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【奥译言】川普提出医保改革计划，呼吁精简FDA

2017年2月28日，美国总统唐纳德·川普（中）在美国国会大厦众议院会议厅举行的美国国会联席会议上发表首次演讲时，美国副总统Mike Pence（左）和美国众议院议长Paul Ryan（右）为其鼓掌称赞。

在上周二（2017年2月28日）晚上举行的一次美国国会联席会议上（今年不要称其为国情咨文），美国总统川普提出了医保改革的框架，主要遵循美国众议院议长Paul Ryan提出的模式。他还呼吁在药品审批方面推行法律方面的改革。

川普说：“今晚，我.…..呼吁国会废除奥巴马医保（Obamacare），并推行替代方案，来扩大选择范围、增加参与途径、削减成本，同时提供更高质量的医疗保障。”川普在说出“奥巴马医保（Obamacare）”后，由于共和党人的欢呼喝彩，川普的演讲不得不短暂停顿。

川普批评道，美国平价医疗法案（ACA）的核心是个人强制医保，实际上是20世纪90年代传统基金会保守主义滋生出来的一种想法。

川普说：“要实现对所有人的医疗保障，应该压低医疗保险的成本，这就是大家将要着手的工作。”随后，川普嘲笑了前总统巴拉克·奥巴马的臭名昭着的“如果你喜欢你的医生，那么你就保留你的医生”的承诺。

川普宣布：“当下，奥巴马医保（Obamacare）正在崩溃，大家必须果断地采取行动保护所有美国人。”那一刻，在场所有共和党人起立鼓掌，而民主党人坚定的坐着一动不动。

川普说：“行动不是选择，而是必然。所以，我呼吁国会的所有民主党人和共和党人与大家一起，共同保护美国人不受即将爆发的奥巴马医保灾难的侵袭。”这时镜头切换到了国会众议院民主党领袖Nancy Pelosi，她一边摇头一边傻笑。

川普提出：“大家将创建一个更完善的医疗体系。”并列出了他认为国会应该遵循的五个原则：

1.    总统川普提出，应该保证美国人有途径获得资金，来治疗投保前就患有的疾病。应保证已经参与ACA医保市场交易的美国人可以实现平稳过渡。
2.    川普建议通过税收减免和扩大医疗储蓄帐户的使用，帮助美国人支付自行承担的部分。“但是，计划必须是他们自己希翼享有的，而不是政府强制施加于他们的”，川普提到。
3.    “大家应该给予州长们更多资源和灵活性，这样他们才能在推行医保时，保证不会有任何人被遗漏。”
4.     由于不必要的成本拉高了保险的价格，川普呼吁推行法律方面的改革来改变这一点，“大家应该致力于拉低药品不正常的高价，立即把药价降下来。”
5.    “终于，是时候赋予美国人跨越各州的边界，去选择购买何种医保的权利了”，川普说。川普认为这一举措将创造一个“真正自由竞争的全国性市场，从而大幅削减成本，医保的质量也会大幅提高”。在这里，川普似乎再次将保险责任范围与医疗保障混为一谈。

川普还提出，2月28日是国际罕见病日，他先容了美国圣母大学一名20岁的学生Megan Crowley，根据白宫发布的资讯简报，Megan Crowley在15个月大的时候被诊断患有庞贝氏症。Megan Crowley的父亲为了开发一种酶替代疗法来治疗庞贝氏症，随后创立了Novazyme Pharmaceuticals（现在由Genzyme拥有）。

川普提出：“FDA缓慢、繁琐的批准程序阻碍了很多处于需要中的人获得有效的治疗方案（就像挽救了Megan Crowley生命的先进疗法），如果大家可以打破这些限制，不只是FDA的限制，还有其他所有政府部门的限制，更多像Megan Crowley一样的奇迹就会发生，大家将得到佑护。”

Trump lays out health insurance reform plan, calls for streamlined FDA

Vice President Mike Pence (L) and Speaker of the House Paul Ryan (R) applaud as President Donald Trump (C) delivers his first address to a joint session of the U.S. Congress on Feb. 28, 2017 in the House chamber of the U.S. Capitol.

In his address Tuesday night to a joint session of Congress — don’t call it a State of the Union this year — President Donald Trump laid out a framework for reforming healthcare, largely following a model proposed by House Speaker Paul Ryan. He also called for unspecified reforms in drug approval.

“Tonight, I am … calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower cost and at the same time, provide better healthcare,” Trump said, pausing after “Obamacare” for an ovation mostly from Republicans.

He criticized the individual insurance mandate that is a centerpiece of the Affordable Care Act — an idea actually hatched by the conservative Heritage Foundation in the 1990s.

“The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going to do,” Trump said. He then took a shot at former President Barack Obama’s infamous “If you like your doctor, you can keep your doctor” promise.

“Obamacare is collapsing and we must act decisively to protect all Americans,” Trump declared. It was one of those moments where every Republican in the room stood and applauded while Democrats sat stoically.

“Action is not a choice, it is a necessity,” Trump said. “So I am calling on all Democrats and Republicans in Congress to work with us to save Americans from this imploding Obamacare disaster.” Cameras cut to House Democratic Leader Nancy Pelosi, who smirked as she shook her head.

Trump laid out five principles he said Congress should follow as “we move to create a better healthcare system.”:

1. People with preexisting conditions should have access to coverage, the president said. There should be a “stable transition” for people with plans from ACA insurance exchanges.
2. He proposed tax credits and expansion of health savings accounts to help people purchase coverage. “But it must be the plan they want, not the plan force on them by our government,” Trump said.
3. “We should give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out.”
4.  He called for unspecified reforms to protect patients and physicians “from unnecessary costs that drive up the price of insurance and work to bring down the artificially high price of drugs.”
5.  “Finally, the time has come to give Americans the freedom to purchase health insurance across state lines,” Trump said. He argued that this move would create a “truly competitive national marketplace that will bring costs way down and provide far better care.” Here, he once again seemed to conflate insurance coverage with care.

Trump also gave a nod to the fact that Feb. 28 is Rare Disease Day, and he introduced 20-year-old Notre Dame student Megan Crowley, who was diagnosed with Pompe Disease when she was 15 months old, according to a White House release. Crowley’s father subsequently founded Novazyme Pharmaceuticals — a company now owned by Genzyme — to develop an enzyme replacement therapy to treat Pompe Disease.

“Our slow and burdensome approval process at the Food and Drug Administration keeps too many advances, like the one that saved Megan’s life, from reaching those in need,” Trump said. “If we slash the restraints, not just at the FDA, but across our government, then we will be blessed with far more miracles just like Megan.”

内容来自：MedCity News

整理翻译：奥咨达