六级阅读真题精读Passage15：普科医生谈医保

看病难、看病贵，这种老百姓关心的问题一直是民主国家致力于解决的问题，中国各项医保政策的出炉就是一个很好的例子。看病难、贵不仅仅是中国才有的问题，美国也不能脱身。君不见，十七年来美国政府竟然因为医保问题一直无法达成共识而关门了！虽然关门时间并不长，但从这可以看出，医保问题是多么复杂和严重。当然，仅仅一篇文章自然不可能就医保问题面面俱到，本文就从普科医生的角度来谈，以小见大，看看最基层的医生遇到了一些什么问题吧。

Crippling 1 health care bills, long emergency-room 2 waits and the inability to find a primary care physician [just] scratch 3 the surface 4 (of the problems) (that patients face [daily].)
压得让人喘不过气的健康保健账单，急诊室前排起的长队，以及无法找到普科医生，这些仅是病人每天要面对的问题中的一部分。
注：1. crippling adj. 严重损害身体的；有严重后果的。

短语：a crippling disease 严重损害健康的疾病；

crippling debts 使经济瘫痪的债务。例：

Our survival is at stake as we face crippling losses which look set to continue well into the year.
我们的生存岌岌可危，因为我们面临着持续到今年的严重损失。
[选自：BBC：NEWS | UK | Save our bacon, urge pig farmes]

v. cripple的现在分词，使残疾，使跛

 2. emergency-room急症室

  He is in the emergency-room.
他在急症室里。
 3. scratch v. 抓，骚，趴。作为动词它有抓，划伤，擦破生计，取消等意思，如短语：scratch sb./sth./from sth. 取消，撤销；scratch the surface of sth. 作肤浅的探讨，浅尝辄止；作为名词有划痕划伤，抓、挠、刮的刺耳声。例

Now, I scratch my head as to why this double standard has proven true.
现在，我抓破头皮都想不通这个双重标准为什么会是对的。
[选自：FORBES: The Tea Party Never Got Pepper Sprayed]

n. 抓，骚，抓痕；起跑线

have a scratch 瘙痒

from scratch 从头做起，白手起家。不是从头部开始。例：

Why don’t start from scratch?
为什么不从头做起呢？
4. surface n.表面，表层，文中此意。on the surface:表面上，从外表看;

adj.表面的，肤浅的surface-to-air(尤指导弹)地对空的，舰对空的;

vi. 升到水面，浮出水面;

vt. 使浮出水面；使成平面。例：

On the surface, a repo agreement seems like a wise way for a firm to borrow.
从表面上看，回购协议是公司借款的一个明智选择。
[选自：NPR: Corzine Steps Down At Collapsed Firm , Hires Lawyer]

Primary care should be the backbone 1 (of any health care system). Countries (with appropriate 2 primary care resources) score 3 [highly] [when it comes to health outcomes and cost.] The U.S. takes the opposite approach [by emphasizing 4 the specialist] [rather than the primary care physician].
基本医疗应该是所有医疗体系的基石。谈到医疗现状及其投入时，有合理基础医疗资源的国家总能得到很高的评价。美国却反其道而行之，注重专科医生而非普科医生。
注：1. backbone n. 支柱（文中此意）；主干网；决心，毅力；脊椎；例：

Hundreds of thousands of foreign workers, once the backbone of the economy, have fled.
成千上万的外国劳工都流失了，他们曾是经济支柱。
[选自： NPR: In Libya's Once Gilded Economy, A Pause]

2. appropriate adj. (to)适当的，恰如其分的。例：

He added in a world where much communication happened online, their direct action was appropriate.
他补充道，在这个大部分交流发生在网上的世界，他们的直接行动很合适。
[选自：BBC: NEWS | UK | England | Bishop of Blackburn backs St Paul's Cathedral protests] 

