奇速英语美文资讯，美国的医疗体制是典型的商业健康保险体制，是将商业健康保险作为医疗卫生体制的主体，通俗来讲就是大家通过购买保险来报销就医费用，程度与保费挂钩。在商业健康保险体制中，市场起主导作用，政府起补缺作用，服务效率较高，但是公平性和可及性较差，医药费用过高，民众满意度较低。

　　Don’t put work-requirements on Medicaid

　　不要把工作要求写在医疗补助计划上

　　No,health insurance is not a disincentive to work

　　不，医疗保险不是限制工作的因素

　　ONE THURSDAY in January 2018,while cable-news shows were scandalised by the latest leak from the White House,the Trump administration made a change to America’s safety-net.The new rule lets states experiment with forcing recipients of Medicaid to work,volunteer or study in exchange for their government-funded health insurance(see article).

　　leak/liːk/CET6 TEM4

　　V-T/V-I If a container leaks,there is a hole or crack in it which lets a substance such as liquid or gas escape.You can also say that a container leaks a substance such as liquid or gas.渗漏(液体或气体);(容器)渗漏

　　recipient/rɪˈsɪpɪənt/CET6 TEM8

　　N-COUNT The recipient of something is the person who receives it.接受者

　　2018年1月的一个周四，正当有线电视新闻节目因白宫最新的泄密事件而陷入丑闻之际，特朗普政府调整了美国的安全保障计划。新规定允许各州试行强迫接受医疗补助的人去工作、做志愿或学习，以换取政府资助的医疗保险。

　　【搭配与表达】

　　in exchange for

　　交换，用……交换，调换

　　【例】

　　I’ve offered to paint the kitchen in exchange for a week’s accommodation.

　　我提出愿意粉刷厨房，条件是让我免费住一周。

　　It attracted little attention at the time.Yet because about 75m poor Americans rely on Medicaid for their health care,this decision has the potential to affect an awful lot of people.

　　awful/ˈɔːfʊl/CET4 TEM4

　　ADJ If you say that someone or something is awful,you dislike that person or thing or you think that they are not very good.令人讨厌的

　　当时几乎没有人注意到这一点。然而，由于大约7500万美国穷人的医疗保健依赖于医疗补助计划，这一决定可能会影响到很多人。

　　【背景介绍】

　　白宫“内鬼”还在行动……

　　白宫内鬼没抓着，特朗普的私人行程却又被泄露。美国《国会山报》网站10日报道称，白宫代理幕僚长穆瓦尼在福克斯新闻台的电视节目中公开喊话，说泄露特朗普日程的白宫内鬼一周内就将被揪出来。不过在穆瓦尼电视喊话播出后几个小时，美国时政网站Axios就再次公布了特朗普的日程。这次曝光的日程安排涵盖过去一周内的4天，其中可以看到特朗普有差不多一半的时间又都花在所谓“行政时间”上了。

　　据Axios此前报道，根据特朗普去年11月初至今年2月1日的日程，他每天早上不到6时就起床了，但起床后第一件事是打电话、看报纸及发推特等，约11时才会去开会，参加各种活动，一天内的“行政时间”前后长达5小时。这3个月内，特朗普总计花了297个小时的“行政时间”看报纸、打电话、发推特和做其他事。

　　10日，特朗普连发推文给自己的“行政时间”进行辩解，“我的工作时间可能长于此前历任总统……我当选总统时，我们国家一团糟……我没别的选择，只能长时间工作！”他还表示，民众从被曝光的总统日程中应该看到积极面而非消极面，因为“行政时间”都是用来工作的。

　　没具体安排的“行政时间”这么多，自然引发总统懒惰的联想。《纽约时报》报道白宫事务的记者哈珀曼发推文表示，白宫助手不惜拿曝光特朗普日程当武器，这很能说明白宫工作人员对他是个什么态度了。不过也有人从日程曝光事件中看到其他问题，认为工作人员如此泄密是前所未有的背叛。

　　特朗普的日程其实没那么机密，能接触到日程表的足足有400人。不过穆瓦尼在电视节目中明确指出，这事的关键不在于日程内容，而在于白宫中竟有人花上3个月的时间收集并曝光总统日程。

