如果你不知道投哪个党，我提供给你一个投票的思路:关注医疗改革，投票给反对党
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今天读到一篇谈加拿大健康服务改革问题的文章。转上来供大家参考，也听听大家的评论。
翻译不正确的地方，欢迎批评修改。
Better health care or financial folly?
是更好的健康服务，还是财政上的下策？
http://www.troymedia.com/2011/04/21/better-health-care-or-financial-folly/
VANCOUVER, BC, Apr. 21, 2011/ Troy Media/ – When it comes to health care, all three of Canada’s major federal political parties are drinking the same Kool-Aid. All three say they will maintain the six per cent annual increases to health care transfer payments to the provinces past 2014. But does it not seem odd they want to spend more money on a problem that has little to do with how much we spend, especially at a time when Ottawa can ill afford it?
一旦讨论到健康服务，三个主要的政党都去喝同样的迷魂药。三个政党都说他们要在2014年以后继续以每年6%增加向省政府下拨的健康服务款项。但是，他们要针对一个其实几乎跟多少钱没有什么关系的问题继续花更多的钱，特别是当渥太华很难支付的时候，难道不是看起来很奇怪吗？
The reality is that Canada’s health care system is already one of the most expensive universal access health care programs in the developed world. On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, only Iceland spent more on their universal access health insurance system than Canada as a share of GDP, while Switzerland spent as much as Canada. The other 25 developed nations who maintain universal health insurance programs spent less than we did; as much as 38 per cent less as a percentage of GDP in the case of Japan.
事实是，加拿大的健康服务系统已经是发达国家全民健康服务系统里面花费最多的系统之一了。根据最近几年可得到的、以年龄为权重调整的相关资料比较，只有冰岛以GDP用于全民健康保险上的支出比例高于加拿大，而瑞士和加拿大花得一样多。其他25个拥有全民医疗保险的发达国家，都比我们支出少，日本用于全民医疗保险的GDP比例比我们居然少38%。
High cost, poor access
高成本，低服务
Yet, despite this very high level of spending, Canadians endure poor access to physicians, poor access to modern and advanced medical technologies (many of which are old and outdated), and some of the longest waiting lists for medical care in the developed world.
尽管如此高的成本支出，加拿大人却忍受着医生和医疗设备的不足(很多是旧的和过时的) ，而且在某些方面是发达国家里面等待医疗服务时间最长的。
The real problem in Canada is not a lack of funds or inadequate transfers from the federal government. It is our inability to put the already generous financial resources to good use. That stems from a lack of policy freedom for Canada’s provinces which has contributed to poor health care policy at the provincial level.
真正的问题，不是资金不足，也不是从联邦下拨的款项不充分。问题在于我们没有能力把已经相当充分的财政资源用到好处。这源于加拿大省政府在政策制定上的自由度不足，从而导致了糟糕的省级医疗服务政策。
All of the top-performing universal access health insurance programs in the developed world, be they programs that outperform others in outcomes from the health care process (such as Sweden, Australia, Switzerland, and Japan) or programs that deliver universal access to care without waiting lists (such as Switzerland, Japan, France, and Germany), subscribe to the same set of health care policies. Every one of these nations has cost sharing for universally insured services, private hospitals delivering universally accessible/publicly funded care, and a private parallel health care (financing and delivery) sector.
所有在发达国家中表现最好的全民医疗服务计划，也就是那些在健康服务的成绩上比其他国家好的(比如瑞典、澳大利亚、瑞士和日本) ，或者是那些让病人们不必排队就可以得到全民医疗服务的(比如瑞士、日本、法国和德国) ，都具有相同的健康服务政策体系。每一个这样的国家，都有成本分摊的全民医疗保险服务，公众投资的或者是私立医院里提供的全民共享的服务，以及一个并行的私立健康服务系统。
Yet none of Canada’s three main political parties mentioned the possibility of adopting, let alone even studying, these sensible and successful health care policies. More importantly, they also made no mention of removing the strings attached to health care transfers by Ottawa so that provinces could be free to choose for themselves how best to organize health care. It seems, the six per cent commitment will come with the usual strings attached, leaving Canadians with more costs, yet the same results from a failing system.
