Follow U.S. investment immigration and stay updated on U.S. political news: The U.S. government has been shut down for some time, and the Democratic and Republican parties are still engaged in a fierce struggle over the Affordable Care Act, leaving the world astonished.
Among developed countries globally, the U.S. healthcare system is a rare "freak": on one hand, the U.S. does not provide universal healthcare benefits; on the other hand, it does not set a cap on annual medical expenditures, which leads to U.S. per capita medical spending being twice the average of OECD member countries, resulting in significant medical waste. Facing this healthcare system characterized by a lack of fairness and low efficiency, the Democratic and Republican parties in the U.S. do not disagree on the need for reform, but rather on how the roadmap should be set.
Obama hopes to make the healthcare system fairer, with the goal of using the "hand of big government" to help over 30 million uninsured Americans gain access to health insurance, raising the coverage rate from approximately 85% to about 95%. The operational path for healthcare reform consists of "three legs": first, to "expand" the Medicaid program jointly funded by federal and local governments to benefit more low- and middle-income citizens; second, to mandate that employers with more than 50 employees purchase health insurance for full-time staff; third, under the "individual mandate" clause, to allow the uninsured to purchase government-subsidized health insurance products online through health insurance exchanges, with those who remain uninsured after six months facing penalties.
However, every reform has its costs. Currently, the "three legs" of healthcare reform are under significant pressure: because the "expansion" of Medicaid inevitably increases the pressure on local government matching funds, and last year's Supreme Court ruling did not require states to fulfill this obligation, about half of the U.S. states have said no to it; furthermore, business owners in industries such as catering and hospitality are unwilling to bear the high costs of employee health insurance, leading to widespread opposition in the industry. In July of this year, the White House was forced to delay the implementation of the employer mandate clause by one year to January 2015; now, even the individual mandate clause is facing obstruction from the Republican Party, which hopes to delay its implementation by one year.
In contrast to the healthcare reform approach proposed by the Democratic administration, the Republican Party emphasizes the "hand of the market" to improve the efficiency of the healthcare system. Last year, Republican vice-presidential candidate Paul Ryan detailed his vision for healthcare reform. Although the Democrats demonized it as a "voucher" system, its core idea is to introduce a medical expenditure cap mechanism adopted by many developed countries to the U.S., thereby controlling the excessive expansion of the fiscal deficit.
According to Ryan's vision, the current "defined benefit" system of public healthcare plans should gradually transition to a "defined contribution" system. Specifically, the federal government would no longer provide a fixed percentage of reimbursement, but instead provide citizens with an allowance of approximately $8,000 to purchase medical services, allowing citizens to choose health insurance products from the market themselves, thereby encouraging insurance companies and hospitals to provide high-quality and affordable services.
Is it "big government" or the "big market"? Since the Affordable Care Act was approved by Congress in 2010, the Republican Party's efforts to repeal or weaken the act have never ceased, with about 40 related legislative activities. As the October 1st launch date of the pillar of Obama's healthcare reform—the "Health Insurance Exchange"—arrived, the game between the two parties became even more intense. As Obama said, the closer healthcare reform gets to the implementation threshold, the more frantic the Republican obstruction becomes. This time, the Republicans were even willing to use the government shutdown as a threat to "hit the brakes" on healthcare reform, indicating that the ideological dispute between the two parties is far from being bridged.
History has proven that once social welfare candy is distributed, it is difficult to turn back; therefore, a full debate before distributing the candy may not be a bad thing.