During the first many decades of this nation’s existence, the United States was a wide-open, dynamic country with a rapidly expanding economy. It was also a country that tolerated a large amount of cruelty and pain — poor people living in misery, workers suffering from exploitation.
Over the years, Americans decided they wanted a little more safety and security. This is what happens as nations grow wealthier; they use money to buy civilization.
Occasionally, our ancestors found themselves in a sweet spot. They could pass legislation that brought security but without a cost to vitality. But adults know that this situation is rare. In the real world, there’s usually a trade-off. The unregulated market wants to direct capital to the productive and the young. Welfare policies usually direct resources to the vulnerable and the elderly. Most social welfare legislation, even successful legislation, siphons money from the former to the latter.
Early in this health care reform process, many of us thought we were in that magical sweet spot. We could extend coverage to the uninsured but also improve the system overall to lower costs. That is, we thought it would be possible to reduce the suffering of the vulnerable while simultaneously squeezing money out of the wasteful system and freeing it up for more productive uses.
That’s what the management gurus call a win-win.
It hasn’t worked out that way. The bills before Congress would almost certainly ease the anxiety of the uninsured, those who watch with terror as their child or spouse grows ill, who face bankruptcy and ruin.
And the bills would probably do it without damaging the care the rest of us receive. In every place where reforms have been tried — from Massachusetts to Switzerland — people come to cherish their new benefits. The new plans become politically untouchable.
But, alas, there would be trade-offs. Instead of reducing costs, the bills in Congress would probably raise them. They would mean that more of the nation’s wealth would be siphoned off from productive uses and shifted into a still wasteful health care system.
The authors of these bills have tried to foster efficiencies. The Senate bill would initiate several interesting experiments designed to make the system more effective — giving doctors incentives to collaborate, rewarding hospitals that provide quality care at lower cost. It’s possible that some of these experiments will bloom into potent systemic reforms.
But the general view among independent health care economists is that these changes will not fundamentally bend the cost curve. The system after reform will look as it does today, only bigger and more expensive.
As Jeffrey S. Flier, dean of the Harvard Medical School, wrote in The Wall Street Journal last week, “In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it.”
Rather than pushing all of the new costs onto future generations, as past governments have done, the Democrats have admirably agreed to raise taxes. Over the next generation, the tax increases in the various bills could funnel trillions of dollars from the general economy into the medical system.
Moreover, the current estimates almost certainly understate the share of the nation’s wealth that will have to be shifted. In these bills, the present Congress pledges that future Congresses will impose painful measures to cut Medicare payments and impose efficiencies. Future Congresses rarely live up to these pledges. Somebody screams “Rationing!” and there is a bipartisan rush to kill even the most tepid cost-saving measure. After all, if the current Congress, with pride of authorship, couldn’t reduce costs, why should we expect that future Congresses will?
The bottom line is that we face a brutal choice.
Reform would make us a more decent society, but also a less vibrant one. It would ease the anxiety of millions at the cost of future growth. It would heal a wound in the social fabric while piling another expensive and untouchable promise on top of the many such promises we’ve already made. America would be a less youthful, ragged and unforgiving nation, and a more middle-aged, civilized and sedate one.
We all have to decide what we want at this moment in history, vitality or security. We can debate this or that provision, but where we come down will depend on that moral preference. Don’t get stupefied by technical details. This debate is about values.
一篇阅读(25)
Obama Loses a Round
While the jury is still out on what President Obama’s China visit has achieved for the long term, the president has most decidedly lost the war of symbolism in his first close encounter with China.
In status-conscious China, symbolism and protocol play a role that is larger than life. U.S. diplomatic blunders could reinforce Beijing’s mindset that blatant information control works, and that a rising China can trump universal values of open, accountable government.
During Mr. Obama’s visit, the Chinese outmaneuvered the Americans in all public events, from the disastrous town hall meeting in Shanghai to the stunted press conference in Beijing. In characteristic manner, the Chinese tried to shut out the public, while the U.S. unwittingly cooperated.
The final image of President Obama in China that circulated around the world is telling: A lone man walking up the steep slope of the Great Wall. The picture is in stark contrast to those of other U.S. presidents who had their photographs taken at the Great Wall surrounded by flag-waving children or admiring citizens. Maybe Mr. Obama wanted a quiet moment for himself before returning home. But a president’s first visit to the wall is a ritual that needs to be properly framed. Mr. Obama could have waited until the next visit, when he could bring the first lady and the children. Instead, he went ahead by himself to pay tribute to China’s ancient culture. In return, the Chinese offered nothing, no popular receptions, not even the companionship of a senior Chinese leader.
The trouble for the U.S. started at the town hall meeting two days earlier — a more scripted event than those organized with students for earlier U.S. presidents. There was no real dialogue, as a programmed audience, most of them Communist League Youth members, asked coached questions.
The Chinese also rejected the U.S. request for live national coverage and defaulted on a promise to live-stream the meeting at Xinhua.net, the online version of China’s state-owned news agency. Mr. Obama scored a point when he managed to address the issue of Internet freedom after the U.S. ambassador, Jon Huntsman, fielded him the question from a Chinese netizen submitted online.
Meanwhile, Chinese officials garnered from the meeting generous quotes from Mr. Obama affirming China’s achievements and America’s expressions of good will, which were turned into glowing headlines for the Chinese media. In this round of the propaganda skirmish, the U.S. scored one point while China reaped a handful.
Mr. Obama was similarly shut out from addressing the public in Beijing. At the Beijing press conference, President Hu Jintao and President Obama read prepared statements and would not take questions from reporters. “This was an historic meeting between the two leaders, and journalists should have had the opportunity to ask questions, to probe beyond the statements,” protested Scott McDonald, the president of China’s Foreign Correspondents Club, but to no avail.
In a final dash to break through the information blockade, the Obama team offered an exclusive interview to Southern Weekend, China’s most feisty newspaper, based in Guangzhou. Once again, journalists’ questions were programmed and the paper censored. In protest, the paper prominently displayed vast white spaces on the first and second page of the edition that carried the interview. Propaganda officials are investigating this act of defiance.
Only the Obama team knows for sure how they allowed themselves to be outmaneuvered. Unwittingly, the U.S. helped to produce a package of faux public events.
Pundits argued that the visitors were not supposed to impose the “American way” on China and that America needs to respect Chinese practices. The argument is both patronizing and condescending. Increasingly, the Chinese public has been clamoring for greater official transparency and accountability, while the Chinese government has been making progress on these fronts. No one in his right mind would ask Mr. Obama to lecture Beijing on human rights. But the Chinese public deserves better accounting, no less than Americans citizens.
To their credit, U.S. officials did try to get their message out online. But it was the Chinese bloggers who were most active in challenging official information control. They at least fought the good fight with growing confidence, a fight the Americans seem unable to wage effectively.
作文只给了个题目： waste not， want not(勤俭节约，吃穿不缺)(60)
2010英语翻译基础
MDGS Millennium Development Goals 千禧年发展计划
Ban Ki-moon 潘基文
國務卿 Secretary of State
雷曼兄弟(Lehman Brothers)
次贷危机subprime lending crisis
西部大开发战略strategy of western development