PBS高端访谈:你是否要为价格昂贵的医疗保健做好准备?

 　　GWEN IFILL: If it feels like you are spending more for health care through higher deductibles or premiums², you may be right. Under the Affordable³ Care Act, insurers are required to post rate increases if they exceed 10 percent, and, in many cases, the price spikes⁴ for the coming year range from 20 percent to 85 percent.

　　And another study shows people who are covered by their employers are also paying more through higher out-of-pocket costs that leave as many as 31 million people underinsured.

　　Larry Levitt studies this for the Kaiser Family Foundation. and Dr. David Blumenthal is the president of the Commonwealth⁵ Fund, which released a second survey on out-of-pocket costs.

　　Larry Levitt, could you explain to me why these price hikes are going up all of a sudden? Or is it not all of a sudden?

　　LARRY LEVITT, Senior Vice⁶ President, Kaiser Family Foundation: Well, first, I would say that it's hard to generalize from what we have seen so far.

　　I mean, as you said, insurers are only required to report right now increases of 10 percent or more. So, not surprisingly, those are all in double digits⁷. But that said, reading the tea leaves, it does look like premiums are heading upwards⁸.

　　And it's for a combination of factors. I mean, first of all, health care costs, which have been growing very slowly recently, are increasing faster, particularly for prescription⁹ drugs. And insurers are for the first time under Obamacare setting premiums based on actual experience with enrollees.

　　Up until now, they were guessing at how much health care people were using. Now they have actually some experience under their belts and in many cases people are — look to be sicker than insurers expected.

　　GWEN IFILL: Well, are sicker people now drawn¹¹ more to this because of Obamacare? Is that part of the connection?

　　LARRY LEVITT: Yes, one of the things that the Affordable Care Act did was eliminated discrimination against people with preexisting conditions.

　　So, for the first time, someone who was sick and wanted insurance can get it. So, the first people in the door tended to be those people who knew they needed insurance and they had pretty high health care needs. The key now is to try and get more healthy people in the door. And the big wild card is, will more people enroll¹⁰ and will those be healthier than the enrollees we have now?

　　GWEN IFILL: Now, as you pointed¹² out, these numbers are only for increases over 10 percent. What about state regulators? Do they have a say in whether these numbers can go up or not?

　　LARRY LEVITT: They do. In most states, the insurance commissioner¹³ has the power to disapprove¹⁴ these increase if he or she feels they're unjustified.

　　So, the actuaries and insurance departments are sharpening their pencils and reviewing these rates. And if history is a judge, many of them will come down, at least somewhat, and in some cases by a lot.

　　GWEN IFILL: And which states are right now the most affected¹⁵ by this? And is it because of medical costs or because of the region or because of whether people have been insured at all before?

　　LARRY LEVITT: Well, medical costs, you know, affect all states. I don't think that's a big factor in the variation across states.

　　Probably, one of the biggest factors is how enrollment¹⁶ is doing. Enrollment has varied¹⁷ tremendously across the country. Florida signed up a lot of people, a very high percentage of the eligible¹⁸ population there. Other states like Iowa, for example, have signed up very few people.

　　GWEN IFILL: OK.

　　Dr. David Blumenthal, I want to turn to you now about your report, which says that 31 million people are underinsured because of this increase in deductibles. What does underinsured mean, first of all?

　　DR. DAVID BLUMENTHAL, President, The Commonwealth Fund: Well, our definition of underinsurance is that you're underinsured if you spend more than 10 percent of your income, excluding premiums, on health care, and you're insured, or if your deductible exceeds 5 percent of your income.

　　Now, if you are poor, that is, if you have an income of less than 200 percent of the federal poverty level, we define underinsurance as spending more than 5 percent of your income on out-of-pocket expenditures¹⁹.

　　GWEN IFILL: Are these out-of-pocket expenditures, these deductibles, are they a tradeoff for getting premiums lower? We were just talking about premiums?

　　DR. DAVID BLUMENTHAL: They can be. One reason why premiums can be kept lower is by asking people who are insured to pay more of the cost of care. That takes the insurance company off the hook for that part of the cost of care.

