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2015考研英语复习正是强化复习阶段,考研英语阅读在考研英语中占了40分,所以考研英语阅读是英语科目中重要的一项。新东方名师范猛老师曾建议过考研生需要坚持每天泛读10-15分钟的英文原刊。强烈推荐了杂志《经济学人》杂志中的文章也是考研英语的主要材料来源.希望考研考生认真阅读,快速提高考研英语阅读水平。
Obamacare
奥巴马医改
Experimental medicine
实验医学
A year after the big launch, is Obamacare working?
实施一年的奥巴马医改到底奏效吗?
TEXAS has a higher share of uninsured citizens thanany state in America. Until recently Shane, a 38-year-old from Houston, was one of them. “I just couldn't afford it,” he says. Shane has HIV; his jobdoes not cover him. Because of his illness, insurers would offer him only a costly plan withlimited benefits. Such discrimination is now illegal. Since January the Affordable Care Act,better known as Obamacare, has required insurers to charge the healthy and the sick the sameprice. For the first time in 20 years, Shane can afford health cover.
堪萨斯州未参与医疗保险的人数比美国其他任一州都多。直到近期来自休斯顿38岁的谢恩才刚刚参保。他说,“我只是无法负担医疗保险费。”谢恩是艾滋病患者,他的工作薪金无法负担他的医药费。由于他的疾病,保险公司只愿意提供有限福利但保费昂贵的保险方案。但是现在,这样的歧视是非法的。自今年一月平价医疗法案,即人们熟知的奥巴马医改要求保险公司向患病及健康的投保人收取同样的保费。这是20年来首次谢恩能够支付得起他的医疗费用。
Across town, Suezen Salinas is less fortunate. Having recently returned to college, she has nojob. Her two children qualify for Medicaid, the public health programme for the poor, but shedoes not. Texas is one of the nearly two dozen states that did not expand Medicaid, despiteObamacare's offer that the federal government would cover most of the cost. Ms Salinas alsoearns too little to qualify for Obamacare's subsidies. So she used some of her college financialaid to buy health cover.
城镇另一端的Suezen Salinas就没有那么幸运了。最近刚返回大学校园继续深造的她还没有工作。她的两个孩子有资格享受专为穷人设置的公共医疗项目—医疗补助计划,但是她不行。尽管奥巴马医改表示联邦政府将会支付医保的绝大部分开支,堪萨斯州是近20个未扩大医疗补助计划覆盖面的州之一。
Health care in America is changing, thanks to Obamacare and the efforts of innovative privatefirms (see article). And not before time. America's health system, the world's biggest, involves atangled mess of rules and a hotch-potch of public and private institutions. It combinesdazzling technology with minimal cost controls and spotty coverage. In 2012 it left some 48mpeople uninsured despite gobbling up 17.2% of GDP, a figure that dwarfs spending in anyother country and has shot up from 4.4% in 1950.
由于奥巴马医改以及锐意创新的私人企业的努力,美国的医疗保健正在改变。在此之前,作为全球最大的医疗体系,美国的医疗体系包含有一堆杂乱无章的规章制度以及混乱的公私机构。它集毫无节制地购买令人眼花缭乱的科技产品和零星的覆盖面于一体。2012年,尽管医疗体系开支占GDP17.2%,但仍然有0.48亿人未享受到医疗保险的福利,而这一数据远远高出其他国家的医疗保险开支,并且远远高出1950年占GDP4.4%的比率。
Rather than scrap this system, Obamacare rejigs it. It expands Medicaid to include millions ofnot-quite-poor Americans. It seeks to create a market where individuals can buy healthinsurance, pooling risks without the backing of a large employer. Ultimately, it aims to expandcoverage and deliver better care at a lower price. Its record is mixed so far.
奥巴马医改重新整顿了这个原本应该弃置的医疗体系。它扩大了医疗补助计划的覆盖范围,将那些不是那么富裕但又处于贫困线以上的数百万人纳入新的医疗救助体系中。它试图创造一个个人能够负担得起的医疗保险市场,在没有大型雇主的支持下让风险集中。最终达到以更低的价格扩大医疗保险的覆盖率同时提供更好的医疗服务。目前为止奥巴马医改所创的记录是多方面的。
Obamacare created new health exchanges, where individuals can shop for private insuranceand, if they earn between $11,670 and $46,680, qualify for subsidies. As well as barringinsurers from charging the sick more, it requires individuals to have health insurance or pay afine.
奥巴马医改创造了新的健康交易模式,在该种模式下,若个体收入在46680美元一下11670美元以上就有资格获得补助金,能够购买私人医疗保险。同时由于它阻止保险公司向病人收取更高的保费,它要求个体购买医疗保险或者缴纳罚款。
In some states Obamacare works well. In others, it does not. Many Republican-run statesrefused to expand Medicaid on the grounds that taxpayers would be stuck with the bill. Thatleft almost 9m adults who earn less than $11,670 a year, like Ms Salinas, too rich for Medicaidbut too poor to receive subsidies on the exchanges.
在有些州奥巴马医改实施得非常好,但是在另一些州则不然。许多共和党人治理的州由于担心纳税人在支付账单时有困难而拒绝扩大医疗救助计划的覆盖面。这让像萨林纳斯小姐一样年收入在11670美元以下的将近900万成年人既没有资格获得医疗救助又无法负担得起购买医疗保险的金额。
Thirty-six states did not set up their own exchanges (as Congress had assumed they would),instead relying on the federal government to do the work. That put a lot of pressure onHealthcare.gov, the federal insurance website, which hardly worked at all when it was launchedon October 1st last year. It is working better now, but problems remain. A new audit warnsthat more must be done to make the site secure.
