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SectionA
Inthissection,thereisapassagewithtenblanks.Youarerequiredtoselectonewordforeachblankfromalistofchoicesgiveninawordbankfollowingthepassage.
Theroboticsrevolutionissettobringhumansfacetofacewithanoldfear-man-madecreationsassmartandcapableaswearewithoutamoralcompass.Asrobotstakeonevermorecomplexroles,thequestionnaturally_____(27).Whowillberesponsiblewhentheydosomethingwrong?
Manufacturers?
Users?
Softwarewriters?
Theanswerdependsontherobot.
Robotsalreadysaveustime,moneyandenergy.Inthefuture,theywillimproveourhealthcare,socialwelfareandstandardofliving.The_____(28)ofcomputationalpowerandengineeringadvanceswill_____(29)enablelower-costin-homecareforthedisabled,_____(30)useofdriverlesscarsthatmayreducedrunkanddistracted-drivingaccidentsandcountlesshomeandservice-industryusesfromstreetcleaningtofoodpreparation.
Butthereare_____(31)tobeproblems.Robotcarswillcrash.Adrone(遥控飞行器)operatorwill_____(32)someone'
sprivacy.Aroboticlawnmower(割草机)willrunoveraneighbor'
scat.Juriessympathetictothe_____(33)ofmachineswillpunishentrepreneurswithcompany-crushing_____(34)anddamagesWhatshouldgovernmentdotoprotectpeoplewhile_____(35),spaceforinnovation?
Big.complicatedsystemsonwhichmuchpublicsafetydepends,likedriverlesscars,shouldbebuilt_____(36)andsoldbymanufacturerswhotakeresponsibilityforensuringsafetyandareliableforaccidents.Governmentsshouldsetsafetyrequirementsandthenletinsurerspricetheriskoftherobotsbasedonthemanufacturer'
sdrivingrecord.notthepassenger'
s.
A.arises
B.ascends
C.bound
D.combination
E.definite
F.eventually
G.interfere
H.invade
I.manifesting
J.penalties
K.preserving
L.programmed
M.proximately
N.victims
O.widespread
SectionB
Inthissection,youaregoingtoreadapassagewithtenstatementsattachedtoit.Eachstatementcontainsinformationgiveninoneoftheparagraphs.Identifytheparagraphfromwhichtheinformationisderived.Youmaychooseaparagraphmorethanonce.Eachparagraphismarkedwithaletter.AnswerthequestionsbymarkingthecorrespondingletteronAnswerSheet2.
ReformandMedicalCosts
[A]Americanaredeeplyconcernedabouttherelentlessriseinhealthcarecostsandhealthinsurancepremiums.Theyneedtoknowifreformwillhelpsolvetheproblem.Theansweristhatnooncehasaneasyfixrisingmedicalcosts.Thefundamentalfix—reshapinghowcareisdeliveredandhowdoctorsarepaidinawasteful,abnormalsystem—islikelytobeaachievedonlythroughtrialandincremental(渐进的)gains.
[B]ThegoodnewsisthatabilljustapprovedbytheHouseandabillapprovedbytheSenateFinanceCommitteewouldimplementortestmanyreformsthatshouldhelpslowtheriseinmedicalcostsoverthelongterm.AsreportinTheNewEnglandJournalofMedicineconcluded."
PrettymucheveryproposedinnovationfoundinthehealthpolicyIiteraturethesedaysiscontainedinthesemeasures."
[C]Medicalspending,whichtypicallyrisesfasterthanwagesandtheoveralleconomy,ispropelledbytwothings:
thehighpriceschargedformedicalservicesinthiscountryandthevolumeofunnecessarycaredeliveredbydoctorsandhospitals,whichoftenperformalotmoretestsandtreatmentsthanpatientreallyneeds.
[D]HerearesomeoftheimportantproposalsintheHouseandSenatebillstotrytoaddressthoseproblem,andwhyitishardtoknowhowwelltheywillwork.
[E]BothbillswouldreducetherateofgrowthinannualMedicarepaymentstohospital,nursinghomesandotherprovidersbyamountscomparabletotheproductivitysavingsroutinelymadeinotherindustrieswiththehelpofnewtechnologiesandnewwaystoorganizework.ThisproposalcouldsaveMedicaremorethan$100billionoverthenextdecade.Ifprivateplansdemandedsimilarproductivitysavingsfromproviders,andrefusedtoletprovidersshiftadditionalcoststothem,thesavingscouldbemuchlarger.CriticssayCongresswillgiveintolobbyistsandletinefficientprovideroffthehook(放过).ThatisfarlesslikelytohappenifCongressalsoadoptsstrong"
pay-go"
rulesrequiringthatanyincreaseinpaymentstoprovidersbeoffsetbynewtaxesorbudgecuts.
[F]TheSenateFinancebillwouldimposeanexcisetax(消费税)onhealthinsuranceplansthatcostmorethan$8,000foranindividualor$21,000forafamily.ItwouldmostlikelycauseInsurestoredesignplanstofallbeneaththethreshould.Enrolleeswouldhavetopaymoremoneyformanyservicesoutoftheirownpockets,andthatwouldencouragethemtothinktwiceaboutwhetheranexpensiveorredundanttestwasworthit.Economistsprojectthatmostemployerswouldshiftmoneyfromexpensivehealthbenefitsintowages,TheHousebillhasnosimilartax.Thefinallegislationshould.
