Isku Daawee Naftaada haddii Obamacare Kordhin Kharashyada Daryeel Caafimaad
Daryeel caafimaad ayaa isticmaalay 4 boqolkiiba dakhliga sanadkii 1960 marka loo eego 6 boqolkiiba sannadka 2013.
Waxaa jiray laba sababood oo kordhay korodhka weyn: siyaasadda dawladda iyo isbeddelka nolosha. Marka hore, Mareykanka waxay ku tiirsan yihiin caymiska caafimaadka gaarka loo leeyahay ee shirkadda . Dawladdu waxay abuurtay barnaamijyo sida Medicare iyo Medicaid si ay u caawiyaan kuwa aan lahayn caymis. Barnaamijyadani waxay dhiirigeliyeen baahida loo qabo adeegyada daryeelka caafimaadka. Taas bixiyayaashu waxay awood u yeesheen inay qiimaha kor u qaadaan. Daraasada Jaamacadda Princeton waxay ogaatay in dadka Maraykanku ay isticmaalaan isla xajmiga daryeelka caafimaadka iyagoo ah dadka deggan dalalka kale. Waxay kaliya bixiyaan lacag dheeraad ah. Tusaale ahaan, sicirada cusbitaalada Mareykanka waa boqolkiiba 60 ka sarreeya kuwa ku yaala Yurub. Dadaaladda dowladda ee dib u habeynta daryeelka caafimaadka iyo dhimista kharashka iyaga oo taas bedelkeeda.
Cudurrada daba dheeraadka ah, sida sonkorowga iyo cudurada wadnaha, ayaa kordhay. Waxay mas'uul ka yihiin 85 boqolkiiba kharashka daryeelka caafimaadka. Ku dhawaad nus dhan dadka Mareykanka ah ayaa haysta ugu yaraan midkood.
Way qaali yihiin oo way adag yihiin in la daweeyo.
Natiijadu, 5 boqolkiiba dadka ugu bukaanku waxay isticmaalaan 50 boqolkiiba kharashka daryeelka caafimaad. Boqolkiiba 50 ee caafimaadka qaba ayaa kaliya isticmaala 3 boqolkiiba qarashka daryeelka caafimaadka qaranka.
Bukaankan badankood waa bukaanka Medicare. Xirfadlaha caafimaad ee Maraykanku wuxuu qabaa shaqadii geesinimo ee badbaadinta nolosha.
Laakiin waxay ku dhacdaa kharash. Kharashka Medicare ee loogu talagalay bukaannada sannadka ugu dambeeya ee nolosha ayaa lix jeer ka weyn celceliska. Daryeelka bukaanku waa qiyaasta afar meelood ee miisaaniyadda Medicare.
Lixdii bilood ee ugu dambeeyey noloshooda, bukaanadaan waxay u tagaan dhakhtarka dhakhtarka 29 jeer celcelis ahaan. Bilaha ugu dambeeya noloshooda, badh waxay tagaan qolka gurmadka. Dabeylka saddex-meeloodba kor u kaca qaybta daryeelka degdegga ah. Mid ka mid ah shanaad ayaa qalliin lagu sameeyaa.
Siyaasadda Dawladda
Intii u dhexeysay 1960 ilaa 1965, kharashka daryeelka caafimaadku wuxuu kordhay celcelis ahaan 8.9 boqolkiiba sannadkii. Sababtoo ah ceymiska caafimaadka ayaa sii ballaariyay. Maaddaama ay daboolayso dad badan, baahida loo qabo adeegyada daryeelka caafimaadka ayaa kor u kacay. Sannadkii 1965, qoysaska ayaa bixiyay jeebka boqolkiiba 44 ee dhammaan kharashyada caafimaadka. Caymiska caafimaadku wuxuu bixiyaa 24 boqolkiiba.
