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Health reform

醫(yī)療改革

Medicare, the opera

醫(yī)改的鬧劇

Another election, another nonsensical fight over theelderly

又一場選舉，又一場關(guān)于老年人的荒謬斗爭

APRIL has been a cheerful month for the Affordable Care Act, better known as Obamacare.More than 7m Americans have signed up for private coverage through the law's exchanges and,by the end of February, more than 3m people had enrolled in Medicaid, the health programmefor the poor. According to the latest Gallup poll, America's share of uninsured has fallen to itslowest level since 2008. These figures are good news for anyone keen to expand healthcoverage. They may not be so helpful for the Democrats' election prospects.

四月對平價醫(yī)療法案(或者稱其為奧巴馬醫(yī)改)來說是值得歡呼的一個月。截至二月末，已有超過七百萬美國人通過法律交換簽署了私人保險，以及超過三百萬人參加了專為窮人設(shè)置的健康計劃—醫(yī)療補助。根據(jù)蓋洛普最新的調(diào)查顯示，美國人未參加保險的比例已降至2008年以來的最低水平。這些數(shù)據(jù)對所有熱衷擴大醫(yī)保范圍的人來說都無疑是個好消息。但對民主黨競選前景的改善可能沒有太大裨益。

To understand why, consider another set of figures. More than 40m older Americans areenrolled in Medicare, the public-health programme for those aged 65 and older, with more than15m of them in private Medicare plans. These are reliable voters in elections. And Republicansare singing them the same aria again and again: Democrats are raiding their benefits to pay forObamacare.

看看另外一組數(shù)據(jù)便知原因。美國參加了醫(yī)保的老年人數(shù)量已超過4千萬，該醫(yī)保是一項為65歲及以上的老年人制定的公共健康計劃，其中超過一千五百萬人同時參與了個人醫(yī)保計劃。這些人都是在選舉中所能夠依賴的選民。共和黨人頻頻高唱同一嘆調(diào)：民主黨人為了支付奧巴馬醫(yī)改而損害了他們的利益。

Democratic politicians are desperate to convince them otherwise. On April 7th health officialsprovided some help: after proposing in February to cut payments to private Medicare plans by1.9%, the Centres for Medicare and Medicaid Services (CMS) said they would rise slightlyinstead. This will not quiet Republicans.

民主黨的政治家竭盡全力的想要說服他們。4月7日，衛(wèi)生部官員也參與其中：在提出將在二月份削減個人醫(yī)保計劃支出費用的1.9%后，醫(yī)療保險和醫(yī)療補助服務(wù)中心(CMS)表示，其支出并非降低，反而微升。但這并不能安撫共和黨人。

Obamacare does indeed lower Medicare spending by $716 billion from 2013 to 2022. Of this, $156 billion comes from Medicare Advantage, which lets the elderly use public money to buyprivate health plans. For years the government has paid more for these private plans, perperson, than for traditional Medicare. Private insurers passed along the extra subsidy toconsumers in the form of additional benefits or lower fees. Obamacare sought to bring privatepayments in line with traditional Medicare.

奧巴馬醫(yī)改確實會在2013至2022年間降低醫(yī)療開支約7160億美元。其中，1560億美元來自醫(yī)療照顧優(yōu)先計劃(Medicare Advantage)，該計劃允許老年人使用公共資金購買個人健康計劃。多年來，政府為每個人在個人健康計劃上的花費要高于傳統(tǒng)醫(yī)保。私人保險公司以給予額外好處或降低保費的形式，對消費者提供額外補貼。奧巴馬醫(yī)改試圖將個人支付帶回傳統(tǒng)醫(yī)保的正軌上來。

This was not a radical idea, but it is politically controversial nevertheless. MedicareAdvantage is increasingly popular—about three in ten Medicare beneficiaries are enrolled in aprivate plan. Insurers argue that Obamacare's cuts, combined with other measures, will forcethem to raise prices or cut benefits.