【派】appropriateness (n.适当)；inappropriate（adj.不适当的）

3. score v. 得分。平时习惯了该词以名词的身份出现，注意这里作动词。例：

On that day he didn’t score, but that doesn't mean he is suddenly a bad player.
在那一天他没有得分，但这并不意味着他突然就成了一个糟糕的球员。
[选自： BBC：SPORT | WORLD CUP | England | England's 'world class' captain]

4. emphasize vt.强调，着重。例：

Most of the new mobile wallet services from PayPal rivals emphasize flexibility in a different way.
来自贝宝竞争对手的大多新的手机钱包服务都以不同方式强调灵活性。
[选自：FORBES: PayPal's Coolest Mobile Wallet Feature: The Oops Button]

A recent study analyzed the providers (who treat Medicare beneficiaries.) The startling 1 finding was that the average Medicare patient saw a total of seven doctors – ^two primary care physicians 2 and five specialists 3^ – [in a given year]. [Contrary to 4 popular belief], the more physicians taking care of you don’t guarantee 5better care. [Actually], increasing fragmentation 6 of care results in a corresponding 7 rise [in cost and medical errors].
最近一项研究分析了负责治疗老年医保受惠的人。得出了令人震惊的研究发现，普通的医保患者一年要看七名医生——包括两名初级护理医生和五名专科医生。与公众的想法刚好相反，更多的医生给你看病并不能保证更好的医疗服务。实际上，医疗服务的日益分化导致的是费用的上升和误诊数量的增多。
注：1. startling adj. 惊人的，让人震惊的；极鲜亮的。

短语：a startling contrast 惊人的对比；startling blue eyes 蓝盈盈的眼睛。例：

What may be more startling, however, is this: Their parents are helping to sign them up.
然而，更让人吃惊的是：他们的父母还在帮他们注册。
[选自:cnn: Parents help kids lie to get on Facebook, study finds]

2. physician n. 内科医生。例：

I was an attending physician.
我是一名主治医生。
Surgeon  外科医生

dentist  牙科医生

pediatrician 儿科医生

gynecologist 妇科医生

3. specialist n. 专家。例：

Dr John Moore-Gillon is a TB specialist and honorary medical advisor for the British Lung Foundation.
 
约翰·莫尔·吉伦博士是结核病专家和英国肺脏基金会的荣誉医疗顾问。
[选自: BBC: News | Health editor | TB smoking toll 'could reach 40m' ]

4. contrary to 和…相反，违反。例：

Contrary to the beliefs held by many professional economists spending does not make an economy grow.
与许多专业经济学家持有的观点相反，支出不会使经济增长。
[选自: FORBES: | INVESTING | What Obama should Really Do To Spur Job Growth]

5. guarantee n. 保证，保证书。例：

Advertising provides a guarantee of reasonable value in the products and services you buy.
广告为你购买的商品和服务提供了合理的价格保证。
vt. 保证，担保。文中此意，例：

I still cannot guarantee you that I must be there on time.
我还是不能向你保证我一定能准时到那儿。
6. fragmentation n. 分裂，破裂。例：

In the coming years, it is going to be vital that we avoid fragmentation and maintain a single interoperable internet.
在未来几年，避免分化和维护单一的可互操作网络，至关重要。
[选自: BBC NEWS | Technology | The Tech Lab: Paul Twomey]

7. corresponding adj. 符合的，相应的，对应的。例：

When you ask “where are the corresponding companies for Skype and Google in the mobile world?”
当你问“在移动领域哪里有与Skype和谷歌相比的公司?”
[选自: BBC: NEWS | Technology | Talk moves on at mobile congress]