Laga soo bilaabo 1966 ilaa 1973, kharashka daryeelka caafimaadka ayaa kacay celcelis ahaan 11.9 boqolkiiba sannadkii. Medicare iyo Medicaid ayaa daboolay dad badan waxayna u ogolaadeen inay isticmaalaan adeegyo daryeel caafimaad oo dheeraad ah. Medicaid waxay u oggolaatay muwaadiniinta waayeelka ah in ay u guuraan guryaha guryaha qaaliga ah oo qaali ah. Marka baahida loo kordhiyo, sidaas qiimaha ayuu sameeyay. Bixiyeyaasha xanaanada caafimaadka waxay lacag badan ku bixiyaan cilmi baaris. Waxay abuurtay mid cusub, laakiin qaali, tiknoolaji.
Medicare wuxuu gacan ka gaystay abuuritaanka xajin badan oo ku saabsan daryeelka isbitaalka.
Daaweynta qolka gurmadka waa mid aad u qaali ah, taasoo ka dhigeysa saddex meelood meel dhammaan kharashyada daryeelka caafimaadka ee Maraykanka. Sannadkii 2011, waxaa jiray 136 milyan oo booqasho qolalka gurmadka ah. Shan qof oo ka mid ah shan qof oo qaangaar ah ayaa isticmaalaya qolka xaaladaha degdegga sanad walba.
Sanadkii 1971, madaxwaynaha Nixon wuxuu hirgeliyey kormeer qiimaha mushahar si loo joojiyo sicir-bararka fudud. Xakameynta qiimaha daryeelka caafimaadka ayaa abuuray baahida sare. Sanadkii 1973-dii, hay'adaha dayactirka caafimaadka ee Nixon ayaa loo jaray kharashka. Qorshayaashan horudhaca ah waxay xadidaan dadka isticmaala koox caafimaad oo gaar ah. HMO ACT ee 1973 waxay bixisay malaayiin doolar oo lagu maalgelinayo HMOs. Waxa kale oo looga baahan yahay loo-shaqeeyayaasha in ay bixiyaan marka la heli karo.
Sanadkii 1973, Nixon wuxuu gabi ahaanba ka tagay heerka dahabka . Marka qiimaha doolarku uu hoos u dhaco, waxaa lagu soo rogay sicir barbar laba-dhajin ah . Qiimaha daryeelka caafimaadka ayaa kor u kacay isla heerkii.
Laga soo bilaabo 1974-kii illaa 1982, qiimaha daryeelka caafimaadku wuxuu kordhay celcelis ahaan 14.1 boqolkiiba sannadkii saddex sababood. Marka hore, qiimaha ayaa dib u soo ceshaday ka dib markii kontaroolkii qiimaha mushaharka uu dhacay 1974-dii. Dhinaca labaad, Golaha wuxuu ansixiyey Sharciga Amniga Dakhliga Hawlgabka ee 1974-kii. Waxay ka dhaaftay shirkadaha bixiya sharciyada gobolka iyo canshuuraha haddii ay iyagu is-caymiyaan. Shirkadaha ayaa ka faa'iideystay qorshooyinkan hooseeya oo dabacsan. Saddexaad, daryeelka caafimaad ee gurigu waa uu baxay, kornaay boqolkiiba 32.5 sannadkii.
Intii u dhaxaysay 1983 iyo 1992, qiimaha daryeelka caafimaadku wuxuu kacay celcelis ahaan 9.9 boqolkiiba sanad walba. Shirweynuhu wuxuu ballaariyey Medicaid si loogu daro muhaajiriinta sharci darrada ah, carruurta (iyada oo loo marayo CHIP), iyo haweenka uurka leh. Qiimaha daawada loo qoro ayaa kor u kacay boqolkiiba 12.1 sannadkii. Qiimaha daryeelka caafimaadka guriga ayaa kor u kacay boqolkiiba 18.3 sanadkii.
