1、Made by 402The reformation of the medical treatment faces lots of obstacles.How did Obama succeed in breaking out of the crisis ? 2數十年來美國歷任總統推行醫改都鎩羽而歸，皆因反對聲四起。奧氏也遇到同樣難題。旨在讓全民都得到醫保的醫改計劃為何遭遇重重阻撓？既然攔阻甚多，這次怎么又能順利過關 ?American former presidents had tried to carry out health reforms in the past years but t

2、hey failed. So many people at all levels reject the health reforms. Obama faced the same difficulties. Why did the health reforms were obstructed heavily even it is good to American? Why Obama got approval this time with solid opposition?3The difficulty of the health care reform in U.Sis encounterin

3、g with opposition美國醫改難 難在遭遇重重反對 團結民主黨 巧用程序阻擊共和黨 Obama strategy is properly to avoid making the same mistakes奧巴馬策略得當 避免重蹈覆轍 United Democratic Party attack Republican Party by using procedures smartly團結民主黨 巧用程序狙擊共和黨 4美國醫改難 難在遭遇重重反對 醫改與美國傳統價值觀相悖Healthcare reform contradicts with the Americans tradition

4、al values 多數人反對建立公共保險機構Most people object to establish the public insurance organization 共和黨極力阻撓醫改 The Republican Party obstructs the healthcare reform vigorously. 保險業堅決抵制醫改The insurance business firm resisting medicine changes醫藥行業反對醫改 The medicine opposethe Healthcare reform中產階級、富人憂心忡忡The middle cl

5、ass and the rich person are heavy-hearted 醫改與美國傳統價值觀相悖Healthcare reform contradicts with the Americans traditional values 民調顯示48%的美國人反對醫改。反對根本原因在于，醫改與美國傳統價值觀相悖。美國人對政府干預市場、國家控制社會的戒心根深蒂固，對政府主導醫療和國家控制醫保的措施保持高度警惕性 .Polls show 48% of Americans opposed to medical reform. Against the fundamental reason is

6、that health care reform with the United States, contrary to traditional values. U.S. government intervention in the market, state-controlled deep-rooted wariness of society, on the government-led control of health care and national health insurance policy to maintain the high degree of vigilance 奧巴馬

7、原想建立非營利公共保險機構，通過與私營保險機構展開競爭有效降低保險費。但大多數人堅決反對，他們認為這是在破壞美國的自由價值觀念，他們青睞市場主導的醫保，要把政府的手拿開。多數人反對建立公共保險機構Most people object to establish the public insurance organization Obama originally wanted to build non-profit public insurance institutions, by means of competing with the private insurance sector to re

8、duce insurance premiums more effectively. But most people firmly opposed, they think this is undermining the American values of freedom, they favor a market-driven health care, to put the governments hand away.共和黨極力阻撓醫改，有黨派思維作祟，但更因執政理念不同。共和黨人一直主張小政府大市場，而醫改將形成強勢政府，對社會生活和經濟產生過分干涉，違背資本主義自由市場經濟的原則 共和黨極力

9、阻撓醫改 The Republican Party obstructs the healthcare reform vigorously. Republicans obstruct medical reform with the thought of party mischief, but more because of the ruling idea is different. Republicans have been advocating small government, big market, while the medical reform will form a strong g

10、overnment, social life and the economy too much interference, which is contrary to the principles of capitalist free market economy保險業堅決抵制醫改The insurance business firm resisting medicine changes受醫改沖擊最大的將是保險業。在美國醫保體系中，保險企業是既得利益者，對醫改持抵制態度。投票前，保險利益集團游說議員，斥巨資投放廣告號召反對醫改。Hardest hit by medical reform will

11、 be the insurance industry. In the United States medical insurance system, insurance companies who have vested interests resisted on medical reform. Before the vote, the insurance interest groups lobby the members and cost lots of money in advertising, called against the medical reform.醫藥行業反對醫改 The

12、medicine oppose the Healthcare reformsome medeine enterprises refuse health reform, for the reforms increase costs. it will use cheap effective medeine and technology, which will cut down the profits of medicine enterprise heavily.what is more, doctor association worry about the reforms may course d