而加拿大的三大政党没有一个提及采纳，或者至少研究，这些合情合理的而且成功的政策的可能性。更重要地，他们也不提及取消那些加在给省政府下拨健康服务款项上的种种限制措施以便于省政府可以灵活组织自己的健康服务计划。看来，这每年6%的经费增长是会附加着和以前一样的限制，让加拿大人承担更多的成本，却得到这个正在失败的系统的同样结果。
The policy restrictions Ottawa attaches to health care transfers can in part be found in the Canada Health Act. The Act, whose principal purpose is to set out the rules under which Ottawa will make cash transfers in support of health and social services to the provinces, specifically prohibits user fees or cost sharing for universally accessible services. Provinces that implement cost sharing, a policy that is employed in all of the developed world’s top performing universal access health care systems, put their health and social transfers from Ottawa at risk.
渥太华给省健康预算下拨款的政策限制，体现在加拿大健康法律。这项法令，主旨是要建立一个让渥太华必须遵从的规矩来下拨款项用于支持省政府的健康和社会服务开支，却明确禁止对于全民医疗服务收取使用费或分摊成本。实行成本分摊的省份，使他们自己冒着失去从联邦得到的健康和社会服务款项的危险，而这样的成本分摊是所有发达国家最成功的全民医疗服务系统都采用的方法。
Ottawa has also repeatedly committed to disallowing a private parallel health insurance system in Canada. While the constitution clarifies that such a policy decision is for the provinces to make, Ottawa’s sizable cash transfers to the provinces no doubt play an important role in provincial policy making.
渥太华也一再声明，不允许一个私立并行的健康保险系统在加拿大存在。虽然宪法规定，这样的政策应该是由省来决定，但是渥太华那项规模巨大的拨款毫无疑问地影响到省政府的政策制定过程。
The only policy common among top-performing universal access health care systems not disallowed by the federal government is private competitive provision of hospital services. Put differently, provinces are free to follow the lead of countries like Sweden and allow private hospitals to deliver health care under the terms of the public insurance program.
唯一没有被联邦禁止的、也是所有最成功的全民健康服务系统共同拥有的政策，是私立竞争性的医院服务。换一种说法就是，省政府可以学那些先进国家比如瑞典的样子，允许私立医院提供在全民保险计划下的医疗服务。
Clearly, the federal government has restricted the provinces’ ability to positively reform health care. The international experience and economic literature show that these policy restrictions have been to the detriment of both Canadians in need of health care and taxpayers who fund health care services.
很明显，联邦政府限制了省政府有效地改革健康服务体制的能力。国际的经验和经济研究都表明这些政策限制已经造成了对需要健康服务的加拿大人和为健康服务集资的纳税人的共同伤害。
Time to revise Canada Health Act
现在是修改加拿大健康法律的时候了
What Canadians need from their major federal parties is a commitment to reforming the Canada Health Act to require universality and portability and to leave the details of how the universal health care insurance program is to be structured to provincial governments. Such a revision to the Canada Health Act leaves intact the noble goals of Medicare but allows choices over health care policy to be made by governments that are much closer to the populations the health care system serves and recognizes that Canada’s 10 provinces often deal with very different realities.
加拿大人现在需要几个主要政党做的，是承诺修改加拿大健康法律，实现全民普遍性和灵活性，并把全民健康保险计划的具体内容留给省政府来制定。这样修改过的加拿大健康法律，保留了医疗保险的高尚目标，同时把健康服务的具体选项留给更接近那些健康服务系统的受益人的省政府来制定，也更能够体现出加拿大十个省份的不同现实。
Canadians are poorly served by commitments to shovel large sums of money at the health care system without any substantial change to the way health care is organized in this country. They would be far better served by commitments to allow the provinces greater flexibility to implement sensible health care reforms and the freedom to depart from our current failing health care policies, many of which are mandated by Ottawa.
