医疗费用的改革

Reform and Medical Costs【医疗费用的改革】

[A] Americans are deeply concerned about the relentless rise in health care costs and health insurance premiums.
美国人深切关注着该国医疗保健费用和健康保险费用的不断上涨。
They need to know if reform will help solve the problem.
他们需要知道改革是否有助于解决这一问题。
The answer is that no one has an easy fix for rising medical costs.
答案是对于上涨的医疗费用，人们找不出简单的对策。
The fundamental fix—reshaping how care is delivered and how doctors are paid in a wasteful, abnormal system—is likely to be achieved only through trial and error and incremental (渐进的）gains.
根本的解决方法是在一个浪费且非常规的系统中，重新制定医疗保健的实施方案和医生的收费方式，但这很可能只有在经过反复试验和渐进方式收效后方能实现。

[B] The good news is that a bill just approved by the House and a bill approved by the Senate Finance Committee would implement or test many reforms that should help slow the rise in medical costs over the long term.
好消息是，一项由众议院刚刚通过的法案和另一项由参议院财政委员会通过的法案，将会对诸多有助于长期减缓医疗费用上涨的改革进行实施和检验。
As a report in The New England Journal of Medicine concluded, "Pretty much every proposed innovation found in the health policy literature these days is contained in these measures."
新英格兰医学期刊中的一篇报道总结说，最近该医疗政策文献中提到的，几乎每一项创新法案，都包括在这些改革措施中。

[C] Medical spending, which typically rises faster than wages and the overall economy, is propelled by two things: the high prices charged for medical services in this country and the volume of unnecessary care delivered by doctors and hospitals, which often perform a lot more tests and treatments than a patient really needs.
医疗费用的上涨速度通常超过工资和整体经济的上涨速度，而医疗费用上涨的两大推动因素则是该国医疗服务收取的昂贵费用，以及医生和医院提供大量不必要的诊疗项目，且后一因素使得病人常常要接受很多超出其实际需要的检查和治疗。

[D] Here are some of the important proposals in the House and Senate bills to try to address those problems, and why it is hard to know how well they will work.
以下是众议院和参议院法案中试图解决以上问题的一些重要提案，和难以预测其自身能发挥多大功效的原因。

[E] Both bills would reduce the rate of growth in annual Medicare payments to hospitals, nursing homes and other providers by amounts comparable to the productivity savings routinely made in other industries with the help of new technologies and new ways to organize work.
这两项法案都将逐步降低，每年支付给医院，疗养院以及其他医疗服务机构的医疗保险费用的增长率，其数额相当于其他行业在新技术和组织工作新方法的帮助下进行常规工作节省下来的生产费用。
This proposal could save Medicare more than $100 billion over the next decade.
这项提议在未来10年里可为医疗保险节省1000多亿美元。
If private plans demanded similar productivity savings from providers, and refused to let providers shift additional costs to them, the savings could be much larger.
如果私人健康保险计划要求医疗服务机构进行类似的生产力节约，并且拒绝医疗服务机构将额外的费用转移给他们，那么节省的钱将会更多。
Critics say Congress will give in to lobbyists and let inefficient providers off the hook That is far less likely to happen if Congress also adopts strong upaygo” rules requiring that any increase in payments to providers be offset by new taxes or budget cuts.
但如果国会同样采取严格的现金现付的制度，规定任何支付给医疗服务机构的费用的增加，都会被新的税收和预算削减所抵消的话，这种情况就不太可能发生。

[F] The Senate Finance bill would impose an excise tax(消费税）on health insurance plans that cost more than 21,000 for a family.
参议院财政委员会的法案将对健康保险计划征收消费税，该保险计划的个人参保费是8000多美元家庭参保费为21,000美元。
It would most likely cause insurers to redesign plans to fall beneath the threshold.
该法案极可能促使保险公司重新设计其健康保险计划已降到起收点之下。
Enrolls would have to pay more money for many services out of their own pockets, and that would encourage them to think twice about whether an expensive or redundant test was worth it.
参保者在接受很多医疗服务时，就需要自掏腰包支付更多的费用，就会促使他们慎重考虑是否值得去做一次昂贵或者多余的检查。
Economists project that most employers would shift money from expensive health benefits into wages.
经济学家预计，大多数雇主会将高额医疗福利折合为工资。
The House bill has no similar tax. The final legislation should.
众议院的法案并没有类似的税收，但最终的立法应该有所规定。

