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Health Care’s Uneven Road to a New Era

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October 5, 2010

:0 Consider what it would be like to have a health
insurance plan that capped annual benefits at $2,000. For any medical care costing more than that, you would have to pay out of pocket. E amples of care that costs more than $2,000 ! :<and often a lot more ! include virtually any cancer treatment, any heart surgery, a year"s worth of diabetes treatment and care for many broken bones. Even a single M.R.I. e am can cost more than $2,000. # typical hospital stay runs thousands of 20dollars more. $o does this insurance plan sound like part of the solution for the country"s health care system ! or part of the problem% # $2,000 plan happens to be one of the main plans 2<that &c'onald"s offers its employees. (t became big news last week, when )he *all $treet +ournal reported that the company was worried the plan would run afoul of a provision in the new health care law. (n response to the provision, &c'onald"s 90threatened to drop the coverage altogether, until the ,bama administration signaled it would grant some e emptions. )his episode was only the latest disruption that the health law seems to be causing. #lso last week, the 9<-rincipal Financial .roup said it was getting out of the health insurance business, while other insurers have said they might stop offering certain types of coverage. *ith each new disruption come loud claims ! some from insurance e ecutives ! that =0the health overhaul is damaging #merican health care. ,n the surface, these claims can sound credible. /ut when you dig a little deeper, you often discover the same lesson that the &c'onald"s case provides0 the =<real problem was the status 1uo.

#merican families spend almost twice as much on health care ! through premiums, paycheck deductions and out2of2pocket e penses ! as families in any other country. (n e change, we <0receive top-notch specialty care in many areas. 3et on the whole, we do not get much better care than countries that spend far less. *e don"t live as long as people in Canada, +apan, most of *estern Europe or even relatively poor <<+ordan. &isdiagnosis is common. &edical errors occur more often than in some other countries. 4ni1ue to the developed world, millions of people have no health insurance, and millions more, like many fast2food workers, are underinsured.

;0(n choosing their health reform plan, -resident
,bama and the 'emocrats eschewed radical changes, for better or worse, and instead tried to minimi5e the disruptions to the current system. $ometimes, &r. ,bama went so far as to suggest ;<there would be no disruptions, saying that people could keep their current plan if they liked it. /ut that"s not 1uite right. (t is not possible to change a system as huge, and as hugely flawed, as ours without some disruptions.

80&c'onald"s offers its hourly workers two different
health care plans, which are known as 6mini2med7 plans. (n one, workers can pay about $890 a year for benefits of up to $2,000. (n the other, they can pay about $:,;;0 a year for benefits of up to $:0,000, 8<)he +ournal reported. (n a memo to federal regulators, &c'onald"s e ecutives argued that their version of health insurance 6positively impacts7 the almost 90,000 workers who are covered. #nd that"s true. # plan >0with a $2,000 or $:0,000 cap can cover some modest health problems and is better than being uninsured.

0 percent of ::<poor #mericans are not covered by &edicaid. #mong the groups of people served by &edicaid are certain eligible 4. the fastest growing aspect of &edicaid is nursing home coverage.< and signed into law on +uly 90. including low2income adults and their children.<. (t is a means2tested program that is Cointly funded by the states and federal government. :D. citi5ens and resident aliens.< was passed by Congress in :0<late2spring of :D.$. (t is estimated that appro imately . . )ruman as the first &edicare beneficiary and presented him with the first &edicare card. &edicare operates as a single2payer health care system. and people with certain disabilities. providing health insurance coverage to people who are aged . +ohnson as amendments to $ocial $ecurity legislation. or who meet other special criteria. by -resident Eyndon /. Medicaid ::0 is the 4nited $tates health program for eligible individuals and families with low incomes and resources. #t the bill2signing ceremony -resident +ohnson enrolled former -resident Farry $. )he medicare program also funds residency training programs for the vast maCority of physicians in the 4nited $tates.>< Vocabulary . -overty alone does not necessarily 1ualify an individual for &edicaid. /ecause of the aging /aby /oomer population.uess the meaning of the following words and indicate in the ? why @ column the elements you used either D0in the conte t or in the word itself to help you. Word to guess capped run afoul disruption overhaul top-notch eschewed flawed 3our guess A English synonym if you canB *hy% Correction D< A few cultural notions :00Medicare # social insurance program administered by the 4nited $tates government. &edicaid is the largest source of funding for medical and health2related services for people with limited income in the 4nited $tates. )he $ocial $ecurity #ct of :D. and is managed by the states.< and over.

