问答题 .  SECTION A MULTIPLE CHOICE QUESTIONS
    PASSAGE ONE
    (1)Gabriel Oak was a sensible man of good character, who had been brought up by his father as a shepherd, and then managed to save enough money to rent his own farm on Norcombe Hill, in Dorset. He was twenty-eight, a tall, well-built man, who did not seem, however, to think his appearance was very important.
    (2)One winter morning he was in one of his fields on the side of Norcombe Hill. Looking over his gate, Gabriel could see a yellow cart, loaded with furniture and plants, coming up the road. Right on top of the pile sat a handsome young woman. As Gabriel was watching, the cart stopped at the top of the hill, and the driver climbed down to go back and fetch something that had fallen off.
    (3)The girl sat quietly in the sunshine for a few minutes. Then she picked up a parcel lying next to her, and looked round to see if the driver was coming back. There was no sign of him. She unwrapped the parcel, and took out the mirror it contained. The sun shone on her lovely face and hair. Although it was December, she looked almost summery, sitting there in her bright red jacket with the fresh green plants around her. She looked at herself in the mirror and smiled, thinking that only the birds could see her. But behind the gate Gabriel Oak was watching too. "She must be rather vain," he thought. "She doesn't need to look in that mirror at all!"
    (4)As the girl smiled and blushed at herself, she seemed to be dreaming, dreaming perhaps of men's hearts won and lost. When she heard the driver's footsteps, she packed the mirror away. The cart moved on downhill to the tollgate. Gabriel followed on foot. As he came closer he could hear the driver arguing with the gatekeeper.
    (5)"My mistress's niece, that's her on top of the furniture, is not going to pay you the extra two pence," said the driver. "She says she's offered you quite enough already." "Well, if she doesn't pay the toll, your mistress's niece can't pass through the gate," replied the gatekeeper. Gabriel thought that two pence did not seem worth bothering about, so he stepped forward. "Here," he said, handing the coins to the gatekeeper, "let the young woman pass."
    (6)The girl in the red jacket looked carelessly down at Gabriel, and told her man to drive on, without even thanking the farmer. Gabriel and the gatekeeper watched the cart move away. "That's a lovely young woman," said the gatekeeper. "But she has her faults," answered Gabriel.
    (7)"True, farmer." "And the greatest of them is what it always is with women." "Wanting to win the argument every time? Oh, you're right."
    (8)"No, her great fault is that she's vain."
    (9)A few days later, at nearly midnight on the longest night of the year, Gabriel Oak could be heard playing his flute on Norcombe Hill. The sky was so clear and the stars so visible that the earth could almost be seen turning. In that cold, hard air the sweet notes of the flute rang out. The music came from a little hut on wheels, standing in the corner of a field. Shepherds' huts like this are used as a shelter during the winter and spring, when shepherds have to stay out all night in the fields, looking after very young lambs.
    (10)Gabriel's two hundred and fifty sheep were not yet paid for. He knew that, in order to make a success of the farming business, he had to make sure they produced a large number of healthy lambs. So he was determined to spend as many nights as necessary in the fields, to save his lambs from dying of cold or hunger.
    (11)The hut was warm and quite comfortable inside. There was a stove, and some bread and beer on a shelf. On each side of the hut was a round hole like a window, which could be closed with a piece of wood. These air-holes were usually kept open when the stove was burning, because too much smoke in a small, airless hut could kill the shepherd.
    (12)From time to time the sound of the flute stopped, and Gabriel came out of his hut to check his sheep. Whenever he discovered a half-dead new lamb, he brought the creature into the hut. In front of the stove it soon came back to life, and then he could return it to its mother.
    (13)He noticed a light further down the hill. It came from a wooden hut at the edge of a field. He walked down to it and put his eye to a hole in the wood. Inside, two women were feeding a sick cow. One of the women was middle-aged. The other was young and wore a cloak. Gabriel could not see her face.
    (14)"I think she'll be all right now, aunt," said the younger woman. "I can come and feed her again in the morning. What a pity I lost my hat on the way here!" Just then the girl dropped her cloak, and her long hair fell on to the shoulders of her red jacket. Gabriel recognized the girl of the yellow cart and the mirror, the girl who owed him two pence. The women left the hut, and Gabriel returned to his sheep.