How did we let primary care slip 1 [so far]? The key is [how] doctors are paid. Most physicians are paid [whenever they perform 2 a medical service.] [The more] a physician does, ^regardless of 3 quality or outcome^, [the better he’s reimbursed.] [Moreover], the amount (a physician receives) leans 4 [heavily] [toward medical or surgical procedures]. A specialist (who performs a procedure [in a 30-minute visit]) can be paid three times [more than a primary care physician using that same 30 minutes to discuss a patient’s disease]. Combine this fact [with 5 annual government threats] [to indiscriminately 6 cut reimbursements 7], physicians are faced [with no choice but to increase quantity to boost 8 income].
我们怎么会使基本医疗下滑得如此之多呢？关键是医生的报酬如何确立。大部分的医生都是出诊一次得到一份报酬。 医生看的病越多，不管疗效如何，政府支付给他的报酬越高。此外，医生的收入在很大程度上受到如何用药或手术的影响。一名专科医生耗时30分钟诊病，其收入要比一名普科医生花同样多的时间问诊的收入高3倍。结合这一事实，在政府将不加区分地减少返还给医生报酬这一压迫之下，普科医生别无选择，只好增加诊病数量来增收了。
注：1. slip vi. 滑，滑到，滑落；溜走。文中此意，例：

The RBI expects inflation to begin easing from December and slip to 7% by March.
印度储备银行预计通胀从12月开始宽松，滑到3月的7%水平。
[选自: WSJ: India Factory Output Growth Slows to Two-Year Low]

n. 疏忽，小错，口误，笔误；纸片。例：

Your slip is showing.
你露出马脚了。
Marry wrote down her address on a slip.
玛丽在一张纸上写上了她的地址。
2. perform v. 履行，执行，做；演出，表演。例：

The doctor performed the operation successful.
医生成功地完成了手术
The boy performed a play.
这个男孩表演了一个节目。
【派】performance  n.表演，演出；履行；性能

3.regardless of 不管。例：

Individuals can and should make their own legal decisions regardless of who their employer is.
个人可以而且应该做出他们自己的法律决定，而不管雇主是谁。
[选自: WHITEHOUSE: Press Briefing]

regardless adj.不留心的，不注意的

a regardless result 毫不在意后果

4. lean vt. 依赖； 使斜靠，倚；使变瘦

vt.& vi. （使）倾斜，屈身

adj. 瘦的；贫瘠的；简洁的；精干的

n. 瘦肉；倾向；倾斜；倾斜度

vi. 倾向于（某种观点、意见或态度等）（与to 或 toward连用），文中此意。

相关短语：

lean towards  朝…倾斜,倾向,偏向

lean backwards  向后倾

lean down to  屈身…

lean forwards  向前倾

lean against  靠在…上

lean on [upon]  倚,靠在…上,依靠

lean to  倾向,偏向

5. combine with 与…结合。例：

We must learn to combine theory with practice.
我们必须学会理论联系实际。
6. indiscriminately adv. 任意地，无差别；不分青红皂白地。例：

The gunman ran off down Dib Lane, past a row of shops, shooting indiscriminately as he went.
枪手从迪布路跑了，路过一排店铺，沿街任意扫射。
[选自: BBC NEWS | UK | England |Force 'shocked' at fatal shooting] 

7.reimbursement n.偿还，补偿，赔偿。例：

The changes in reimbursement also shifted substantial workforce to primary care for a time.
报销的变化也在一段时间内从大量的劳动力转移到初级护理。
[选自: FORBES: The Best- And Worst-Paying Jobs For Doctors]

It can take up to five months before reimbursements are paid.
最长的要等5个月才能得到赔付。
8.boost vt. 鼓励，促进；替...做广告，宣扬。文中此意，例：

Investors want the Italian government to quickly pass measures to boost growth and cut debt.
投资者希望意大利政府迅速通过促进经济增长以及削减债务的措施。
[选自: NPR: Asia Stocks Up As Greece Looks Set To Get Bailout]

He wants the government to take action to boost the economy.
他希望政府采取行动促进经济发展。
Will this boost our ratings?
这会增加我们的收视率吗?
n. 增加，帮助。例：