[G] Any doctor who has wrestled with multiple forms from different insurers, or patients who have tried to understand their own parade of statements, know that simplification ought to save money.
任何奋力应对不同保险公司各种表格的医生或者试图了解保险公司声明的病人都明白，简单化才应该是省钱的。
When the health insurance industry was still cooperating in reform efforts, its trade group offered to provide standardized forms for automated processing.
当医疗保险行业仍在配合改革，使行业中的交易部门提议为自动化处理提供标准形式。
It estimated that step would save hundreds of billions of dollars over the next decade. The bills would lock that pledge into law.
根据估计，这一举措将在未来10年里节省数千亿美元，参众两院的法案将会承诺纳入法律中。

[H] The stimulus package provided money to convert the inefficient, paper-driven medical system to electronic records that can be easily viewed and transmitted.
经济刺激方案为低效，以纸质单据为主的医疗系统向易于被浏览和传播的电子病历的转变提供了资金。
This requires open investments to help doctors convert.
这需要开放化投资来帮助医生转变。
In time it should help restrain costs by eliminating redundant tests, preventing drug interactions, and helping doctors find the best treatments.
最后对医疗系统的转变会通过免除溶于的检查，防止药物相互作用，并威胁医生找到最佳的治疗方案等手段，来助力于控制医疗成本。

[I] Virtually all experts agree that the fee-for-service system—doctors are rewarded for the quantity of care rather than its quality or effectiveness—is a primary reason that the cost of care is so high.
几乎所有专家都认为，按服务项目收费的系统，医生凭借其接诊的数量而非诊疗的质量和效果来获得酬劳，是医疗费用居高不下的主要原因。
Most agree that the solution is to push doctors to accept fixed payments to care for a particular illness or for a patient's needs over a year.
大多数人认为解决办法是鼓励医生在一年之内对一种特定疾病或一个人的需求只收固定的诊疗费。
No one knows how to make that happen quickly.
没有人知道如何快速实现这一解决办法。
The bills in both houses would start pilot projects within Medicare.
参众两院的法案都将针对医疗保险启动试点项目。
They include such measures as accountable care organizations to take charge of a patient's needs with an eye on both cost and quality, and chronic disease management to make sure the seriously ill, who are responsible for the bulk of all health care costs, are treated properly.
项目包括这样一些措施，比如可信赖的医疗机构负责处理病人的需求，既要注重医疗成本，也要注重医疗质量，慢性病管理机构确保自行承担大部分医疗保健费用的患者，能够接受合理的救治。
For the most part, these experiments rely on incentive payments to get doctors to try them.
在大多数情况下，这些试点项目需要激励政策，以激励鼓励医生去尝试。

[J] Testing innovations do no good unless the good experiments are identified and expanded and the bad ones are dropped. 除非能够识别并扩大好的试点项目，识别并终止不好的试点项目，否则尝试新的无济于事。The Senate bill would create an independent commission to monitor the pilot programs and recommend changes in Medicare's payment policies to urge providers to adopt reforms that work. 参议院的法案将设立一个独立的委员会，以监督试点项目，并对医疗保险支付政策提出改善建议，进而促使医疗服务机构进行有效的改革。The changes would have to be approved or rejected as a whole by Congress, making it hard for narrow-interest lobbies to bend lawmakers to their will.这些政策的改善建议需要经过国会的统一批准或否决，这使得那些追求狭隘利益的游说团体难以左右立法者的意愿。