Intii u dhaxaysay 1993 iyo 2010, sicirka ayaa kor u kacay celcelis ahaan 6.4 boqolkiiba sannadkii. Horraantii 1990s, shirkadaha caymiska caafimaadku waxay isku dayeen inay kantaroolaan qiimaha iyagoo isticmaalaya adeegsiga HMOs mar kale. Shirwaynaha ayaa markaa isku dayay in uu kantaroolo kharashka Sharciga Dakhliga Bixinta ee 1997-kii. Taa bedelkeeda, waxay ku khasabtay bixiyayaal badan oo daryeel caafimaad ah ganacsi. Sidaa darted, Golaha wuxuu ka soo horjeeday xayiraadaha lacag bixinta ee Sharciga Dib-u-dhiska Miisaaniyadda ee 1999 iyo Sharciga Hagaajinta iyo Sharciga Ilaalinta ee 2000.
Ka dib 1998, dadku waxay ku kaceen oo waxay dalbadeen doorasho dheeraad ah ee bixiyeyaasha. Maadaama baahida loo kordhiyay mar kale, sidaas qiimaha ayuu sameeyay. Waqtigan, shirkadaha dawooyinka ayaa soo saara noocyo cusub oo daawooyinka dhakhtar qoray. Waxay si toos ah u dhajiyeen macaamiisha waxayna abuurtay dalab dheeraad ah.
Sanadkii 2003, Sharciga Casriyeynta Medicare wuxuu ku daray Medicare Part D si uu u daboolo caymiska kharashka daawada. Waxa kale oo ay bedeshay magaca Medicare Qeybta C barnaamijka Medicare Advantage . Tirada dadka isticmaalaya qorshooyinkaasi waxay u dhigmeen ilaa 17.6 milyan sannadka 2016. Qiimahaas ayaa ka kacay dhaqsaha badan ee kharashka Medicare laftiisa.
Ku tiirsanaanta qaran ee caymiska caafimaadka gaarka loo leeyahay ee shirkadaha gaarka ah ayaa ka tagay dad badan oo aan lahayn dhakhtar daryeel. Sannadkii 2009, kala badh dadka (46.3 boqolkiiba) oo cusbitaal u isticmaalay ayaa sheegay in ay baxsadeen sababtoo ah meel kale uma haysan daryeel caafimaad. Daaweynta Daaweynta Degdegta ah iyo Sharciga Shaqada Shaqada (Active Labor Labor Act) waxay u baahdeen isbitaallo si ay ula dhaqmaan qof kasta oo ku soo galay qolka gargaarka degdegga ah. Bukaanadan aan caymis lahayn waxay kharashka ku baxaan isbitaallada $ 10 bilyan sannadkii. Isbitaalada waxay ku bixiyeen kharashka sidan oo kale Medicaid.
Cudurada Dabiiciga ah
Sababta labaad ee kor u qaadista kharashka daryeelka caafimaadka waa cudur faafa oo cudurada laga hortegi karo. Afarta sababood ee ugu badan ee dhimashada waa cudur wadne, kansar, xanuunka sambabada ee joogtada ah, iyo stroke. Cudurada joogtada ah waxay keenaan dhammaantood. Waa laga hortagi karaa ama kharash yar ayay u noqon kartaa in la daweeyo haddii wakhtigaa la qabto. Khatarta khatarta cudurka wadnaha iyo stroke waa nafaqo xumo iyo cayil. Sigaar cabidu waa astaamaha khatarta kansarka sanbabada (nooca ugu caansan) iyo COPD. Cayilka ayaa sidoo kale ah arrin khatar ah oo ku saabsan noocyada kale ee kansarka.
Cuduradani waxay ku kacayaan $ 7,900 oo dheeraad ah. Taasi waa shan jeer in ka badan qof caafimaad leh. Celceliska qiimaha daaweynta sonkorowga, tusaale ahaan, waa $ 26,971 qoyskiiba. Cuduradani way adag yihiin in la maareeyo maaddaama ay bukaanadu daalan yihiin qaadashada daawooyinka kala duwan. Kuwa dib u jarjaray ayaa naftooda ka hela qolka gargaarka degdega ah iyagoo qaba wadno-xanuun, istaroogga iyo dhibaatooyin kale. (Waxaa laga soo xigtey: "Saameynta Cudurada Dabiiciga ah ee Daryeelka Caafimaadka," A Healthier America, 2014.)