[G]Anydoctorwhohaswrestledwithmultipleformsfromdifferentinsurers,orpatientswhohavetriedtounderstandtheirownparadeofstatements,knowthatsimplificationoughttosavemoney.Whenthehealthinsuranceindustrywasstillcooperatinginreformefforts,itstradegroupofferedtoprovidestandardizedformsforautomatedprocessing.Itestimatedthatstepwouldsavehundredsofbillionsofdollarsoverthenextdecade.Thebillswouldlockthatpledgeintolaw.
[H]Thestimuluspackageprovidedmoneytoconverttheinefficient,paper-drivenmedicalsystemtoelectronicrecordsthatcanbeeasilyviewedandtransmitted.Thisrequiresopeninvestmentstohelpdoctorsconvert.Intimeitshouldhelprestraincostsbyeliminatingredundanttest,preventingdruginteractions,andhelpingdoctorsfindthebesttreatments.
[I]Virtuallyallexpertsagreethatthefee-for-servicesystem—doctorsarerewardedforthatthecostofcareissohigh.Mostagreethatthesolutionistopushdoctorstoacceptfixedpaymentstocareforaparticularillnessorforapatient'
sneedsoverayear.Nooneknowshowtomakethathappenquickly.ThebillsinbothhouseswouldstartpilotprojectswithinMedicare.Theyincludesuchmeasuresasaccountablecareorganizationstotakechargeofapatient'
sneedswithaneyeonbothcostandquality,andchronicdiseasemanagementtomakesuretheseriouslyill,whoareresponsibleforthebulkofallhealthcarecosts,aretreatedproperly.Forthemostpart,theseexperimentsrelyonincentivepaymentstogetdoctorstotrythem.
[J]Testinginnovationsdonogoodunlessthegoodexperimentsareidentifiedandexpandedandthebadonesarcdropped.TheSenatebillwouldcreateanindependentcommissiontomonitorthepilotprogramsandrecommendchangesinMedicare'
spaymentpoliciestourgeproviderstoadoptreformsthatwork.ThechangeswouldhavetobeapprovedorrejectedasawholebyCongress,makingithardfornarrow-interestlobbiestobendlawmakerstotheirwill.
[K]Thebillsinbothchamberswouldcreatehealthinsuranceexchangesonwhichsmallbusinessesandindividualscouldchoosefromanarrayofprivateplansandpossiblyapublicoption.Alltheplanswouldhavetoprovidestandardbenefitpackagesthatwouldbeeasytocompare.Togetaccesstomillionsofnewcustomers,insureswouldhaveastrongincentivetosellontheexchange.Andthehead-to-headcompetitionmightgivethemastrongincentivetolowertheirprices,perhapsbyacceptingslimmerprofitmarginsordemandingbetterdealsfromproviders.
[L]Thefinallegislationmightthrowapublicplanintothecompetition,butthankstothefierceoppositionoftheinsuranceindustryandRepublicancritics,itmightnotsavemuchmoney.TheoneintheHousebillwouldhavetonegotiaterateswithproviders,ratherthanusingMedicarerates,asmanyreformerswanted.
[M]Thepresident'
sstimuluspackageispumpingmoneyintoresearchtocomparehowwellvarioustreatmentswork.Issurgery,radiationorcarefulmonitoringbestforprostate(前列腺)cancer?
Isthelatestandmostexpensivecholesterol-loweringdruganybetterthanitscommoncompetitors?
Thependingbillswouldspendadditionalmoneytoacceleratethiseffort.
[N]Criticshavechargedthatthissensibleideawouldleadtorationingofcare.(Thatwouldbetrueonlyifyoubelievethatpatientsshouldhaveanunrestrainedrighttotreatmentsproventobeinferior.)Asaresult,thebillsdonotrequires,astheyshould,thattheresultsofthesestudiesbeusedtosetpaymentratesinMedicare.
[O]CongressneedstofindthecouragetoallowMedicaretopaypreferentiallyfortreatmentsproventobesuperior.Sometimesthebesttreatmentmightbethemostexpensive.Butoverall,wesuspectthatspendingwouldcomedownthrougheliminationofalotofunnecessaryorevendangeroustestsandtreatments.
[P]TheHousebillwouldauthorizethesecretaryofhealthandhumanservicestonegotiatedrugpricesinMedicareandMedicaid.Someauthoritativeanalystsdoubtthatthesecretarywouldgetbetterdealsthanprivateinsurersalreadyget.Webelievenegotiationcouldwork.Itdoesinothercountries.
[Q]Missingfromthesebillsisanyseriousattempttoreininmalpracticecosts.Malpracticeawardsdodriveupinsurancepremiumsfordoctorsinhigh-riskspecialties,andthereissomeevidencedoctorsengagein"
defensivemedicine"
byperformingtestsandtreatmentsprimarilytoprovetheyarenotneg