Ω 草莓酱拌饭小组Ω BY单眼皮VS肿眼皮——耐住寂寞，努力沉淀，戒除浮躁

dairymanUID：2683905

恩？上海上门按摩，糟糕，我思想有些毛糙

单眼皮vs肿眼皮UID：2705887

今天很挫的把第一篇阿狗扔给莉香MM。。。韶华MM也帮着改了。。。(╥﹏╥)
要努力了，不再灌水。

AW我来了，一定要打败你！

ddcmj519UID：176326

欣慰啊。。一路检查作业过来。。完成度是前几个报到最好的。。。我要泪奔了。。。

单眼皮vs肿眼皮UID：2705887

哇，草莓MM出现了！抱住，大大的MUA一口。
处女写很挫，我又修改了一下。在9楼。。。
ECO读了，还没放上来！

单眼皮vs肿眼皮UID：2705887

有了草莓MM的鼓励，我也要更加努力了！

单眼皮vs肿眼皮UID：2705887

This incentive problem even extends to patients. If patients pay very little out of their own pockets they have little desire to curb consumption. Though this is a problem in many OECD countries, in America the proportion of out-of-pocket(不列入预算的) spending has declined sharply in the past few decades. And a new report by McKinsey, a firm of management consultants, identifies a more subtle problem. Having examined insurance and out-of-pocket spending for several health risks, it concludes that Americans are generally “over-insured and under-saved”. It is prudent for individuals to have comprehensive health insurance against catastrophic health risks such as heart attacks or cancer. But McKinsey finds that Americans with private health insurance often have generous coverage for non-essential and even medically unjustified care (see chart 3). This encourages over-consumption.

The power of sunshine

A second big factor pushing up health costs is the lack of competition among operators of American hospitals. Thanks to a wave of consolidation in recent years, argues Harvard’s Ms Herzlinger, “most parts of the United States are dominated by oligopolistic（寡头，垄断式的） hospital systems.” George Halvorson, who heads Kaiser Permanente, insists that “there is an almost total lack of price competition among providers.”

Nimble upstarts and innovators are challenging the incumbents（在职，现任） in some areas. Such efforts range from specialist heart hospitals, which get better outcomes at more reasonable prices than local general hospitals, to retail clinics at Wal-Mart stores. Remote medicine, in the form of technology for tele-care or medical tourism to Thailand and Costa Rica, also poses a threat. But medical lobbies are using political influence and outdated regulations to thwart（阻挠，使受挫）competition where they can (for example, through rules preventing a doctor from treating a patient in another state).

To counter this（反驳之）, reforms could allow federal regulators to overrule state-level obstacles to entrants such as clinics staffed by inexpensive nurse-practitioners. More transparency would help too, by empowering patients to choose hospitals and doctors providing good value and better results. Electronic medical records would make shopping around easier.

Another useful way to promote transparency and value would be to evaluate the cost-effectiveness of new drugs, devices and treatments. This may be common sense, but it is rarely done in America. Britain’s National Institute for Health and Clinical Excellence (NICE) pioneered this approach, and other European countries have followed it. Andrew Dillon, the agency’s chief executive, accepts that “the NICE model is not transportable in precise form” but he still insists that “one can dissect（解剖） and apply what is relevant to other countries.”

单眼皮vs肿眼皮UID：2705887

Illustration by Otto Steininger

In America, the drugs and devices lobbies are violently opposed to a NICE-style agency that could issue mandatory rulings. They paint a scary picture of Americans being denied access to life-saving new drugs by faceless bureaucrats. In Britain NICE has come under fire for rulings that limited access to expensive drugs for Alzheimer’s and cancer on the NHS. America could get around this problem by requiring and perhaps even funding studies, but leaving insurers and individuals to decide whether to pay for treatments.

More competition and transparency would help, but the main goal of any reform plan must be to address the perverse incentives that encourage overconsumption and drive up costs. Medicare has been tinkering（拙劣修补） with “pay for performance”, a promising experiment. Mr Halvorson insists that by rejigging（改造）incentives other health providers can also create their own “virtual Kaisers（虚拟的帝王）”.

