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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  55
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.
【F1】
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答案就像我在“价格难题”中所描述的那样，医保价格根据受保人居住地区的不同而有着巨大的差别——差距达到百分之三百，甚至更多。
解析 ①本句为主从复合句，包含一个状语从句。②主句为主谓结构，depending on where you live为现在分词短语作状语，意为“根据受保人所居住的地区”；by three…or more，为介词短语作方式状语，说明差距的幅度。③句末为as引导的方式状语从句，说明医保价格存在差别就像在“价格难题”中所描述的那样。
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