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高额医疗费用使参保者倍感威胁

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经济发展放缓使得没有医疗保险的人数增多。 同时,对于有医保人,情况一样不容乐观,保险的赔偿额太少,或者他们无力支付个人需支出的那部分。

在美国,有一亿五千八百万人投保雇主健康保险。高额的保险年费、相对低廉的赔偿额、过多的扣除费及自付金,使保险成本比以往更高。这让大部分雇主健康保险参与者的生活陷入困境。

伴随着医疗价格的飞涨,很多人的保险赔付额已经无法给他们提供足够的保障。去一趟急诊室或一个大手术就会使他们陷入经济困境。 对于一些人来说,他们尽量不去看医生。因为日常的花销,食品和汽油已经够他们受的了。

图森市所辖的一个农民联盟官员詹姆斯?科尔宾说:“人们的收入在一天天被消耗。”

科尔宾先生和他和同事们都是雇主健康计划的投保人。他们每年须为家人的医疗账单支付高达4000美元以及1600美元的保险费。而五年前,他们每年医疗费大约为2000美元,且没有保险负担。

科尔宾先生说:“一个月的工资就这么没了,这可是一大步。”

很多医生也表示,疲软的经济状况使得一些受伤者不愿去医院处理伤势。因为他们不愿为之付出50美元的自付金。新泽西州利文斯顿市的一位儿科医生,理查德?兰德说,父母“等孩子病了一阵子才带孩子来看医生,他们会说‘小孩病的不重,她的体温才102’”

虽然有医保的人倍感煎熬,医疗保健的费用问题对于没有保险的人来说,更显严峻。而这部分人群的数量将超过四千八百万。

自2001年的经济衰退以来,职工投保家庭医疗保险的保费几乎翻了一番,从1800美元涨到3300美元,但他们的收入并没有随之有任何的上涨。 据德勤会计师事务所统计,美国家庭的医疗支出占其总收入的12%,占其总支出的1/5。

德勤保健研究中心在最近的一份调查中指出,只有7%的人感觉他们未来的医疗保健没有金钱方面的顾虑。

去年,来自华盛顿瓦拉瓦拉的雪莉?吉雅得的丈夫雷蒙得突发心肌梗塞,需接受起搏器和电击器治疗。这使她措手不及。 因为雷蒙得的工作不提供医保,她为他们参与投保了单职工家庭保险。雪莉经营一家叫紫阳伞的店铺,卖婚纱和礼服。

但当雷蒙得生病之时,吉雅得发现,她的保险仅能赔付两万两千美元,他们需支付另外的十万美金。

虽然医院已将他们的账单减少至五万美元,吉雅得仍然觉得很难付清。因外部经济环境原因,她的紫阳伞最近没什么进帐。她的丈夫,现已残疾,失去了工作的能力,明年连接受医疗保险的资格都没有了,更不用说个人保险了。而雪莉无法每月拿出758美元,给他投保州立保险计划。

她最近抵押了她的车--2002年的丰田汉兰达--以支付她丈夫每月400美元的医药费。

专家们说,这种情况对于被保险人来说,很正常。保险赔付说起来好听,实际上,只有在人们没有医疗问题的时候,保险才保险。

保健系统变化研究中心的所长保罗?B?吉斯伯格说:“事实上,一旦得病,医疗负担就转移到得病的人身上了。”

华盛顿200余位大雇主组成的协会—国家商业健康组织—其主席海伦?达令说,公司和政策制定者还没有开始关注蹒跚不前的经济对雇员医疗保障的影响。她说,“如果一个人或一个家庭须为医保计划支付三倍,四倍甚至五倍于他们在上次经济衰退时的支出,那形势可不妙了。”“美国人民付给医疗保健系统的钱一直在增加。”

赛哲?赫本是一位62岁的图书馆技师,身患糖尿病,活跃于圣?保罗的地方联合会。她说,2003年她们联合会的成员们协议冻结两年的工资,以保证他们的医疗保障。 这个联合会今秋要进行的下轮合同的商议,赫本女士说,这个计划很难继续下去了。 “走到这里,我们无论怎样都受损失,”她说。

“我每个月的薪水总是花个精光,” 赫本女士说,她就职于宗主国州立大学,年薪接近4万美金。

她1999年开始这份工作的时候,医疗福利使得她看医生无需要自付费。现在,她看一次医生要花25美元,还有每月的糖尿病药费38美元。 对于糖尿病患者来说,眼睛的检查的很重要的,她也知道,她需要一付新眼镜,但是,她已经两年没去看过眼科大丈了。同样的,因为医疗服务的费用,她尽量规律地自查血糖。

她说,这虽算不上一项奢侈消费,但它增大了你的支出。 日用品、汽油、食物的增长以及维修她的94年产的雪佛兰车花的几百块都不及医药费增长带来的开支增加。

职工们向雇主要求报销更多的医药费,这使得很多雇主意识到他的员工们身处财务困境。#p#分页标题#e#

里德Elsevier出版公司,主管北美福利事务方面的副主席,安妮?丝渥曼说,“这种情形使得我们必须开展的工作更具挑战性,员工的可支配收入已经捉襟见肘。”