If American reformers doubt the power of incentives, they should visit Sweden. Like other relatively cheap OECD systems, Sweden’s single-payer model has been plagued by long waiting-lists—a sign, to American conservatives, of the rationing that goes with socialised medicine. Swedish health officials tried and failed to cut queues by increasing direct funding for hospitals and even issued an edict（法令）
requiring hospitals to cut queues for elective operations to three months. Then, last year, the health ministry said it would create a fund into which it would pay SKr1 billion ($128m) a year for local authorities that managed to reduce waiting times to that threshold（门槛，起点）. Nine months ago virtually none of the counties passed, but this month the health minister revealed that nearly all had cut their queues to three months or less.

Anders Knape, the head of the organisation representing county governments, ascribes this to “a dramatic change in incentives”. In the past, he explains, hospital bosses believed waiting lists were a sign of being overloaded, so they tolerated them in the hope of winning more funding. With the new scheme, however, “no queues means more resources”.

If getting incentives right can mobilise even a state-run health system like Sweden’s, surely there is scope for such reforms to fix America’s mess too. If the United States couples（连接;结合;把...拴在一起） its efforts to expand coverage with such a radical restructuring of the underlying（在下面的，根本的） drivers of cost inflation, there is every reason to think its health system can become the best in the world—and not merely the priciest.

单眼皮vs肿眼皮UID：2705887

As the rich world grows older and sicker and the poor world gets wealthier and fatter, the cost of health care is soaring（激增）. Governments and insurers the world over are struggling to cope with runaway (难以控制的)health inflation. Adding to the demographic（人口统计学的） shift in OECD（经合组织）countries and the wealth effect in the emerging giants is the unprecedented wave of technological innovation in new pills, procedures and devices made possible by the ongoing convergence of biology and engineering.

The potential health and welfare benefits of this revolution are breathtaking（激动人心的）,
every bit as much as the wave of innovation that earlier produced vaccines, for example, which are among the most powerful of all health interventions. But the coming grand convergence could, some argue, instead turn into a tale of need versus greed, a conflict between the haves and have nots.

Even if such a battle royal（激烈争辩） is not on the cards（可能的）, the pace of medical innovation and the seemingly insatiable growth in demand for health care certainly raise the question of how to pay for future medical marvels(奇迹). Some argue that commonsense tests of economics, ranging from cost-benefit analysis to comparative effectiveness reviews, are essential to weed out the worthy from the wasteful. But others argue that such tools are crude and anti-innovation at best, and, if wielded（支配，掌权） by stingy governments, implements of cruel health-care rationing (or "death panels", as Sarah Palin, the former Alaskan governor, famously called this) at worst.

One of the most prominent voices making the latter case of late has been Newt Gingrich, the former Speaker of America's House of Representatives. In his aggressive opening defence of the motion for our debate, he makes a clear link between comparative effectiveness reviews (CERs) and patient harm: when such tools are "combined with the pressure to control costs and the power to decide who gets what," he insists, "innovation will suffer and patients will suffer."

Mr Gingrich's strident arguments appear to flow from a political philosophy, much more commonly expressed in America than in Europe, that emphasises individual rights and choices over collective action or the optimal societal outcome. On his view, a rational health-care future will emphasise personalised therapies tailored to the genetic needs of the individual, not the number-crunched and coldly utilitarian（功利的，实利的） calculus offered by CERs. The sharp end of his argument is summed up by this simple question: "Do you want the government to decide?"

Britain's National Institute for Health and Clinical Excellence (NICE) is a government body that has pioneered the use of CERs and other related policies. Sir Michael Rawlins, its chairman, offers a full-throated defence of that approach as his opening salvo in opposition to the motion. He makes it plain early on that his faith in comparative effectiveness tools flows from a respect for the social compact by posing this revealing rhetorical question: "On what basis should nations use their resources to treat ill-health in a manner that is fair to all?" This suggests his thinking is more in line with European sensibilities. Defenders of America's individualistic and market-oriented health system often say that it is better and more innovative than its rivals, but few dare to claim that it is "fair to all".

