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| Local governments across China, facing a financial tipping point after three years of expensive Covid measures, are forcing abrupt changes on the country’s health care system, squeezing benefits and angering citizens. | 实行了三年代价高昂的新冠“清零”政策后，中国的地方政府面临财政危机，被迫突然修改国家的医保制度，消减公民享有的福利，引起了民众的愤怒。 |
| Thousands of seniors, who are most vulnerable to the cutbacks, converged on municipal parks and other public spaces in recent days to protest the changes. They gathered in the chilly northeastern city of Dalian, in semitropical Guangzhou nearly 1,500 miles away and in Wuhan in central China, where the Covid pandemic began at the end of 2019. | 最近几天，数以千计的老年人聚集在各地的公园和其他公共场所抗议这些改革措施，他们是受影响最大的群体。从寒冷的东北城市大连，到与大连相距2400公里的亚热带城市广州，再到新冠病毒大流行于2019年底开始的地方——中部城市武汉，都出现了抗议集会。 |
| One of the most immediate problems is that municipal insurance funds that pay for many people’s hospital care are running out of money. The funds, supported by taxes on employers, face big deficits that city governments are required by law to top up. | 最紧迫的问题之一是，覆盖许多人住院治疗费用的政府医保基金已经花光。这些基金来自对雇主的征税，如今正面临着巨额赤字，按照法律要求，地方政府需要弥补这些赤字。 |
| To free up money to bail out hospitals, municipalities have started contributing much less to another important category of insurance, known as personal health accounts, which the middle class uses to pay for medicine and outpatient care. | 为了腾出钱来帮助医院度过困境，市政当局已开始减少对医保个人账户的投入。中产阶级用个人账户来支付医药费和门诊费。 |
| While public opposition to the changes has not reached the scale of demonstrations in late November against “zero Covid,” the strict policy of mass testing and lockdowns that was reversed in early December, they underscore the disillusionment among many Chinese. Benefits promised to seniors when the economy was growing fast are becoming more precarious. | 虽然公众对这些变化的反对还没有达到去年11月下旬反对新冠“清零”的示威活动的规模（政府已在去年12月初取消了大规模核酸检测和封控的严格政策），但它们凸显了许多中国人的幻灭感。经济快速增长时向老年人承诺的福利正变得越来越不可靠。 |
| “The personal account is our own money,” Chen Guangyao, 59, a retiree from a state-owned factory in Wuhan, said last week. He didn’t join protesters on Feb. 15 and 16, but said he shared their anger. | “个人账户就是我们自己的钱，”现年59岁的陈广遥（音）上周说，他是武汉一家国企的退休职工。他没有参加2月15日和16日抗议活动，但他说，他和那些参加抗议的人一样愤怒。 |
| “The government can’t take money from other people’s pockets through medical reform, which is encroaching on the interests of the people,” he said, pausing from practicing his saxophone in a park. | “你不能通过医改，你不能想着这个心思上，把人家钱拿了，绝对不行，侵占了人民的利益，”正在一个公园里练习萨克斯的陈广遥停下来说道。 |
| Each city government is taking a slightly different approach to finding savings on health insurance. In Wuhan, the authorities are trying to soften the blow from big cuts in personal health accounts by adding some outpatient coverage and medicine purchases to hospitalization plans. | 为节省医保费用，各地政府采取的做法略有不同。武汉当局正试图通过把更多医疗机构和药店纳入职工医保门诊统筹结算范围，来减轻个人账户大幅削减带来的冲击。 |
| The furor over health insurance highlights a broader fiscal crunch in China’s localities, which often bear the brunt of paying for policies handed down from Beijing, such as “zero Covid.” | 对医保改革的愤怒凸显出中国地方政府普遍存在财政紧缩的状况。在执行北京下达的政策时（比如“清零”政策），地方政府往往是承担代价的一方。 |
| On top of bearing extra costs during the pandemic, local governments face growing health care needs for a rapidly rising number of retirees. Yet the main source of municipal revenue has shriveled as real estate developers buy less public land because of a housing shakeout long in the making. | 除了在疫情期间承担“清零”的额外代价外，地方政府还面临着人数迅速增长的退休人员越来越多的医保需求。然而，地方政府的主要财政来源已经萎缩，因为已经持续了一段时间的房地产市场震荡，导致房地产开发商减少了购买公共土地。 |
| Some civil servants and teachers are being paid late or getting pay cuts. Entities affiliated with local governments are missing loan payments or trying to reschedule their debts, which could force losses on banks and other lenders. | 一些公务员和教师被拖欠工资或减薪。与地方政府有关联的实体已出现拖欠还贷或试图重组债务的情况，这可能会迫使银行和其他贷款方蒙受损失。 |
