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本帖最后由 thatll 于 2009-8-2 22:56 编辑
EDITORIAL
Curbing Runaway Health Inflation
Published: August 1, 2009
This year’s effort to reform health care revolves around(围绕的意思,就是以什么为中心展开这样的感觉,这个词很好,要学起来) two powerful, conflicting(就是冲突的,矛盾的,不相容的) imperatives( : an obligatory act or duty ). One is to cover tens of millions of uninsured Americans. The other is to absorb the enormous cost of that plan — which could reach $1 trillion over 10 years — without(强调了不同时伴随后面所说的两种情况) increasing the budget deficit in the next decade or setting the nation on a course that(set sth. on a course that...这个句型很好啊,) will drive up(抬高,迫使...上升) deficits later.
revolve:
transitive verb
1 : to turn over at length in the mind : PONDER *revolve a scheme*
2 : ROTATE 1
intransitive verb
1 : RECUR
2 a : to ponder something b : to remain under consideration *ideas revolved in his mind*
3 a : to move in a curved path round a center or axis b : to turn or roll round on an axis
4 : to have or come to a specified focus : CENTER --- usually used with around *the dispute revolved around wages*
也就是revolve about [round]
围绕...而旋转
反复考虑
围绕(某一个问题)
It is easier to see how to accomplish the first task than the second. But Congress should not slow the push for(放慢推动什么的步伐) near-universal coverage while it looks for ways to apply the brakes to the growth in(寻找方法对什么的增长进行刹车) costs. We can be virtually certain(真正的确认) that the reforms enacted will be deficit-neutral over the first 10 years. President Obama and Democratic leaders will find cuts in Medicare and raise sufficient taxes to offset(抵消) the initial cost of insurance expansion.
It is much harder to find ways to slow inflation in health care costs. Peter Orszag, Mr. Obama’s budget director, has been searching for what he calls “game changers” that can “bend down the cost curve” in coming years. The question is how well he and Congressional champions of health care reform have succeeded.
WHY IT’S IMPORTANTThe skyrocketing(大幅上升,飞涨) cost of health care is driving up federal deficits, threatening to(威胁到了什么) bankrupt Medicare, forcing(迫使) employers to cut or drop benefits, and leaving(使得谁人落得某一下场) workers and their families with unaffordable bills.【其实这里的表达真的很有气势,skyrocketing cost is driving up sth., threatening to sth., forcing sb. to do sth., and leaving sb. with sth.】 Even a relatively small reduction in(即使是在某一方面的一个相对小的减少) the average annual growth rate over the next decade — from, say, 6.2 percent to 4.7 percent — could save more than $2 trillion for the health care system and hundreds or thousands of dollars for the average family. There is an enormous amount of money in the health care system, much of it spent on tests and procedures that do not improve health. It should be possible to wring out(绞出,压榨出) some of that spending.
HOW CAN WE JUDGE SUCCESS? Douglas Elmendorf, director of the Congressional Budget Office, testified(testify本身有两个含义,一个是证实,一个是宣称,那这里就是宣称) in mid-July that he saw no fundamental changes offered by the bills then emerging(作为后置定语,表示后来,也就是这位director宣称之后,变得emerging了) that would reduce the trajectory of federal health spending significantly. The implication was that(隐含的意义就是) the pending bills could actually make deficits bigger after the initial break-even(收支相当) decade. That’s because covering the uninsured would increase federal spending and a high rate of medical inflation applied to that larger base would make future deficits worse. However, Mr. Elmendorf was looking only at bills that had cleared committees, which did not include one still being fashioned by the pivotal Senate Finance Committee.
Senator Max Baucus, the Democrat who heads that committee, revealed last week that the C.B.O. had evaluated a draft of his bill and concluded that it would cover 95 percent of all Americans, for a cost below $900 billion, and would actually start reducing the deficit in 2019. That is better than the administration’s goal of being deficit-neutral in that final year, but we will not know for sure until the C.B.O. issues a verdict on a final bill.
The budget office provides vitally important(极为重要的) guidance to Congress, but focuses primarily on how new legislation might affect federal spending and federal deficits. The office gives only a cursory glance at how reforms might cut costs for the overall system and yield savings for employers, families and state and local governments, the issue that concerns most people.(这是一件很多人关心的事)
Moreover, the office makes middle-of-the road(中庸的) estimates of cost and more pessimistic estimates of savings. That makes sense (lawmakers and government agencies routinely exaggerate the virtues of their proposals), but it makes it harder to evaluate proposed innovations.
Respected analysts who are not bound by the C.B.O.’s conservatism have projected significant savings from reforms that the C.B.O. scores poorly. The Commonwealth Fund, a research organization, and David Cutler, a Harvard health economist, separately estimate that an array of reforms could save the government hundreds of billions of dollars in the first decade and the health care system even more. These estimates, coming from advocates of reform, may be too rosy(光明的,有希望的,就是promising), but underscore the point that(强调了某点,注意不是低估哦) the C.B.O. may undervalue savings.
