2015考研英语阅读英文原刊《经济学人》：奥巴马医改

　　Higher public spending on health threatens to crowd out education, infrastructure and morebesides. In July the Congressional Budget Office predicted that, despite the recent slowdown,government health programmes would become the single biggest area of public spending within20 years, and grow from 4.8% of GDP now to 8% in 2039.

　　在医保上投入更多的公共支出会将缩减用于教育、基础设施建设及其他更多方面的公共支出。七月，国会预算局预计，尽管近几年用于医疗保险的共公开支有所减少，在今后的20年，政府的医保项目将仍然是唯一的最大的公共开支支出领域，到2039年前，其占GDP的比重将由现在的4.8%涨至8%。

　　America's health system is terrible at controlling costs for two main reasons. First, insurers andMedicare usually pay doctors when they deliver many services, rather than when they keeppatients well. Second, America relies on a private market of doctors and insurers, yet their costsand quality remain opaque. For decades the doctors' lobby has fought to hide detailed dataon doctors' performance and prices. Robert Kocher and Ezekiel Emanuel report that 30-40%of top academic hospitals have contracts that bar insurers from relaying hospital prices toemployers or patients. What quality measures exist are mostly tied to procedures, not results.

　　美国的医保体系由于两大原因在控制成本方面做得很糟糕。第一，保险公司和医疗保险经常在医生提供服务而非他们治好病人时支付薪水。第二，美国依赖于医生和保险公司的私人市场，然而他们的成本及质量都模棱两可、不清不楚。数十年来，医生的游说者试图隐藏医生工作表现及治疗价格的详细数据。罗伯特·柯歇尔和伊其基尔·伊曼纽尔报告指出30%至40%的顶级学院型医院订有合同阻止保险公司给予投保人或病人医院原有的价格。什么样的质量检测的存在与结果无关而在很大程度上于步骤过程有关。

　　So patients have been left in the dark. When they have visited the doctor, they have had noidea what anything costs or that it all ultimately comes out of their wages. So they have notobjected when doctors gave them unnecessary tests, or overcharged.

　　因此病人就被这样的机制遗漏在病痛的黑暗中。当他们去找医生时，他们对那些药品的花费或者药费最终出自于他们的工资一无所知。因此，当医生要求他们做不必要的检查或收取高额费用时他们不会拒绝。

　　Thus the cost of a back scan in New York City ranges from $416 to more than ten times thatamount, according to Castlight, a firm in California. A prostate-specific antigen test inPhiladelphia could be $20 or $407 (see chart 3). Quality is erratic, too. Laurent Glance of theUniversity of Rochester found that rates of complications from caesarean deliveries variednearly fivefold among American hospitals.

　　因此，根据一个名为“揭露真相”的一家加利福尼亚公司的资料，在纽约，脊背扫描检查的费用在416美及甚至高于这一数据的十倍之多之间波动。在费城，一项前列腺特定抗体检查费用可能在20美元至407美元之间波动。并且检查的质量也有很大的不确定性。罗切斯特大学的劳伦·格兰仕发现美国剖腹产并发症的概率变化达到5倍。

　　Obamacare tries various ways to curb costs. For example, it urges groups of doctors andhospitals to become Accountable Care Organisations (ACOs), rewarded for keeping Medicarepatients' costs below a set limit. However, data published on September 16th show that only aquarter saved enough to earn a bonus. Obamacare also orders the health department to makecosts and quality more transparent. This, too, is proceeding fitfully. In April health officialspublished Medicare payments to specific doctors. This revealed which doctors perform a lot ofprocedures. However, it did not reveal whether those interventions were appropriate orsuccessful. Medicare's more useful data, which would show which doctors keep patients well,have yet to be broadly released; there are worries about privacy.

