H.R. 676, the United States National Health Insurance Act, also known as “expanded and improved Medicare for all,” has moved through Congress, and is expected to be signed into law shortly. The legislation provides publicly funded health insurance, with a free choice of health care providers, for every United States citizen and permanent resident.
After the bill passed, Speaker of the House Nancy Pelosi declared, “We can now proudly say that the United States has caught up with the rest of the developed world in granting all our citizens access to high-quality, comprehensive medical care.” Prior to the bill's passage, the U.S. health care system was widely regarded to be in a state of severe crisis. Over 46 million Americans have been without health insurance and another 50 million have been under-insured.
Despite spending more money per capita on health care than any other nation, the U.S. has lagged behind many countries in such key health-related categories as life preventable deaths. The Institute of Medicine estimates that in recent years approximately 22,000 people have died annually in the U.S. due to a lack of health insurance. Furthermore, nearly one million Americans, many who have private health insurance plans, have filed for bankruptcy each year because they have been unable to pay medical bills. In recent polls, a clear majority of Americans have said they believe government should guarantee health care for all U.S. residents.
Despite growing popular support for a single-payer system, Pelosi acknowledged that Congress would not have voted for this bill without the dedicated grassroots organizing of national groups like Healthcare-NOW and Physicians for National Health Program, regional groups like the California Nurses Association and the New York-based Private Health Insurance Must Go Coalition, and over 450 union organizations across the country that had endorsed H.R. 676. Pelosi said that many formerly undecided congressional representatives were also swayed by seeing Michael Moore's film, “Sicko,” and by the cogent arguments presented in a 2008 pocket-sized books, “10 Excellent Reasons for National Health Care,” edited by Mary E. O'Brien and Martha Livingston, which was given to every member of Congress.
Under the private insurance system that has been in place until now, 30 percent of health insurance premiums have gone toward administrative costs, including advertising, profits, and executive salaries. This compares with a 3 percent cost for administering Medicare. Moving from the private health insurance system to single-payer is expected to save $350 billion dollars each year, enough to fund health care for those who are currently uninsured or under insured.
Under the H.R. 676, the expanded Medicare for All system will be paid for through a 3.3 percent payroll tax on employers and employees, a stock transfer tax, an income tax surcharge on the top 5 percent of taxpayers, and by reversing the Bush tax cuts on the wealthiest Americans. According to the Congressional Budget Office, most U.S. residents—including those who previously received employer-based coverage—will pay less for this new public health insurance than they did for their private insurance, since there will no longer be any premium, copy, or deductible charges. Eliminating private insurance companies, including HMOs, and moving to a publicly administered system will be no simple ask. The private health-care industry is enormous, employing over 14 million people and costing 2.3 trillion dollars in 2007.
1. Which of the following statements is NOT true about the H.R. 676?
[A] It is expected to take effect soon.
[B] People enjoy freedom in choosing health care providers.
[C] The U.S. health care system once collapsed.
[D] The medical care is characterized by high quality and comprehensiveness.
2. The word “lagged” (Line 1, Paragraph 3) most probably means _____.
[A] delayed
[B] not caught up with
[C] tracked
[D] left
3. According to Pelosi, the followings are the reasons that Congress voted for this bill except that _____.
[A] special grassroots organizations are formed
[B] the film “Sicko” has swayed Congress members' attitude
[C] 30% of the premiums were paid for the administrative expense
[D] persuasive theory in the pocket-sized book affects people's thought
4. The single-payer system is more beneficial than private insurance mainly because _____.
[A] the former provides high-quality, comprehensive medical care
[B] private insurance is more expensive
[C] it allows people to choose health care providers with freedom
[D] premiums in private insurance can't be distributed reasonably
5. Towards the legislation, the author's attitude can be said to be _____.
[A] affirmative
[B] negative
[C] biased
[D] neutral
1. Which of the following statements is NOT true about the H.R. 676?
[A] It is expected to take effect soon.
[B] People enjoy freedom in choosing health care providers.
[C] The U.S. health care system once collapsed.
