问题的关键在于：这是原则问题，还是经济问题。 如果不是原则问题，那就变成了一个问题——我们所有人愿意接受的价格是多少。 我之前提出、而你质疑的观点是： 通过提高透明度、拆分那些滥用市场力量的公司、并建立具有竞争性和效率的市场， 各州或整个国家，才能真正审视医疗成本，并判断在州级或国家层面推行全民医疗是否合理。 我不认为我们可以从现有体系直接“跳转”到全民医疗。 既得利益太多了。 目前的市场被保险公司和大型医院集团所控制。 即便有人试图推行“全民医保（Medicare for All）”， 这些公司也会将其扭曲，最终把它变成一场只对他们有利的暴利盛宴。 如果 @doj（美国司法部） 和 @ftc（联邦贸易委员会） 能真正履行职责、将这些巨头拆分， 那么市场机制或许才能开始发挥作用，逐步淘汰中间商。 当竞争把成本压低到足够低时， 各州或整个国家，才能基于真实的人均医疗成本， 做出务实、理性、且有数据支撑的决策。 我相信，如果我们能把成本降到足够低， 最早的实践会出现在城市或州一级。 如果行得通，其他州自然会跟进、复制。 The question is whether its principle or economics. If it’s not principle, then it’s a question of what is the price we are all willing to accept. My point, that you questioned, is that with transparency, breaking up companies that are abusing the market, and creating competitive, efficient markets, states or the country as a whole, can look at the cost of care and determine if universal care at the state or national level makes sense I don’t think we can just convert from where we are , to universal care. There are too many entrenched interests. The markets are controlled by insurance companies and huge hospital networks. Even if someone tried to create M4 All, those companies would bastardize it and make it a windfall for themselves. If the @doj and @ftc do their jobs, and break them up, then hopefully the market does its job, and eliminates the middlemen. Then competition can drive costs low enough where states or the country as a whole can look at the actual cost of healthcare per person and make a pragmatic , educated decision I believe if we can get the costs low enough, the first implementations will come at the city or state level. If it works , other states will copy.