Section 六級系統(tǒng)精講之閱讀理解2——長篇閱讀Directions:Inthissection,youaregoingtoreadapassagewithtenstatementsattachedtoit.Eachstatementcontainsinformationgiveninoneoftheparagraphs.Identifytheparagraphfromwhichtheinformationisderived.Youmaychooseaparagraphmorethanonce.Eachparagraphismarkedwithaletter.AnswerthequestionsbymarkingthecorrespondingletteronAnswerSheet2.ReformandMedicalAmericansaredeeplyconcernedabouttherelentlessriseinhealthcarecostsandhealthinsurancepremiums.Theyneedtoknowifreformwillhelpsolvetheproblem.Theansweristhatnoonehasaneasyfixforrisingmedicalcosts.Thefundamentalfix—reshahowcareisdeliveredandhowdoctorsarepaidinawastefulabnormalsystem—islikelytobeaachievedonlythroughtrialanderrorandincremental(漸進的)gains.ThegoodnewsisthatabilljustapprovedbytheHouseandabillapprovedbytheSenateFinanceCommitteewouldimplementortestmanyreformsthatshouldhelpslowtheriseinmedicalcostsoverthelongterm.AsreportinTheNewEnglandJournalofMedicineconcluded,“Prettymucheveryproposedinnovationfoundinthehealthpolicyliteraturethesedaysiscontainedinthesemeasures.”Medicalspending,whichtypicallyrisesfasterthanwagesandtheoveralleconomy,ispropelledbytwothings:thehighpriceschargedformedicalservicesinthiscountryandthevolumeofunnecessarycaredeliveredbydoctorsandhospitals,whichoftenperformalotmoretestsandtreatmentsthanapatientreallyHerearesomeoftheimportantproposalsintheHouseandSenatebillstotrytoaddressthoseproblems,andwhyitishardtoknowhowwelltheywillwork.BothbillswouldreducetherateofgrowthinannualMedicarepaymentstohospitals,nursinghomesandotherprovidersbyamountscomparabletotheproductivitysavingsroutinelymadeinotherindustrieswiththehelpofnewtechnologiesandnewwaystoorganizework.ThisproposalcouldsaveMedicaremorethan$100billionoverthenextdecade.Ifprivateplansdemandedsimilarproductivitysavingsfromproviders,andrefusedtoletprovidersshiftadditionalcoststothem,thesavingscouldbemuchlarger.CriticssayCongresswillgiveintolobbyistsandletinefficientprovidersoffthehookThatisfarlesslikelytohappenifCongressalsoadoptsstrong“pay-go”rulesrequiringthatanyincreaseinpaymentstoprovidersbeoffsetbynewtaxesorbudgetcuts.TheSenateFinancebillwouldimposeanexcisetax(消費稅)onhealthinsuranceplansthatcostmorethan$8,000foranindividualor$21,000forafamily.Itwouldmostlikelycauseinsurerstoredesignplanstofallbeneaththethreshold.Enrolleeswouldhavetopaymoremoneyformanyservicesoutoftheirownpockets,andthatwouldencouragethemtothinktwiceaboutwhetheranexpensiveorredundanttestwasworthit.Economistsprojectthatmostemployerswouldshiftmoneyfromexpensivehealthbenefitsintowages.TheHousebillhasnosimilartax.Thefinallegislationshould.Anydoctorwhohaswrestledwithmultipleformsfromdifferentinsurers,orpatientswhohavetriedtounderstandtheirownparadeofstatements,knowthatsimplificationoughttosavemoney.Whenthehealthinsuranceindustrywasstillcooperatinginreformefforts,itstradegroupofferedtoprovidestandardizedformsforautomatedprocessing.Itestimatedthatstepwouldsavehundredsofbillionsofdollarsoverthenextdecade.Thebillswouldlockthatpledgeintolaw.Thestimuluspackageprovidedmoneytoconverttheinefficient,paper-drivenmedicalsystemtoelectronicrecordsthatcanbeeasilyviewedandtransmitted.Thisrequiresopeninvestmentstohelpdoctorsconvert.Intimeitshouldhelprestraincostsbyeliminatingredundanttests,preventingdruginteractions,andheldoctorsfindthebesttreatments.Virtuallyallexpertsagreethatthefee-for-servicesystem—doctorsarerewardedforthatthetyofcareratherthanitsqualityoreffectiveness—isaprimaryreasonthatthecostofcareissohigh.Mostagreethatthesolutionistopushdoctorstoacceptfixedpaymentstocareforaparticularillnessorforapatient’sneedsoverayear.Nooneknowshowtomakethathappenquickly.ThebillsinbothhouseswouldstartpilotprojectswithinMedicare.Theyincludesuchmeasuresasaccountablecareorganizationstotakechargeofapatient’sneedswithaneyeonbothcostandquality,andchronicdiseasemanagementtomakesuretheseriouslyill,whoareresponsibleforthebulkofallhealthcarecosts,aretreatedproperly.Forthemostpart,theseexperimentsrelyonincentivepaymentstogetdoctorstotrythem.Testinginnovationsdonogoodunlessthegoodexperimentsareidentifiedandexpandedandthebadaredropped.TheSenatebillwouldcreateanindependentcommissiontomonitorthepilotprogramsmendchangesinMedicare’spaymentpoliciestourgeproviderstoadoptreformsthatwork.ThechangeswouldhavetobeapprovedorrejectedasawholebyCongress,makingithardfornarrow-interestlobbiestobendlawmakerstotheirwill.Thebillsinbothchamberswouldcreatehealthinsuranceexchangesonwhichsmallbusinessesandindividualscouldchoosefromanarrayofprivateplansandpossiblyapublicoption.Alltheplanswouldhavetoprovidestandardbenefitpackagesthatwouldbeeasytocompare.Togetaccesstomillionsofnewcustomers,insureswouldhaveastrongincentivetosellontheexchange.Andthehead-to-headcompetitionmightgivethemastrongincentivetolowertheirprices,perhapsbyacceptingslimmerprofitmarginsordemandingbetterdealsfromproviders.Thefinallegislationmightthrowapublicplanintothecompetition,butthankstothefierceoppositionoftheinsuranceindustryandRepublicancritics,itmightnotsavemuchmoney.TheoneintheHousebillwouldhavetonegotiaterateswithproviders,ratherthanusingMedicarerates,asmanyreformerswanted.The’sstimuluspackageispummoneyintoresearchtocomparehowwellvarioustreatmentswork.Issurgery,radiationorcarefulmonitoringbestforprostate()cancer?Isthelatestandmostexpensivecholesterol-loweringdruganybetterthanitscommoncompetitors?Thependingbillswouldspendadditionalmoneytoacceleratethiseffort.Criticshavechargedthatthissensibleideawouldleadtorationingofcare.(Thatwouldbetrueonlyifyoubelievedthatpatientsshouldhaveanunrestrainedrighttotreatmentsproventobeinferior.)Asaresult,thebillsdonotrequire,astheyshould,thattheresultsofthesestudiesbeusedtosetpaymentratesinCongressneedstofindthecouragetoallowMedicaretopaypreferentiallyfortreatmentsproventobesuperior.Sometimesthebesttreatmentmightbethemostexpensive.Butoverall,wethatspendingwouldcomedownthrougheliminationofalotofunnecessaryorevendangeroustestsandtreatments.TheHousebillwouldauthorizethesecretaryofhealthandhumanservicestonegotiatedrugpricesinMedicareandMedicaid.Someauthoritativeystsdoubtthatthesecretarywouldgetbetterdealsthanprivateinsurersalreadyget.Webelievenegotiationcouldwork.Itdoesinothercountries.Missingfromthesebillsisanyseriousattempttoreininmalpracticecosts.Malpracticeawardsdodriveupinsurancepremiumsfordoctorsinhigh-riskspecialties,andthereissomeevidencethatdoctorsengagein“defensivemedicine”byperformingtestsandtreatmentsprimarilytoprovetheyarenotnegligentshouldtheyge