承诺把巨额款项用于健康服务系统，却不在实质上改变这个健康服务系统在这个国家的运行机制，加拿大人是得不到什么好处的。承诺给省政府在制定合理的健康服务系统上更大的灵活空间，并给省政府对目前的失败的健康服务政策----这些政策很多是来自渥太华的命令----进行改革的自由，会让加拿大人生活得更好。
Nadeem Esmail is a senior fellow with the Fraser Institute.
作者是Fraser研究所的资深研究人员
翻译不正确的地方，欢迎批评修改。
Better health care or financial folly?
是更好的健康服务，还是财政上的下策？
http://www.troymedia.com/2011/04/21/better-health-care-or-financial-folly/
VANCOUVER, BC, Apr. 21, 2011/ Troy Media/ – When it comes to health care, all three of Canada’s major federal political parties are drinking the same Kool-Aid. All three say they will maintain the six per cent annual increases to health care transfer payments to the provinces past 2014. But does it not seem odd they want to spend more money on a problem that has little to do with how much we spend, especially at a time when Ottawa can ill afford it?
一旦讨论到健康服务，三个主要的政党都去喝同样的迷魂药。三个政党都说他们要在2014年以后继续以每年6%增加向省政府下拨的健康服务款项。但是，他们要针对一个其实几乎跟多少钱没有什么关系的问题继续花更多的钱，特别是当渥太华很难支付的时候，难道不是看起来很奇怪吗？
The reality is that Canada’s health care system is already one of the most expensive universal access health care programs in the developed world. On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, only Iceland spent more on their universal access health insurance system than Canada as a share of GDP, while Switzerland spent as much as Canada. The other 25 developed nations who maintain universal health insurance programs spent less than we did; as much as 38 per cent less as a percentage of GDP in the case of Japan.
事实是，加拿大的健康服务系统已经是发达国家全民健康服务系统里面花费最多的系统之一了。根据最近几年可得到的、以年龄为权重调整的相关资料比较，只有冰岛以GDP用于全民健康保险上的支出比例高于加拿大，而瑞士和加拿大花得一样多。其他25个拥有全民医疗保险的发达国家，都比我们支出少，日本用于全民医疗保险的GDP比例比我们居然少38%。
High cost, poor access
高成本，低服务
Yet, despite this very high level of spending, Canadians endure poor access to physicians, poor access to modern and advanced medical technologies (many of which are old and outdated), and some of the longest waiting lists for medical care in the developed world.
尽管如此高的成本支出，加拿大人却忍受着医生和医疗设备的不足(很多是旧的和过时的) ，而且在某些方面是发达国家里面等待医疗服务时间最长的。
The real problem in Canada is not a lack of funds or inadequate transfers from the federal government. It is our inability to put the already generous financial resources to good use. That stems from a lack of policy freedom for Canada’s provinces which has contributed to poor health care policy at the provincial level.
真正的问题，不是资金不足，也不是从联邦下拨的款项不充分。问题在于我们没有能力把已经相当充分的财政资源用到好处。这源于加拿大省政府在政策制定上的自由度不足，从而导致了糟糕的省级医疗服务政策。
All of the top-performing universal access health insurance programs in the developed world, be they programs that outperform others in outcomes from the health care process (such as Sweden, Australia, Switzerland, and Japan) or programs that deliver universal access to care without waiting lists (such as Switzerland, Japan, France, and Germany), subscribe to the same set of health care policies. Every one of these nations has cost sharing for universally insured services, private hospitals delivering universally accessible/publicly funded care, and a private parallel health care (financing and delivery) sector.
所有在发达国家中表现最好的全民医疗服务计划，也就是那些在健康服务的成绩上比其他国家好的(比如瑞典、澳大利亚、瑞士和日本) ，或者是那些让病人们不必排队就可以得到全民医疗服务的(比如瑞士、日本、法国和德国) ，都具有相同的健康服务政策体系。每一个这样的国家，都有成本分摊的全民医疗保险服务，公众投资的或者是私立医院里提供的全民共享的服务，以及一个并行的私立健康服务系统。
Yet none of Canada’s three main political parties mentioned the possibility of adopting, let alone even studying, these sensible and successful health care policies. More importantly, they also made no mention of removing the strings attached to health care transfers by Ottawa so that provinces could be free to choose for themselves how best to organize health care. It seems, the six per cent commitment will come with the usual strings attached, leaving Canadians with more costs, yet the same results from a failing system.
