2016年06月六级第2套长篇阅读匹配原文翻译及答案

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.

美国人对医疗成本和健康保险费的不断上涨深感担忧。他们需要知道改革是否有助于解决这个问题。答案是，没有人能轻松解决不断上涨的医疗成本。根本性的解决方案——在浪费、异常的系统中重塑医疗服务的提供方式和医生的薪酬方式——可能只能通过试错和渐进式收益来实现。

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 New England Journal of Medicine concluded, "Pretty much every proposed innovation found in the health policy literature these days is contained in these measures.

好消息是，众议院刚刚批准的一项法案和参议院财政委员会批准的一项法案将实施或测试许多改革措施，这些措施应有助于长期减缓医疗成本的上涨。正如《新英格兰医学杂志》的一份报告所总结的，“如今卫生政策文献中提出的几乎所有创新都包含在这些措施中。”

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.

医疗支出通常增长速度快于工资和整体经济，它由两个因素推动：本国医疗服务的高收费以及医生和医院提供的不必要护理量，后者往往进行的测试和治疗远超患者实际需要。

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.

以下是众议院和参议院法案中一些试图解决这些问题的重要提案，以及为什么很难知道它们的效果如何。

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 to let 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.

两项法案都将减少联邦医疗保险计划向医院、疗养院和其他提供者支付的年度增长额，减少量与其他行业在新技术和新工作方式帮助下常规实现的生产力节省相当。这一提案可能在未来十年为联邦医疗保险节省超过1000亿美元。如果私人计划要求类似的提供者生产力节省，并拒绝让提供者将额外成本转移给他们，节省可能更大。批评者说国会将屈服于游说者，放过效率低下的提供者。如果国会也采用强有力的“量入为出”规则，要求任何支付增加都通过新税收或预算削减来抵消，这种情况就不太可能发生。

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.

参议院财政法案将对个人费用超过8000美元或家庭费用超过21000美元的健康保险计划征收消费税。这很可能导致保险公司重新设计计划以低于阈值。参保者将不得不自掏腰包支付更多服务费用，这会鼓励他们三思昂贵或冗余的测试是否值得。经济学家预测，大多数雇主会将资金从昂贵的健康福利转移到工资上。众议院法案没有类似的税收。最终立法应该包含。

G) Any doctor who has wrestled with multiple forms 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 reform 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.

任何曾与不同保险公司的多种表格作斗争的医生，或试图理解自己一连串账单的患者，都知道简化应该能省钱。当健康保险行业仍在合作进行改革努力时，其贸易团体提出提供标准化表格以实现自动化处理。估计这一步骤将在未来十年节省数千亿美元。这些法案将把这一承诺写入法律。

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.

刺激计划提供资金，将效率低下、纸质驱动的医疗系统转换为可以轻松查看和传输的电子记录。这需要公开投资来帮助医生转换。随着时间的推移，它应通过消除冗余测试、预防药物相互作用和帮助医生找到最佳治疗方案来帮助控制成本。

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.

几乎所有的专家都同意，按服务收费系统——医生因护理数量而非质量或有效性获得奖励——是护理成本如此高的主要原因。大多数人同意，解决方案是推动医生接受固定支付来照顾特定疾病或患者一年的需求。没有人知道如何快速实现这一点。两院的法案将在联邦医疗保险计划内启动试点项目。它们包括诸如责任医疗组织等措施，负责患者需求并兼顾成本和质量，以及慢性疾病管理，以确保负责大部分医疗成本的严重疾病患者得到适当治疗。在大多数情况下，这些实验依赖于激励支付来让医生尝试它们。

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.

测试创新没有好处，除非好的实验被识别和扩展，坏的被放弃。参议院法案将创建一个独立委员会来监督试点项目，并建议改变联邦医疗保险计划的支付政策，以敦促提供者采用有效的改革。这些变化必须由国会整体批准或否决，这使得狭隘利益游说团体很难让立法者屈服于他们的意愿。

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.

两院的法案将创建健康保险交易所，小企业和个人可以在其中从一系列私人计划和可能的公共选项中选择。所有计划都必须提供易于比较的标准福利包。为了接触数百万新客户，保险公司会有强烈的动机在交易所销售。直接竞争可能会给他们强烈的动机降低价格，也许是通过接受更低的利润率或要求更好的提供者交易。

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.

最终立法可能会将公共计划投入竞争，但由于保险行业和共和党批评者的激烈反对，它可能不会节省太多钱。众议院法案中的公共计划将不得不与提供者谈判费率，而不是使用许多改革者希望的联邦医疗保险费率。

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 cholesterol-lowering drug any better than its common competitors? The pending bills would spend additional money to accelerate this effort.

总统的刺激计划正在向研究投入资金，以比较各种治疗方案的效果。对于前列腺癌，手术、放疗还是仔细监测最好？最新最昂贵的降胆固醇药物是否比其常见竞争对手更好？待决的法案将花费额外资金来加速这一努力。

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.

批评者指控这个明智的想法会导致护理配给。（这只有在你认为患者应该不受限制地享有被证明劣质的治疗权利时才成立。）因此，这些法案没有要求，但应该要求，将这些研究的结果用于设定联邦医疗保险的支付费率。

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 the most expensive. But overall, we suspect that spending would come down through elimination of a lot of unnecessary or even dangerous tests and treatments.

国会需要找到勇气，允许联邦医疗保险优先支付被证明更优的治疗。有时最好的治疗可能最昂贵。但总体而言，我们怀疑支出将通过消除许多不必要甚至危险的测试和治疗而下降。

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.

众议院法案将授权卫生与公众服务部长在联邦医疗保险和医疗补助中谈判药品价格。一些权威分析师怀疑部长是否能获得比私人保险公司已经获得的更好交易。我们相信谈判可以奏效。在其他国家它确实有效。

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.

这些法案中缺少任何认真控制医疗事故成本的尝试。医疗事故赔偿确实推高了高风险专科医生的保险费，有证据表明医生进行“防御性医疗”，主要通过测试和治疗来证明他们在被起诉时没有疏忽。