Sida ACA hoos u dhigtay kicinta kharashka daryeelka caafimaadka
Sannadkii 2009, kor u qaadista kharashka daryeelka caafimaadka ayaa isticmaalay miisaaniyadda federaalka. Medicare iyo Medicaid waxay ku kacday $ 676 bilyan. Taasi waa boqolkiiba 10.4 miisaaniyadda guud. Canshuurta mushaharka ayaa kaliya ku daboolan kala bar Medicare iyo midkoodna Medicaid. Kharashka loo yaqaan " khasaarinta khasabka ah" waxaa sidoo kale ka mid ah hawlgabka, daryeelka iyo dulsaarada deymaha ee federaalka iyo kuwa mushaarka. Waxay baaba'day boqolkiiba 60 miisaaniyadda federaalka .
Maxaa xitaa ka sii daran, ka fariista caruurta Boomers waxay ka badnaan doontaa labanlaab ee kharashka Medicare iyo Medicaid illaa 2020. Maadaama kharashyada daryeelka caafimaadku ay kor u kaceen koritaanka dhaqaalaha, canshuurta Medicare iyo Sanduuqa Trust ayaa bixin doona wax ka yar iyo ka yar. Ilaa iyo 2030, Sanduuqa Nabadgelyada ayaa noqon doona bakhaarro, canshuurtu waxay bixinaysaa keliya boqolkiiba 48 kharashka.
Kharashka daryeelka caafimaad ee federaalka ayaa qayb ka ah miisaaniyadda khasabka ah . Taas macnaheedu waa waa in la bixiyaa. Sidaa darteed, waxay cunayaan maaliyad miisaaniyadeed oo aan miisaan lahayn, sida difaaca , waxbarashada ama Waaxda Garsoorka.
Taasina waa hal sabab oo ah in Congress loo ogolaado Obamacare . Waxay uga baahan tahay shirkadaha caymiska inay bixiyaan daryeel kahortag bilaash ah. Waxay daweeyeen xaalado dabadheeraad ah inta aanay u baahneyn daaweyn qolka gurmadka degdegga ah ee cusbitaalka. Waxay kaloo hoos u dhigtay bixinta ceymiska Medicare Advantage.
Laga soo bilaabo 2010, marka Xeerka Daryeelka Lacagta la saxeexan yahay, kharashka daryeelka caafimaadku wuxuu kor u kacay 4.3% sanadkii. Waxay gaartay hadafkeeda ah inay hoos u dhigto kororka kharashka daryeelka caafimaadka.
Sannadkii 2010, xukuumaddu waxay ku qanacday in kharashka Medicare uu kor u kici doono 20 boqolkiiba oo keliya shan sano. Taasi waxay ka timid $ 12,376 qof kasta oo ka faa'iideysanaya 2014 ilaa $ 14,913 sannadka 2019. Halkii, falanqeeyayaasha ayaa la yaabay si ay u ogaadaan kharashka uu hoos u dhacay $ 1,000 qofkiiba, ilaa $ 11,328 sanadka 2014. Waxaa sabab u ah afar sababood oo qaas ah:
- ACA waxay hoos u dhigtay bixiyayaasha Medicare Advantage providers. Qiimaha bixiyeyaasha ee loo maamulo Qaybaha A iyo B waxay kor u kaceen kharashka dawladda. Bixiyeyaasha 'ma caddayn karaan qiimaha sare. Taa bedelkeeda, waxay u muuqatay inay aheyd inay xad-gudub ku sameeyaan dawladda.