Sir Michael insists that the use of CERs has grown into a "sophisticated scientific discipline" that seeks to answer two critical questions: does a new technology offer benefits when compared with existing options, and if so by how much? He points to various case studies, including the increased use of thromolytic technology to treat heart attacks and diminished use of SSRI ('selective serotonin reuptake inhibitors') anti-depressants to treat children, that prove the value of CERs. Taking all the evidence into account, he thunders: "It is inconceivable that any rational person would either object to, or want to stand in the way of, comparative effectiveness reviews." 双重否定句（inconceivable… object to/stand in the way of（阻碍））

The topic of our debate is a timely and important one. Our debaters are genuine heavyweights and, as their opening arguments make plain, are spoiling for a fight （激烈论战）. The first shots have been fired. Now is the time for you, gentle reader, to weigh in（加入）with your vote.

单眼皮vs肿眼皮UID：2705887

这里的every bit as much as the wave of innovation that earlier produced vaccines, for example, which are among the most powerful of all health interventions.

不是很理解？？！！

单眼皮vs肿眼皮UID：2705887

今天接到指导员的命令了：务必要在周末前完成铁血任务！

虽然有点怕怕，但是，嗯，这点挑战都不能完成，还考什么G！

被米饭指导员教育了，AW要自己改！嗯，坐等救济的心态是万万不可的，自己动手才会丰衣足食。【其实人家是想被表扬一下嘛，因为人家已经改了一遍了，不过估计最后的结局是打击得更厉害】

匿去，继续单词任务！

dairymanUID：2683905

很不错呀，小眼皮子只要坚持看那个debate绝对就没问题的了~
我也要旁听着看~

单眼皮vs肿眼皮UID：2705887

今天阅读awintro argu部分的感想：
AWINTRO:
你所需要做的任务是什么呢？

Your task is to discuss the logical soundness of the author's case by critically examining the line

of reasoning and the use of evidence.
找出author推理和举例中的逻辑错误；

you should pay special attention to

• what is offered as evidence, support, or proof

• what is explicitly stated, claimed, or concluded

• what is assumed or supposed, perhaps without justification or proof

• what is not stated, but necessarily follows from what is stated
找出author给出的conclusion，以及支持这个conclusion作者所例举的evidence, assumption；那我们需要思考的是，除出这些例子/原因，还有没有其他原因呢？如果有的话，是否就必然导致author所得出的结论呢？
类似于：∵A->B，∴->C
那我们是否可以这样思考：1）A并不一定->B，也许D/E/F->B



2）即使A->B；是否就一定 ->C?

写出一篇优秀的阿狗，需要我们怎么做呢？ETS给出了

An excellent way to prepare for the "Analyze an Argument" task is to practice writing on some of the published Argument topics. There is no one way to practice that is best for everyone. Some prefer to start practicing without adhering to the 30-minute time limit. If you follow this approach, take all the time you need to analyze the argument. No matter which approach you take, you should

• carefully read the argument—you might want to read it over more than once

审题，破题

• identify as many of its claims, conclusions, and underlying assumptions as possible

它的观点，结论，尽可能多的找出它的assumptions

• think of as many alternative explanations and counterexamples as you can

思考alternative explanations

• think of what additional evidence might weaken or lend support to the claims

思考能够削弱或支持论点的其他例子

• ask yourself what changes in the argument would make the reasoning more sound

问问自己论点什么地方变化了，能使推理更完整更具说服力

NaperyUID：2710990

哎呦 眼皮 小爪子 补作业补得累死了 哎

小爪子下午有比赛 嘿嘿 不过是九死一生的球赛 希望不要输得太难看~~~

眼皮好厉害 更新的真勤快啊 小爪子要跟你学习~~~

单眼皮vs肿眼皮UID：2705887

今天有些急躁冒进了，抓住草木的基础写作，看两眼；又打开无夏前辈的心经，看两眼；一会又想着追星也没看；又打开eco开始看；单词也只完成了4个list; 想着周末就要交作业了，急得真是嘴角都开始起泡了。完全没有静下心来，一个一个认认真真完成。总想着看看这个，又摸摸那个。

不说了，滚回去，继续剩下的6个list单词；继续eco分析，继续基础写作。

米饭袜子UID：2532172

进度不错~加油！

不过。。貌似没看到你处女作的感想？（困惑。。。郁闷。。。疑问。。都可以写）