The words of our president was a boost to our spirits.
校长的讲话是对我们精神的一种鼓舞。
Primary care physicians (who refuse to compromise 1 quality) are [either] driven out of 2 business or to cash-only practices, [further contributing to the decline of primary care].
那些不愿意降低行医质量的普科医生或者无法继续行医，或者只能从事收现金的诊治，这样更有损于基本医疗体系。
注：1. compromise vt. 妥协，折中。文中此意。

compromise to sb. 向某人妥协。例：

However, despite agreeing to stop fighting, neither side seems ready to compromise on the key issues.
然而，尽管同意停止战斗，双方似乎不准备在关键问题上妥协。
[选自: BBC  NEWS | Africa | Nigeria snubs Ivory Coast force]

n. 妥协，折中 

短语：reach a compromise over sth. 就某事达成妥协；例：

Let’s try to reach a compromise over the current situation.
让我们就目前的情形达成妥协吧。
2. driven out of v. 驶出；将...驱逐出。例：

Let’s drive out of the big city.
让我们开车离开这个大城市。
He has driven out the inhabitants of this land.
他将这些居民驱逐出去了。
Medical students are not blind to this scenario 1. They see how [heavily] the reimbursement deck is stacked against 2 primary care]. The recent numbers show that [since 1997], (newly graduated U.S. medical) students (who choose primary care <as a career>) have declined 3 [by 50%]. This trend results in 4 emergency rooms [being overwhelmed with 5 patients without regular doctors].
医学院的学生对此并非一无所知。他们看得到取得报酬的平台有多么不利于基础护理。最近的数据表明，自1997年以来，美国医学院的毕业生选择基础护理作为职业的人数下降了50%。这样的趋势导致急诊室里病人多而医生少，应付不过来。
注：1. scenario n. (行动的)方案；剧情概要。例：

The programme assumes 1.25% growth in economic output, or GDP, for 2002 as a base scenario.
该计划以2002年为基年假定经济产出或国内生产总值增长1.25%。
[选自: BBC NEWS | BUSINESS | Eurozone chiefs 'mull Germany's plight']

2. stack against 使不利于；靠在...上堆放。例：

There are too many factors stacking against me.
有很多因素对我不利。
to stack against the tree靠树堆放

3. decline vi. 下倾，下降，下垂。文中此意。例：

Europe is China’s biggest export market, meaning the euro’s decline has made Chinese exports less competitive.
欧洲是中国最大的出口市场，这意味着欧元的下降使得中国的出口竞争力下降。
[选自: BBC: NEWS | BUSINESS | Chinese yuan flexibility comments buoy markets]

vt. 拒绝，谢绝。例：

The film director declined to comment it.
导演拒绝评论它。
n.下降，下垂；倾斜

on the decline 在衰退中

in decline  下降

4.results in v.引起，导致，以...为结局；落得；致使。例：

Too much warfarin can cause dangerous internal bleeding, and too little can result in strokes.
华法林阻凝剂过多会导致危险的内出血，太少又会导致中风。
[选自: MSN: FDA clears blood thinner for irregular heart beat]

Failure will result in frustration.
失败会导致挫败心理。
5.be overwhelmed with 被覆盖，应付不来。例：

This small clinic could soon be overwhelmed with patients.
这个小诊所可能很快就会人满为患 。
[选自: BBC: NEWS | world | Latin America | Cite Soleil clinic fronts Haiti's fight against cholera]

overwhelm vt. 压倒，制服。例：

The robber was overwhelmed by the police.
抢劫犯被警察制服了。
How do we fix this problem?
怎么解决这个问题。
It starts [with reforming 1 the physician reimbursement system]. Remove the pressure [for primary care physicians to squeeze in more patients] [per hour], and reward them [for optimally 2 managing their diseases and practicing evidence-based 3 medicine]. Make primary care <more attractive 4> [to medical students] [by forgiving student loans 5 for those (who choose primary care <as a career>) and reconciling 6 the marked difference (between specialist and primary care physician salaries)].
首先应该从改革医生报酬体制做起。减轻普科医生每小时看更多病人的压力，对于治疗取得效果和循证医学给予奖励。通过减免选择从事基本医疗职业的医学院学生的学费贷款，缩小专科医生和普科医生在收入上的显著差异，好让基本医疗对医科学生更具吸引力。
注：1. reform vt 改革，改进，改良；例：