36个州没有像国会预设的那样建立他们自己的医疗保险交易,而是寄希望于联邦政府去做这件事。这给联邦保险网站—医疗保健政府官网极大的压力,而该网站自去年十月一日上线以来几乎没做任何工作。尽管现在运转良好但是问题依然存在。新的审计警告要使该网站安全要投入更多的工作。
For now Obamacare seems to have expanded cover. Data-crunchers at Gallup, HarvardUniversity, the Urban Institute and the Commonwealth Fund agree that the proportion ofAmerican adults who are uninsured dropped by 22%-26% from the third quarter of 2013, justbefore Obamacare's exchanges opened, to the second quarter of 2014, when enrolment ended.Between 8m and 10.3m adults have gained cover. Much of this gain appears to have come fromthe expansion of publicly-funded Medicaid, however. Nearly 20% of adults are uninsured instates that did not expand Medicaid, about twice the share in states that did, according to theUrban Institute.
目前奥巴马医改似乎已经扩大了其覆盖面。在哈佛大学、盖洛普、城市研究所及联邦基金会搞数据工作的人同意,在奥巴马医改交易实施以前,登记截止之时,未参保的美国成年人的比例由2013年第三季度到2014年第二季度的比例下降了22%-26%。大约有800万至1030万成人被纳入医疗保险中。但是,这其中的绝大多数人似乎是来自公共基金支持的医疗救助计划的扩展。根据城市研究所的数据,在医疗救助计划未扩展的州府将近20%的成人未被纳入医保中,而在医疗救助计划扩展的州府纳入医保的成人的比例是40%。
How many people have gained coverage through the new exchanges is unclear. Officials saythat more than 8m have signed up, but this includes some who had insurance before. In MayMcKinsey, a consultancy, estimated that 26% of those who had bought policies on the individualmarket had been previously uninsured.
到底有多少人通过新的交易被纳入到医保中还不是很明确。官员声称超过800万人已签订合同,但这包含那些原本就参保的人。五月份,麦肯锡咨询公司估计在个体市场26%购买保险的人之前都未参保。
Politically, Obamacare remains highly controversial. A poll of polls finds that 51% of Americansdisapprove of it; only 41% approve. Republicans bash it in stump speeches; Democratsmention it only in passing. A lawsuit, Halbig v Burwell, contends that the law allows insurancesubsidies only through state-run exchanges, not through the federal one. If the plaintiffs win,they could kneecap the entire reform.
政治上来讲,奥巴马医改依然备受争议。民意测验的比较发现51%的美国民众不赞同该医改,仅有41%的人支持它。共和党人在竞选演说中猛烈抨击奥巴马医改,而民主党只是顺便提一提。Halbig v Burwell诉讼案件争论法律只允许通过国营的交易而非联邦交易给予保险补助金。如果原告获胜,他们将保障整个改革。
Assuming it survives legal challenges, however, Obamacare's success depends largely on howmany uninsured people eventually sign up for coverage on the exchanges. Legally, they areobliged to have coverage, but if prices are too high, some will opt to pay the penalty instead.Education should help—most of the uninsured are unaware of the subsidies available tothem. But premiums matter more, and are rising, by an average of 7% across 33 states,according to PwC, a consultancy. There is broad variation. Premiums are to rise by an averageof only 2.4% in Colorado, but by a whopping 14% in Tennessee, according to PwC. The nextround of enrolment starts in November; many people will discover whether their premiums areto rise or fall just before the mid-term elections.
假设奥巴马改革能够挺过法律这一挑战,它的成功依然在很大程度上依赖于最终多少未参保的人会在医疗保险单上签字。法律上说,他们应该被纳入到医保覆盖范围,但是倘若保费泰国高昂,有些人将会选择付罚金而非保费。教育程度应该会起作用——许多未参保的人都意识不到他们能得到的补助金。但是保险费所起的作用更大,并且价格一直在上涨。根据普华永道咨询公司的数据在33个州府中,保费平均涨幅达7%。并且各地的保费差异很大——在科罗拉多州保费的平均涨幅仅2.4%,而在田纳西州涨幅高达14%。下一轮的参保将在一月展开,在中期选举之前许多人将会讨论他们的保费到底是会涨还是会跌。
Growth in health spending per person slowed from a shocking 7.4% a year from 1980 to 2009to 3% from 2009 to 2012. It may rise again, alas. The lousy economy caused some of therecent slowdown. The government's actuaries expect spending to jump by 5.6% this year and6% a year from 2015 to 2023. As more Americans age and gain insurance, they will demandmore health care. Shane, for example, ignored an aching shoulder and blocked sinuses whenhe was uninsured. Now that he has cover, he is seeking treatment. Big hospitals say they areseeing more patients: Tenet, a giant hospital firm, reported a 4% jump in patient volumes inthe second quarter, compared with a year earlier.
用于医疗保险的开支年增长率在1980年至2009年是7.4%,但是到2009年至2012年却急剧降至3%。或许它还可能上涨。疲软的经济在某种程度上也导致了近段时间增长率的下滑。政府精算师希望今年医疗开支能够上涨5.6%,2015年至2023年能上涨6%。由于越来越多的美国人年龄增长并参保,他们更需要医疗保健。比如说,谢恩在未参保时,会忽视肩膀的酸痛以及因鼻窦炎堵塞的鼻子。现在既然他享受医疗保险他也会寻求治疗。大型医院称他们迎来越来越多的病患。大型医疗公司特内特报告指出相较一年以前,病人的数量增长了4%。
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