而加拿大的三大政党没有一个提及采纳，或者至少研究，这些合情合理的而且成功的政策的可能性。更重要地，他们也不提及取消那些加在给省政府下拨健康服务款项上的种种限制措施以便于省政府可以灵活组织自己的健康服务计划。看来，这每年6%的经费增长是会附加着和以前一样的限制，让加拿大人承担更多的成本，却得到这个正在失败的系统的同样结果。
The policy restrictions Ottawa attaches to health care transfers can in part be found in the Canada Health Act. The Act, whose principal purpose is to set out the rules under which Ottawa will make cash transfers in support of health and social services to the provinces, specifically prohibits user fees or cost sharing for universally accessible services. Provinces that implement cost sharing, a policy that is employed in all of the developed world’s top performing universal access health care systems, put their health and social transfers from Ottawa at risk.
渥太华给省健康预算下拨款的政策限制，体现在加拿大健康法律。这项法令，主旨是要建立一个让渥太华必须遵从的规矩来下拨款项用于支持省政府的健康和社会服务开支，却明确禁止对于全民医疗服务收取使用费或分摊成本。实行成本分摊的省份，使他们自己冒着失去从联邦得到的健康和社会服务款项的危险，而这样的成本分摊是所有发达国家最成功的全民医疗服务系统都采用的方法。
Ottawa has also repeatedly committed to disallowing a private parallel health insurance system in Canada. While the constitution clarifies that such a policy decision is for the provinces to make, Ottawa’s sizable cash transfers to the provinces no doubt play an important role in provincial policy making.
渥太华也一再声明，不允许一个私立并行的健康保险系统在加拿大存在。虽然宪法规定，这样的政策应该是由省来决定，但是渥太华那项规模巨大的拨款毫无疑问地影响到省政府的政策制定过程。
The only policy common among top-performing universal access health care systems not disallowed by the federal government is private competitive provision of hospital services. Put differently, provinces are free to follow the lead of countries like Sweden and allow private hospitals to deliver health care under the terms of the public insurance program.
唯一没有被联邦禁止的、也是所有最成功的全民健康服务系统共同拥有的政策，是私立竞争性的医院服务。换一种说法就是，省政府可以学那些先进国家比如瑞典的样子，允许私立医院提供在全民保险计划下的医疗服务。
Clearly, the federal government has restricted the provinces’ ability to positively reform health care. The international experience and economic literature show that these policy restrictions have been to the detriment of both Canadians in need of health care and taxpayers who fund health care services.
很明显，联邦政府限制了省政府有效地改革健康服务体制的能力。国际的经验和经济研究都表明这些政策限制已经造成了对需要健康服务的加拿大人和为健康服务集资的纳税人的共同伤害。
Time to revise Canada Health Act
现在是修改加拿大健康法律的时候了
What Canadians need from their major federal parties is a commitment to reforming the Canada Health Act to require universality and portability and to leave the details of how the universal health care insurance program is to be structured to provincial governments. Such a revision to the Canada Health Act leaves intact the noble goals of Medicare but allows choices over health care policy to be made by governments that are much closer to the populations the health care system serves and recognizes that Canada’s 10 provinces often deal with very different realities.
加拿大人现在需要几个主要政党做的，是承诺修改加拿大健康法律，实现全民普遍性和灵活性，并把全民健康保险计划的具体内容留给省政府来制定。这样修改过的加拿大健康法律，保留了医疗保险的高尚目标，同时把健康服务的具体选项留给更接近那些健康服务系统的受益人的省政府来制定，也更能够体现出加拿大十个省份的不同现实。
Canadians are poorly served by commitments to shovel large sums of money at the health care system without any substantial change to the way health care is organized in this country. They would be far better served by commitments to allow the provinces greater flexibility to implement sensible health care reforms and the freedom to depart from our current failing health care policies, many of which are mandated by Ottawa.