　　So far,only one state—Arkansas—has imposed extensive work requirements on Medicaid.Fourteen other states have applied to follow its example.They should look at what has happened in Arkansas and think again.

　　state/steɪt/CET4 TEM4

　　1.N-COUNT You can refer to countries as states,particularly when you are discussing politics.(政治上所指的)国家

　　2.N-SING You can refer to the government of a country as the state.政府

　　impose/ɪmˈpəʊz/CET4 TEM4

　　V-T If you impose something on people,you use your authority to force them to accept it.强制实行

　　extensive/ɪkˈstɛnsɪv/CET4 TEM4

　　1.ADJ Something that is extensive covers or includes a large physical area.广阔的

　　2.ADJ Something that is extensive covers a wide range of details,ideas,or items.广泛的

　　到目前为止，只有阿肯色州对医疗补助计划提出了各种工作要求。另有14个州已申请仿效他的做法。不过他们应该看看阿肯色州发生了什么，然后再想一想要不要这么做。

　　【搭配与表达】

　　apply to

　　1.申请

　　【例】

　　I applied to four universities and was accepted by all of them.

　　我向四所大学提出申请，都被录取了。

　　2.适用于

　　【例】

　　Do the same rules apply to part-time workers?

　　这些规定对兼职人员也适用吗？

　　3.应用

　　【例】

　　New technology is being applied to almost every industrial process.

　　新技术几乎应用到所有的工业流程中应用。

　　4.致力于

　　【例】

　　Over the next months,he applied himself to improving the technique.

　　在接下来的几个月里，他专心致志地改进技术。

　　The theory behind tying cash benefits to work requirements is sound.Asking people to do something in exchange for a payment can build political support for welfare programmes.Without the requirements,beneficiaries are easily dismissed as scroungers.Moreover,encouraging people back into work is the best anti-poverty scheme.

　　exchange/ɪksˈtʃeɪndʒ/CET4 TEM4

　　V-RECIP If two or more people exchange things of a particular kind,they give them to each other at the same time.交换

　　political/pəˈlɪtɪkəl//CET4 TEM4

　　ADJ Political means relating to the way power is achieved and used in a country or society.政治的

　　beneficiary/bɛnɪˈfɪʃərɪ/CET6 TEM8

　　N-COUNT Someone who is a beneficiary of something is helped by it.受益者

　　将现金福利与工作要求挂钩的理论是合理的。要求人们做些事情来换取报酬，可以为福利计划建立政治基础。如果没有这些要求，受益人很容易被当作寄生虫而被抛弃。此外，鼓励人们重返工作岗位是消除贫困的最佳方法。

　　【长难句分析】

　　Asking people to do something in exchange for a payment can build political support for welfare programmes.

　　1.asking people to do something是动名词作主语。

　　2.support for对······的支持。

　　【例】

　　There was widespread support for the war.人们普遍支持这场战争。

　　3.in support of支持

　　【例】

　　They signed a petition in support of the pay claim.他们在请愿书上签名支持加薪要求。

　　【语法拓展】

　　1）动名词做主语时，谓语动词为单数

　　2）在动名词和不定式中，作为介词的宾语是动名词

　　3）动名词的否定直接在其前加否定词，通过代词的宾格或所有格形式给出逻辑主语

　　4）有些词后面只能接动名词

　　acknowledge;admit;advise;advocate;allow;appreciate;avoid;be worth（后面的动名词必须是主动形式）;celebrate;consider;contemplate;defer;delay;deny;detest;discontinue;dislike;dispute;enjoy;it entails;escape;excuse;explain;fancy;feel like;finish;forgive;hinder;imagine;it involves;keep;it means;mention;mind;miss;it necessitates;pardon;postpone;practice;prevent;recall;report;resent;resist;risk;stand;suggest;understand...

　　5）另外还有一些接-ing形式的常用说法

　　it’s no good;

　　it’s no/little/hardly any/use;

　　it’s not/hardly/scarcely use;

　　it’s worthwhile;

　　spend money/time;

　　there’s no;

　　there’s no point in;

　　there’s nothing worse than;

　　what’s the use/point...

