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1、The reformation of the medical treatment faces lots of obstacles. How did Obama succeed in breaking out of the crisis ?,2,数十年来美国历任总统推行医改都铩羽而归，皆因反对声四起。奥氏也遇到同样难题。旨在让全民都得到医保的医改计划为何遭遇重重阻挠？既然拦阻甚多，这次怎么又能顺利过关 ?,American former presidents had tried to carry out health reforms in the past years but they fail
2、ed. 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?,3,The difficulty of the health care reform in U.S is encountering wit
3、h opposition 美国医改难 难在遭遇重重反对,团结民主党 巧用程序阻击共和党,Obama strategy is properly to avoid making the same mistakes 奥巴马策略得当 避免重蹈覆辙,United Democratic Party attack Republican Party by using procedures smartly 团结民主党 巧用程序狙击共和党,4,美国医改难 难在遭遇重重反对,民调显示48%的美国人反对医改。反对根本原因在于，医改与美国传统价值观相悖。美国人对政府干预市场、国家控制社会的戒心根深蒂固，对政府主导医疗和
4、国家控制医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 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-
5、led control of health care and national health insurance policy to maintain the high degree of vigilance,奥巴马原想建立非营利公共保险机构，通过与私营保险机构展开竞争有效降低保险费。但大多数人坚决反对，他们认为这是在破坏美国的自由价值观念，他们青睐市场主导的医保，要把政府的手拿开。,Obama originally wanted to build non-profit public insurance institutions, by means of competing with the
6、private insurance sector to reduce 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.,共和党极力阻挠医改，有党派思维作祟，但更因执政理念不同。共和党人一直主张小政府大市场，而医改将形成强势政府，对社会生活
7、和经济产生过分干涉，违背资本主义自由市场经济的原则,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 government, social life and the economy too m
8、uch interference, which is contrary to the principles of capitalist free market economy,受医改冲击最大的将是保险业。在美国医保体系中，保险企业是既得利益者，对医改持抵制态度。投票前，保险利益集团游说议员，斥巨资投放广告号召反对医改。,Hardest hit by medical reform will be the insurance industry. In the United States medical insurance system, insurance companies who have v
9、ested 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.,some medeine enterprises refuse health reform, for the reforms increase costs. it will use cheap effective medeine an
10、d technology, which will cut down the profits of medicine enterprise heavily.what is more, doctor association worry about the reforms may course damage to doctors interests.,药品企业也反对医改，因为医改要控制成本，必然将更多地使用便宜而有效的适宜药品、适宜技术，医药企业的盈利空间将会大大缩小；三是医生协会，也担心医改会损害医生的利益。,除不得不缴纳更多税收来为穷人享受医保“埋单”外，中产阶级、富裕阶层还担心，大量穷人在获保
11、后涌入医疗服务市场，而医疗资源相对有限，富人们曾经享受的VIP式服务将可能不复存在,In addition to have to pay more taxes to enjoy medical insurance for the poor, pays the bill, the middle class and wealthy class is also concerned that a large number of poor by the influx of medical services after the insurance market, while relatively limi
12、ted medical resources, the rich people who enjoy the VIP-style services may no longer exist,11,奥巴马策略得当 避免重蹈覆辙,雷厉风行动用舆论压力 Vigorous and resolute use of public pressure,先易后难 逐个击破 The easier one by one break,抢在中期选举前推动改革 Rush to promote the revolution before the mid-term elections,顶住压力 坚持信念 Withstand the
13、 pressure of its convictions,吸取教训 只提纲领 Lessons provided only program,懂得妥协和放弃 Know how to compromise and give up,奥巴马在6月9日民主党参议院公布医改方案之后，次日即在全国动员全美200万草根支持者在50个州展开宣传，掀起一场全国性的大讨论。这实际上也是借助公众舆论的力量迫使既得利益集团低头。,On June 9 , Obama announced the Senate Democratic health care reform proposal, the next day in na
14、tional grassroots mobilization of the nations two million supporters in 50 states to have a publicity, which set off a big national discussion. This is actually using the power of public opinion forced the bow of vested interests.,雷厉风行动用舆论压力 Vigorous and resolute use of public pressure,Obama has the
15、 full support of high-profile medical reform program,and then he faced the problems from the interference 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
16、 if such contact is not happy.,顶住压力 坚持信念 Withstand the pressure of its convictions,奥巴马高调全面支持医改方案之后，面临了来自国会和利益集团的干扰，甚至众多选民也开始动摇对他的支持。但奥巴马并未因此受制于人，而是采取了更积极的接触态势，哪怕这样的接触并不愉快,先易后难 逐个击破 The easier one by one to break,奥巴马针对各个利益集团，按难易程度采取分别谈判、各个击破的战略。奥巴马积极游说此前一直被称为“医改禁区”的美国医学协会，与全美医院体系达成共识，并得到了全美护士协会的支持,Obama have a active lobby with the American Medical Association ,which is referred to as restricted medical reform . Then reach a consensus with the nations hospital system and has been supported by the