- Medicare wuxuu billaabay inuu soo rogo hay'adaha daryeelka caafimaadka lala xisaabtamo, lacagaha la xirxiro iyo lacag-bixinta qiimaha leh. Qiimaha kharashka daryeelka isbitaalku wuu sii jirayaa tan iyo 2011. Qayb ka mid ah sababaha tani waxay tahay in dib-u-cusbooneysiinta cusbataallada ay hoos u dhacdey 150,000 sannadkii 2012 iyo 2013. Taasi waa mid ka mid ah isbitaalada meelaha lagu ciqaabayo haddii ay dhaafaan heerarka. Waxay keentay kor u kaca iyo tayada daryeelka bukaanka.
- Dakhliga soogalootiga badan ayaa bixiyay cashuur dheeraad ah ee canshuurta Medicare iyo Qaybta B iyo D. Waxaa loola jeedaa in caymiska Medicare Qaybta B ee lagu soo oogay qof kasta oo kale in uu sii ahaan karo heerka uu hadda yahay $ 104.90 bishiiba. Wixii dheeraad ah, fiiri Canshuuraha Obamacare .
- Sannadkii 2013, isxukuninta waxay hoos u dhigtay lacagaha Medicare 2 boqolkiiba bixiyeyaasha iyo qorshayaasha.
Iyadoo lagu saleynayo isbeddelladan cusub, kharashka Medicare ayaa la saadaalinayaa inuu koro 5.3 boqolkiiba sanadkiiba inta u dhexeysa 2014 iyo 2024.
Kharashka Daryeelka Caafimaadka Sanadka
| Sannad | Kharashka Qaran ee Caafimaadka (Miisaaniyada) | Kobaca Boqolleyda | Kharashka Qofka | Dhacdada |
|---|---|---|---|---|
| 1960 | $ 27.2 | NA | $ 146 | Dhibaatada |
| 1961 | $ 29.1 | 7.1% | $ 154 | Is-dhaafintu way dhammaatay |
| 1962 | $ 31.8 | 9.3% | $ 166 | |
| 1963 | $ 34.6 | 8.6% | $ 178 | |
| 1964 | $ 38.4 | 11.0% | $ 194 | LBJ waxay bilowday Medicare iyo Medicaid |
| 1965 | $ 41.9 | 9.0% | $ 209 | |
| 1966 | $ 46.1 | 10.1% | $ 228 | Dagaal Vietnam |
| 1967 | $ 51.6 | 11.9% | $ 253 | |
| 1968 | $ 58.4 | 13.3% | $ 284 | |
| 1969 | $ 65.9 | 12.9% | $ 318 | |
| 1970 | $ 74.6 | 13.1% | $ 355 | Dhibaatada |
| 1971 | $ 82.7 | 11.0% | $ 389 | Xakamaynta qiimaha mushaharka |
| 1972 | $ 92.7 | 12.0% | $ 431 | Stagflation |
| 1973 | $ 102.8 | 11.0% | $ 474 | Heerka dahabka ayaa dhamaaday. Xeerka HMO |
| 1974 | $ 116.5 | 13.4% | $ 534 | ERISA. Kantaroolka qiimaha mushaharka ayaa dhammaanaya. |
| 1975 | $ 133.3 | 14.4% | $ 605 | Sicir-bararka 6.9% |
| 1976 | $ 152.7 | 14.6% | $ 688 | Sicir-bararka 4.9% |
| 1977 | $ 173.9 | 13.8% | $ 777 | Sicir-bararka 6.7% |
| 1978 | $ 195.3 | 12.4% | $ 865 | Sicir-bararka 9.0% |
| 1979 | $ 221.5 | 13.4% | $ 971 | Sicir-bararka 13.3% |
| 1980 | $ 255.3 | 15.3% | $ 1,108 | Sicir-bararka 12.5% |
