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主题:国庆后的思绪片段:杯子半满半空;左右脚换着走;摸石过河论 -- 红军迷

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家园 国庆后的思绪片段:杯子半满半空;左右脚换着走;摸石过河论

1. 那天看直播,包括白天阅兵和晚上联欢,感觉有豪气有喜气,成功起到震慑敌人鼓舞人民的作用。我当然也跟着升了豪气染了喜气。但看到即使在“阅兵蓝”之下,空中和地表仍不清爽,可以说是雾蒙蒙的,心情添了些许沉重。直播结束之后,两张康辉、海霞吸氧的照片在网络上被传了开。康辉解释说:“有人问你们是不是因为太累了、辛苦,或者说怕播出过程当中出现什么问题,所以才要吸氧。其实不是,我觉得更主要的是,我们希望在准备过程当中,让自己不管是身体还是整个心理状态能调试到一个最好的状态,它更是心理上的一种稳定。”我虽然无法断定这理由是否全对,但总觉得吸氧跟北京的污染有些关系。我爸妈北京家里装了负离子空气清洁机。估计很多人家也有吧?政府说要治霾也不少年了,措施肯定也采取了不少,但看来真是积重难返。也或许是治理不力?更或许是重污染工业一时半会无法转移?总之,在中国成为第一工业国的过程中,付出了极其沉重的代价。杯半满?杯半空?

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2. 今天一位老友发来个视频,是某女学者谈在毛主席领导下,中国的医疗卫生体制解决了全民医疗服务问题,1978年世界卫生组织将此作为全球的榜样推荐,而后来改开把它毁了。其中一个数据尤其令人震惊,让我觉得简直不可思议:到了2000年,世卫组织在全球191个国家中把中国评为倒数第四。我好奇这个倒数第四是指什么?于是搜了一下。原来是指“Fairness of financial contribution to health systems”(医疗系统付费的公平性)。其中说:“great inequality characterizes a few countries in which nearly all health spending is out-of-pocket, notably China, Nepal and Viet Nam”(中国、尼泊尔、越南等几个国家非常不公平, 几乎所有医疗费用都是病人自掏腰包支付)。该报告还几次提到中国从80年代起实行市场改革了:

By the late 1980s, the transformation from communist to market-oriented economies was under way in China, central Europe, and the former Soviet Union. Heavy-handed state intervention in the economy was becoming discredited everywhere, leading to widespread divestiture of state enterprises, promotion of more competition both internally and externally, reduction in government regulation and control, and in general, much more reliance on market mechanisms. Ideologically, this meant greater emphasis on individual choice and responsibility. Politically, it meant limiting promises and expectations about what governments should do, particularly via general revenues, to conform better to their actual financial and organizational capacities.

看来这改开与中国的公平性评分倒数第四有直接关系。当然,我不知道世卫组织的数据是否可靠,因为我印象国内的公费医疗始终没有摧毁到这种地步。好奇的我查看了后来的报告,非常有意思的是2010年的报告(最近的一次报告)正好以全民医保为主题,其中大赞2000年之后中国在这方面的大举措大进展:

Many countries are reforming the way they finance health care as they move towards universal coverage, among them two of the most important global economies, China and the United States of America.

In April 2009, the Chinese government announced plans to provide “safe, effective, convenient and affordable” health services to all urban and rural residents by 2020 (25). If fully implemented, the reform will end market-based mechanisms for health that were introduced in 1978. Prior to then, the government had offered basic but essentially free health-care services to the entire population, but the new market-based approach resulted in a major increase in direct payments – from little more than 20% of all health spending in 1980 to 60% in 2000 – leaving many people facing catastrophic health-care costs. The new approach also meant that hospitals had to survive on patient fees, which put pressure on doctors to prescribe medicines and treatment based on their revenue-generating potential rather than their clinical efficacy.

The government took steps to address these issues. The New Cooperative Medical Schemes, initiated in 2003 to meet the needs of rural populations, and the Urban Residents Basic Medical Insurance scheme, piloted in 79 cities in 2007, are at the heart of the latest reforms. The government aims to reduce dependence on direct payments and increase the proportion of the population covered by formal insurance from 15% in 2003 to 90% by 2011, and to expand access to services and financial risk protection over time (26).

报告说中国2003年实施“新合作医疗制度”,2007年实施“城市居民基本医疗保险制度”,计划将正式医保范围从2003年的15%扩大到2011年90%,到2025年就会完全取代1978年后实行的市场化医疗体制。如果这些数字都属实,则中国政府在80年代初右脚迈了一大步,2000年之后左脚迈了一大步。在当前的政治气氛下,我想左脚还会迈得更远一些吧?如此左一步右一步,七十年走来,有时候难免晃晃悠悠的,但总算是走的正路吧,尤其是举目全球,应该说是创造了奇迹。

3. 今天早上听NPR电台采访纽约时报撰稿人Andrew Marantz。此君最近撰文诟病“言论自由绝对主义”(free speech absolutism),认为没有什么政治理念和规矩是绝对正确的,例如言论自由在美国就有限制,不能鼓吹暴力和犯罪等等。言语间听得出他矛头是指向特朗普这些“民粹”右派的,认为他们言语过激了。随后网上就有好多人骂他,说这是美国宪法第一修正案规定的权利,神圣不可侵犯。问他“Why don't you move to China or North Korea?”我首先想到的是纽约时报本身正是奉行“言论自由绝对主义”呀!支持香港“民粹”鼓吹暴力实施犯罪一点儿也不含糊。这还真是双标到家了。

然而他话锋转向更广泛的话题后,却让我有似曾相识之感,感觉不无道理。他说没有一个理想的社会理论、政治制度是终极的、神圣的、放之四海而皆准的、能解决所有问题的。作为理论来源,他提出了美国哲学家Richard Rorty的Contingency, Irony, and Solidarity (1989)。据他介绍,Rorty的一个基本观点就是没有什么政治理想和制度是天经地义不可动摇、神圣不可改动的;政治体制是人造的,是脆弱的,是会垮塌的;其实合理的态度是根据具体情况变换修正这些理念和制度,要不断根据实际情况改造这些体制,才能解决新问题(即所谓contingency,也就是随机应变吧)。Andrew Marantz以此推论美国宪法、美国制度并不“特殊”,并不神圣,也会出问题,要根据实际情况不断改进。让我想起“实事求是”、“实践是检验真理的标准”、“摸着石头过河”来了。

西西河“左中右”三派人也在争论现执政党、领导人、体制、方向好得很还是糟得很。“左派”说糟得很要彻底拥毛反习反伪共。“右派”说在习近平上台之前是好的,但好得不够(共产党下台最好),习近平上台后变糟了,要彻底反毛反习反共。我们一些“中派”大致的观点是:中国的强盛得来不易,弯路是走了一些,但目前还是举世最正的路。习近平已经奋力纠偏了几年,而且是旗帜鲜明从根子上找回初心(“坚持毛泽东思想”),行动上有所作为(反贪扶贫斗美帝等等)。左右两派如果想打倒重来那就是大错特错。对中国现状、对习近平,都要看大方向。中国革命这个杯子我看大半杯是满的。走路从来需要左右两只脚。摸着石头过河没什么不好的。

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