华信惠悦咨询公司一位福利顾问表示,即便如此,大多数公司除了要求员工交纳更多的医疗费用以外没什么其它办法。当衰退的经济逐渐损害职业保障时,他说,工人们也只能接受减少的福利。

然而拉斯鲍姆先生和另一些顾问们认为,未见得会有很多雇主简单的让他的员工们失去保障,衰退的经济将促使雇主们推出所谓的消费者导向计划。类似的计划通过提高每年的扣除额来弥补降低的保险费。

通常,此类计划还允许雇员将税前收入存入特别的医疗保健账户,然后假定工人们可以享有一份全面的医疗保障。 大约六百万人口参与了这种医疗计划。

在雇主中受到压力最大的是小企业主们。 他们交的保费相应的高于大企业主,因为小公司与保险公司之间没什么讨价的余地。

俄州波特兰一家小型服装商场的所有者,迈克?罗彻说,医疗保障正在给小企业掘坟。他最近在一次关于保险赔付额听证会上作证。这次参议院听证会由俄勒冈州民主党人罗?威登主持。

去年,罗彻先生为他的八位员工交了两万七千美元的保费。 “这可是个巨大的转变,”他说,因为他不得不将他的雇员们的年扣除金提高50%,至750美元。

在全国范围内,一些工人们由于雇员健康计划的费用过高而放弃。

佛州米尔顿市的Brian Falacienski,原任职于一家建筑公司,做测量员,去年被辞退了,现在,他找到了另外一个职位。 但新的保健计划需要每月支付800美元,以及每年1000美元的扣除费。这可超出了Falacienski先生的支付能力,他今年38岁,已婚,而且有一个两岁的女儿了。

他的妻子玛丽娜,则开始研究个人保险业务,并找到了一份给她丈夫和女儿的基本保险业务。如果投保最小保障额的话,父亲和女儿每月只需161美元。 但是32岁的Falacienski夫人患有关节炎和严重的消化系统紊乱克罗恩病,她还没有参保。 她说,基于她个人的身体状况,四家主要的保险公司都不给她入保。

她还说:“我还申请了医疗救助计划,但是我的收入也达不到他们的标准。”

译文:Even the Insured Feel the Strain of Health Costs


The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.

“It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.

Mr. Corbin said that under their employer’s health plan, he and his co-workers are now obliged to pay up to $4,000 of their families’ annual medical bills, on top of about $1,600 a year in premiums. Five years ago, they paid no premiums and were responsible for only about $2,000 of their families’ medical bills.

“That’s a big jump,” Mr. Corbin said. “You’ve just lost a month’s pay.”

Already, many doctors say, the soft economy is making some insured people hesitant to get care they need, reluctant to spend a $50 co-payment for an office visit. Parents “are waiting longer to bring in their children,” said Dr. Richard Lander, a pediatrician in Livingston, N.J. “They say, ‘The kid isn’t that sick; her temperature is only 102.’ ”

The problem of affording health care is most acute for people with no insurance, a group expected to soon exceed 48 million, but those with insurance say they too are feeling the pain.

Since the recession of 2001, the employee’s average cost of an annual health care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up. Factor in other out-of-pocket medical costs, and the portion of the average American household’s income that goes toward health care has risen about 12 percent, according to the consulting and accounting firm Deloitte, and is now approaching one-fifth of the average household’s spending.

In a recent survey by Deloitte’s health research center, only 7 percent of people said they felt financially prepared for their future health care needs.

Shirley Giarde of Walla Walla, Wash., was not prepared when her husband, Raymond, suddenly developed congestive heart failure last year and needed a pacemaker and defibrillator. Because his job did not provide health benefits, she has covered them both through a policy for the self-employed, which she obtained as the proprietor of a bridal and formal-wear store, the Purple Parasol.

But when Raymond had his medical problems, Ms. Giarde discovered that her insurance would cover only $22,000, leaving them with about $100,000 in unpaid hospital bills.

Even though the hospital agreed to reduce that debt to about $50,000, Ms. Giarde is still struggling to pay it — in part because the poor economy has meant slumping sales at the Purple Parasol. Her husband, now disabled and unable to work, will not qualify for for another year, and she cannot afford the $758 a month it would cost to enroll him in a state-run insurance plan for individuals who cannot find private insurance.

She recently refinanced her car, a 2002 Toyota Highlander, to help pay for her husband’s heart medicines, which cost some $400 a month.

Experts say that too often for the underinsured, coverage can seem like health insurance in name only — adequate only as long as they have no medical problems.

“There’s a real shift in the burden of health care to people who happen to be sick,” said Paul B. Ginsburg, the president of the Center for Studying Health System Change, a research group in Washington.

Companies and policy makers have yet to focus on what the faltering economy means for employees’ medical care, said Helen Darling, president of the National Business Group on Health, a Washington association of about 200 large employers.

“It’s a bad-news situation when an individual or household has to pay out-of-pocket three, four or five times as much for their health plan as they would have at the time of the last recession,” she said. “Americans have been giving their pay raise to the health care system.”

