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Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.
The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how healthcare dollars are spent.
In practical terms, the new guidelines being developed could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment—at the end of life, for example—is too expensive. In the extreme, some critics have said that making treatment decisions based on cost is a form of rationing.
Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions, even though there's no obligation to follow them. Medical society guidelines are also used by insurance companies to help determine reimbursement (报销) policies.
Some doctors see a potential conflict in trying to be both providers of patient care and financial overseers.
"There should be forces in society who should be concerned about the budget, but they shouldn't be functioning simultaneously as doctors, said Dr. Martin Samuels at a Boston hospital. He said doctors risked losing the trust of patients if they told patients, not going to do what I think is best for you because I think it's bad for the healthcare budget in Massachusetts."
Doctors can face some grim trade-offs. Studies have shown, for example, that two drugs are about equally effective in treating macular degeneration, and eye disease. But one costs $ 50 a dose and the other close to $ 2,000. Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug, Avastin, instead of the costlier one, Lucentis.
But the Food and Drug Administration has not approved Avastin for use in the eye, and using it rather than the alternative, Lucentis, might carry an additional, although slight, safety risk. Should doctors consider Medicare^ budget in deciding what to use?
"I think (在道德层面上) we are just worried about the patient in front of us and not trying to save money for the insurance industry or society as a whole," said Dr. Donald Jensen.
Still, some analysts say that there's a role for doctors to play in cost analysis because not many others are doing so. "In some ways," said Dr. Daniel Sulmasy, "it represents a failure of wider society to take up the issue."
1
What do some most influential medical groups recommend doctors do?
A.
Reflect on the responsibilities they are supposed to take.
B.
Pay more attention to the effectiveness of their treatments.
C.
Take costs into account when making treatment decisions.
D.
Readjust their practice in view of the cuts in health care.
本题答案：
A
B
C
D
参考答案：
C
系统解析：
事实细节题。定位句指出医疗集团建议医生在决定病人的治疗方案时，不仅要考虑疗效，还要医疗成本费用，故答案为 C。
2
What were doctors mainly concerned about in the past?
A.
Specific medicines to be used.
B.
Effects of medical treatment.
C.
Professional advancement.
D.
Patients' trust.
本题答案：
A
B
C
D
参考答案：
B
系统解析：
推理判断题。从定位句及其所在段落可以看出，作者提到一个关于医生角色的关键性的变化，即从单纯考虑病人个体转为对医疗费用的使用施加影响，可见，医生过去只考虑治疗效果,故答案为 B。
3
What may the new guidelines being developed lead to?
A.
The redefining of doctors' roles.
B.
Overuse of less effective medicines.
C.
Conflicts between doctors and patients.
D.
The prolonging of patients' suffering.
本题答案：
A
B
C
D
参考答案：
A
系统解析：
事实细节题。定位句指出，医生会基于价格考虑，从而决定药品的使用和医疗方案，这与上一段首到的 redefine their roles 相呼应，医生从仅仅只考虑疗效到在决定中引入费用因素，其角色确实发生了转变，故答案为 A。
4
What risk do doctors see in their dual role as patient care providers and financial overseers?
A.
They may be involved in a conflict of interest.
B.
They may be forced to divide their attention.
C.
They may have to use less effective drugs.
D.
They may lose the respect of patients.
本题答案：
A
B
C
D
参考答案：
D
系统解析：
事实细节题。第五段首先提到医生作为医疗服务提供者和医疗成本监察员，本就存在着潜在矛盾，而在随后的第六段第二句中又明确指出，这样会使医生失去病人的信任，故答案为 D。
5
What do some experts say about doctors' involvement in medical cost analysis?
A.
It may add to doctors' already heavy workloads.
B.
It will help to save money for society as a whole.
C.
It results from society's failure to tackle the problem.
D.
It raises doctors' awareness of their social responsibilities.
本题答案：
A
B
C
D
参考答案：
C
系统解析：
推理判断题。最后一段首句指出，尽管医生兼任医药成本监察员的职责并不合适，但又不得不为之，因为很少有其他群体能做到，而作者更进一步引用丹尼尔·赛尔马西医生的话指出，整个社会没能成功处理这一问题，故答案为 C。
Economic inequality is the "defining challenge of our time," President Barack Obama declared in a speech last month to the Center for American Progress. Inequality is dangerous, he argued, not merely because it doesn't look good to have a large gap between the rich and the poor, but because inequality itself destroys upward mobility, making it harder for the poor to escape from poverty. "Increased inequality and decreasing mobility pose a fundamental threat to the American Dream," he said.