[K] The bills in both chambers would create health insurance exchanges on which small businesses and individuals could choose from an array of private plans and possibly a public option.参众两院的法案都提到将创建医疗保险交易所，在那里小型企业和个人可以在大量的私人健康保险计划，甚至可能是一个公共的保险计划中进行选择。
All the plans would have to provide standard benefit packages that would be easy to compare.所有计划都必须提供易于对比的标准福利计划。 To get access to millions of new customers, insurers would have a strong incentive to sell on the exchange. 为了赢得数以百万计的新用户，保险公司会有强大的动力在交易所中销售其保险计划。And the head-to-head competition might give them a strong incentive to lower their prices, perhaps by accepting slimmer profit margins or demanding better deals from providers.势均力敌的竞争可能会促使这些保险公司降低自己的价格。这种降价或许是通过接受较小的利润空间来实现，又或者是通过医疗服务机构提供更优惠的协议来实现。

[L] The final legislation might throw a public plan into the competition, but thanks to the fierce opposition of the insurance industry and Republican critics, it might not save much money. 最终的立法可能会在竞争中投入一项公共计划，但是由于遭到保险行业和共和党批评人士的强烈反对，该计划或许不会节省很多钱。The one in the House bill would have to negotiate rates with providers, rather than using Medicare rates, as many reformers wanted.众议院法案中的一项条款，需要与医疗服务机构协商医疗支付率，而非使用医疗保险的支付率，这正是诸多改革者所希望的。

[M] The president's stimulus package is pumping money into research to compare how well various treatments work. 总统的经济刺激方案在为研究注入资金，以对比不同治疗方法的效果。Is surgery, radiation or careful monitoring best for prostate (前列腺) cancer? 手术，放射疗法，又或者细心检查，哪种治疗前列腺癌症的效果最好? Is the latest and most expensive cholesterol-lowering drug any better than its common competitors? 最新最贵的降胆固醇药物比普通的同类药物更好吗?The pending bills would spend additional money to accelerate this effort.悬而未决的法案将投入更多的资金来加快这方面的研究。

[N] Critics have charged that this sensible idea would lead to rationing of care. 批评人士指责这一合理的想法会导致医疗保健的定量配额。(That would be true only if you believed that patients should have an unrestrained right to treatments proven to be inferior.) (只有当你认为病人可以无限制的接受那些被证明是积极的治疗时，医疗保健配给才会成为事实)
As a result, the bills do not require, as they should, that the results of these studies be used to set payment rates in Medicare.因此这些法案并未要求把这些研究结果应用于设置医疗保险支付率，即使他们本应如此。

[O] Congress needs to find the courage to allow Medicare to pay preferentially for treatments proven to be superior. 嗯，在允许医疗保险优先支付，经证明是高级治疗的费用，一事上，国会是需要勇气的。Sometimes the best treatment might be the most expensive. 有时最好的治疗可能是最昂贵的。But overall, we suspect that spending would come down through elimination of a lot of unnecessary or even dangerous tests and treatments.但是总体而言，我们才想通过免去许多不必要甚至是危险的检查和治疗，医疗花费将会减少。

[P] The House bill would authorize the secretary of health and human services to negotiate drug prices in Medicare and Medicaid. 众议院的法案将授权卫生与公共服务部部长去协商医疗保险和医疗援助药品的价格。Some authoritative analysts doubt that the secretary would get better deals than private insurers already get.一些权威分析人士质疑部长能否取得比私营保险公司已经拿到的更为优惠的协议。 We believe negotiation could work.但我们相信该协商会奏效。 It does in other countries.在其他国家便是如此。

[Q] Missing from these bills is any serious attempt to rein in malpractice costs.这些法案没有涉及任何真正尝试控制医疗事故赔偿费用的条款。 Malpractice awards do drive up insurance premiums for doctors in high-risk specialties, and there is some evidence that doctors engage in "defensive medicine" by performing tests and treatments primarily to prove they are not negligent should they get sued. 医疗事故赔偿的确为高危专科医生抬高了保险费用，而且有证据显示，医生主要会通过实施检查和治疗来进行防御式医疗，在他们被起诉时，可以借此来证明自己没有玩忽职守。