Questions 57 to 61 are based on the following passage.
Almost everyone agrees that America’s health-care system has the incentives all wrong. Under the fee-for-service system, doctors and hospitals get paid for doing more, even ff added tests, operations and procedures have little chance of improving patients’ health. So what happens when someone proposes that we alter the incentives to reward better care, not more care
Spiraling health spending is the crux (症结)of our federal budget problem. In 1965, health spending was 2.6 percent of the budget. In 2010, it was 26.5 percent. The Obama administration estimates it will be 30.3 percent in 2016. By contrast, defense spending is about 20 percent; scientific research and development is 4 percent.
Uncontrolled health spending isn’t simply crowding out other government programs; it’s also restraining overall living standards. Health economists Michael Chernew, Richard Hirth and David Cutler recently reported that higher health costs consumed 35.7 percent of the increase in per capita income from 1999 to 2007.
Rep. Paul Ryan proposes to change that. Beginning in 2022, new (not existing)Medicare beneficiaries would receive a voucher(凭证), valued initially at about $ 8,000. The theory is . Suddenly empowered, Medicare beneficiaries would shop for lowest-cost, highest-quality insurance plans providing a required package of benefits. The health-care delivery system would be forced to restructure by reducing costs and improving quality.
It’s shock therapy. Would it work No one knows, but two things are clear.
First, as Medicare goes, so goes the entire health-care system. Medicare is the nation’s largest insurance program, with 48 million recipients and spending last year of $ 520 billion. About 75 percent of beneficiaries have fee-for- service coverage. If Medicare remains largely fee-for-service, the rest of the system will, too.
Second, few doubt that today’s health-care system has much waste: medical care that does no good; high overhead costs. In one survey, 20 percent of patients reported that doctors repeated tests because records were unavailable; care of patients with chronic conditions is often slapdash (草率的), so that, for example, only 43 percent of diabetics receive recommended treatment.
Under Ryan’s plan, incentives would shift. Medicare would no longer be an open ATM; the vouchers would limit total spending. Providers would face pressures to do more with less. The Obama administration argues that better results can be achieved by modifying incentives within the existing system. Perhaps. But history suggests skepticism. Presidents since Jimmy Carter have made proposals to control spending, hardly with any results.
It’s Ryan’s radicalism vs. President Obama’s tinkering (修补). Which is realistic and which is wishful thinking This important debate should rise above cheap political debate. Burdened by runaway spending, Medicare "as we know it" is going to end. The only questions are when and on whose terms.
Questions 57 to 61 are based on the following passage.What will the Medicare be like according to Ryan’s proposal