VOA标准英语2009年-Serious Debate Begins on Future of US Heal

By Melinda Smith
Washington
16 September 2009
Part 1 of VOA's 5-part series on Health Care
 

The American health care system has been called one of the best and worst in the world. Many experts say it is certainly the most expensive, costing $2.5 trillion a year or about $7,000 to $8,000 per person. Most Americans pay for their medical care through private insurance, which is partially¹ subsidized by their employers. Elderly Americans receive health care largely paid for by a government trust fund that may eventually run out of money. An estimated 30 million others - a majority of them considered the working poor - have no health insurance at all. Here's our report on some of the causes for a health care system in crisis.

Wanting it all
 

 
Some Americans say that health care reform cannot wait, it must not wait, and it will not wait another year
As a nation, America seems to want it all. Patients want the best medical treatment. But some, like Jarene Williams whose young son was sick with a congenital defect, are shocked when the bill comes in. 

"We started getting these surprise bills," she said. "I said 'wait a minute. We're insured.'"

Family physician David Ellington says doctors want to provide the latest medical treatment, but reimbursements³ they receive from health insurance companies are not enough to cover their expenses or keep them in practice.

"There is going to have to be some type of arrangement in the way doctors are paid," he said.

Too Costly⁴
 

Small business owners say they want to provide medical coverage⁵ for their employees, but are finding it hard to sustain their share of the cost.

Amy Milstead Ellzey is president of family-owned Milstead Automotive Ltd. She says struggles to provide an affordable⁶ plan for her employees. 

"It is terrible," she said. "We cannot afford a 44 percent increase in medical insurance, so that, in turn, makes us have to start looking elsewhere for different plans and it makes us have to cut the plan back some."

Nationwide polls have shown that most Americans want improvements made in their health care system. President Barack Obama signaled to Congress recently that decades of rising costs for a medical system which does not treat everyone fairly must end.

 
President Obama speaking on health-care reform before a joint⁷ session of Congress, 09 Sep 2009
"The cost of our health-care has weighed down our economy and the conscience of our nation long enough," said Mr. Obama. "So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year."

Everyone should be included
 

Jonathan Weiner is a professor of health policy at the Johns Hopkins School of Public Health in Baltimore, Maryland. 

He says the biggest challenge in health reform is making sure that everyone is included: that no American be shut out from some kind of medical coverage, whether it be private insurance or government funded, because of a pre-existing medical condition or low income.

"For the many 40-50 millions of Americans who don't have health insurance, of course, that's the number one issue, getting them covered," noted⁸ Weiner. " Without a health insurance card, it's not as if we don't care for people without insurance cards, the care is sporadic⁹ and often incomplete. And they get half the health care coverage that everyone else gets."

New program for working poor
 

Weiner believes the eventual² legislation will include the working poor who earn too much to qualify for the government assistance program called Medicaid. He says they will be enrolled¹⁰ in some kind of other public option program or private insurance plan.

"That's going to be one of the most positive changes in health care that I think every American should be pleased to see, that health insurers must take you without regard to your disease," he said. "

Weiner also says for too long the American health care system has paid medical fees based on the severity of the patient's illness and far less for prevention of chronic¹¹ diseases.

"Right now doctors get paid more and more for ordering tests," he said. "The sicker their patients become, the more they get paid. We need to shift to a system that - that - rewards efficiency, that rewards making people healthy."

Costly proposal
 

President Obama says his health care proposals would cost about $900 billion over the next decade, funded in part by money already allocated¹² in the existing health care system. 

Critics say the existing system is wasteful¹³, inefficient¹⁴, full of unnecessary administrative¹⁵ costs, and steered¹⁶ by poor management. 

Patients and their insurers, they say, pay inflated¹⁷ prices for medical care that is sometimes not appropriate, as well as for the care of others who are uninsured.

In a joint address to the U.S. Congress on September 9, President Obama said it has been almost a century since another president, Theodore Roosevelt, first called for health care reform. 