　　GWEN IFILL: Well, what happens? Do people just seek less care? Are they less likely to go to the doctor?

　　DR. DAVID BLUMENTHAL: Yes. About half of people who are underinsured report that they are having trouble paying medical bills or getting less medical care than they think they need.

　　GWEN IFILL: So, what's the connection then to the Affordable Care Act here? Some would look at this and say, this was one of the problems that the Affordable Care Act was supposed to solve.

　　DR. DAVID BLUMENTHAL: We have been tracking this since 2003.

　　Most of the increase that we have observed in underinsurance occurred before the Affordable Care Act became law, between 2003 and 2010.

　　GWEN IFILL: So the trend had kicked in already?

　　DR. DAVID BLUMENTHAL: The trend had kicked in. Since 2010, there really hasn't been much of a change.

　　And another thing to keep in mind is that for us to consider you underinsured, you had to have insurance for a full year. Many of the people who responded to our survey had no insurance prior to 2014 or, if they had had insurance through Obama — through the Affordable Care Act, they only had it for six months. So we don't feel that this survey captures the effect of the Affordable Care Act.

　　GWEN IFILL: OK. Well, I want to ask you both now to answer a very basic question, which is, either way, no matter what the cause of this is, health care has grown more expensive for people for whatever reason. What do consumers do? Do they shop for a better deal? Do they just go without?

　　I will start with you, Dr. Blumenthal.

　　DR. DAVID BLUMENTHAL: Well, one of the things that the Affordable Care Act has done, which is advantageous²⁰ to consumers, is created these marketplaces, where people can go online and comparison-shop.

　　That was very hard to do before the Affordable Care Act, especially for people who had individual insurance policies. So, the opportunity to see what a given insurance company charges for a given type of coverage²¹ is new and available to people. And one of the reasons why these announced premium¹ increases may not be as serious as they are regarded is that people will have choice.

　　They will have a chance to move out of a high-price insurance into a lower-price insurance.

　　GWEN IFILL: Will they have a choice on out-of-pocket costs?

　　DR. DAVID BLUMENTHAL: Well, they will, yes.

　　They — the way the Affordable Care Act works is, it creates bands of insurance with — according to generosity²², and the level of deductibles and co-pays is part of the choice.

　　GWEN IFILL: Let me ask you Larry Levitt, what is your prescription for what consumers should do when faced with these new — this sticker shock?

　　LARRY LEVITT: Well, I would agree with David.

　　The — what we have seen in the first two years of Obamacare is that insurers are jockeying for position in these new marketplaces. So, while there are some insurers that are increasing premiums substantially, there are others that are actually decreasing premiums. So there are good deals to be had.

　　But consumers really have to look around. Many consumers did shop after the first year of the ACA going into this year, but many just let momentum²³ take hold and stuck with their old plan, potentially paying much more. So, shopping around is really the key here.

　　GWEN IFILL: Well, the Supreme²⁴ Court may have a lot to say about what happens to all of this by the end of this month.

　　Larry Levitt of the Kaiser Family Foundation, and David Blumenthal of the Commonwealth Fund, thank you both very much.

　　DR. DAVID BLUMENTHAL: Thank you.

　　LARRY LEVITT: Thank you.

1 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

2 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

3 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。

4 spikes   

n.穗( spike的名词复数 )；跑鞋；（防滑）鞋钉；尖状物v.加烈酒于( spike的第三人称单数 )；偷偷地给某人的饮料加入（更多）酒精（ 或药物）；把尖状物钉入；打乱某人的计划

参考例句：

• a row of iron spikes on a wall 墙头的一排尖铁
• There is a row of spikes on top of the prison wall to prevent the prisoners escaping. 监狱墙头装有一排尖钉，以防犯人逃跑。 来自《简明英汉词典》

5 commonwealth   

n.共和国，联邦，共同体

参考例句：

• He is the chairman of the commonwealth of artists.他是艺术家协会的主席。
• Most of the members of the Commonwealth are nonwhite.英联邦的许多成员国不是白人国家。

