好想尼克松海星 译 晓融 校

chrisxsy

【编者按：保尔·克鲁格曼是美国普林斯顿大学的经济学教授和《纽约时报》的专栏作家。2008年，他获得了诺贝尔经济学奖。这篇题为《好想尼克松》的文章不仅准确地指出奥巴马医改方案受阻的原因，也敏锐地指出了美国民主在过去30多年遭遇到了巨大侵蚀和污染的现实。在他看来，善治在美国已经是稀有“物质”，要改变这种状况需要长期和坚定的政治改革。选一个好总统是一回事，让政府有效和公正地管理国家是另一回事。既得利益者阻挠改革其实不是美国的特色，任何一个国家的改革者都必然遇到这样的阻挠。阻挠改革的阴险、自私、倒退的力量常常裹着“爱国”、“爱民”和“爱自由”的外衣，往往可以有效而有力地把改革势力和它的骨干分子打成“叛徒”、“内奸”和“***贼”。美国如此，中国也一样。对美国人来说，尼克松不是好总统，但尼克松时代却值得怀念。对中国人来说，我们希望政府在改革方面也有“摸着石头过河”的勇气和胆略神。】
    很多回忆泰德·肯尼迪生平的悼念文章都提及他后悔当初没有接受理查德·尼克松提出的两党联袂推出的医改方案。这些评论家从肯尼迪的遗憾中得到的教训是现今的医疗改革者们应当做当年肯尼迪不愿意做的事：与反对党合作。
　　但这却是一个很糟糕的类比，因为今日的政治氛围与20世纪70年代早期相比早已大相径庭。实际上，纵观当今政治，我发现自己格外想念理查德·尼克松。
　　不，我没有失去理智。从掌握行政大权的人来看，尼克松确实是有史以来除了迪克·切尼以外最糟糕的政客。
　　但在尼克松时代，两党领袖能够就政策制定理智地进行交流，其决策的制定也不像今天这样受大公司的支配和控制。与35年前相比，现在的美国在诸多方面有所改善和进步，然而，我们的政治体制应对问题的能力反倒是急剧下降，以致于有时我都在怀疑这个政府还能不能管理这个国家。
　　正如许多人所指出的那样，尼克松当初的医改提案与今日民主党的提案颇为相似。实际上，尼克松的方案在某些方面比现在的方案还要好。目前，共和党人对大型企业和单位必须向其雇员提供医保的规定犹豫不决。当年，尼克松的方案要求所有的企业和单位，而不仅仅是大企业和单位，要为其员工提供医保。
　　尼克松还主张对保险公司实行更严厉的监管，授权各州“批准具体计划，监督费用，确保信息公开，要求年度审计并采取其他适当的措施”。尼克松的方案并不认为市场机制可以提供解决问题的有效办法。
　　那么，一位共和党总统能摆脱意识形态偏见并拿出一项如此合情合理的提案的日子怎么会一去不返了呢？
　　部分答案在于历史学家里克·佩尔斯坦所说的“疯狂对于他们是一种既存状态”的极右翼现今已接管了我们两个主要政党中的一个。而能参与探讨医疗改革事宜的共和党人中的温和派不是已被挤出党外就是遭到胁迫而缄默不语。当参与决策制定的关键性人物之一--爱荷华州参议员查理·葛拉斯理也在散播“死亡专家小组”（death panels）的流言蜚语之时，民主党人还能与谁去沟通？
　　目前的医疗改革比尼克松执政时代更举步维艰的另一个原因在于企业的影响力极度膨胀。
　　我们认为现在的形势跟当年没什么区别--庞大的游说集团在权力的走廊里安营扎寨，为了阻止触犯了它们底线的立法活动，商业公司一面播放误导性的广告，一面组织虚假的草根抗议。然而，商业公司和现金支配的体制是个相对新兴的事物，它的出现大体是在20世纪70年代末期。
　　由于这种体制的存在，任何改革都极为艰难,对于医保改革更是如此。在这一领域日益增长的财政支出使得既得利益者的权势与尼克松时代相比要大得多。比如医疗保险产业，其在GDP中所占的比重从1970年的1.5%跃升到了2007年的5.5%，因此曾经无足轻重的参与者俨然已成长为一头政治巨兽，现正以每日140万美元的开销在国会游说。
　　大公司的游说催生了那些看起来令人费解的辩论。为什么像来自北达科他州参议员康纳德这样的“中立”民主党人会如此反对奥巴马的公共医保提案？这项提案可以让美国人从政府直接购买医疗保险，以此与商业保险公司竞争。不用在意他们自相矛盾的观点；真正起作用的是现金。
　　大佬党（共和党）的极端与大企业的实力的结合使得我们不得不怀疑，即便医疗改革方案得以通过（尽管是否有这样的结局还不得而知），它可能还不如尼克松当年的提案，尽管民主党人控制着白宫，并在国会有着压倒性的优势。
　　其他的挑战又是怎样的呢？我所能想到的每一项亟须进行的改革，从温室气体排放控制到重建财政收支平衡，都不得不同样遭遇游说和谎言的重重阻挠。
　　我并不是说改革者们应当坐以待毙。但是他们必须意识到自己面临着的困难是什么。去年，人们热议奥巴马将如何成为一位“变革型”的总统。然而，真正的变革不仅仅是选举出一位仪表堂堂的领袖。实际上，要改变这个国家的走向意味着年复一年的长期鏖战，因为敌人是那些不计一切代价捍卫一个已经几近瘫痪的政治制度的既得利益集团。