Sage Holben, a 62-year-old library technician with diabetes who is active in her local union in St. Paul, says that in 2003 union members agreed to a two-year freeze on wages to protect their health care coverage. But for the union, which will begin talks on the next contract this fall, it may be difficult to continue that trade-off, Ms. Holben said. “It’s at the point where we’re losing, anyway,” she said.

“I live paycheck to paycheck,” said Ms. Holben, who makes close to $40,000 a year at Metropolitan State University.

When she took the job in 1999, she says, the health benefits required no co-payments for doctor visits. Now, her out-of-pocket cost per visit is $25, and she pays $38 a month for her diabetes medicine. She has not been to the eye doctor in two years, even though eye exams are crucial for people with diabetes and she knows she needs new glasses. Nor does she monitor her blood sugar as regularly as she should because of the cost of the supplies.

“It’s not an extravagant expense,” she said. “It just adds up.” And it comes atop the increasing cost of utilities, gasoline and food — and the few hundred dollars of repairs her 1994 Chevrolet Cavalier needs.

Many employers do recognize that their workers are struggling financially even as they are asking them to pick up more of their health-care bills.

“It makes the work we have to do even more challenging,” said Anne Silverman, the vice president in charge of benefits in North America for the publishing company . “Employees are being stretched in terms of their disposable income.”

Even so, more companies may see themselves as having little choice but to require employees to pay even more of their health expenses, said Ted Nussbaum, a benefits consultant at the firm Watson Wyatt Worldwide. And when a weak economy undermines job security, he said, workers may simply have to accept reduced benefits.

While Mr. Nussbaum and other consultants say it is unlikely that significant numbers of employers will simply drop coverage for their workers, the weak economy could prompt more of them to push for so-called consumer-driven plans. Such plans tend to offset lower premiums with higher annual deductibles.

And while these plans often allow employees to put pre-tax savings into special health care accounts, they typically end up forcing the worker to assume a bigger share of overall medical costs. About six million people are now enrolled in these medical plans.

Among employers, the hardest pressed may be small businesses. Their insurance premiums tend to be proportionately higher than ones paid by large employers, because small companies have little bargaining clout with insurers.

Health costs are “burying small business,” said Mike Roach, who owns a small clothing store in Portland, Ore. He recently testified on health coverage at a Senate hearing led by , Democrat of Oregon.

Last year, Mr. Roach paid about $27,000 in health premiums for his eight employees. “It’s a huge chunk of change,” he said, noting that he was forced to raise his employees’ yearly deductible by 50 percent, to $750.

Around the nation, some workers are simply priced out of their employee health plans.

After Brian Falacienski of Milton, Fla., was laid off last year from his job as a surveyor for a construction company, he found another position. But the cost of his new health plan — $800 a month for coverage with a $1,000 annual deductible — was beyond the means of Mr. Falacienski, 38, who is married and has a 2-year-old daughter.

His wife, Marianne, started researching individual insurance policies and was able to find policies for her husband and daughter offering basic, if minimal, coverage, costing $161 a month for father and daughter. But Ms. Falacienski, 32, who has arthritis and the severe digestive disorder Crohn’s disease, is now uninsured. Because of her conditions, she said, four major insurers rejected her.

“I even applied for ,” she said, “but I wasn’t low-income enough.”

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   一、引言词汇是语言的建筑材料[1](P2)。汉语和英语这两种语言中都存在大量色彩词汇,有趣的是,在不同的语言中对同一物体或现象却用不同颜色来加以描述。比如英语中的black tea,我们不可译为黑茶,而应译为红茶。汉语中的红白喜事我们英译为weddings and fun erals。颜色词除表示其具体实际的色彩外,还会由于不同国家的不同文化而具有不同的涵义。二、语言与文化学语言的目的是为了交流。人类的交际不单是一种语言现象,也是一种跨文化现象。在英语学习中,要对两种交际文化进行对比,我们首先从文化谈起。文化culture一词是一个含义极度其广泛的词语。它狭义指文学,音乐、美术等,而广义讲是一个社会学术语,按照社会学家和人类学家对"文化"所下的定义,我们所说的"文化"是指一个社会所具有的独特的信仰、习惯、制度、目标和技术的总模式。语言是文化的一部分,并对文化起着重要作用。没有语言就没有文化,语言又受文化的影响,反映文化。语言与文化互相影响,互相作用;理解语言必须了解文化,理解文化必须了解语言。中西方文化的差异很大程度上反映在用词。我们从红色、白色、黑色、黄色、蓝色这些颜色词汇来比较英语与汉语两种文化的差异,看语言和文化是如何相互影响的,了解为何英语语言学习中必须要学习了解文化。(一)红色1.汉语-英语红色象征革命和社会主义。在汉语和英语中都有用red(红)表示这种意义的词语,如:红卫兵(red guard)。英语中的Red(大写R)一词本身常用作共产主义者或共产党员的同义词,但有贬义。不过,有些带红字的汉语词语译成英语的red并表达原有的含义。例如,把又红又专译作redand expert表达不出汉语词语的原义

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