    (15)As the sun was rising the next morning, Gabriel waited outside his hut until he saw the young woman riding up the hill. She was sitting sideways on the horse in the usual lady's position. He suddenly thought of the hat she had lost, searched for it, and found it among some leaves on the ground. He was just going to go up to her to give it back, when the girl did something very strange. Riding under the low branches of a tree, she dropped backwards flat on the horse's back, with her feet on its shoulders. Then, first looking round to make sure no one was watching, she sat up straight again and pulled her dress to her knees, with her legs on either side of the horse. This was obviously easier for riding, but not very ladylike. Gabriel was surprised and amused by her behaviour. He waited until she returned from her aunt's hut, and stepped out into the path in front of her.
    PASSAGE TWO
    (1)"Like Florence in the Renaissance." That is a common description of what it is like to live in Silicon Valley. America's technology capital has an outsize influence on the world's economy, stockmarkets and culture. This small portion of land running from San Jose to San Francisco is home to three of the world's five most valuable companies. Giants such as Apple, Facebook, Google and Netflix all claim Silicon Valley as their birthplace and home, as do trailblazers (先驱) such as Airbnb, Tesla and Uber. The Bay Area has the 19th-largest economy in the world, ranking above Switzerland and Saudi Arabia.
    (2)The Valley is not just a place. It is also an idea. Ever since Bill Hewlett and David Packard set up in a garage nearly 80 years ago, it has been a byword (代名词) for innovation and ingenuity. It has been at the centre of several cycles of Schumpeterian (熊彼特的) destruction and regeneration, in silicon chips, personal computers, software and internet services. Some of its inventions have been ludicrous: internet-connected teapots, or an app that sold people coins to use at laundromats (自助洗衣机). But others are world-beaters: microprocessor chips, databases and smartphones all trace their lineage to the Valley.
    (3)Its combination of engineering expertise, thriving business networks, deep pools of capital, strong universities and a risk-taking culture have made the Valley impossible to clone, despite many attempts to do so. There is no credible rival for its position as the world's pre-eminent innovation hub. But there are signs that the Valley's influence is peaking. If that were simply a symptom of much greater innovation elsewhere, it would be cause for cheer. The truth is unhappier.
    (4)First, the evidence that something is changing. Last year more Americans left the county of San Francisco than arrived. According to a recent survey, 46% of respondents say they plan to leave the Bay Area in the next few years, up from 34% in 2016. So many startups (初创公司) are branching out into new places that the trend has a name, "Off Silicon Valleying". Peter Thiel, perhaps the Valley's most high profile (知名度高的) venture capitalist, is among those upping sticks. Those who stay have broader horizons: in 2013 Silicon Valley investors put half their money into startups outside the Bay Area; now it is closer to two-thirds.
    (5)The reasons for this shift are manifold, but chief among them is the sheer expense of the Valley. The cost of living is among the highest in the world. One founder reckons young startups pay at least four times more to operate in the Bay Area than in most other American cities. New technologies, from quantum computing to synthetic biology, offer lower margins than internet services, making it more important for startups in these emerging fields to husband their cash. All this is before taking into account the nastier features of Bay Area life: clogged traffic, discarded syringes (注射器) and shocking inequality.
    (6)Other cities are rising in relative importance as a result. The Kauffman Foundation, a non-profit group that tracks entrepreneurship, now ranks the Miami-Fort Lauderdale area first for startup activity in America, based on the density of startups and new entrepreneurs. Mr Thiel is moving to Los Angeles, which has a vibrant tech scene. Phoenix and Pittsburgh have become hubs for autonomous vehicles; New York for media startups; London for fintech; Shenzhen for hardware. None of these places can match the Valley on its own; between them, they point to a world in which innovation is more distributed.