　　奥巴马医改试图通过多种途径抑制医疗开支。比方说，它敦促医生团体及医院成为负责任医疗组织，该组织奖励那些将医疗保险病人的支出控制在一定的限制一下的医护行为。但是，9月16号公布的数据表明所节约的资金中仅有四分之一用于奖金。奥巴马医改同时要求卫生部门进一步将成本与质量透明化。这同样也在顺利稳步进行。四月，卫生官员想特定的医生公开医疗保险开支。这透露哪些医生执行了一系列的程序步骤。但是它并不能说明哪些干涉是合适并且成功地。有关医疗保险更为有用的资料，即能表现哪些医生治好了病人的疾病却还没能广泛地公开。因为人们担心会侵犯相关人员的隐私。

　　A long way to go

　　医疗改革任重道远

　　18. Mark McClellan of the Brookings Institution, a think-tank, points out that insurers anddoctors' groups are testing their own versions of ACOs, which might be more successful thanthe government's. Companies are also slowly lifting the veil from doctors' costs and quality.Castlight compiles data from employers' insurance bills, then presents prices to patients.UnitedHealthcare, Aetna, Humana and Kaiser Permanente, four huge insurance and healthcompanies, have given reams of data to an independent research centre. Next year it willlaunch a website where any insured patient can log in and view quality and cost information forspecific doctors and hospitals.

　　智囊团布鲁金斯学会的马克·麦克莱伦指出保险公司及医生行业正在检测他们自己的负责任的医疗组织版本，这将比政府的版本更为成功。公司也逐渐揭开医生看病成本及治疗质量的面纱。“揭露真相”根据雇员的保险单编制资料，然后将价格告知病患。联合医疗保险公司、安泰保险公司、瑚玛纳及凯撒永久医疗集团这四家大型保险及医疗公司已经给一个独立的研究中心大量的资料。明年它将推出一个专门网站，在该网站任何参保的病人都能登录进去查看特定医院特定医生诊治的开支以及医治质量。

　　Patients may increasingly demand change, too. Employers are pushing workers into plans withhigh deductibles, which means they must pay for more care out of their own pockets beforeinsurance kicks in. The share of workers with deductibles jumped from 55% in 2006 to 80% in2014. This gives patients a good reason to shop around for cheaper treatment. In some cases,employers are asking workers to shop around for insurance too, giving them cash to buycoverage on privately-run health exchanges.

　　现在病患也越来越追求变化。雇主驱使工人参保高的自付额的医疗保险，这意味着在医保生效之前他们必须自己掏腰包为健康付费。有自付额的工人的比重由2006年的55%增加到2014年的80%。这是病患货比三家寻求更廉价治疗方案的一个很好的理由。在某些情况下，雇主会建议工人通过货比三家选择医疗保险，为他们提供资金购买私人运营的医疗保险交易。

　　When patients act like shoppers, health-care providers serve them better. In August thenumber of retail clinics, which treat patients at malls and outside regular hours, was up 17%over last year, according to Merchant Medicine, a consultancy. Obamacare's exchanges haveinspired new insurance entrepreneurs. Oscar, started by techies in New York, tries to be thepatient's ally, swapping insurers' usual perplexing drivel for clear information. MedicareAdvantage, a complement to the traditional public scheme for the elderly, often pays doctorsa capped fee to care for patients. Providers profit when patients are well and costs are cut.America's health market has long been an example of what not to do. If it can serve patients, itjust might become the opposite.

　　当病患像消费者一样货比三家时，提供医疗服务的人将会更好的微病患服务。根据商业药品这个咨询公司的消息，八月，那些在大型商场或者在紧急时段治疗病患的零售药房的数量自去年以来增长了17%。奥巴马医改交易激励了新的保险企业家。奥斯卡，通过纽约哥布林工程师开始，试图与病患组成同盟以厘清保险公司令人费解的说辞获取清晰的信息。医保利益组织，作为传统年长者公共计划的补充，在一身个提供医疗服务时通常支付他们限定额治疗费。当治好病患并且治疗费用减少时提供服务的而机构将会有所收获。长久以来，美国的医疗市场已成为一个典型的反面教材。但倘若它能为病患服务，那么它将成为典型的正面教材，成为大家效仿的楷模。

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