英文(纽约时报，2009年8月31日)

Missing Nixon by Paul Kurgman

Many of the retrospectives on Ted Kennedy’s life mention his regret that he didn’t accept Richard Nixon’s offer of a bipartisan health care deal. The moral some commentators take from that regret is that today’s health care reformers should do what Mr. Kennedy balked at doing back then, and reach out to the other side.
But it’s a bad analogy, because today’s political scene is nothing like that of the early 1970s. In fact, surveying current politics, I find myself missing Richard Nixon.

No, I haven’t lost my mind. Nixon was surely the worst person other than Dick Cheney ever to control the executive branch.
But the Nixon era was a time in which leading figures in both parties were capable of speaking rationally about policy, and in which policy decisions weren’t as warped by corporate cash as they are now. America is a better country in many ways than it was 35 years ago, but our political system’s ability to deal with real problems has been degraded to such an extent that I sometimes wonder whether the country is still governable.
As many people have pointed out, Nixon’s proposal for health care reform looks a lot like Democratic proposals today. In fact, in some ways it was stronger. Right now, Republicans are balking at the idea of requiring that large employers offer health insurance to their workers; Nixon proposed requiring that all employers, not just large companies, offer insurance.
Nixon also embraced tighter regulation of insurers, calling on states to “approve specific plans, oversee rates, ensure adequate disclosure, require an annual audit and take other appropriate measures.” No illusions there about how the magic of the marketplace solves all problems.
So what happened to the days when a Republican president could sound so nonideological, and offer such a reasonable proposal?
Part of the answer is that the right-wing fringe, which has always been around — as an article by the historian Rick Perlstein puts it, “crazy is a pre-existing condition” — has now, in effect, taken over one of our two major parties. Moderate Republicans, the sort of people with whom one might have been able to negotiate a health care deal, have either been driven out of the party or intimidated into silence. Whom are Democrats supposed to reach out to, when Senator Chuck Grassley of Iowa, who was supposed to be the linchpin of any deal, helped feed the “death panel” lies?
But there’s another reason health care reform is much harder now than it would have been under Nixon: the vast expansion of corporate influence.
We tend to think of the way things are now, with a huge army of lobbyists permanently camped in the corridors of power, with corporations prepared to unleash misleading ads and organize fake grass-roots protests against any legislation that threatens their bottom line, as the way it always was. But our corporate-cash-dominated system is a relatively recent creation, dating mainly from the late 1970s.
And now that this system exists, reform of any kind has become extremely difficult. That’s especially true for health care, where growing spending has made the vested interests far more powerful than they were in Nixon’s day. The health insurance industry, in particular, saw its premiums go from 1.5 percent of G.D.P. in 1970 to 5.5 percent in 2007, so that a once minor player has become a political behemoth, one that is currently spending $1.4 million a day lobbying Congress.
That spending fuels debates that otherwise seem incomprehensible. Why are “centrist” Democrats like Senator Kent Conrad of North Dakota so opposed to letting a public plan, in which Americans can buy their insurance directly from the government, compete with private insurers? Never mind their often incoherent arguments; what it comes down to is the money.
Given the combination of G.O.P. extremism and corporate power, it’s now doubtful whether health reform, even if we get it — which is by no means certain — will be anywhere near as good as Nixon’s proposal, even though Democrats control the White House and have a large Congressional majority.
And what about other challenges? Every desperately needed reform I can think of, from controlling greenhouse gases to restoring fiscal balance, will have to run the same gantlet of lobbying and lies.
I’m not saying that reformers should give up. They do, however, have to realize what they’re up against. There was a lot of talk last year about how Barack Obama would be a “transformational” president — but true transformation, it turns out, requires a lot more than electing one telegenic leader. Actually turning this country around is going to take years of siege warfare against deeply entrenched interests, defending a deeply dysfunctional political system.
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