&CI J CostsK-remiums.000. is a metric used in managed health care and health insurance to measure medical costs as a percentage of premium revenues. A/riefly. . EM0 It is too early to say whether insurance premiums will be affected. Everyone with income up to :99L of federal poverty level will be eligible for &edicaid.200 federally funded community health centers offer low2cost basic care. )hese plans cost much less than comprehensive health insurance. -ayments are based upon the planGs Hschedule of benefitsH and are usually paid directly to the service provider. the term is &edical Eoss Iatio. these plans have taken the name mini2 med plans or association plans. and :9<pharmacy. they are not meant to replace a traditional comprehensive health insurance plan. :=<Without Covera e $ome options for low2wage workers if they donGt get health insurance on the Cob !nder current system Startin in 201" under health overhaul# &ay be eligible for &edicaid. $ome insurers now call &CI Hbenefit cost ratioH A/CIB. a medical cost ratio of ><L or less is desirable. (n the 4nited $tates. especially families with children Can purchase private insurance on individual market. :90Medical care ratio A&CIB. (t is calculated by dividing those premiums allocated for fully insured or self2funded health care coverage into the total e penses for inpatient. )hese plans may provide benefits for hospitali5ation. -remiums are capped at 2L of income for those at the lowest end of that scale and D. (n recent years.B -eople with income between :99L and =00L of poverty level will be eligible for subsidi5ed health insurance.B #s a general rule. outpatient. #dditional $:: billion spent on community health centers :<0 . and medical benefit ratio. the federal2 state program for the poor.<L of income at the highest end. also known as medical cost ratio. professional Aphysicians and other licensed providersB. surgical. A-overty level for individual is $:0.000 to $2<. Fowever. but these benefits will be limited and are not meant to be effective for catastrophic events.:20Scheduled health insurance plans are an e panded form of Fospital (ndemnity plans. #nnual benefit ma imums for a typical scheduled health insurance plan may range from $:. and physician services. medical loss ratio.>90 in 20:0. $cheduled health insurance plans are more of a basic policy providing access to day2to2day health :2<care such as going to the doctor or getting a prescription drug. $ome :. 2011 health reform requirement re1uires insurers to spend at least >0L to ><L of its premium revenues :=0on medical care # premium is a sum of money that you pay regularly to an insurance company for an insurance policy. but premiums are likely to be too costly n Fospital emergency rooms must treat all comers without regard to ability to pay.

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(o" ought not to tell her. yo" can not. &e might have missed the b"s. conseil ought to déd"ction lo)i3"e conseil should déd"ction lo)i3"e Might I borrow yo"r laptop !o yo" may/can not. &e shouldn’t spend his money so carelessly ' :4 should be eno")h to leave as a tip. Can I watch TV !o. &e may (not) have )ot the messa)e. yo" may/can not. le professe"r 3"i parle décide.2:0 $appels rammaire# au%iliaires de modalit&s Modal be able to Nature possibilité possibilité. Could there be a vir"s in this file !o. yo" must not be late2. It may (not) rain tomorrow. &e could have taken a different road% &e could have called me ' Could I open the window !o. there's plenty of time I have to pay my ta. (o" might have told me ' can permission possibilité. it+s )leamin) ' &e can’t/couldn’t(ils sont ici synonymes) have for)otten ' It must be free1in) o"tside. re3"7te possibilité (faible) $ossibilité faible passé reproche might permission devoir. have got to conseil absence d+obli)ation obli)ation (ori)ine e. capacité Exemples (formes + et -) I was(not) able to prevent the theft. please !o. she*s not in. yo" can't.es before the end of -arch. &e must have washed the car. 2(o" must come to school on time. 0 cannot be bi))er than /. / is bi))er than B which is bi))er than 0. I might come to yo"r party if I can )et off work on time. (o" should spend more time on yo"r homework. look at the frost on the window ' It can’t be rainin) ' Teacher to p"pil. That ought to be eno")h petrol to last "s "ntil we )et to 9yons.terne) forte probabilité must obli)ation (ori)ine interne) $robabilité 456 may permission. It must be late as it is already dark. 2:< . Origine interne. I+m not s"re. (o" had better not be late. there couldn't. Birds can fly. I was unable to arrest the thief. so / must be bi))er than 0. (o" ought to apolo)i1e to yo"r sister for havin) h"rt her feelin)s. capactié could $ossibilité (passé)% reproche permission had better needn’t have to. if yo" don*t want to be late. Origine externe. (o" had better )et movin). monkeys cannot. You needn't hurry. May I speak to -rs 8. I ran the anti#vir"s. les lois de l*état.