| But the changes to health insurance are being felt in an acutely personal way. | 但是，医保的变化让人们有了非常切身的感受。 |
| Three-quarters of China’s population of 1.4 billion — farmers, migrant workers and others in low-wage occupations as well as children — don’t have personal health accounts and must rely on bare-bones coverage known as residents insurance. | 中国14亿人口中有四分之三的人没有医保个人账户，包括农民、农民工和其他从事低收入职业的人以及儿童，这些人必须依赖被称为居民保险的最基本保障。 |
| Roughly a quarter of the people have employee hospitalization plans plus personal health accounts, including many current and former employees of state-owned enterprises and better-paid employees and retirees of private companies. Civil servants, who make up only a tiny share of the population, have supplementary insurance in addition to hospital insurance and personal health accounts, said Xian Huang, an associate professor of political science at Rutgers University who studies China’s health care system. | 在中国，大约四分之一的人口拥有医保统筹基金和个人账户，其中包括许多国企的在职员工和退休员工，以及民营企业薪酬较高的员工和退休人员。公务员只占人口的很小一部分，除了医院保险和医保个人账户外，他们还有补充保险，罗格斯大学研究中国医保制度的政治学副教授黄宪（音）说。 |
| Holders of personal health accounts who are not part of the civil service — the people protesting now — “are not the most privileged group, but they are still a privileged group,” Professor Huang said. | 不属于公务员队伍的个人账户持有者，也就是现在正在发起抗议的群体“不是最有特权的群体，但仍是特权群体”，黄宪说。 |
| During the pandemic, the national government allowed many businesses to reduce their mandatory contributions to the health insurance funds for employees that pay hospitalization costs. Lower contributions from businesses coincided with higher costs at hospitals because of Covid. | 疫情期间，中央政府允许很多企业减少对员工医保统筹基金的缴款，这个强制性缴纳的健康保险基金是用来支付住院费用的。在企业减少缴纳保险基金的同时，新冠病毒大流行导致住院费用的增加。 |
| It is no accident that the biggest protests have been in Wuhan. | 最大规模的抗议活动发生在武汉并非偶然。 |
| In January 2020, the city’s hospitals responded to the first Covid outbreak with a successful but extremely expensive effort to stamp out the disease by medically isolating and treating thousands of infected people. The national government subsequently announced that it would overhaul hospitalization insurance within three years. | 2020年1月，武汉的医院对新冠疫情第一波数以千计的感染者进行了医学隔离和治疗，这种做法虽然成功地消除了感染，但成本极其高昂。中央政府随后宣布将在三年内对住院保险进行全面改革。 |
| Demographic changes in China have complicated the task. The number of births each year has dropped by nearly two-thirds since the late 1980s. Fewer young workers support more and more retirees who require ever more health care. | 中国人口结构的变化让这项工作变得复杂。中国现在每天出生的人口比20世纪80年代后期下降了近三分之二。工作年龄的人口越来越少，他们要为越来越多需要更多医疗服务的退休人员贡献医保基金。 |
| Cities are now cutting how much money their hospitalization plans transfer to the personal health accounts of retirees. Wuhan’s reduction of transfer amounts by a little more than two-thirds is particularly steep. | 中国各地的城市现在正在削减从统筹基金转入退休人员个人医保账户的金额。武汉将转入个人账户的金额减少了三分之二以上，步子迈得尤其大。 |
| Local governments are also introducing or increasing deductibles. Wuhan has begun requiring retirees to pay the first $75 of expenses each year and current workers to pay the first $100. | 地方政府也在引入或提高起付线。武汉退休人员的医保起付线是每年500元，在职人员的医保起付线是每年700元。 |
| The average income for urban retirees is about $6,000 a year, not including personal savings. Rural retirees subsist on much less. | 中国城市退休人员的平均年收入约为4万元，不包括个人存款。农村退休人员的生活费要低得多。 |
| Social policy experts have cautiously welcomed the health insurance policy changes. | 社会政策专家对医保制度的变化持谨慎欢迎的态度。 |