"I understand how difficult this health care debate has been," the president said. "I know that many in this country are deeply skeptical¹⁸ that government is looking out for them. "

1 partially   

adv.部分地，从某些方面讲

参考例句：

• The door was partially concealed by the drapes.门有一部分被门帘遮住了。
• The police managed to restore calm and the curfew was partially lifted.警方设法恢复了平静，宵禁部分解除。

2 eventual   

adj.最后的，结局的，最终的

参考例句：

• Several schools face eventual closure.几所学校面临最终关闭。
• Both parties expressed optimism about an eventual solution.双方对问题的最终解决都表示乐观。

3 reimbursements   

n.偿还( reimbursement的名词复数 )；退款；补偿；赔偿

参考例句：

• We had to put in for the food reimbursements again. 我们不得不再次申请食物赔偿。 来自互联网
• Have you figured up the total of the reimbursements I gave you? 你有没有把我给你的报销账目全部加总了呢？ 来自互联网

4 costly   

adj.昂贵的，价值高的，豪华的

参考例句：

• It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
• This dictionary is very useful,only it is a bit costly.这本词典很有用，左不过贵了些。

5 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

6 affordable   

adj.支付得起的，不太昂贵的

参考例句：

• The rent for the four-roomed house is affordable.四居室房屋的房租付得起。
• There are few affordable apartments in big cities.在大城市中没有几所公寓是便宜的。

7 joint   

adj.联合的，共同的；n.关节，接合处；v.连接，贴合

参考例句：

• I had a bad fall,which put my shoulder out of joint.我重重地摔了一跤，肩膀脫臼了。
• We wrote a letter in joint names.我们联名写了封信。

8 noted   

adj.著名的，知名的

参考例句：

• The local hotel is noted for its good table.当地的那家酒店以餐食精美而著称。
• Jim is noted for arriving late for work.吉姆上班迟到出了名。

9 sporadic   

adj.偶尔发生的 [反]regular；分散的

参考例句：

• The sound of sporadic shooting could still be heard.仍能听见零星的枪声。
• You know this better than I.I received only sporadic news about it.你们比我更清楚，而我听到的只是零星消息。

10 enrolled   

adj.入学登记了的v.[亦作enrol]( enroll的过去式和过去分词 )；登记，招收，使入伍（或入会、入学等），参加，成为成员；记入名册；卷起，包起

参考例句：

• They have been studying hard from the moment they enrolled. 从入学时起，他们就一直努力学习。 来自《简明英汉词典》
• He enrolled with an employment agency for a teaching position. 他在职业介绍所登了记以谋求一个教师的职位。 来自《简明英汉词典》

11 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

12 allocated   

adj. 分配的 动词allocate的过去式和过去分词

参考例句：

• The Ford Foundation allocated millions of dollars for cancer research. 福特基金会拨款数百万美元用于癌症研究。
• More funds will now be allocated to charitable organizations. 现在会拨更多的资金给慈善组织。

13 wasteful   

adj.（造成）浪费的，挥霍的

参考例句：

• It is a shame to be so wasteful.这样浪费太可惜了。
• Duties have been reassigned to avoid wasteful duplication of work.为避免重复劳动浪费资源，任务已经重新分派。

14 inefficient   

adj.效率低的，无效的

参考例句：

• The inefficient operation cost the firm a lot of money.低效率的运作使该公司损失了许多钱。
• Their communication systems are inefficient in the extreme.他们的通讯系统效率非常差。

15 administrative   

adj.行政的，管理的

参考例句：

• The administrative burden must be lifted from local government.必须解除地方政府的行政负担。
• He regarded all these administrative details as beneath his notice.他认为行政管理上的这些琐事都不值一顾。

16 steered   

v.驾驶( steer的过去式和过去分词 )；操纵；控制；引导

参考例句：

• He steered the boat into the harbour. 他把船开进港。
• The freighter steered out of Santiago Bay that evening. 那天晚上货轮驶出了圣地亚哥湾。 来自《简明英汉词典》

17 inflated   

adj.（价格）飞涨的；（通货）膨胀的；言过其实的；充了气的v.使充气（于轮胎、气球等）( inflate的过去式和过去分词 )；（使）膨胀；（使）通货膨胀；物价上涨

参考例句：

• He has an inflated sense of his own importance. 他自视过高。
• They all seem to take an inflated view of their collective identity. 他们对自己的集体身份似乎都持有一种夸大的看法。 来自《简明英汉词典》

18 skeptical   

adj.怀疑的，多疑的

参考例句：

• Others here are more skeptical about the chances for justice being done.这里的其他人更为怀疑正义能否得到伸张。
• Her look was skeptical and resigned.她的表情是将信将疑而又无可奈何。