) !hen was younger. 0*est asse1 rare d*employer might comme cela a". Could. seulement dGune action 1ui peut Rtre accompli S un certain moment. . 2Il fa"t 3"e vo"s fassie1 le devoir po"r . )a)ner le lotto. Be able to a le mRme sens 1ue can mais il a cette diffOrence 1uGon ne lGemploie pas pour parler dGune capacitO. ou des parents. Il en informe ses parents. (Nécessité.e empr"nter votre ordinate"r portable (<e demande la permission .) Might borrow your laptop# $o"rrais#.'&tails Ee tableau ci2dessus nGest 1uGun rOsumO des au iliaires modau . Can et could sont é)alement possible ici. est aussi employO pour parler du possible.*étais pl"s . 9ors3"e . Il pe"t . (Obligation interne. o" c*est fortement probable.) 2=< • Must & Have to 2<0Must est employO pour les obligations dites GinternesG. could run for miles without getting out of breath . $on contraire est do!does not have to. o" sarcasti3"e.e po"rrais a"ssi employer may. Il se pe"t 3"*il ple"ve. Eors1uGon emploie could pour parler de ce 1ui est possible maintenant. pe"t#7tre.) • • 29< May & Might May est employO pour parler de la possibilitO. en revanche.) could beat you at chess.e"ne.e empr"nter votre . En voici les dOtails des diffOrents modau 0 Can. !o"s po"rrions.) May spea" to Mr Connell# $"is#. 2<e dois faire mon devoir po"r . l*obli)ation vient de l"i. ave to. (Obligation externe.) 2.o"rs le professe"r 3"i est l*a"torité. est can't. dans ce cas.emple. Il est nécessairement tard p"is3"*il fait noir. (<e parle de ce 3"i est possible maintenant. 9ors3"*il s*arr7tera de ple"voir.n peut employer can et could aussi pour la permission. • • • 290 He can play the piano.*étais capable dans le passé.B. par e. Could serais pl"s so"ten". might.) t must be late as it's already dar"( Il doit 7tre tard p"is3"*il fait noir dé. Must est aussi employO pour parler de la nOcessitO ou dGune forte probabilitOU son contraire. le prOtOrit de can. (l sGemploie S tous les temps. mais pas probable # donc might pl"t=t 3"e may. (<e parle de sa capacité.*emploie la fa?on pl"s so"ten"e. soit maintenant AoP il a la valeur dGun conditionnelB soit dans le passO. cGest2S2dire 1ue lGobligation vient de celui 1ui parle ou Ocrit0 il est lGautoritO.e po"vais co"rir des miles sans 7tre hors d*haleine. (<e parle de ce 3"i sera possible bient=t # dans l*avenir. est employO aussi pour la possibilitO lors1ue les chances sont moindres. 2<< • • $eacher% &You must do your homewor" for ne't $hursday&( $rofesse"r. 2=0 • • • t may rain.) !e might win the lotto. we will be able to go out for a wal" .o"rnal (<e demande la permission.) !hen it stops raining.e"di prochain2. (0*est possible. comme les lois dGun Otat. cela pe"t 7tre considéré comme prétentie". <e po"rrais vo"s battre dans "ne partie d*échecs. 0*est to". Ees deu . no"s po"rrons sortir no"s promener. Could & Be Able to 220Can est employO pour parler de ce 1ui est possible. . $on contraire est mustn't.o"er d" piano. (>n parle d*"ne possibilité. il a un sens plus attOnuO 1ue can AGpourraitG plutQt 1ue GpeutGB. cGest2S2dire 1ue lGobligation vient dGune autoritO e terne. sont employOs aussi pour parler de la permission ou pour faire une re1uRte 2 might Otant plus soutenu 1ue may.) Can borrow your newspaper# $"is#. l*élAve parle d*"ne obli)ation 3"i l"i a été imposée.e"di prochain2.0 • . may et might.) )upil% & have to do my homewor" for ne't $hursday&( @lAve. 22<. 9e professe"r est l*a"torité.e parler avec -onsie"r 0onnell (<e demande la permission .o"rd*h"i. est employO pour les obligations dites Ge ternesG. le rTglement dGune Ocole. Ee prOtOrit. (<e parle de ce dont . .