| “After years of delay, the government needs to reform a social safety net that is extremely fragmented and unequal, with relatively good benefits for people like those protesting in Wuhan and very sparse benefits for people in the countryside or without formal employment,” said Mary Gallagher, a professor specializing in China’s labor and social issues at the University of Michigan. | “经过多年拖延后，政府需要改革一个极度分散和不平等的社会保障体系。目前的医保为武汉抗议者这样的人提供相对较好的福利，为农民或没有正式职业的人提供的福利非常少，”密歇根大学研究中国劳工和社会问题的教授高敏(Mary Gallagher)说。 |
| Yang Qingming, 69, worked as a housemaid and never qualified for employee insurance. Now in retirement in Wuhan, she relies on residents insurance, like three-quarters of China’s people. She lives on $300 a month and spends half of it on medicine for high blood pressure and diabetes. Her insurance reimburses her for almost none of the cost of her medicine. | 69岁的杨清明（音）当了一辈子保姆，从来没有资格参加职工医保。她退休后住在武汉，她和四分之三没有医保的中国人一样依靠城乡居民基本医疗保险。她每月只有2100元的生活费，其中一半花在治疗高血压和糖尿病上。她的保险几乎不报销她的药费。 |
| Her recent gallstone surgery cost nearly $1,500, but less than a third of it could be expensed under her insurance plan, she said. She has delayed surgery for colitis, she said, because she does not have the money. | 她说，她最近做的胆结石手术花了约一万元，保险仅支付了不到三分之一的费用。她说，因为没有钱，她已经推迟了结肠炎手术。 |
| “If I don’t go for treatment, the pain is unbearable; if I go to see a doctor, I can hardly afford it,” she said. | “不去治，疼得受不得了；要看病，又看不起，”她说。 |
| The new medical insurance system rolled out by Wuhan allows people with employee insurance to use the money from their existing personal accounts to begin paying for the medical care of their parents, spouses or children. | 武汉推出的新医保制度允许参保职工用个人账户中现有的钱支付父母、配偶或子女的医疗费用。 |
| Many older urban Chinese feel that they led difficult lives when they were young and China was poor. Those with employee health insurance contend that they helped build today’s relatively prosperous China, and resent being asked to sacrifice money from their personal health accounts. | 中国城市的许多老年人认为，他们年轻时生活艰难，因为那时中国很穷。那些拥有职工医疗保险的人认为，他们帮助建设了今天相对繁荣的中国，他们对于牺牲个人账户资金的要求感到不满。 |
| “The socialist country today was created by us, the older generation,” said a senior who said he had attended recent protests in Wuhan. He spoke on the condition of anonymity to avoid police retaliation. | “因为社会主义国家到今天，是我们老一辈创造的，”一名自称参加了武汉最近的抗议活动的老年人说。为避免遭到警方报复，他不愿透露姓名。 |
| Some in China favor raising taxes to pay for more social services and stabilize the finances of local governments. China has almost no property taxes, except for nominal sums collected in several cities, including Shanghai. China has no inheritance taxes or taxes on investment gains. | 中国有些人赞成提高税收以提供更多的社会福利，稳定地方政府的财政。中国几乎没有财产税，除了在包括上海在内的几个城市收取很少的财产税外。中国也没有遗产税或投资收益税。 |
| In a speech last month at the National University of Singapore, Lou Jiwei, a former finance minister who still has considerable influence, called for broader experiments with real estate taxes. | 上个月，在新加坡国立大学发表讲话时，仍具有相当影响力的中国前财政部长楼继伟呼吁更广泛地展开征收房地产税的试点工作。 |
| Robin Xing, the chief China economist at Morgan Stanley, said a real estate tax would not raise enough money to bail out the country’s local governments. He predicted that these governments would have to sell some of their many assets, like hotels and conference centers. | 摩根士丹利首席中国经济学家邢自强表示，征收房地产税无法提供救助中国地方政府所需的足够资金。他预计，地方政府将不得不出售它们众多资产中的一部分，例如酒店和会议中心。 |
| The health insurance difficulties are just the start of a much bigger problem from China’s rapid aging. | 医保困难只是中国快速老龄化带来的一个更大问题的冰山一角。 |
| Pensions are also handled by local governments, and government agencies allowed many employers to reduce pension contributions, too, during the pandemic. | 养老金也由地方政府负责，政府机构在新冠病毒大流行期间也曾允许许多雇主减少缴纳养老金。 |
| “Health care is Part 1,” Mr. Xing said. “Pensions, when you get more and more people retiring, is Part 2.” | “医保问题是第一章，”邢自强说。“退休的人越来越多时，养老金是第二章。” |
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