POTENTIAL GAME CHANGERS It seems hard to believe that over the long haul(在长时间中) the introduction of electronic medical records will not save substantial money. It would help eliminate the costly(花费很大的) repetition of tests, and prevent medication errors that harm patients and lead to costly hospitalization. But it takes money to get started (Mr. Obama’s stimulus package calls for $50 billion over five years) and time(花钱花时间就是take money and time to do sth.) to overcome physicians’ reluctance. Savings in the first decade, if any, are likely to be small.(什么东西,如果有的话,很有可能是什么样的,就是sth., if any, is likely to be...)
So, too, it seems likely that a stimulus investment of $1.1 billion in comparative effectiveness research to gauge(估计,测量) which medicines and procedures work best is likely to pay off in future decades.
pay off:
transitive verb
1 a : to give all due wages to; especially : to pay in full and discharge (an employee) b : to pay (a debt or a creditor) in full c : BRIBE
2 : to inflict retribution on
3 : to allow (a thread or rope) to run off a spool or drum
intransitive verb : to yield returns
The approach has been wrongly portrayed as an effort by government bureaucrats to dictate “cookbook” medicine that will prevent doctors from doing what’s best for their patients and lead to rationing of care. More than 60 physicians’ groups have urged Congress to make comparative effectiveness research an important component of reform. They believe the information would help doctors and patients understand which treatments work best. In some cases, the better treatments might be more expensive, in others less. Either way, patients benefit.(无论哪一种,都是某人获利)
And so it goes, through such ideas as changing Medicare’s payment incentives to encourage better care not just more care, and to encourage new arrangements of doctors and hospitals that might control costs and provide more coordinated care than the fee-for-service system does. All will take time to bear fruit.(任何都得花时间才能有成果)
TAXES One way to keep deficits in check(约束注deficits) would be to impose taxes within the health care system instead of more broadly, which should ensure that revenues increase at the rate of health care inflation. A tax on the value of an employer’s contribution to insurance could lead beneficiaries to choose cheaper policies and think twice before undergoing costly tests. We have been leery of(不随便附和,对什么怀有戒心) recommending a tax that would affect many workers, but a tax on very expensive plans might make sense.
make sense:
1. Be understandable. This usage, first recorded in
1686, is often used in a negative context, as in
This explanation doesn't make sense.
2. Be reasonable, wise, or practical, as in
It makes sense to find out first how many will attend the conference. This term employs
sense
in the meaning of "what is reasonable," a usage dating from
1600.
OTHER IDEASThe administration seems to have scoured the health policy literature for ideas(scour sth for sth就是在什么里面搜索什么), and its proposals reflect the thinking of the nation’s leading experts. Most of these ideas would first be tried on a small scale in Medicare — to see if they reduced costs while improving or at least maintaining the quality of care — before being adopted on a wide scale in government programs. Ideas that work for Medicare would presumably migrate out to the private sector.
We believe that some of the reforms in pending legislation could be strengthened. Both public and private insurance plans, for example, should be allowed — not forbidden — to base reimbursement policies on comparative effectiveness findings. But for the most part, the nation is embarking on(着手,从事) a long-term experiment to see what works, so small-scale tests and pilot programs seem appropriate.
THE OVERSEERWith so much uncertainty, it seems imperative to ensure that the government can change course rapidly to drop approaches that do not work and expand approaches that do. Proposals have been made to create an independent commission of experts, responsible to either the president or Congress, to perform this function at a step removed from the distorting influences of political lobbying.
It is a good idea, if the commission has sufficient power and resources to do an effective job. The panel should be directed to pursue both cost reduction and quality improvement. It should be given cost reduction targets to meet and a mandate to impose across-the-board(全面的) cuts in Medicare if it falls short(不符合,不足,达不到目标). It should have sufficient resources to evaluate and sponsor studies, a membership beholden to no special interest, and be insulated from political pressure by requiring Congress to approve or reject recommendations as a package, without fighting over individual items of interest to lobbyists.
WRONG-HEADED CRITICISM The Republican Party has started a campaign charging that President Obama is conducting a dangerous and reckless experiment in health care reform that will damage the economy, kill jobs, drive up health care costs, and harm patients. That is a bit hard to take after(学样,像) the Bush administration’s reckless squandering of government surpluses with tax cuts for wealthy Americans that cost $1.7 trillion over 10 years and an expensive Medicare drug benefit that is projected to(预计) cost almost $1 trillion over the next 10 years, without making provisions to cover their costs.
take after:
Follow the example of; also, resemble in appearance, temperament, or character. For example,Bill took after his uncle and began working as a volunteer for the Red Cross.
[Mid-1500s]
The Obama administration is paying meticulous attention to the need for offsets and new revenues. Most important, it seems headed in the right direction to finally slow the rate of growth in health care spending — a beast that has defied past efforts to tame it.(一头拒绝之前驯服它的努力)
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