<*estime 3"e le livre est asse1 lo"rd po"r 7tre placé contre la porte de fa?on B l*emp7cher de se fermer. • You had better hurry. Ea diffOrence entre eu est 1ue le premier est 28<plutQt moralisateurU on insiste plus sur la vertu de ce 1ui est conseillO. '"ici 20:= les partisans de la rOforme de la santO devront avoir trouvO des stratOgies viables pour mettre en place efficacement un nouveau systTme plus O1uitable pour tout le monde. on peut employer needn't. sinon vo"s sere1 en retard.) You needn't hurry. (!onseil.) You should brush your teeth after every meal. 0el"i 3"i parle n*est pas l*ori)ine de l*obli)ation. soit should. les personnes les plus dOmunies ont touCours dW se dObrouiller toutes seules sans attendre la moindre chose d"un gouvernement 1ui les a souvent laisseOs pour compte.< • You mustn't be late( Vo"s ne devre1 pas 7tre en retard. . • • 2>0 You ought to save your money instead of spending every penny you earn( T" devrais économiser ton ar)ent a" lie" de dépenser cha3"e so" 3"e t" )a)nes. 0*est .) You don't have to wor" on *undays( Vo"s n*7tes pas obli)é de travailler le dimanche.B Ought to & Should -our donner un conseil.. or you'll be late( Vo"s ferie1 mie". there's plenty of time( 0e n*est pas la peine de vo"s précipiter. (l est impossible 1ue tant de gens dans un pays aussi riche 1ue les Etats24nis n"aient pas touCours pas de couverture sociale satisfaisante. (Absence d'obligation. if possible( T" devrais te brosser les dents aprAs cha3"e repas. si cela est possible. o'cloc" because the sun is still shining( Il ne pe"t pas 7tre CCh55 p"is3"e le soleil brille to". Eors1uGon veut signaler 1ue 1uel1ue action nGest pas obligatoire. tandis 1ue le dernier parle de lGabsence dGune obligation A1uel1ue chose 1uGon nGest pas obligO de faire.) 2D0 • 2D< (h)me rammatical :. >n pe"t a"ssi employer needn't. =. Ici le ton est pl"t=t moralisate"r. il en parle simplement. 2.) • 2><Had better & Needn't -our donner un conseil. be heavy enough to "eep the door open( 0e livre doit 7tre asse1 lo"rd po"r )arder la porte o"verte.o"rs.) $his boo" ought to -should.) (l ne faut pas confondre mustn't et don't have to0 le premier concerne une obligation nOgative A1uel1ue 280chose 1uGon ne devrait pas faireB. . Ees deu sont aussi employOs pour parler de la probabilitO. il reste bea"co"p de temps. (!onseil.bama fasse autant de promesses avant les Olections pour aprTs laisser traVner une rOforme pourtant indispensable pour un pays 1ui se targue d"Rtre un e emple pour le monde. . o" c*est trAs pe" probable. ("robabilité. D*aprAs cel"i 3"i parle. <. on emploie soit ought to. >n pe"t a"ssi employer should et ought to. (Obligation négative.n ne devrait pas dOpendre de son emploi pour Rtre convenablement assurO 2 comme cela est souvent le cas au Etats24nis2 car cela engendre bien des inCustices 900 90< 9:0 . il n*y a"c"ne notion de moralité.• • 2. (!onseil. ( mpossibilité ou improbabilité . il n*est pas possible 3"*il soit CCh55. (Absence d'obligation .) t can't be +. Ea directive de 20:: stipule 1ue les assureurs devraient dOpenser au moins ><L de leurs revenus pour prodiguer des soins mOdicau 9. >n pe"t a"ssi dire don't have to."ste "n bon conseil. En fait. de vo"s presser. 0el"i 3"i parle est l*ori)ine de l*obli)ation. on peut employer had better. Ce n"Otait vraiment pas la peine 1ue &.

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