Reform and Medical Costs
[A] Americans are deeply concerned about the relentless rise in health care costs and health insurance premiums.They need to know if reform will help solve the problem.The answer is that no one has an easy fix for rising medical costs.The fundamental fix—reshaping how care is delivered and how doctors are paid in a wasteful.abnormal system—is likely to be achieved only through trial and error and incremental(渐进的) gains.
[B] The good news is that a bill just approved by the House and a bill approved by the Senate Finance Committee would implement or test many reforms that should help slow the rise in medical costs over the long term.As a report in The Nel4,England Journal of medicine concluded."Pretty much every proposed innovation found in the health policy literature these days is contained in these measures."
[C] Medical spending, which typically rises faster than wages and the overall economy,is propelled by two things：the high prices charged for medical services in this country and the volume of unnecessary care delivered by doctors and hospitals,which often perform a lot more tests and treatments than a patient really needs.
[D] Here are some of the important proposals in the House and Senate bills to try to address those problems, and why it is hard to know how well they will work.
[E] Both bills would reduce the rate of growth in annual Medicare payments to hospitals, nursing homes and other providers by amounts comparable to the productivity savings routinely made in other industries with the help of new technologies and new ways to organize work.This proposal could save Medicare more than$100 billion over the next decade.If private plans demanded similar productivity savings from providers, and refused t01et providers shift additional costs to them.the savings could be much larger.Critics say Congress will give in to lobbyists and let inefficient providers off the hook(放过). That is far less likely to happen if Congress also adopts strong"pay—go"rules requiring that any increase in payments to providers be offset by new taxes or budget cuts.
[F] The Senate Finance bill would impose an excise tax(消费税)on health insurance plans that cost more than$8, 000 for an individual or$21.000 for a family.It would most likely cause insurers to redesign plans to fall beneath the threshold.Enrollees would have to pay more money for many services out of their own pockets, and that would encourage them to think twice about whether an expensive or redundant test was worth it.Economists project that most employers would shift money from expensive health benefits into wages.The House bill has no similar tax.The final legislation should.
[G] Any doctor who has wrestled with multiple form.s from different insurers, or patients who have tried to understand their own parade of statements, know that simplification ought to save money.When the health insurance industry was still cooperating in reforin efforts.its trade group offered to provide standardized forms for automated processing.It estimated that step would save hundreds of billions of dollars over the next decade.The bills would lock that pledge into law.
[H] The stimulus package provided money to convert the inefficient, paper—driven medical system to electronic records that can be easily viewed and transmitted.This requires open investments to help doctors convert.In time it should help restrain costs by eliminating redundant tests.preventing drug interactions, and helping doctors find the best treatments.
[I] Virtually all experts agree that the fee.for—service system—doctors are rewarded for the quantity of care rather than its quality or effectiveness—is a primary reason that the cost of care is so high.Most agree that the solution is to push doctors to accept fixed payments to care for a particular illness or for a patient's needs over a year.No one knows how to make that happen quickly.The bills in both houses would start pilot projects within Medicare.They include such measures as accountable care organizations to take charge of a patient's needs with an eye on both cost and quality,and chronic disease management to make sure the seriously ill.who are responsible for the bulk of all health care costs.are treated properly.For the most part.these experiments rely on incentive payments to get doctors to try them.
[J] Testing innovations do no good unless the good experiments are identified and expanded and the bad ones are dropped.The Senate bill would create an independent commission to monitor the pilot programs and recommend changes in Medicare's Payment policies to urge providers to adopt reforms that work.The changes would have to be approved or rejected as a whole by Congress, making it hard for narrow—interest lobbies to bend lawmakers to their will.
[K] The bills in both chambers would create health insurance exchanges on which small businesses and individuals could choose from an array of private plans and possibly a public option.All the plans would have to provide standard benefit packages that would be easy to compare, To get access to millions of new customers.insurers would have a strong incentive to sell on the exchange.And the head—to—head competition might give them a strong incentive to lower their prices.perhaps by accepting slimmer profit margins or demanding better deals from providers.
[L] The final legislation might throw a public plan into the competition, but thanks to the fierce opposition of the insurance industry and Republican critics.it might not save much money The one in the House bill would have to negotiate rates with providers.rather than using Medicare rates.as many reformers wanted.
[M] The president's stimulus package is pumping money into research to compare how well various treatments work.Is surgery,radiation or careful monitoring best for prostate(前列腺)cancer?Is the latest and most expensive cholester01.10wering drug any better than its common competitors?The pending bills would spend additional money to accelerate this effort.
[N] Critics have charged that this sensible idea would lead to rationing of care.(That would be true only if you believed that patients should have an unrestrained right to treatments proven to be inferior.)As a result, the bills do not require, as they should, that the results of these studies be used to set payment rates in Medicare.