    (7)If great ideas can bubble up in more places, that has to be welcome. There are some reasons to think the playing-field for innovation is indeed being levelled up. Capital is becoming more widely available to bright sparks everywhere: tech investors increasingly trawl the world, not just California, for hot ideas. There is less reason than ever for a single region to be the epicentre of technology. Thanks to the tools that the Valley's own firms have produced, from smartphones to video calls to messaging apps, teams can work effectively from different offices and places. A more even distribution of wealth may be one result, greater diversity of thought another. The Valley does many things remarkably well, but it comes dangerously close to being a monoculture of white male nerds. Companies founded by women received just 2% of the funding doled out by venture capitalists last year.
    (8)The problem is that the wider playing-field for innovation is also being levelled down. One issue is the dominance of the tech giants. Startups, particularly those in the consumer-internet business, increasingly struggle to attract capital in the shadow of Alphabet, Apple, Facebook et al. In 2017 the number of first financing rounds in America was down by around 22% from 2012. Alphabet and Facebook pay their employees so generously that startups can struggle to attract talent (the median salary at Facebook is $240,000). When the chances of startup success are even less certain and the payoffs not so very different from a steady job at one of the giants, dynamism suffers—and not just in the Valley. It is a similar story in China, where Alibaba, Baidu and Tencent are responsible for close to half of all domestic venture-capital investment, giving the giants a big say in the future of potential rivals.
    (9)The second way in which innovation is being levelled down is by increasingly unfriendly policies in the West. Rising anti-immigrant sentiment and tighter visa regimes of the sort introduced by President Donald Trump have economy-wide effects: foreign entrepreneurs create around 25% of new companies in America. Silicon Valley first bloomed, in large part, because of government largesse (慷慨解囊). But state spending on public universities throughout America and Europe has fallen since the financial crisis of 2007 -2008. Funding for basic research is inadequate—America's federal-government spending on R&D was 0.6% of GDP in 2015, a third of what it was in 1964—and heading in the wrong direction.
    (10)If Silicon Valley's relative decline heralded the rise of a global web of thriving, rival tech hubs, that would be worth celebrating. Unfortunately, the Valley's peak looks more like a warning that innovation everywhere is becoming harder.
    PASSAGE THREE
    (1)In a sunny room in a small apartment in the Tokyo satellite town of Kunitachi lies Yasuyuki Ibaraki, eyes closed and breathing laboured. Yukio Miyazaki, his doctor, who visits fortnightly from a local clinic, suspects that he does not have much time left: he has brain damage from a cerebral infarction (脑梗死), a tumour in his digestive system and is unable to swallow or talk. Reiko, his wife, feeds him through a tube to his stomach and clears phlegm (痰) from his throat. "He is from a close-knit family and is a quiet man, so I think it is better for him to be here rather than in a hospital," she says, over green tea and grapes.
    (2)Life expectancy in Japan is the highest in the world, at 84. This is good news for its people, but means that an ever-higher share of the population is elderly. Fully 28% of Japanese are older than 65, compared with 15% of Americans and 21% of Germans. More old people, in turn, means higher health-care costs. Last year the government budgeted ¥15trn ($138bn, or 15% of its total expenditure) for health care and nursing, excluding the charges it levies for the public health-insurance scheme. With public debt at 250% of GDP, and debt service consuming a further 24% of spending, the government is looking desperately for ways to cut costs. It reckons caring for people at home is one of its best options.
    (3)All Japanese pay a monthly premium to the public insurance scheme, either through their employer or the local municipality. In return they are entitled to treatment and drugs from public and private doctors and hospitals, although they must also pay a portion of the cost of treatment (a co-payment, in American parlance), subject to a cap. In 2000 Japan introduced an additional public insurance scheme for long-term care for those over 65, into which people must pay from the age of 40. It works the same way. The premiums and co-payments cover around 60% of the cost of the services provided; the government pays for the rest. And it is the old who cost the most. The government reckons that the average annual cost of health care for someone over 75 is ¥942,000, compared with just ¥221,000 for everyone else.
    (4)By the standards of ageing nations, Japan has managed to curb medical costs fairly well, says Naoki Ikegami of St Luke's International University in Tokyo. The government sets fees for services to keep costs down (although that encourages providers to perform unnecessary procedures to make more money: Japan has more CT scanners relative to its population than any other country). It has also promoted the use of generic drugs, which are cheaper.
    (5)Nonetheless, the country has crept up to sixth place in the OECD's ranking of the share of GDP spent on health care, behind France and America, but ahead of Italy and South Korea—two other ageing countries. It is not just that the number of old people is increasing; spending per person is rising, too, as people live longer with diseases like Alzheimer's (阿尔茨海默症) and diabetes.
    (6)Japan has promoted home care for many years, but it is pushing it harder now. The policy is especially beneficial given that the average hospital stay in Japan is three times longer than in the Netherlands, for instance. The health ministry reckons that 1m people will receive care at home in 2025—one-and-a-half times the current total. The number of special nursing units exclusively for home visits has risen from 7,473 in 2014 to 10,418 in 2018.
    (7)Last year a government panel suggested raising the amount doctors are paid for home visits and making consultations conducted via video-conferencing services eligible, too. It also proposed new rules to encourage care at home. Hospitals should be obliged to talk to social services when they discharge a patient, for example.
    (8)Some municipalities are already offering good care in the community. Onomichi, a small provincial city that is even older than the country as a whole, is one. Its medical facilities have 15-minute "care conferences" with doctors, nurses, family members and even dentists, to discuss how they will go about looking after people. "It used to be hard for hospitals to tell a patient to return home as there was no system for that; that has changed," says Hisashi Katayama, a doctor.
    (9)Community care for specific diseases is improving, too. Take dementia (痴呆), which currently affects 5m Japanese (4% of the population), and will afflict 6%-7% by 2030. Rather than provide only institutional care and medicine, some towns, such as Matsudo, north-east of Tokyo, have set up cafés to offer advice and companionship to patients and their carers. Day centres that give respite to families tending to elderly relatives are common. Much more could be done: only 13% of Japanese die at home, although most say they want to.
    (10)But more widespread home care will not be enough to make Japan's health care affordable. The government of Shinzo Abe wants to revamp the social-security system, which it reckons will help reduce health-care costs. Raising the retirement age, for example, will keep people active, healthier and paying tax for longer. The government also wants to try to reduce the incidence of diseases that affect older people, but have their origins in behaviour at a younger age. "We have tended to focus on the old, but we need to look at the younger to prevent disease," says Kazumi Nishikawa of the economy ministry. He is particularly focused on giving people more information on what causes diabetes, which is on the rise in Japan, or exercises that can stem the progression of dementia.
