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The more expensive it is, the better it must be. That’s how people used to think about healthcare costs. As has become apparent

admin2019-08-08  25
问题    The more expensive it is, the better it must be. That’s how people used to think about healthcare costs. As has become apparent in recent years, however, this is flat wrong. 【F1】The costs of care vary wildly depending on where you live—by three hundred per cent or more, as I reported in "The Cost Conundrum (难题)". And research has found no consistent relationship between cost and quality across the country. Some of the most expensive places are among the most mediocre.
   But nearly all this research was based on the analysis of government insurance programs, especially Medicare, the program for the elderly. Private insurers do not have to make information on whom they pay, how much, or what they pay for publicly available. Only government insurance programs do. A fascinating study out this week, however, manages to crack open the black box of private insurance. 【F2】It analyzes payment data compiled, for the first time, from three of the country’s largest commercial insurers which cover fourteen per cent of the U.S. population.
   Medicare can use its authority to set prices for hospitals. Private insurers can’t. They have to negotiate with individual hospitals. In general, they end up paying higher and far more variable prices than Medicare does. 【F3】There’s a big exception: Congress has prevented Medicare from setting drug prices—and as a result it often pays higher prices than other insurers do. That, the new research finds, can lead to a completely different cost picture for the privately insured.
   Differences in the number of tests and treatments given from place to place are still huge for the privately insured. 【F4】But the cost of health care is like the cost of groceries goods—the total depends on the price of every item and on how many items you get. Both Medicare and private insurers have adopted policies and reforms that are reducing unnecessary tests and treatments and improving preventive care.
   It’s the Cost Conundrum Squared. 【F5】The bigger the hospital, the more it can adopt systems that deliver better-organized, higher-quality, less-wasteful care;but the bigger the hospital, the more power it has to raise prices.
   We have a few ways out of the conundrum. We can regulate the prices hospitals charge insurers—this is what Maryland does. We can break up big hospitals. We can encourage hospitals to become the insurers. Or we can expand Medicare to more and more people until we’re single payer.
【F3】
选项
答案但也有一个例外：国会禁止老年医保制度制定药物价格——因此它常常比其它私人保险公司以更高价格购买药品。
解析 ①此句可视为and连接的两个分句。冒号后面的同位语从句是对there be句型中的主语exception的解释说明。②冒号后的同位语从句中，prevent…from…意为“阻止、禁止某人做某事”；set price意为“制定价格”。③破折号后and连接的分句2为比较句，比较的是老年医保和私人保险公司“在药物方面要支付的价格”，因此句末的do是省略的用法，意为“other insurers pay the drug prices”。
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