6 vice   

n.坏事；恶习；[pl.]台钳，老虎钳；adj.副的

参考例句：

• He guarded himself against vice.他避免染上坏习惯。
• They are sunk in the depth of vice.他们堕入了罪恶的深渊。

7 digits   

n.数字( digit的名词复数 )；手指，足趾

参考例句：

• The number 1000 contains four digits. 1000是四位数。 来自《简明英汉词典》
• The number 410 contains three digits. 数字 410 中包括三个数目字。 来自《现代英汉综合大词典》

8 upwards   

adv.向上，在更高处...以上

参考例句：

• The trend of prices is still upwards.物价的趋向是仍在上涨。
• The smoke rose straight upwards.烟一直向上升。

9 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

10 enroll   

v.招收；登记；入学；参军；成为会员（英)enrol

参考例句：

• I should like to enroll all my children in the swimming class.我愿意让我的孩子们都参加游泳班。
• They enroll him as a member of the club.他们吸收他为俱乐部会员。

11 drawn   

v.拖，拉，拔出；adj.憔悴的，紧张的

参考例句：

• All the characters in the story are drawn from life.故事中的所有人物都取材于生活。
• Her gaze was drawn irresistibly to the scene outside.她的目光禁不住被外面的风景所吸引。

12 pointed   

adj.尖的，直截了当的

参考例句：

• He gave me a very sharp pointed pencil.他给我一支削得非常尖的铅笔。
• She wished to show Mrs.John Dashwood by this pointed invitation to her brother.她想通过对达茨伍德夫人提出直截了当的邀请向她的哥哥表示出来。

13 commissioner   

n.（政府厅、局、处等部门）专员，长官，委员

参考例句：

• The commissioner has issued a warrant for her arrest.专员发出了对她的逮捕令。
• He was tapped for police commissioner.他被任命为警务处长。

14 disapprove   

v.不赞成，不同意，不批准

参考例句：

• I quite disapprove of his behaviour.我很不赞同他的行为。
• She wants to train for the theatre but her parents disapprove.她想训练自己做戏剧演员，但她的父母不赞成。

15 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

16 enrollment   

n.注册或登记的人数；登记

参考例句：

• You will be given a reading list at enrollment.注册时你会收到一份阅读书目。
• I just got the enrollment notice from Fudan University.我刚刚接到复旦大学的入学通知书。

17 varied   

adj.多样的，多变化的

参考例句：

• The forms of art are many and varied.艺术的形式是多种多样的。
• The hotel has a varied programme of nightly entertainment.宾馆有各种晚间娱乐活动。

18 eligible   

adj.有条件被选中的；(尤指婚姻等)合适(意)的

参考例句：

• He is an eligible young man.他是一个合格的年轻人。
• Helen married an eligible bachelor.海伦嫁给了一个中意的单身汉。

19 expenditures   

n.花费( expenditure的名词复数 )；使用；（尤指金钱的）支出额；（精力、时间、材料等的）耗费

参考例句：

• We have overspent.We'll have to let up our expenditures next month. 我们已经超支了，下个月一定得节约开支。 来自《简明英汉词典》
• The pension includes an allowance of fifty pounds for traffic expenditures. 年金中包括50镑交通费补贴。 来自《简明英汉词典》

20 advantageous   

adj.有利的；有帮助的

参考例句：

• Injections of vitamin C are obviously advantageous.注射维生素C显然是有利的。
• You're in a very advantageous position.你处于非常有利的地位。

21 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。

22 generosity   

n.大度，慷慨，慷慨的行为

参考例句：

• We should match their generosity with our own.我们应该像他们一样慷慨大方。
• We adore them for their generosity.我们钦佩他们的慷慨。

23 momentum   

n.动力，冲力，势头；动量

参考例句：

• We exploit the energy and momentum conservation laws in this way.我们就是这样利用能量和动量守恒定律的。
• The law of momentum conservation could supplant Newton's third law.动量守恒定律可以取代牛顿第三定律。

24 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。