[D] The medical care is characterized by high quality and comprehensiveness.
1. 下面關(guān)于H.R. 676的說法哪項(xiàng)是錯(cuò)誤的?
[A] 它有望在近期生效。
[B] 人們可以自由選擇醫(yī)療服務(wù)機(jī)構(gòu)。
[C] 美國(guó)的醫(yī)療保險(xiǎn)制度曾一度崩潰。
[D] 這種醫(yī)療保險(xiǎn)制度的特點(diǎn)在于高質(zhì)量且全方位。
答案:C 難度系數(shù):☆☆☆
分析:細(xì)節(jié)題。題目要求找出對(duì)H.R. 676表述錯(cuò)誤的一項(xiàng)。A項(xiàng)在第一段有所提及,...is expected to be signed into law shortly說明有望近期簽署生效。B項(xiàng)在第一段也有體現(xiàn),...with a free choice of health care providers說明可以自由選擇醫(yī)療服務(wù)機(jī)構(gòu)。第二段中的the U.S. health care system was widely regarded to be in a state of severe crisis說的是醫(yī)療保險(xiǎn)制度面臨嚴(yán)重危機(jī),并未表明一度崩潰,且它不屬于該法案的特點(diǎn),因此C項(xiàng)表述錯(cuò)誤。D項(xiàng)在第二段中有體現(xiàn),說美國(guó)已經(jīng)趕上其他發(fā)達(dá)國(guó)家,擁有高質(zhì)量且全方位的醫(yī)療保險(xiǎn)制度,其實(shí)也就是H.R. 676本身具備了high-quality and comprehensiveness的特點(diǎn)。
2. The word “lagged” (Line 1, Paragraph 3) most probably means _____.
[A] delayed
[B] not caught up with
[C] tracked
[D] left
2. 單詞“lagged”(第三段第一行)最有可能的意思是_____。
[A] 延遲
[B] 趕不上
[C] 跟蹤
[D] 離開
答案:B 難度系數(shù):☆☆
分析:猜詞題。句首處despite表轉(zhuǎn)折,說“與其他國(guó)家相比,盡管美國(guó)在人均醫(yī)療服務(wù)方面投入了更多的資金,但……”, 而且lagged后面接的是behind,據(jù)此大概能猜出這個(gè)短語(yǔ)是落在了后面的意思,結(jié)合上下文可知,盡管投了這么多錢,但還是趕不上其他國(guó)家。所以lagged是“落后,趕不上”的意思。
3. According to Pelosi, the followings are the reasons that Congress voted for this bill except that _____.
[A] special grassroots organizations are formed
[B] the film “Sicko” has swayed Congress members' attitude
[C] 30% of the premiums were paid for the administrative expense
[D] persuasive theory in the pocket-sized book affects people's thought
3. 根據(jù)佩洛西所說,下列選項(xiàng)中除了_____都是國(guó)會(huì)為這項(xiàng)法案投票的原因。
[A] 成立了一些專門的基層組織
[B] 電影《醫(yī)療內(nèi)幕》動(dòng)搖了國(guó)會(huì)議員的態(tài)度
[C] 30%的保險(xiǎn)費(fèi)用花在了行政開銷上
[D] 口袋書中具有說服力的理論影響了人們的思想
答案:C 難度系數(shù):☆☆
分析:細(xì)節(jié)題。國(guó)會(huì)議員為這項(xiàng)法案投票的原因出現(xiàn)在第四段:Congress would not have voted for this bill without the dedicated grassroots organizing of... 由此可得出A是正確的。由Pelosi said that many formerly undecided congressional representatives were also swayed by...可知國(guó)會(huì)議員的態(tài)度受到了下文提到的電影和書的影響,sway意為“動(dòng)搖”,可見,這些還是觸動(dòng)了議員,故 B和D 也正確。C項(xiàng)說的是私人保險(xiǎn)費(fèi)用花在了哪些方面,與議員投票沒有直接關(guān)系,故答案為C項(xiàng)。