承诺把巨额款项用于健康服务系统，却不在实质上改变这个健康服务系统在这个国家的运行机制，加拿大人是得不到什么好处的。承诺给省政府在制定合理的健康服务系统上更大的灵活空间，并给省政府对目前的失败的健康服务政策----这些政策很多是来自渥太华的命令----进行改革的自由，会让加拿大人生活得更好。
Nadeem Esmail is a senior fellow with the Fraser Institute.
作者是Fraser研究所的资深研究人员
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因为根据现行加拿大建康法，联邦政府对于医院经营无能为力
这么长的贴，其实说到点子上的不多，只有老闹子转贴的菲莎研究所的文章，才有一定道理。菲莎作为保守党宣传部，是给哈珀的理念摇旗呐喊呢。
只有哈珀政府愿意修改建康法，让各省有更大自主权，自己决定公有制或私有制，单轨或双轨，而自由新民两党，则把保守党这种主张当作违法（违反建康法）来批判，他们主张的是，严格全民公费公有医疗制度，给各省增加拨款以保证单轨公有制，对于各省明里暗里引进私人机构的行为要严罚。有个数据说明，哈珀政府因各省违反全民健康法而对各省的罚款，比前自由党政府受到的罚款，大幅减少一个数量级，不是因为哈珀时代各省都守法了，相反各省为广开财源变相引入私人机构参予公费医疗体系的事情多了，而哈珀睁一只眼闭一只眼，他的理念是只要病人能得到最好的医疗服务，怎么都是可以的。
个人人为，如果认同加拿大全民公费医疗制度到了要大修的时候了，不反对双轨制私有制，那么哈珀的“违法”是好事情。如果你的理念相同，你在自由新民以及魁人党中找不到知音，你应该选择保守党。
老闹子的转贴的转贴 说:
今天有空，多整点浮云。
老闹子给出了电视辩论的录像，但是好像没有抓住哈珀讲了什么。哈珀的反动言论是样子的：
“governments across this country have experimented with alternative service delivery….We’re not going to wave the finger at provinces because they experiment with different delivery.”
“加拿大各级政府正在进行替代[医疗]服务的试验...我们[保守党联邦政府]不会因为各省政府试验不同的[医疗服务]方式而出手制止。”[译错请指正]
对于各省违反公费健康法律的事情，哈珀看来心知肚明，自由党新民党批判他对健康体系“不作为”，大概言出于此，这种“不作为”，是鼓励各省摸一摸石头过河，找到比现行联邦健康法更有效更有力省民的健康医疗运作体制，因为哈珀了解，这个加拿大健康法 不work，至少 不 work well。至于诸位，认不认同，自己心里有杆秤了。
老闹子给出了电视辩论的录像，但是好像没有抓住哈珀讲了什么。哈珀的反动言论是样子的：
“governments across this country have experimented with alternative service delivery….We’re not going to wave the finger at provinces because they experiment with different delivery.”
“加拿大各级政府正在进行替代[医疗]服务的试验...我们[保守党联邦政府]不会因为各省政府试验不同的[医疗服务]方式而出手制止。”[译错请指正]
对于各省违反公费健康法律的事情，哈珀看来心知肚明，自由党新民党批判他对健康体系“不作为”，大概言出于此，这种“不作为”，是鼓励各省摸一摸石头过河，找到比现行联邦健康法更有效更有力省民的健康医疗运作体制，因为哈珀了解，这个加拿大健康法 不work，至少 不 work well。至于诸位，认不认同，自己心里有杆秤了。
That's well said. I always believe the true issue on our health care is system problem rather than fund problem. Efficiency is too low and waste is too much. It is not an issue of shortage on fund at alll, but very bad jobs done under this system. Actually, there's almost no any business run by a government can do well, that's why I believe small government is the right thing to do for Canada.
