068《经济学家》读译参考之六十八：不经历风雨怎么见彩虹-美医疗改革论战.doc

经济学家读译参考 Translated & Edited by Chen JilongTEXT 68High risk, high reward不经历风雨，怎么见彩虹？（陈继龙 编译）Oct 12th 2006 | WASHINGTON, DCFrom The Economist print editionReutersA frying pan, a pair of sneakers and some amoxycillin please请给我一只煎锅、一双运动鞋和一些阿莫西林。（路透社）THESE are tough times for Wal-Mart, Americas biggest retailer. （1）Long accused of wrecking small-town America and condemned for the stinginess of its pay, the company has lately come under fire for its meanness over employees health-care benefits. The charge is arguably unfair: the firms health coverage, while a_ less extensive than the average for big companies, is on a par with1 other retailers. But bad publicity, coupled with rising costs, has stirred the Bentonville giant to action. Wal-Mart is making changes that should shift the ground in Americas health-care debate.对于美国最大的零售商沃尔玛而言，现在是困难时期。由于实行低价策略（Always Low Prices）而把美国搞得土里土气，并且支付薪水也很“抠”，该公司长期以来备受责难。最近它又因为在员工医疗保险待遇上的吝啬而遭到指责。有证据表明，这一指责是不公平的尽管该公司医疗保险所涵盖的项目不及大公司平均水平，但与其它零售商相比都是一样的。不过，由于舆论宣传不利，加之成本不断增长，这个位于Bentonville的巨无霸一气之下再也坐不住了。沃尔玛的改革将会把人们讨论的话题转移到对美国医疗保险制度的争论之上。One strategy is to slash the prices of many generic, or out-of-patent, prescription drugs. Wal-Mart recently announced that its Florida stores would sell a list of some 300 generic drugs at $4 for a months supply; other states will follow. That is above cost but far less than the prices charged by many pharmacy chains, which get profits from fat m_ on generics.策略之一就是对许多普通类（或非专利类）处方药品进行大减价。沃尔玛最近宣布，其在佛罗里达州的门店将把大约300种药品按每月用量4美元的价格出售，其它州的门店也将效仿这一做法。这一价格高于成本，但远远低于许多连锁药店的价格，而这些连锁药店就是从普通类药品高额的差价中获利的。Wal-Marts critics dismiss the move as a publicity s_. The list of drugs includes only 143 different medicines and excludes many popular generics. True, but short-sighted. Wal-Mart has transformed retailing by using its size to squeeze suppliers and passing the gains on to consumers. It could do the same with drugs. Target, another big retailer, has already announced that it will match the new pricing. （2）A “Wal-Mart effect” in drugs will not solve Americas health-costs problem: generics account for only a small share of drug costs, which in turn make up only 10% of overall health spending. But it would help.批评沃尔玛的人士驳斥这一举措纯属哗众取宠的花招。降价药品目录中仅包含143种不同的药品，许多常用的普通类药品都不在降价之列。这么说是没错，可就是目光太短浅了。沃尔玛已经通过利用其规模（影响力）逼迫供应商紧缩利润空间并还利于消费者，从而实现了零售转型。它在药品销售上同样也能做到这一点。另一家大型零售商塔基特已宣布将响应这一新的定价。药品方面的“沃尔玛效应”并不会解决美国的医疗费用问题普通类药品仅占药费的一小部分，而药费也仅占全部医疗费用的10。但这种效应还是能够起到帮助作用的。The firms other initiative is more controversial. Wal-Mart is joining the small but fast-growing group of employers who are controlling costs by shifting to health insurance with high deductibles2.该公司另一个行动引发了更多的争议。沃尔玛正在加入到一些迅速兴起的小雇主行列之中，这些雇主都是通过转为高减免额医疗保险模式来对成本加以控制。From January 1st new Wal-Mart employees will only be offered insurance with very low premiums (as little as $11 a month for an individual) but rather high deductibles (excesses): an individual must pay at least the first $1,000 of annual health-care expenses, and on a family plan, the first $3,000. Unusually, Wal-Marts plan includes three doctor visits and three prescription drugs before the big deductible kicks in3. （3）Since most employees go to the doctor less often than that, the company argues, they will be better off because of the lower premiums. That may be true for the healthy, say critics; sicker workers will see their health costs s_.自1月1日起，沃尔玛将对新聘员工仅提供保险费极低（每人每月仅为11美元）的医疗保险，不过这种保险减免额（超支部分）相当高，即就个人保险而言，每人必须至少支付年度医疗开支中最先产生的1000美元，而对家庭而言，则至少支付3000美元。与众不同的是，沃尔玛的方案中还包括减免部分的高额费用产生之前，员工可就诊3次和开3次处方药。该公司认为，由于大多数员工一般就诊都不到3次，因此在仅需支付较低保险费的情况下他们的生活仍会很宽裕。批评人士说，对健康的人来说的确如此，可有病之人就要眼见着他们的医疗费用飞涨了。This debate, writ large4, is the biggest controversy in American health care today. The Bush administration has been pushing high-deductible plans as the best route to controlling health costs and has encouraged them, with tax-breaks for health-saving accounts. The logic is a_. （4）Higher deductibles encourage consumers to become price-conscious for routine care, while insurance kicks in for catastrophic expenses.显而易见，这是针对当今美国医疗保障制度最激烈的一场论战。布什当局一直以来力推高减免额保险方案作为控制医疗费用的最佳路径，并通过对保健储蓄帐户（HSV）实行免税来鼓励这一方案。按常理，这十分具有吸引力。较高的减免额可增强消费者在一般性医疗中的价格意识，而保险则会在发生巨额开支时生效。Early evidence suggests these plans do help firms control the cost of health insurance. But critics say that the savings are misleading. （5）They argue that the plans shift costs to sicker workers, discourage preventative care and will anyway do little to control overall health spending, since most of the $2 trillion (a sixth of its entire GDP) that America spends on health care each year goes to people with multiple chronic diseases.早些时候的证据表明，这类方案确实能够帮助公司控制医疗保险成本。不过批评人士说，保健储蓄容易造成误导。他们认为，该方案将成本支出转嫁到了患病的人，也阻碍了预防保健工作的发展，而且基本上无益于控制整体医疗费用，因为美国人每年20亿美元（相当于GDP的1/6）的医疗开支中大多数都集中在患有慢性疾病的人身上。For the moment, relatively few Americans are covered by these “consumer-directed” plans. But they are becoming increasingly popular, especially among firms employing low-skilled workers. And now Americas biggest employer has joined the high-deductible trend. That is bound to have an impact. 目前这类“消费者定向”方案涉及的美国人还相对较少，但正在不断普及，尤其是在雇用低技术水平员工的企业中。何况现在美国最大的企业也已加入了这个高减免额保险潮流之中，这类方案必定会产生一定的效果。 QUIZ1. 根据上下文和英文释义，补全单词：a_（adv. used when you are admitting that something is true）m_（n. the difference between what it costs a business to buy or produce something and what they sell it for）s_（n. something that is done to attract peoples attention, especially in advertising or politics）s_（v. to increase quickly