(Medicare for All),將廢除私人醫療保險,轉而由政府全額支付所有醫療服務的費用。這一幕不會發生。但它確實指向了一個有可能運行得更好的系統:一種類似於日本的公私混合型醫保體系。
到目前為止,在國會和媒體中,桑德斯的方案已經遭到強烈質疑。儘管它獲得一些民主黨參議員的背書,但眾議院少數黨領袖佩洛西(Nancy Pelosi)已經表態不予支援。《華盛頓郵報》的蘭佩爾(Catherine Rampell)寫道:「1.78億人目前擁有僱主資助的醫療保險,而且絕大多數人對此是滿意的,這些人會支援桑德斯的計劃嗎?這樣一個計劃自然需要大幅增稅來兜底,個人和僱主能否忍受令人咋舌的價格標籤?由於聯邦醫療補助(Medicare)的報銷率遠低於私營保險公司,如果醫院由此破產,那怎麼辦?最重要的是,你如何為一個如此龐大,價值數萬億美元之巨的醫改法案埋單?」
在我看來,桑德斯的激進計劃主要是一種政治談判策略。民主黨人普遍認為,當奧巴馬總統在2009年制定他的醫改計劃時,他過於努力地嘗試尋找一種能夠被共和黨人接受的妥協方案,到頭來不但單方面稀釋了這一方案,而且沒有贏得共和黨人的任何支援。鑑於共和黨目前掌控國會兩院,一項如此極端的醫改計劃根本沒有通過的可能。桑德斯此舉顯然是希望將辯論話題轉入對全民醫療保險倡導者更加有利的方向。
因此,想像最終的妥協計劃應該是什麼樣子,就落在了我們這些專家的頭上。這是一項極其艱鉅的任務,因為醫療保健是一個極其複雜,涉及許多方面的議題。但一種富有成效的方式是,悉心觀察其他國家,尋找一種看來運作良好的體系,然後思考如何加以複製。
那麼,日本怎麼樣?這個島國的醫療體系位居全球最便宜之列。就醫療支出在國內生產總值(GDP)的佔比而言,日本的醫療開支幾乎比任何一個發達經濟體都要低。更加難得的是,儘管日本是世界上人口老齡化問題最嚴重的國家之一,但它仍然實現了低水平醫療支出這一成就。
所以,儘管日本必須得照顧更多的老年人,並且維繫著很高的醫療水平,但它在醫療方面的開支仍然非常低。很少有人質疑這套體系的成果——日本人的人均壽命比世界上其他任何地方都要高。
當然,這種長壽在很大程度上是拜健康的飲食習慣所賜,但無論如何,任何人都很難辯駁日本的醫療體系是失敗的。雖然更好的飲食習慣會在一定程度上降低美國的醫療成本,但它絕對無法推動這項開支接近日本的水平。
那麼,日本是如何做到的?其成功的祕訣是什麼?日本踐行一套混合型醫療體系。政府負責支付所有醫療費用的70%,除非你是一位低收入老年人——在這種情況下,政府會支付高達90%的醫療費用。剩餘的30%由私營醫療保險支付——要麼是僱主資助,要麼是私人購買的醫療保險。私人購買醫療保險以負擔30%「共付額」(co-pay)的開支,這些花費是部分免稅的。每個人享受同樣的待遇;不同於美國的許多醫保計劃,日本政府提供的醫療保險覆蓋牙科和精神健康疾病。對於大病、窮人、殘障人士,或者某些慢性病患者,政府往往會支付更高的醫療費用比例。
這跟聯邦醫療補助已經採用的方式並無區別。聯邦醫療補助設有免賠額(這一點不同於日本)和固定的共付額。為應對這種安排,許多患者購買了補充性醫療保險Medigap。只要把這項政策覆蓋到所有美國人身上,那麼美國的醫療體系就將與日本沒有太大的不同。私營保險業將繼續存在——是作為政府醫療保險的補充,而不是與之競爭。
一個以顯著「共付額」作為補充的單一付款人體系,擁有多項優勢。最重要的是,聯邦政府的主導地位將允許它著力下調美國奇高無比的醫療服務價格。在日本,醫療服務的費用由一個政府委員會設定上限,但這並不是一項必需措施——只需要讓聯邦醫療補助系統利用其議價能力來協商更便宜的醫療服務,就能夠基本上解決美國的醫療成本問題。政府也可以審慎地利用其議價能力,允許創新性醫療方式收取高價格,以鼓勵它們的發展。
一個日本式醫療體系所安排的高共付額,可以為政府的財政預算提供一條逃生路線。如果事實證明,高稅收將成為經濟不堪承受之重負,那麼共付額可以相應地增加,這樣做不僅有助於維持政府的議價能力,還能減少所需的徵稅額。此外,高共付額將確保私營保險業繼續發揮作用,由此保留目前在該行業工作的數百萬人長期積累的知識和專長。
所以,美國並不需要實施桑德斯建議的那種全部由政府埋單的醫療體系,而應該考慮一種類似於日本的混合型體系。如果政府出面談判,並提供安全網,由私營保險業來做剩餘的工作,美國就能夠保持現行體制做得最好的方面,同時解決這套體系的不足之處。(撰文:Noah Smith)
#美國醫改 #桑德斯 #共付額

Las Vegas massacre



美國境內的超大型戶外演唱會上來自三十層高樓向下掃射的大屠殺事件.
(中央社拉斯維加斯2日綜合外電報導)美國內華達州賭城拉斯維加斯驚傳槍手行凶。警方表示,事件至少造成50人喪生、200多人受傷。警長隆巴度(Jo…
CNA.COM.TW|作者:中央社新聞粉絲團

Bloomberg
Here's everything we know so far from Las Vegas, after the deadliest shooting in modern U.S. history https://bloom.bg/2yiFnsz