摘要：美国的医疗费用最近几年一直在大幅度攀升。高额的医疗账单为普通美国家庭带来了沉重的负担。本文原载于《今日美国》，文章由一名来自新罕布什尔的初级保健医生撰写。文章的逻辑缜密，语言也不艰涩。
英语听力原文：
Cripping health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.
日益上涨的医保费用，急诊室内长时间的等待，初级保健医生的短缺，这些都只是患者日常面临的一小部分问题。
Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.
初级保健应该是整个医保制度的支柱。在谈到健康状况和医疗费用时，初级保健资源完善的国家情况令人满意。美国却反其道而行，重视专门医生而非初级保健医生。
A recent study analyzed the providers who treat Medicare beneficiaries（老年医保受惠人）. The startling finding was that the average Medicate patient saw a total of seven doctors - two primary care physicians and five specialists - in a given year.
最近，一项研究对负责老年医保受惠人的医生进行了调查分析。令人惊讶的发现是，每个受惠人每年平均看的医生多达七位——两个初级保健医生和五个专科医生。
Contrary to popular belief, the more physicians taking care of you doesn't guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.
与人们普遍的想法相反，照顾你的医生越多并不能证明医疗保健的效果越好。事实上，医保越分散，医疗费用会越高，医疗错误也越多。
How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed（返还费用）. Moreover, the amount a physician receives leans heavily toward medical or surgical procedures.
为什么我们如此不重视初级保健呢？问题的关键在于医生的收费制度。大多数医生，无论何时，只要他们给人看病就可以收取费用。医生出诊的次数越多，无论医疗效果如何，他们获得的费用也会越多。另外，医生在收费时，在很大程度上是按看诊过程或手术内容进行的。
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 annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.
一个专业医生看诊30分钟收取的费用是一个初级保健医生同样时间问诊费用的3倍。考虑到以上原因，再加之政府每年随意削减医生诊费，医生们别无他法，只能靠增加问诊次数来提高收入。
Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.
不愿只求数量而忽视医疗效果的初级保健医生或者关门歇业，或者弃医从商，使初级保健的状况进一步恶化。
Medical students aren't blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.
医科专业的学生并非没有意识到这一情况，他们认识到费用返还制度对初级医保极其不利。最近的数据显示，自1997年以来，美国医科毕业生选择初级保健作为职业的人数已下降50%。这一趋势导致急诊室内人满为患，医生短缺。
英语词汇整理：
1. emergency - room 急症室
eg: The emergency room was in disorder.
急诊室里一片混乱。
同近义词：
1）casualty n. 急诊室
eg: They rushed her to casualty but she was dead on arrival.
他们赶紧把她送往急诊室,但她被送到时已死亡。
短语：
casualty of (某事的)受害者
rush to casualty 送往急诊室
2）emergency department n. 急诊室
eg: The nearest Accident Emergency Department to the Chinese University is the Prince of Wales Hospital.
最接近中文大学之急症室位于沙田威尔斯亲王医院。
2. primary adj. 主要的
eg: The primary task for socialism is to develop the productive forces.
社会主义的首要任务是发展社会生产力。
短语：
primary education 初等教育
primary evidence 基本证据
primary importance 头等重要
primary school 小学
词语用法：
1）primary的基本意思是“首要的,主要的,基本的”,形容在进展顺序上占首位,也指在重要性方面占主导地位,也可表示“最初的,初级的”。
2）primary不用于比较等级,在句中只用作定语。
3. physician n. 医师
eg: He is a prominent physician.
他是位著名的内科医生。
短语：
physician in charge 主治医生
physician to the king 御医
army physician 军医
visiting physician 出诊医生
词义解析：
physician, doctor, surgeon
这组词都可指“医生”。doctor为普通用语,泛指以看病为职业的各科医生；physician主要指内科医生,也可指一般医生,词义庄重,在美式英语中较常用；surgeon指外科医生。
4. scratch v. 抓；挖出
eg: That cat has scratched up all my young plants again!
那只猫又把我种的那些幼苗给扒出来了！
短语：
scratch about 扒,刨
scratch away 抓；刮
scratch from 从……中除名
scratch out 刮掉；划去；勉强维持
scratch up 掘起,挖出
from scratch 白手起家；从头做起
start from scratch 从头开始；白手起家
up to scratch 达到标准
without a scratch 安然无恙
on scratch 准时，正点
scratch for oneself [美国口语]关心自身利益
5. backbone n. 骨干
eg: These men are the backbone of the country.
这些人是国家的中坚力量。
短语：
to the backbone 彻底地，完完全全地，地地道道
backbone road 干道
backbone chain 主链
6. startling adj. 令人吃惊的
eg: The results were quite startling -- a 77% increase in six month.
结果非常令人吃惊--六个月增长百分之七十七。
短语：
startling news 爆炸性新闻
startling effect 令人惊讶的效果；惊人效应
7. given adj. 给定的，约定的
eg: You have to finish the work within the given time.
你们必须在规定时间内完成这项工作。
短语：
given time 给定时间
given name 教名；名字
given value 给定值，已知值
given price 已知价格
be given to 有……癖好；倾向于
8. guarantee v. 确保
eg: Surplus resources alone do not guarantee growth.
仅有富足的资源并不能确保发展。
短语：
guarantee from 保证不
guarantee against 保证不……
bank guarantee 银行担保
legal guarantee 法律保证，法律担保
letter of guarantee 保证书
9. fragmentation n. 分裂，破碎
eg: The fragmentation of society has been lamented for some time.
人们对社会分裂感到悲哀已有较长一段时间了。
短语：
Sleep fragmentation 睡眠片断化；睡眠断断续续
fragmentation bomb 碎裂弹
thermal fragmentation 热裂
fragmentation test 碎片试验
10. corresponding adj. 一致的，相应的
eg: All rights carry with them corresponding responsibilities.
一切权利都带有与之相应的责任。
短语：
corresponding to 与……一致的
corresponding period 同期
11. regardless of 不管，无论
eg: All our proposals were rejected, regardless of their merits.
我们所有的建议都遭到拒绝，不管这些建议的价值如何。
短语：
regardless of whether 不管不顾
regardless of the elements 风雨不改
regardless of source 不论来源
regardless of my business 不关我的事
12. reimburse v. 偿还，补偿
eg: The company will reimburse you for travel expenses.
公司会为你报销差旅费。
短语：
reimburse expenses 赔偿开支
reimburse for 为......
13. indiscriminately adv.不加区别的，不加选择的
eg: Investors dumped emerging market assets more or less indiscriminately in may and june.
今年5月份和6月份，投资者多少有些不加选择地抛售新兴市场资产。
短语：
bomb indiscriminately 狂轰滥炸
arrest indiscriminately 滥捕
14. reimbursement n. 退还
eg: Tell me what you have spent and I will reimburse you.
告诉我你花了哪些费用，以便我还给你。
短语：
tax reimbursement 退税
apply for reimbursement 报销
15. scenario n. 事态
eg: What's your worst-case scenario for Asia?
你认为在亚洲可能发生的最恶劣情形会是怎样?
短语：
scenario analysis 情境分析；场景分析
scenario planning 情景规划
usage scenario 使用场景
16. overwhelm v. 覆盖，征服
eg: Flood overwhelmed the city.
洪水淹没了那座城市。
短语：
overwhelm by 以…压倒…
overwhelm with 被……压倒；由于…使某人对…不知所措
佳句采摘：
Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.
不愿只求数量而忽视医疗效果的初级保健医生或者关门歇业，或者弃医从商，使初级保健的状况进一步恶化。 |