Obama is only the most prominent public figure to declare inequality Public Enemy No.1 and the greatest threat to reducing poverty in America. A number of prominent economists have also argued that ifs harder for the poor to climb the economic ladder today because the rungs (横档) in that ladder have grown farther apart.
For all the new attention devoted to the 1 percent, a new dataset from the Equality of Opportunity Project at Harvard and Berkeley suggests that, if we care about upward mobility overall, we're vastly exaggerating the dangers of the rich-poor gap. Inequality itself is not a particularly strong predictor of economic mobility, as sociologist Scott Winship noted in a recent article based on his analysis of this data.
So what factors, at the community level, do predict if poor children will move up the economic ladder as adults? what explains, for instance, why the Salt Lake City metro area is one of the 100 largest metropolitan areas most likely to lift the fortunes of the poor and the Atlanta metro area is one of the least likely?
Harvard economist Raj Chetty has pointed to economic and racial segregation, community density, the size of a community's middle class, the quality of schools, community religiosity, and family structure, which he calls the "single strongest correlate of upward mobility." Chetty finds that communities like Salt Lake City, with high levels of two-parent families and religiosity, are much more likely to see poor children get ahead than communities like Atlanta, with high levels of racial and economic segregation.
Chetty has not yet issued a comprehensive analysis of the relative predictive power of each of these factors. Based on my analyses of the data, of the factors that Chetty has highlighted, the following three seem to be most predictive of upward mobility in a given community：
1. Per-capita (人均) income growth
2. Prevalence of single mothers (where correlation is strong, but negative)
3. Per-capita local government spending
In other words, communities with high levels of per-capita income growth, high percentages of two-parent families, and high local government spending—which may stand for good schools—are the most likely to help poor children relive Horatio Alger's rags-to-riches story.
6
How does Obama view economic inequality?
A.
It is the biggest obstacle to social mobility.
B.
It is the greatest threat to social stability.
C.
It is the No. 1 enemy of income growth.
D.
It is the most malicious social evil of our time.
本题答案：
A
B
C
D
参考答案：
A
系统解析：
事实细节题。定位句提到，奥巴马把不公平称为“我们这个时代决定性的挑战”，并指出不公危险是因为它破坏了社会阶层的提升，令贫困者难以摆脱贫困，故答案为 A。
7
What do we learn about the inequality gap from Scott Winship's data analysis?
A.
It is fast widening across most parts of America.
B.
It is not a reliable indicator of economic mobility.
C.
It is not correctly interpreted.
D.
It is overwhelmingly ignored.
本题答案：
A
B
C
D
参考答案：
B
系统解析：
事实细节题。定位句指出，不公平本身并不是社会流动性的强预警信号，也就是说不公平不是社会流动性的可靠指标，后文还论证并列举了与社会活动性相关度较高的若干因素，故答案为 B。
8
Compared with Atlanta, metropolitan Salt Lake City is said to______.
A.
have placed religious beliefs above party politics
B.
have bridged the gap between the rich and the poor
C.
offer poor children more chances to climb the social ladder
D.
suffer from higher levels of racial and economic segregation
本题答案：
A
B
C
D
参考答案：
C
系统解析：
事实细节题。定位句指出，像盐湖城这样兼具双亲的虔诚宗教家庭比例较高的社区，比亚特兰种族和经济隔离程度高的社区更能为贫困孩子提供上升机会，可见，它能为贫困孩子提供更多攀登社会阶梯的机会，故答案为 C。
9
What is strongly correlated with social mobility according to economist Raj Chetty?
A.
Family structure.
B.
Racial equality.
C.
School education.
D.
Community density.
本题答案：
A
B
C
D
参考答案：
A
系统解析：
事实细节题。根据定位句可知，在查蒂提到的若干影响社会活动性的因素中，家庭结构是“社会阶层提升的唯一强相关因素”，故答案为 A。
10
What does the author seem to suggest?
A.
It is important to increase the size of the middle class.
B.
It is highly important to expand the metropolitan areas.
C.
It is most imperative to focus our efforts on the elimination of income inequality.
D.
It is better to start from the community to help poor children move up the social ladder.
本题答案：
A
B
C
D
参考答案：
D
系统解析：
推理判断题。从定位段中可看出，作者提到如何帮助穷苦孩子提高社会经济地位时，一直都是从社区层面进行分析的，前文也多次有类似的提示，故答案为 D。
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