No approach to reforming Medicare will be perfect or painless for everyone under all circumstances.
在任何情况下，对于每个人来说，没有任何医疗改革方式是完美的、没有痛苦的。
[选自: FORBES: The Two Approaches to Medicare Reform: Rationing vs. Individual Choice]

2.optimally adv. 最佳；最适宜。例：

Dell is on the same track, attempting to build a supermarket for CIOs to create an optimally outsourced IT portfolio.
戴尔正在同一个轨道上试图建立一个CIOs超市来营造一个最佳外包IT投资组合。
[选自:FORBES:| Most Popular | Transforming CIOs from Benevolent Dictators to Product Managers]

To function optimally, our brains need to maintain this level of fat.
为了达到最佳运作效果，我们的大脑需要保持这个水平的脂肪量。
3. evidence-based adj. 基于证据的，循证的

evidence-based surgery 循证外科学

evidence-based nursing 循证护理

evidence-based diagnosis 循证诊断。例：

Traditional Chinese medicine is not scientific, as it is not evidence-based and it cannot conform to the principle of falsification.
中医是不科学的，因为它不是循证的，且不符合可证伪的准则。
4. attractive adj. 有吸引力的，引起兴趣的人；动人的。例：

Everyone says Bill is an attractive guy.
人人都是比尔是一个有吸引力的人。
【派】unattractive(adj.不引人注意的)

5. loan n. [常pl.]贷款；暂借的东西。，文中此意。例：

Eurozone officials are withholding the next loan installment until Athens formally approves the rescue package.
欧元区官员扣留下一批贷款，直到雅典正式批准救援计划。
[选自: NPR: Greece, Italy Turn To Experts For Way Out Of Debt]

短语：approve a loan 批准贷款

on loan 暂借的（地）。例：

The bicycle is a loan from my friend.
这辆自行车是跟朋友暂借的。
vt. 借出。例：

If you want, I could loan you some money.
如果你需要的话，我可以借你点钱。
6. reconcile vt. 使和好，调解，使调和；使一致。例：

The girl didn’t want to be reconciled with her former boyfriend.
这个女孩不想和自己的前男友和好。
短语：reconcile to 顺从，服从。例：

The fundamental dilemma: how do we reconcile liberty with security in this new world?
根本困境是：在这个世界上我们如何协调安全和自由？
[选自: BBC: NEWS | UK | UK Politics | In full: Tony Blair's speech]

A mediator reconciled the differences between the two sides.
仲裁人消除了双方的分歧，使他们达成了一致。
We’re at a point (where primary care is needed [more than ever].) [Within a few years], the first wave (of the 76 million Baby Boomers) will become eligible 1 [for Medicare]. Patients older than 85, (who need chronic 2 care [most],) will rise [by 50%] [this decade].
我们正处于对基本医疗需求比以往都多的时期。在几年之内，第一波7600万婴儿潮一代将成为医疗保险的服务对象。在未来的十年期间年龄大于85岁、最需要长期看护的病人数量将会增加50%。
注：1. eligible adj. 有条件的被选中的，有恰当资格的，合格的。例：

The judge said he should serve at least 32 years before being eligible for parole.
法官说他至少要等32年才有资格获得假释。
[选自: BBC: NEWS | Scotland | Glasgow & West | Police apologise over murders of Diane and Holly Fallon]
2.chronic adj. (疾病)慢性的；积习难改的；严重的。例：

They can be blind, deaf, or mentally retarded, or suffer with chronic lung disease.
他们会变瞎、聋哑，智障或遭受慢性肺部疾病的折磨。
[选自:The New Yorker| Medical Dispatch | A Child in Time]

The chronic illness generates a large part of healthcare costs.
这种慢性疾病会产生很大的医疗开销。
George was described by his teacher as a chronic underachiever.
乔治被他的老师描述成一个积习难改的学生。
Pollution is the chronic problem of the country.
污染问题是该国最大的问题。

Who will be [there] [to treat them]?
到时谁给他们看病？