PartB
Directions:
Inthefollowingtext,somesentenceshaveremoved.ForQuestions41-45,choosethemostsuitable onefromthelistA-Gtofitintoofthenumberedblanktherearetwoextr achoices,whichdonotfitinanyofthegaps.MarkyouranswersonANSWERSHEET1.(10points)
Canada’spremiers(theleadersofprovincialgovernments),iftheyhaveanybreathleftaftercomplainingaboutOttawaattheirlateJulyannualmeeting,mightspareamomenttodosomething,together,toreducehealth-carecosts.
They’reallgroaningaboutsoaringhealthbudgets,thefastest-growingcomponentofwhicharepharmaceuticalcosts.
41.________
Whattodo?BoththeRomanowcommissionandtheKirbycommitteeonhealthcare--tosaynothingofreportsfromotherexperts--recommendedthecreationofanationaldrugagency.Insteadofeachprovincehavingitsownlistofapproveddrugs,bureaucracy,proceduresandlimitedbargainingpower,allwouldpoolresources,workwithOttawa,andcreateanationalinstitution.
42.________
But“national”doesn’thavetomeanthat.“National”couldmeaninterprovincial--provincescombiningeffortstocreateonebody.
Eitherway,onebenefitofa“national”organizationwouldbetonegotiatebetterprices,ifpossible,withdrugmanufacturers.Insteadofhavingoneprovince--oraseriesofhospitalswithinaprovince--negotiateapriceforagivendrugontheprovinciallist,thenationalagencywouldnegotiateonbehalfofallprovinces.
Ratherthan,say,Quebec,negotiatingonbehalfofsevenmillionpeople,thenationalagencywouldnegotiateonbehalf31millionpeople.Basiceconomicssuggeststhegreaterthepotentialconsumers,thehigherthelikelihoodofabetterprice.
43.________
AsmallstephasbeentakeninthedirectionofanationalagencywiththecreationoftheCanadianCoordinatingOfficeforHealthTechnologyAssessment,fundedbyOttawaandtheprovinces.Underit,aCommonDrugReviewrecommendstoprovinciallistswhichnewdrugsshouldbeincluded.Predictably,andregrettably,Quebecrefusedtojoin.
Afewpremiersaresuspiciousofanyfederal-provincialdeal-making.They(particularlyQuebecandAlberta)justwantOttawatoforkoveradditionalbillionswithfew,ifany,str ingsattached.That’sonereasonwhytheideaofanationallisthasn’tgoneanywherewhiledrugcostskeeprisingfast.
44.________
PremierslovetoquoteMr.Romanow’sreportselectively,especiallythepartsaboutmorefederalmoney.Perhapstheyshouldreadwhathehadtosayaboutd rugs:“Anationaldrugagencywouldprovidegovernmentsmoreinfluenceonpharmaceuticalcompaniesinordertoconstr aintheever-increasingcostofdrugs.”
45.________
SowhenthepremiersgatherinNiagaraFallstoassembletheirusualcomplaintlist,theyshouldalsogetcrackingaboutsomethingintheirjurisdictionthatwouldhelptheirbudgetsandpatients.
41.___________________
[A]Quebec’sresistancetoanationalagencyisprovincialistideology.OneofthefirstadvocatesforanationallistwasaresearcheratLavalUniversity.Quebec’sDrugInsuranceFundhasseenitscostsskyrocketwithannualincreasesfrom14.3percentto26.8percent!
[B]OrtheycouldreadMr.Kirby’sreport:“thesubstantialbuyingpowerofsuchanagencywouldstr engthenthepublicprescription-druginsuranceplanstonegotiatethelowestpossiblepurchasepricesfromdrugcompanies.”
[C]Whatd oes“national”mean?RoyRomanowandSenatorMichaelKirbyrecommendedafederal-provincialbodymuchliketherecentlycreatedNationalHealthCouncil.
[D]Theproblemissimpleandstark:health-carecostshavebeen,are,andwillcontinuetoincreasefasterthangovernmentr evenues.
[E]AccordingtotheCanadianInstituteforHealthInformation,prescriptiondrugcostshaverisensince1997attwicetherateofoverallhealth-carespending.Partoftheincreasecomesfromdrugsbeingusedtoreplaceotherkindsoftr eatments.Partofitarisesfromnewdrugscostingmorethanolderkinds.Partofitishigherprices.
[F]So,iftheprovinceswanttorunthehealth-careshow,theyshouldprovetheycanrunit,startingwithaninterprovincialhealthlistthatwouldendduplication,saveadministr ativecosts,preventoneprovincefrombeingplayedoffagainstanother,andbargainforbetterdrugprices.
[G]Ofcoursethepharmaceuticalcompanieswillscream.Theylikedividedbuyers;theycanlobbybetterthatway.Theycanusethethreatofremovingjobsfromoneprovincetoanother.Theycanhopethat,ifoneprovinceincludesadrugonitslist,thepressurewillcauseotherstoincludeitontheirs.Theywouldn’tlikeanationalagency,butself-interestwouldleadthemtodealwithit.
正确答案：E