4. The single-payer system is more beneficial than private insurance mainly because _____.
[A] the former provides high-quality, comprehensive medical care
[B] private insurance is more expensive
[C] it allows people to choose health care providers with freedom
[D] premiums in private insurance can't be distributed reasonably
4. 單一給付體制比私人保險(xiǎn)更有益的主要原因是 _____。
[A] 前者能提供高質(zhì)量且全方位的醫(yī)療服務(wù)
[B] 私人保險(xiǎn)費(fèi)用更昂貴
[C] 它允許人們自由選擇醫(yī)療服務(wù)機(jī)構(gòu)
[D] 私人保險(xiǎn)中的保險(xiǎn)費(fèi)得不到合理分配
答案:D 難度系數(shù):☆☆☆☆☆
分析:推理題。最后兩段通過和私人保險(xiǎn)做對(duì)比,顯示出單一給付體制的優(yōu)越性。其中提到,30%的醫(yī)療保險(xiǎn)費(fèi)用都花在了行政開銷上,如廣告、利潤(rùn)以及工資支出等,而用于醫(yī)療保險(xiǎn)實(shí)施的支出只占全部的3%左右。在新的公共醫(yī)療保險(xiǎn)制度下,額外保險(xiǎn)費(fèi)、重復(fù)繳費(fèi)或扣費(fèi)都不復(fù)存在,因此人們可以支付比購(gòu)買私人保險(xiǎn)更少的費(fèi)用。歸根結(jié)底,私人保險(xiǎn)費(fèi)用不能被合理分配,而實(shí)際用于醫(yī)療保險(xiǎn)方面的只有3%。相比而言,單一給付體制將避免這些問題,因此益處更多,當(dāng)然受到人們的青睞。故D項(xiàng)為正確答案。
5. Towards the legislation, the author's attitude can be said to be _____.
[A] affirmative
[B] negative
[C] biased
[D] neutral
5. 作者對(duì)這項(xiàng)法案的態(tài)度可以認(rèn)為是_____。
[A] 肯定的
[B] 否定的
[C] 有偏見的
[D] 中立的
答案:A 難度系數(shù):☆☆☆
分析:態(tài)度題。文章雖然措辭比較客觀,但是從作者的論述過程中還是可以發(fā)現(xiàn),作者對(duì)這項(xiàng)醫(yī)療保險(xiǎn)法案還是很贊同的,如拿私人保險(xiǎn)與單一給付體制做對(duì)比,突出單一給付體制的優(yōu)勢(shì),這些都可以看出作者肯定的態(tài)度。故A項(xiàng)為正確答案。
H.R. 676, 美國(guó)國(guó)家醫(yī)療保險(xiǎn)方案,又名“擴(kuò)大改進(jìn)全民醫(yī)療保險(xiǎn)方案”目前國(guó)會(huì)已通過,并有望于近期簽署生效。該法案將為每一位美國(guó)公民和在美國(guó)永久居住的公民提供公共醫(yī)療保險(xiǎn)基金,并允許他們自主選擇醫(yī)療服務(wù)機(jī)構(gòu)。
該法案通過后,眾議院發(fā)言人南希·佩洛西發(fā)表聲明說,“我們現(xiàn)在可以自豪地說,在保障公民享受高質(zhì)量且全方位的醫(yī)療服務(wù)方面,美國(guó)已經(jīng)趕上了世界其他發(fā)達(dá)國(guó)家的步伐。”而在該法案通過之前,人們都普遍認(rèn)為美國(guó)的醫(yī)療保險(xiǎn)制度已經(jīng)面臨嚴(yán)峻危機(jī)。超過4600萬(wàn)美國(guó)民眾一直沒有醫(yī)療保險(xiǎn),另有5000萬(wàn)人享受的保險(xiǎn)服務(wù)低于應(yīng)有水平。