　　【语法小测】

　　I would appreciate ___C____ back this afternoon.

　　A.you to call

　　B.you call

　　C.you calling

　　D.you’re calling

　　（C换成your calling也对）

　　Even so,tying health care to work is a mistake,for two reasons.The first is practical.Safety-net programmes work best when they are simple,well-understood and governed by rules that are easy to administer.The Arkansas experiment fails this test.

　　即便如此，将医疗保健与工作联系起来也是一个错误。原因有二。首先是实用性。安全保障计划简单、易于理解且规则易于管理时，它们的效果才最佳。阿肯色州的实验并没有通过这个测试。

　　To be eligible for Medicaid,you must earn less than$17,000 a year and must prove that you are working,studying or taking care of young children or infirm relatives for at least 80 hours a month.Many people who earn so little have unpredictable patterns of work.One month they will put in enough hours to meet the criteria for eligibility,the next they will not.

　　eligible/ˈɛlɪdʒəbəl/CET6 TEM8

　　ADJ Someone who is eligible to do something is qualified or able to do it,for example,because they are old enough.有资格的

　　infirm/ɪnˈfɜːm/TEM8

　　ADJ A person who is infirm is weak or ill,and usually old.(常指因年迈而)体弱的

　　unpredictable/ʌnprɪˈdɪktəbəl/TEM4

　　ADJ If you describe someone or something as unpredictable,you mean that you cannot tell what they are going to do or how they are going to behave.不可预测的

　　要想获得医疗补助，你每年的收入必须少于1万7千美元，并且必须证明你在工作、学习或者照顾年幼的孩子或是虚弱的亲戚，一个月至少工作80个小时。这些收入微薄的人的工作模式都具有不可预知性。一个月内他们投入足够的时间来达到这种工作的资格，但下一个月就未必能够实现。

　　【长难句分析】

　　To be eligible for Medicaid,you must earn less than$17,000 a year and must prove that you are working,studying or taking care of young children or infirm relatives for at least 80 hours a month.

　　1.主句是you must earn less than$17,000 a year and must prove that···

　　2.to be eligible for Medicaid是不定式表目的，you are working,studying or taking care of young children or infirm relatives for at least 80 hours a month是prove的宾语从句。

　　Worse,Arkansas made it unnecessarily hard for people to register their work effort.In a state with one of the lowest rates of internet usage,Medicaid recipients had to log their working hours on a website that shut down between 9pm and 7am.As a result,18,000 of the approximately 80,000 people who were asked to report their schedules lost their coverage.

　　register/ˈrɛdʒɪstə/CET4 TEM4

　　N-COUNT A register is an official list or record of people or things.登记簿

　　usage/ˈjuːsɪdʒ/CET4 TEM4

　　N-UNCOUNT Usage is the way in which words are actually used in particular contexts,especially with regard to their meanings.(词在特定语境中的)使用

　　coverage/ˈkʌvərɪdʒ/CET6 TEM8

　　1.N-UNCOUNT The coverage of something in the news is the reporting of it.报道

　　2.N-UNCOUNT The protection an insurance company gives you,so that it pays you money if you are injured,something is stolen.保险范围

　　更糟糕的是，在阿肯色州登记工作成果要经历很多不必要的困难。在这个互联网使用率最低的州，接受医疗补助的人必须在晚上9点到早上7点之间关闭的网站上记录他们的工作时间。结果，被要求报告日程安排的约8万人中，有1.8万人（因没有按时记录）失去了保险资格。

　　Supposing these problems can be overcome,tying access to health care to work is still wrong,because it is based on a misconception about incentives.When the Trump administration announced the new policy,it observed that“higher earnings are positively correlated with longer lifespan.”

　　misconception/mɪskənˈsɛpʃən/CET6

　　N-COUNT A misconception is an idea that is not correct.错误观念

　　lifespan/ˈlaɪfspæn/

　　N-VAR The lifespan of a person,animal,or plant is the period of time for which they live or are normally expected to live.(人或动植物的)寿命