這個想法并不激進，但在政治上卻引起爭議。醫(yī)療照顧優(yōu)先計劃愈發(fā)流行，約有三成的醫(yī)保受益者參加了個人計劃。保險公司抱怨到，奧巴馬醫(yī)改中與其他措施相配合的縮減政策，會迫使他們提價或削減福利。

Last month's special election in Florida was a cautionary tale for Democrats. “To pay forObamacare, Washington is forcing seniors to endure deep cuts to Medicare Advantage,” purredan advertisement. “Sadly, Alex Sink supports these cuts.” Ms Sink lost her campaign. Notsurprisingly, Republicans as well as many anxious Democrats implored CMS not to lowerpayments. In February 40 senators wrote to CMS to ask as much. On April 3rd 29congressional Democrats and Republicans sent their own letter.

上月佛羅里達的補選一事，值得民主黨警惕。一則競選標語這樣寫道：“為了支付奧巴馬醫(yī)改，華盛頓正迫使老年人忍受醫(yī)療照顧優(yōu)先計劃的削減。不幸的是，Alex Sink支持這項削減政策。”隨后Sink失掉了競選。不出意料，共和黨人以及許多焦慮的民主黨人懇求醫(yī)療保險和醫(yī)療補助服務(wù)中心(CMS)不要削減這項支出。2月，40名參議員致函醫(yī)療保險和醫(yī)療補助服務(wù)中心(CMS)提出同樣的要求。4月3日，國會中29名民主黨人和共和黨人致函醫(yī)療保險和醫(yī)療補助服務(wù)中心(CMS)。

In the end CMS said it would raise payments by 0.4%. The true effect on Medicare Advantage ismore complex. America's Health Insurance Plans, the industry group that had lobbied againstcuts, maintains that CMS's changes still amount to lower payments. Ana Gupte of LeerinkSwann, an investment bank, points out that delaying cuts now may mean a bigger cut nextyear.

最后，醫(yī)療保險和醫(yī)療補助服務(wù)中心(CMS)表示將支付金額提高0.4個百分點。醫(yī)療照顧優(yōu)先計劃的真正影響比這更加復(fù)雜。美國健康保險計劃是一個反對削減支出的行業(yè)組織，他們認為，醫(yī)療保險和醫(yī)療補助服務(wù)中心(CMS)的承諾仍舊意味著降低支付。來自Leerink Swann投行的Ana Gupte指出，現(xiàn)在的推遲可能意味著明年更大幅度的削減。

The ruckus belies a simple fact. Both Democrats and Republicans agree that Medicare spendingmust be contained. The budget proposed by congressional Republicans, written by Paul Ryan,would preserve all Obamacare's cuts to Medicare, including those to Medicare Advantage. Justdon't expect Republicans to mention that on the campaign trail.

騷動掩蓋了一個簡單的事實：民主黨人和共和黨人均認為，必須遏制醫(yī)療支出。國會共和黨提出的預(yù)算由PaulRyan撰寫，該預(yù)算保留了所有奧巴馬醫(yī)改中對醫(yī)療支出的削減政策，其中也包括了醫(yī)療照顧優(yōu)先計劃。但別指望著共和黨人會在競選中提及此事。

1.sign up 報名參加;簽約雇用

例句:And it remains to be seen whether largenumbers of younger, healthier Americans will sign upfor coverage.

是否會有大批年輕健康的美國人報名還有待觀察。

2.more than 超過

例句:He had notched up more than 25 victories worldwide.

他已贏得了超過25次國際級別賽事的勝利。

3.keen to 熱衷于

例句:He is keen to point out the benefits which the family network can provide.

他很樂意指出家庭網(wǎng)絡(luò)可以帶來的好處。

4.pay for 支付

例句:In a 27-page order released Friday, judge Lucy KOH vacated$ 450 million of the originalaward and ordered a new trial to sort out how much Samsung should pay for 13 devices wherethe jury 's math is in dispute.

上周五公布的判決書長達27頁，法官高蘭惠減免了三星4.5億美元的賠償金，同時要求重新審理，以確定陪審團存在爭議的13款設(shè)備，三星究竟應(yīng)該支付多少賠償金。