與其他國(guó)家相比,盡管美國(guó)在人均醫(yī)療服務(wù)方面投入了更多的資金,但與健康息息相關(guān)的關(guān)鍵領(lǐng)域,如可預(yù)防性死亡等方面,還是落后于許多國(guó)家。據(jù)美國(guó)醫(yī)學(xué)研究所預(yù)測(cè),近年來(lái),每年約有2.2萬(wàn)人因?yàn)闆]有醫(yī)療保險(xiǎn)而死亡。此外,每年,近一百萬(wàn)美國(guó)人盡管有私人醫(yī)療保險(xiǎn),但是由于無(wú)力支付醫(yī)療費(fèi)而申請(qǐng)破產(chǎn)。最近的民意調(diào)查顯示,絕大多數(shù)美國(guó)人認(rèn)為政府應(yīng)該保障其公民的醫(yī)療服務(wù)項(xiàng)目。
佩洛西認(rèn)為,盡管越來(lái)越多的人支持單一給付體制(由單一機(jī)構(gòu)[政府]提供醫(yī)療服務(wù)所需的所有資金,讓原本無(wú)法獲得醫(yī)療服務(wù)的民眾獲得醫(yī)療保障,實(shí)現(xiàn)全民醫(yī)療保險(xiǎn),而且民眾無(wú)論是否就業(yè),都可獲得單一給付體制的保障),但是如果沒有專門的基層國(guó)家組織,如“醫(yī)療保健—就是現(xiàn)在”和“國(guó)民健康醫(yī)師項(xiàng)目”等,以及區(qū)域組織,如“加州護(hù)士協(xié)會(huì)”和“紐約私人醫(yī)保聯(lián)盟”等類似組織的參與,以及全國(guó)超過450個(gè)聯(lián)合組織同意H.R. 676,國(guó)會(huì)議員將不會(huì)為該法案投票。他還指出,許多以前態(tài)度就搖擺不定的國(guó)會(huì)代表在看了邁克爾·摩爾拍攝的電影《醫(yī)療內(nèi)幕》以及2008年由瑪麗·E. 奧布賴恩和瑪莎·利文斯頓共同編寫的《國(guó)民醫(yī)療保險(xiǎn)的10大主因》這部口袋書里所列舉的強(qiáng)大理論后,現(xiàn)在態(tài)度也發(fā)生了改變,其中這本口袋書國(guó)會(huì)議員人手一本。
自私人保險(xiǎn)制度實(shí)施以來(lái),30%的醫(yī)療保險(xiǎn)費(fèi)用都花在了行政開銷上,如廣告、利潤(rùn)以及工資支出等,而用于醫(yī)療保險(xiǎn)實(shí)施的支出相比之下卻只占全部的3%左右。如果把私人醫(yī)保制度轉(zhuǎn)變成單一給付體制,每年將有望節(jié)省3500億美元,這些將足以為目前尚未投?;驘o(wú)力投保的人提供足夠的醫(yī)療服務(wù)基金。
按照H.R. 676的條款,醫(yī)療保險(xiǎn)范圍擴(kuò)大,其費(fèi)用將會(huì)通過向雇主和雇員征收3.3%的工資所得稅、股票轉(zhuǎn)讓以及對(duì)排名前5%的最高納稅人征收收入附加稅來(lái)實(shí)現(xiàn),該政策結(jié)束了布什時(shí)期向最富有的美國(guó)人實(shí)施的減稅政策。美國(guó)國(guó)會(huì)預(yù)算辦公室稱,大多數(shù)美國(guó)公民,包括之前有雇主責(zé)任保險(xiǎn)的公民,在新的公共醫(yī)療保險(xiǎn)制度下,將支付比購(gòu)買私人保險(xiǎn)更少的費(fèi)用,因?yàn)樵谶@項(xiàng)政策下,繳納額外費(fèi)用、重復(fù)繳費(fèi)或扣費(fèi)的現(xiàn)象都將不復(fù)存在。根除諸如像健康保護(hù)組織HMOs這樣的私人保險(xiǎn)公司,進(jìn)而轉(zhuǎn)向公共管理體制并非易事。私人醫(yī)療行業(yè)十分龐大,2007年其員工就超過1400萬(wàn)人,運(yùn)營(yíng)成本為2.3萬(wàn)億美元。