[O] Congress needs to find the courage to allow Medicare to Pay preferentially for treatments proven to be superior.Sometimes the best treatment might be spending would come down through elimination of treatments,the most expensive.But overall, we suspect that a lot of unnecessary or even dangerous tests and
[P] The House bill would authorize the secretary of health and human services to negotiate drug prices in Medicare and Medicaid.Some authoritative analysts doubt that the secretary would get better deals than private insurers already get.We believe negotiation could work.It does in other countries.
[Q] Missing from these bills is any serious attempt to rein in malpractice costs, Malpractice awards do drive up insurance premiums for doctors in high.risk specialties, and there is some evidence that doctors engage in"defensive medicine"by performing tests and treatments primarily to prove they are not negligent should they get sued.
36.With a tax imposed on expensive health insurance plans, most employers will likely transfer money from health expenses into wages.
37.Changes in policy would be approved or rejected as a whole so that lobbyists would find it hard to influence lawmakers.
38.It is not easy to curb the rising medical costs in America.
39.Standardization of forms for automatic processing will save a lot of medical expenses.
40.Republicans and the insurance industry are strongly opposed to the creation of a public insurance plan.
41.Conversion of paper to electronic medical records will help eliminate redundant tests and prevent drug interactions.
42.The high cost of medical services and unnecessary tests and treatments have driven up medical expenses.
43.One main factor that has driven up medical expenses is that doctors are compensated for the amount of care rather than its effect.
44.Contrary to analysts' doubts, the author believes drug prices may be lowered through negotiation.
45.Fair competition might create a strong incentive for insurers to charge less.
答案解析：
由题干中的关键词 a tax imposed on expensive health insurance plans” (对昂贵健康保险计划征税) 和 transfer money from health expenses into wages” (将钱从健康开支转为工资) 定位到 F 段。该段提到 Economists project that most employers would shift money from expensive health benefits into wages”，与题干信息完全一致。所以选 F。
由题干中的关键词 approved or rejected as a whole” (作为一个整体被批准或拒绝) 和 lobbyists...influence lawmakers” (说客影响立法者) 定位到 J 段。该段提到 The changes would have to be approved or rejected as a whole by Congress, making it hard for narrow-interest lobbies to bend lawmakers to their will”，与题干信息完全一致。所以选 J。
由题干中的关键词 not easy to curb the rising medical costs” (抑制不断上涨的医疗成本并不容易) 定位到 A 段。该段明确指出 no one has an easy fix for rising medical costs”，即没有人有抑制医疗成本上涨的简单方法。所以选 A。
由题干中的关键词 Standardization of forms” (表格的标准化) 和 save a lot of medical expenses” (节省大量医疗费用) 定位到 G 段。该段提到 its trade group offered to provide standardized forms for automated processing. It estimated that step would save hundreds of billions of dollars”，与题干信息完全一致。所以选 G。
由题干中的关键词 Republicans and the insurance industry” (共和党和保险业) 和 opposed to the creation of a public insurance plan” (反对创建公共保险计划) 定位到 L 段。该段提到 thanks to the fierce opposition of the insurance industry and Republican critics, it might not save much money”，明确指出了共和党和保险业的强烈反对。所以选 L。
由题干中的关键词 Conversion of paper to electronic medical records” (纸质病历转为电子病历) 和 eliminate redundant tests and prevent drug interactions” (消除冗余测试并防止药物相互作用) 定位到 H 段。该段提到 it should help restrain costs by eliminating redundant tests, preventing drug interactions”，与题干信息完全一致。所以选 H。
由题干中的关键词 high cost of medical services” (高昂的医疗服务费用) 和 unnecessary tests and treatments” (不必要的检查和治疗) 定位到 C 段。该段明确指出医疗开销是由两件事推动的：the high prices charged for medical services” 和 the volume of unnecessary care delivered by doctors and hospitals”，与题干信息完全一致。所以选 C。
由题干中的关键词 doctors are compensated for the amount of care rather than its effect” (医生按服务量而非效果获得报酬) 定位到 I 段。该段指出 Virtually all experts agree that the fee-for-service system—doctors are rewarded for the quantity of care rather than its quality or effectiveness—is a primary reason that the cost of care is so high”，与题干信息完全一致。所以选 I。
由题干中的关键词 analysts' doubts” (分析师的怀疑) 和 drug prices may be lowered through negotiation” (通过谈判可以降低药价) 定位到 P 段。该段先提到 Some authoritative analysts doubt that...”，然后作者表明自己的观点 We believe negotiation could work”，与题干信息完全一致。所以选 P。
由题干中的关键词 Fair competition” (公平竞争) 和 incentive for insurers to charge less” (激励保险公司降低收费) 定位到 K 段。该段提到 And the head-to-head competition might give them a strong incentive to lower their prices”，与题干信息完全一致。所以选 K。
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