Hellander I, Moloo J, Himmelstein D U, Woolhandler S, Wolfe S M
Physicians for a National Health Program, Chicago, IL 60604, USA.
Int J Health Serv. 1995;25(3):377-92. doi: 10.2190/AQTP-FLAQ-PWXN-DYMR.
Despite a massive expansion of Medicaid and an upswing in the economy, the total number of Americans uninsured in 1993 was 39.7 million, more than at any time since the passage of Medicaid and Medicare in the 1960s. Since 1989, the ranks of the uninsured have swelled by 6.3 million. Millions more would be uninsured if Medicaid enrollment had not risen dramatically, by 10.5 million people since 1989. Loss of health coverage is a growing problem for middle-income families, women, and children, as it has long been for low-income families. Even in Hawaii, whose employer mandate program is often cited as a model of universal coverage, there was a large increase in uninsurance. Nationwide, the sharp upswing in the number of Americans who are uninsured has coincided with government and corporate policies to encourage medical competition and push people into managed care plans. Republican proposals to limit AFDC benefits threaten to further increase uninsurance, particularly among women and children. Only a Canadian-style single-payer reform can assure universal coverage and simultaneously contain costs.
尽管医疗补助计划大幅扩张且经济有所回升，但1993年未参保的美国人总数仍达3970万，比20世纪60年代医疗补助计划和医疗保险通过以来的任何时候都多。自1989年以来，未参保人数增加了630万。如果医疗补助计划的参保人数没有自1989年以来急剧增加1050万人，那么未参保人数还会多出数百万。失去医保覆盖对中等收入家庭、妇女和儿童来说，正成为一个日益严重的问题，长期以来这对低收入家庭也是如此。即便在夏威夷，其雇主强制参保计划常被视作全民医保的典范，但未参保人数也大幅增加。在全国范围内，未参保美国人数量的急剧上升与政府和企业鼓励医疗竞争并促使人们加入管理式医疗计划的政策同时出现。共和党限制对有子女家庭补助福利的提议，可能会进一步增加未参保人数，尤其是妇女和儿童中的未参保人数。只有加拿大式的单一支付者改革才能确保全民医保并同时控制成本。