| 1981 | $ 296.2 | 16.0% | $ 1,273 | Qiyaasta kordhay |
| 1982 | $ 334.0 | 12.8% | $ 1,422 | Is-dhaafintu way dhammaatay |
| 1983 | $ 367.8 | 10.1% | $ 1,550 | Khidmadda canshuurta iyo kharashka difaaca |
| 1984 | $ 405.0 | 10.1% | $ 1,692 | |
| 1985 | $ 442.9 | 9.4% | $ 1,833 | |
| 1986 | $ 474.7 | 7.2% | $ 1,947 | Canshuur dhimista |
| 1987 | $ 516.5 | 8.8% | $ 2,099 | Black Monday |
| 1988 | $ 579.3 | 12.2% | $ 2,332 | Qiyaasta kordhay |
| 1989 | $ 644.8 | 11.3% | $ 2,571 | Dhibaatada S & L |
| 1990 | $ 721.4 | 11.9% | $ 2,843 | Dhibaatada |
| 1991 | $ 788.1 | 9.2% | $ 3,070 | Dhibaatada |
| 1992 | $ 854.1 | 8.4% | $ 3,287 | |
| 1993 | $ 916.6 | 7.3% | $ 3,487 | HMOs |
| 1994 | $ 967.2 | 5.5% | $ 3,641 | |
| 1995 | $ 1,021.6 | 5.6% | $ 3,806 | Qiyaasta kordhay |
| 1996 | $ 1,074.4 | 5.2% | $ 3,964 | Dib-u-habaynta daryeelka |
| 1997 | $ 1,135.5 | 5.7% | $ 4,147 | Xeerka Miisaaniyada ee Balansiinta |
| 1998 | $ 1,202.0 | 5.8% | $ 4,345 | Dhibaatada LTCM |
| 1999 | $ 1,278.3 | 6.4% | $ 4,576 | BBRA |
| 2000 | $ 1,369.7 | 7.1% | $ 4,857 | BIPA |
| 2001 | $ 1,486.8 | 8.5% | $ 5,220 | Weerarrada 9/11 |
| 2002 | $ 1,629.2 | 9.6% | $ 5,668 | Dagaalka Argagixisada |
| 2003 | $ 1,768.2 | 8.5% | $ 6,098 | Sharciga Casriyeynta Medicare |
| 2004 | $ 1,896.3 | 7.2% | $ 6,481 | |
| 2005 | $ 2,024.2 | 6.7% | $ 6,855 | Sharciga Dhacdooyinka |
| 2006 | $ 2,156.5 | 6.5% | $ 7,233 | |
| 2007 | $ 2,295.7 | 6.5% | $ 7,628 | |
| 2008 | $ 2,399.1 | 4.5% | $ 7,897 | Kharashka oo hoos udhacay. |
| 2009 | $ 2,495.4 | 4.0% | $ 8,143 | |
| 2010 | $ 2,598.8 | 4.1% | $ 8,412 | ACA saxiixday. |
| 2011 | $ 2,689.3 | 3.5% | $ 8,644 | Dhibaatada Deynta |
| 2012 | $ 2,797.3 | 4.0% | $ 8,924 | Qalab maaliyadeed |
| 2013 | $ 2,879.0 | 2.9% | $ 9,121 | Canshuurta ACA |
| 2014 | $ 3,026.2 | 5.1% | $ 9,515 | Is-beddelka ayaa la furay . |
| 2015 | $ 3,200.8 | 5.8% | $ 9,994 | |
| 2016 | $ 3,337.2 | 4.3% | $ 10,348 |
(Waxaa laga soo xigtey: "Kharashka Qaran ee Kharashka Caafimaadka Qaranka oo ay ka mid yihiin Share of GDP, CY 1960-2016," Xarumaha Adeegyada Medicare iyo Adeegyada Medicaid. " Sicirka Sannadka ee Sannadka ," Balance. " Taariikhda Caafimaadka Qaadashada ee Maraykanka, 1960-2013 , "Xarumaha Adeegyada Medicare iyo Medicaid, Noofambar 19, 2015." Kharashka Daryeelka Caafimaadka ee Mareykanka: Yaa bixiya? "Xarunta Caafimaadka ee California, Diisambar 2015.)