谢谢参加讨论并提供评论。正如你说的，前面那些帖子更多的是表达一种态度，而这篇文章具体讨论一些改革的道路问题。
我基本上支持文中所分析的改革思路，但是对于作者的结论，也就是联邦放权，把改革的具体方法完全留给省政府去做，不能完全认同。作者的理由是说因为省政府比联邦更接近医疗服务的对象，并且各个省面临的具体困难也不同，所以联邦除了给钱其他方面不应该干涉各省的医疗服务运行机制。这个意见不是完全没有道理，但是我觉得也不能绝对。面对如此严重的医疗服务落后于国民经济水平的现象，联邦不能无所作为。而作者在参考其他国家的成功经验来讨论加拿大的具体改革方法时，也并没有说那些事情联邦就做不到。所以可以看出，作者分析问题的思路和他得出的结论，并不是顺理成章的。因此看完这篇文章，我的印象与其说作者是为保守党摇旗呐喊，不如说他是为省政府从联邦争取权力的御用研究者。
退一步说，就算是改革的出路只能是联邦放权给省政府，那就必须修改医疗服务法案。这就是联邦政府应该好好讨论并且去推行的事情。哈博政府在过去的五年，并没有去推动这样的讨论，也没有做其他的改革。我对于支持哪个党的医疗政策没有成见。但是在大选中选民对于执政党的判断，应该不是看他们说的未来政策有多么好，而是看他在位时具体做了什么。
个人之见，不足为信。我也在观望中。
谢谢参加讨论并提供评论。正如你说的，前面那些帖子更多的是表达一种态度，而这篇文章具体讨论一些改革的道路问题。
我基本上支持文中所分析的改革思路，但是对于作者的结论，也就是联邦放权，把改革的具体方法完全留给省政府去做，不能完全认同。作者的理由是说因为省政府比联邦更接近医疗服务的对象，并且各个省面临的具体困难也不同，所以联邦除了给钱其他方面不应该干涉各省的医疗服务运行机制。这个意见不是完全没有道理，但是我觉得也不能绝对。面对如此严重的医疗服务落后于国民经济水平的现象，联邦不能无所作为。而作者在参考其他国家的成功经验来讨论加拿大的具体改革方法时，也并没有说那些事情联邦就做不到。所以可以看出，作者分析问题的思路和他得出的结论，并不是顺理成章的。因此看完这篇文章，我的印象与其说作者是为保守党摇旗呐喊，不如说他是为省政府从联邦争取权力的御用研究者。
退一步说，就算是改革的出路只能是联邦放权给省政府，那就必须修改医疗服务法案。这就是联邦政府应该好好讨论并且去推行的事情。哈博政府在过去的五年，并没有去推动这样的讨论，也没有做其他的改革。我对于支持哪个党的医疗政策没有成见。但是在大选中选民对于执政党的判断，应该不是看他们说的未来政策有多么好，而是看他在位时具体做了什么。
个人之见，不足为信。我也在观望中。
First thing first. In Conservative's point of view, the first priority for now is stablize the economy and reduce the deficit.
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现在4个党中没有一个党有行动纲领， 就是因为哪怕很小比例的自费，都会得罪很多的下层选民， 这个党就肯定没有上台的机会。
这就好比在一艘在海上颠簸的船上， 船上的人都带有很重的包裹，里面是以后生活的必需品。 现在海水开始往船里漫， 解决的方法就是丢掉你身上包裹里部分东西。 这个方法对于有钱人问题不大， 他们只要能安全上岸，再花钱重新买这些物质。 但是船上的穷人占大多数。 这些穷人不愿意丢弃任何东西，说这是他们以后生活的保障。
糟糕的是船上采用民主制度选择船长。 如果你想当船长，你就不能得罪船上占大多数的穷人。 大家只能眼睁睁地看着船沉下去。
这就好比在一艘在海上颠簸的船上， 船上的人都带有很重的包裹，里面是以后生活的必需品。 现在海水开始往船里漫， 解决的方法就是丢掉你身上包裹里部分东西。 这个方法对于有钱人问题不大， 他们只要能安全上岸，再花钱重新买这些物质。 但是船上的穷人占大多数。 这些穷人不愿意丢弃任何东西，说这是他们以后生活的保障。
糟糕的是船上采用民主制度选择船长。 如果你想当船长，你就不能得罪船上占大多数的穷人。 大家只能眼睁睁地看着船沉下去。