　　假设这些问题能够被克服，将获得医疗保健与工作联系起来仍然是错误的。因为这是一种对激励机制的误解。特朗普政府宣布这项新政策时指出：“收入与寿命成正相关。”

　　That is true,but the White House has the causation backwards:healthy people lead longer,more productive lives.People do not work in order to be healthy;they can work because they are healthy already.

　　causation/kɔːˈzeɪʃən/

　　N-UNCOUNT The causation of something,usually something bad,is the factors that have caused it.诱因

　　这是事实，但白宫却将因果关系倒过来了。健康的人生活得更长久、更有成效。人们工作不是为了健康；他们可以工作，因为他们已经很健康了。

　　Medicaid does have a problem with work incentives,but it is not the one the White House has identified.When the Affordable Care Act,aka Obamacare,became law,the intention was that low-income Americans would either be eligible for Medicaid or for government subsidies to help them buy their own,private insurance policies.

　　incentive/ɪnˈsɛntɪv/CET6 TEM4 N-VAR If something is an incentive to do something,it encourages you to do it.鼓励

　　医疗补助计划确实存在工作激励方面的问题，但这不是白宫发现的。《平价医疗法案》(即奥巴马医改)成为法律时，本意是让低收入的美国人要么有资格享受医疗补助，要么有资格获得政府补贴，帮助他们购买自己的私人保险。

　　In fact 14 states decided not to implement part of the law.In these 14 states,people whose earnings are close to the cut-off for Medicaid eligibility can lose their health insurance if they work a few more hours.This is a huge disincentive to extra work.If states want to fix the real problem with Medicaid,that That left about 2m Americans in limbo,earning too much to qualify for Medicaid but too little to be eligible for Obamacare subsidies.

　　implement/'ɪmplɪm(ə)nt/CET4 TEM4

　　V-T If you implement something such as a plan,you ensure that what has been planned is done.实施;执行

　　disincentive/dɪsɪnˈsɛntɪv/

　　N-VAR A disincentive is something which discourages people from behaving or acting in a particular way.使...受挫折的事物

　　事实上，有14个州决定不实施部分法律。在这14个州，收入接近医疗补助资格的人如果再多工作几个小时，就可能失去医疗保险。这让很多人不愿意再做额外工作。如果各州想要解决医疗补助计划真正的问题，那就会让大约200万美国人陷入困境，他们的收入太高，无法享受医疗补助计划，但收入太少，无法享受奥巴马医改的补贴。

　　【拓展理解】

　　美国的医疗体制是典型的商业健康保险体制，是将商业健康保险作为医疗卫生体制的主体，通俗来讲就是大家通过购买保险来报销就医费用，程度与保费挂钩。在商业健康保险体制中，市场起主导作用，政府起补缺作用，服务效率较高，但是公平性和可及性较差，医药费用过高，民众满意度较低。奥巴马实施医改，就是要给已有保险的人提供安全保护，给没有医疗保险的人提供医疗保险，控制医疗费用，实现公平与可及。法案初稿建设议成立公营医疗保险，管制私人市场转保，由私人健保转到公营健保。奥巴马的医改有几个原则：第一是要保证选择性，要让每个美国人都能选择自己的医疗保险计划和医生；第二是要控制成本，减少医疗资源浪费、欺诈行为和高额的管理费用；第三是要保护家庭财政健康，必须减少医疗保险费用和美国企业、个人承担的其他医疗支出，保证人们在患重病时不会破产；第四是在预防疾病和保健方面增加投入，减少肥胖、缺乏运动、吸烟等现象，增加预防性治疗服务；第五是关于医疗保险的可流动性，人们的医疗保险不能再锁定在一个就业岗位上；第六是全民普遍原则，每个美国人都应享受医疗保险；第七是改善患者安全，提高医疗服务质量。

　　奥巴马实施医改，就是要给已有保险的人提供安全保护，给没有医疗保险的人提供医疗保险，控制医疗费用，实现公平与可及。法案初稿建设议成立公营医疗保险，管制私人市场转保，由私人健保转到公营健保。更多英语美文阅读请持续关注奇速英语阅读频道：www.qisuabc.com