13、amage to doctors interests.藥品企業也反對醫改，因為醫改要控制成本，必然將更多地使用便宜而有效的適宜藥品、適宜技術，醫藥企業的盈利空間將會大大縮小；三是醫生協會，也擔心醫改會損害醫生的利益。除不得不繳納更多稅收來為窮人享受醫保“埋單”外，中產階級、富裕階層還擔心，大量窮人在獲保后涌入醫療服務市場，而醫療資源相對有限，富人們曾經享受的VIP式服務將可能不復存在 In addition to have to pay more taxes to enjoy medical insurance for the poor, pays the bill, the middle c

14、lass and wealthy class is also concerned that a large number of poor by the influx of medical services after the insurance market, while relatively limited medical resources, the rich people who enjoy the VIP-style services may no longer exist中產階級、富人憂心忡忡The middle class and the rich person are heavy

15、-hearted 11奧巴馬策略得當 避免重蹈覆轍 雷厲風行動用輿論壓力Vigorous and resolute use of public pressure 先易后難 逐個擊破The easier one by one break搶在中期選舉前推動改革 Rush to promote the revolution before the mid-term elections頂住壓力 堅持信念Withstand the pressure of its convictions 吸取教訓 只提綱領Lessons provided only program 懂得妥協和放棄Know how to co

16、mpromise and give up 奧巴馬在6月9日民主黨參議院公布醫改方案之后，次日即在全國動員全美200萬草根支持者在50個州展開宣傳，掀起一場全國性的大討論。這實際上也是借助公眾輿論的力量迫使既得利益集團低頭。On June 9 , Obama announced the Senate Democratic health care reform proposal, the next day in national grassroots mobilization of the nations two million supporters in 50 states to have a

17、publicity, which set off a big national discussion. This is actually using the power of public opinion forced the bow of vested interests.雷厲風行動用輿論壓力Vigorous and resolute use of public pressure Obama has the full support of high-profile medical reform program,and then he faced the problems from the i

18、nterference of Congress and interest groups, and even many voters began to waver on his support. But Obama has not manipulated by them, instead of taking a more active engagement situation to face it , even if such contact is not happy.頂住壓力 堅持信念Withstand the pressure of its convictions 奧巴馬高調全面支持醫改方案

19、之后，面臨了來自國會和利益集團的干擾，甚至眾多選民也開始動搖對他的支持。但奧巴馬并未因此受制于人，而是采取了更積極的接觸態勢，哪怕這樣的接觸并不愉快先易后難 逐個擊破The easier one by one to break奧巴馬針對各個利益集團，按難易程度采取分別談判、各個擊破的戰略。奧巴馬積極游說此前一直被稱為“醫改禁區”的美國醫學協會，與全美醫院體系達成共識，并得到了全美護士協會的支持 Obama have a active lobby with the American Medical Association ,which is referred to as restricted m

20、edical reform . Then reach a consensus with the nations hospital system and has been supported by the National Nurses Association.吸取教訓 只提綱領Lessons provided only program 克林頓也曾力推醫改，拿出長達數百頁的報告，卻連國會投票也沒爭取到。有了前車之鑒，奧巴馬沒有推出幾百頁方案，讓議員在看懂之前就失去耐心，而是推出一些綱領和方針，交由國會自行擬訂方案。Clinton has pressed for medical reform wi

21、th hundreds of pages of reports but it failed to get any votes from the Congress. With this lesson, Obama did not release hundreds of pages of the program which will make the Members lose patience before understand, but to introduce programs and policies which is drafted by Congress.搶在中期選舉前推動改革 Rush to promote the revolution before the mid-term elections奧巴馬他在上任后第一年就開始大刀闊斧推行這一改革，爭取在中期選舉季節到來之前取得成果，以免因改革努力受到政治需求限制 懂得妥協和放棄Know how to compromise and give up 奧巴馬作出了讓步，有關設立公共保險機構的構想在參議院的最終版本醫改議案中消失了。這不僅平息了巨大爭議，也將大大降低政府開支。Obama made a concession that the relevant idea of setting up pu