蓝色为难词或词组（即自己不熟悉，不做红宝非红宝区别，觉得没必要），绿色为语言表达借鉴，橙色为文章大致思路分析，黄色为结构注释，红色评注或问题
1.
about the debates
As the rich world grows older and sicker and the poor world gets wealthier and fatter, the cost of health care is soaring. Governments and insurers(承保人；承保公司；承保方) the world over (后置修饰，自己较少用)are struggling to cope with runaway health inflation. Adding to the demographic shift in OECD 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）.（此句话结构复杂，不是很理解，还麻烦透彻的人指点一下，尤其是ongoing convergence的含义） The potential health and welfare benefits of this revolution are breathtaking—but who will pay? Are all medical inventions deserving of reimbursement?
Some argue that common-sense 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 by stingy governments, implements of cruel health-care rationing at worst. What do you think? 长注释： 1.
经济合作与发展组织，简称经合组织（英语：Organization for Economic Co-operation and Development）OECD 2.
Background reading
Heading for the emergency room Jun 25th 2009 | WASHINGTON, DC
From The Economist print edition America’s health care is the costliest in the world, yet quality is patchy and millions are uninsured. Incentives for both patients and suppliers need urgent treatment 3.
Illustration by Otto Steininger NO ONE will be astonished to hear that health care costs more in Indiana than in India. However, a few might be surprised to learn that Americans spend more than twice as much per person on health care as Swedes do. And many may be shocked to be told that in Miami people pay twice as much as in Minnesota, even for far worse care. The American health-care system, which gobbles up about 16% of the country’s economic output, is by far the most expensive in the world (see chart 1). The Congressional Budget Office (CBO) estimates that on current trends spending on Medicare and Medicaid, the government schemes for the old and the poor, will rise from 4% of GDP in 2007 to 12% in 2050. The prospect of long-term fiscal disaster is the main reason why efforts to reform health care are gaining momentum in Washington, DC. As Peter Orszag, the director of Barack Obama’s Office of Management and Budget, puts it, “that ‘long term’ keeps getting closer and closer.” 1.
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(官僚作风的人). In Britain NICE has come under fire for rulings that limited access to expensive drugs for Alzheimer’s and cancer on the NHS((in the UK) National Health Service). 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. 2.
More competition and transparency would help, but the main goal of any reform plan must be to address (处理)the perverse (contrary to the accepted or expected standard or practice)incentives that encourage overconsumption and drive up (使……上升)costs. Medicare has been tinkering with（胡乱地修补） “pay for performance”, a promising experiment. Mr Halvorson insists that by rejigging （重新装备）incentives other health providers can also create their own “virtual Kaisers”. Kaiser [ˈkʌɪzə，德 kaɪzɒ] Georg (1878–1945), German dramatist. He is best known for his expressionist plays The Burghers of Calais (1914), and Gas I (1918) and Gas II (1920); the last two provide a gruesome vision of futuristic science, ending with the extinction of all life by poisonous gas 凯泽，格奥尔格(1878–1945，德国剧作家，因表现主义剧作《加来公民》 [1914]、《瓦斯第一部》 [1918]和《瓦斯第二部》 [1920]而最为著名；后两部作品展现了可怕的未来科学景象，以万物被毒气消灭殆尽而结束） 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 (伴随)socialised medicine. Swedish health officials tried and failed to cut queues by increasing direct funding for hospitals and even issued an edict (法令，布告；命令)requiring hospitals to cut queues for elective operations to three months. Then, last year, the health ministry (卫生部)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. 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 mobilize(动员起来, 调动, 鼓动起) even a state-run health system like Sweden’s, surely there is scope(the opportunity or possibility to do or deal with something) for such reforms to fix America’s mess too. If the United States couples its efforts to expand coverage with such a radical(forming an inherent or fundamental part of the nature of someone or something) restructuring of the underlying 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.
其实做了很多eco的标注，但就不一一往上传了。 | 
发表于 2009-10-31 23:27:05
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