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What has gone wrong with America? With The Conscience of a Liberal, best-selling author Paul Krugman points the way to a new New Deal.

America emerged from Franklin Roosevelt's New Deal with strong democratic values and broadly shared prosperity. But for the past thirty years American politics has been dominated by a conservative movement determined to undermine the New Deal's achievements - a movement whose founding manifesto was Barry Goldwater's The Conscience of a Conservative. That movement has been highly successful in turning the clock back: both the inequality of today's America and the corruption of its political life hark back to the age of the robber barons.

Now the tide may be turning - and in The Conscience of a Liberal Paul Krugman, the world's most widely read economist and one of its most influential political commentators, charts the way to reform.

Krugman ranges over a century of history, from the political economy of the Gilded Age - which seems all too familiar these days - to the calamities of the Bush years, which he argues were inevitable once movement conservatives gained full control of the U.S. government. He shows that neither the middle-class America the baby boomers grew up in nor the increasingly oligarchic nation we have become over the past generation evolved naturally: both were created, to a large extent, by government policies guided by organized political movements. He explains how defenders of inequality have exploited cultural and racial divisions to their advantage, while reformers have found ways to bridge those divisions. And he argues that the time is ripe for another great era of reform.

Last but not least, The Conscience of a Liberal outlines a program for change. It shows how universal health care can be the centerpiece of a new New Deal, just as Social Security was the core of the original. It explains what can be done to narrow the wealth and income gap. And it shows how a new political coalition can both support and be supported by reform, making our society not just more equal but more democratic.

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Paul Krugman has at least three jobs: he is professor of economics and international affairs at Princeton University; Centenary Professor at the London School of Economics; and, perhaps his best-known job, an op-ed columnist for the New York Times. In recognition of his influence the Washington Monthly called him “the most important political columnist in America.”

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但凡有可能，保险公司总会仔细审查申请人，寻找他们可能需要昂贵治疗的迹象，如家族史、工作性质等，尤其是保前疾病。如有一丝迹象表明，一位申请者比一般人更易带来高额医疗开支，公司就绝不会向他提供买得起的保险。

保险公司却花大钱来筛选候选申请人，抗拒付款。医生、医院等医疗服务提供者也花大钱与保险公司周旋、对抗，以得到付款。在美国当前的医疗体系中有一个被称为“拒付处理”的产业，即那些在保险公司拒付时帮助医生与其进行交涉的公司。

在美国，包括保险公司成本与医疗提供者成本在内的总管理成本占医疗开支的 31%，而在加拿大则不到 17%。

美国的体制还有一个不得不提的可怕缺陷：保险公司几乎没有动力为预防性医疗付账，而这能节省大笔的潜在医疗开支。最招致恶评的例子是糖尿病：对于可能在早期控制病情的治疗措施，保险公司常常不愿意付费，但却愿意为糖尿病失控后经常导致的截足手术付款。

目前为止，我把美国的体系说的像一场噩梦，对许多人而言这并不夸张。但约 85% 的美国人是享有医疗保险的，而且大多得到妥善的治疗。这一体系为何运转的还不错？

原因之一是，政府也在提供医疗保障方面扮演了关键角色。... 另一个原因是，绝大多数享有私人医疗保险的美国人是通过其雇主得到这种保险的。

雇主必须向所有员工提供相同的医疗待遇，不论过去的健康状况如何。所以，以雇佣关系为基础的保险为一些真正需要的人提供了保险，使其免为保险公司的筛选所害。... 但这一曾经的解药正在失效。

基于雇佣关系的保险衰落的动因是保险成本的上升。... 保险为何在变贵？答案竟然是医疗进步。由于医疗科技的革新，许多过去无法救治的疾病现在也能治疗了，不过费用不菲。保险公司为这些治疗付账，但提高保险费以弥补损失。

现有的医疗保障体制经常导致人们做出非理性的选择，而费用的上涨则会加剧这种非理性。特别是，美国的医疗保障体系把过国民分为体制内和体制外两种类型。体制...

现在谈谈好消息：数年来政策分析人士和政治家已经研究出了一套医疗改革构想，它似乎是条可行的折中路线，既考虑经济利益，也顾及政治现实。这套构想包括四个基本要素：1. 统一费率；2. 低收入家庭补助；3. 强制保险；4. 公私竞争。

若有人被认为在政治上不可靠，日子就会相当难过。

里根早期政治成功的要诀是应和人们在族群与性别上的焦虑感，拿人们对共产主义的恐惧做文章，而且最重要的是，以隐秘的方式利用白人对民权运动及其影响的逆反情绪，从中渔利。

大多数美国人的医疗保险是和就业挂钩的，这就意味着，大多数即将失业的人也将失去他们的医疗保险。

除去共和党和共和党政治家外，保守主义运动还包括传媒机构、智库、出版社等。人们可以在这个网络里度过整个职业生涯，而且有人的确是这么做的。他们知道不管发生什么事，只要保持政治忠诚，便能够得到回报。

里根早期政治成功的要诀是迎合人们在族群与性别上的焦虑感，拿人们对共产主义的恐惧做文章，而且最重要的是，以隐秘的方式利用白人对民权运动及其影响的逆反情绪，从中渔利。。

书籍介绍

What has gone wrong with America? With The Conscience of a Liberal, best-selling author Paul Krugman points the way to a new New Deal.

America emerged from Franklin Roosevelt's New Deal with strong democratic values and broadly shared prosperity. But for the past thirty years American politics has been dominated by a conservative movement determined to undermine the New Deal's achievements - a movement whose founding manifesto was Barry Goldwater's The Conscience of a Conservative. That movement has been highly successful in turning the clock back: both the inequality of today's America and the corruption of its political life hark back to the age of the robber barons.

Now the tide may be turning - and in The Conscience of a Liberal Paul Krugman, the world's most widely read economist and one of its most influential political commentators, charts the way to reform.

Krugman ranges over a century of history, from the political economy of the Gilded Age - which seems all too familiar these days - to the calamities of the Bush years, which he argues were inevitable once movement conservatives gained full control of the U.S. government. He shows that neither the middle-class America the baby boomers grew up in nor the increasingly oligarchic nation we have become over the past generation evolved naturally: both were created, to a large extent, by government policies guided by organized political movements. He explains how defenders of inequality have exploited cultural and racial divisions to their advantage, while reformers have found ways to bridge those divisions. And he argues that the time is ripe for another great era of reform.

Last but not least, The Conscience of a Liberal outlines a program for change. It shows how universal health care can be the centerpiece of a new New Deal, just as Social Security was the core of the original. It explains what can be done to narrow the wealth and income gap. And it shows how a new political coalition can both support and be supported by reform, making our society not just more equal but more democratic.