    (11)People are likely to have to pay more for health care, too. Co-payments for many of those over 75 are only 10%, compared with 30% for everyone else. The government should start by doubling that to 20%, says Shigefumi Kawamoto, managing director of Kenporen, the national federation of health-insurance societies. "Some elderly people don't have resources, but many do," he avers (断言). The government could exclude some items from coverage, he says, such as over-the-counter drugs.
    (12)Meanwhile, back in Kunitachi, Dr Miyazaki talks to Reiko about her husband's condition. She is worried that her husband is getting worse, she says, and is anxious between visits. The doctor promises to come weekly from now on.1.  It can be concluded from Para. 1 that Gabriel Oak ______. (PASSAGE ONE)
【正确答案】 C
【答案解析】 推理判断题。根据题干提示定位至第一段。该段第一句提到加布里埃尔·奥克在由父亲抚养长大之后设法攒够钱在多塞特郡诺科姆山上租下自己的农场,该句中的manage to do sth. 表示“设法做某事且做成功了”,由此可知,加布里埃尔最终在诺科姆山上租下了一个农场,故C为答案。该段第一句提到Gabriel Oak was a sensible man of good character,这是指加布里埃尔·奥克是个品行优良、通情达理(sensible)的人,而不是指他生性敏感(sensitive),故排除A;该段第一句只提到加布里埃尔·奥克的父亲把他抚养长大成一个牧羊人,并未提及他的成长环境是否极度贫穷,故排除B;第二句虽然提到加布里埃尔对自己外表的看法,但是指他并不认为自己的外表非常重要,而不是指他认为好看的相貌不如金钱重要,故排除D。
[参考译文] PASSAGE ONE
   (1)加不里埃尔·奥克是个品行优良、通情达理的人,他的父亲把他抚养长大成一个牧羊人,之后他设法攒够钱在多塞特郡诺科姆山上租下自己的农场。他28岁,身材高大健壮,不过他好像并不认为自己的外表非常重要。
   (2)一个冬天的早晨,他正在诺科姆山边自己的某块田地里。从大门看过去,加布里埃尔可以看到一辆装满家具和花卉的黄色马车沿路驶来。就在那堆东西上面坐着一位漂亮的年轻女士。当加布里埃尔盯着看时,马车停在了山顶上,车夫爬下来,走回去把掉落的东西捡回来。
   (3)那位姑娘静静地在阳光下坐了几分钟。然后,她拿起放在身边的一个包袱,环顾四周看看车夫是否正要回来。没有车夫的影子。她打开包袱,并从中拿出镜子。太阳照在她美丽的脸庞上和头发上。尽管是十二月,但她却像在明媚的夏日,身穿亮红色的短上衣,四周环绕着葱翠的植物。她看着镜中的自己笑了,以为只有小鸟会看见她。但在大门后,加布里埃尔也正在看着。“她肯定很虚荣,”他心想。“她根本就不需要照那面镜子!”
   (4)当姑娘朝着她自己微笑和脸红时,她似乎在做梦,或许在幻想着那些赢得和失去的男人心。当她听到车夫的脚步声时,她收起了镜子。马车继续向山下的路卡驶去。加布里埃尔步行跟着。当他走近一点时,他能听到车夫在和守卡人争吵。
   (5)“我的女主人的侄女,就是坐在家具上的这位女士,不会再付给你另外的两便士,”车夫说道。“她说她已经给了你足够的钱。”“好吧,如果你的女主人的侄女不付过路费,她就不能从这个路卡通过,”守卡人回答道。加布里埃尔觉得不值得为两便士如此费心,所以他走上前。“给,”他说道,把硬币递给了守卡人,“让这位姑娘过去。”
   (6)穿红色短上衣的姑娘不经意地向下看了一眼加布里埃尔,然后叫车夫继续赶路,甚至都没有谢谢农夫。加布里埃尔和守卡人看着马车离开。“那是一位漂亮的年轻女士,”守卡人说道。“不过她有她的缺点,”加布里埃尔回答。
   (7)“确实,农夫。”“最大的缺点总是与女人为伴。”“每次争吵都想赢?噢,你是对的。”
   (8)“不,她最大的缺点是她很虚荣。”
   (9)几天后,在一年中最漫长的那个夜晚,接近午夜时分,可以听到加布里埃尔·奥克在诺科姆山上吹奏长笛。天空是如此晴朗,星星是如此清晰可辨,以至于几乎能看到地球在转动。在那寒冷的空中,响起甜美的笛声。这乐声来自一个停在田野角落的移动小棚屋。在牧羊人整夜都得呆在田野里照看小羊羔的冬季和春季期间,牧羊人的这种棚屋就被当作一个遮风避雨处。
   (10)加布里埃尔的250只羊还未付钱。他知道,要想在养殖业上获得成功,他就得保证这些羊生出大量健康的羊羔。因此,他下定决心根据需要在田野上停留多个夜晚,以免自己的羊羔被冻死或饿死。
   (11)棚屋里面既温暖又十分舒适。有一个炉子,架子上还有一些面包和啤酒。在棚屋的每一侧都有一个像窗户一样的圆孔,可以分别用一块木头把它们关上。当炉子在烧火时,这些气孔通常是开着的,因为狭小又不通风的棚屋里,太多的烟能夺走牧羊人的性命。
   (12)笛声不时地停下来,加布里埃尔走出他的棚屋去查看羊群。每当他发现一只半死的新生羊羔,他就把这只小动物带进棚屋里。它在炉子前很快就活过来了,然后他就把它还给母羊。
   (13)他注意到山下稍远的地方有灯光。这灯光来自田边的一座木棚屋。他下山走近木棚屋,把一只眼睛凑向木板上的一个孔。屋里,两个女人正在喂一头生病的母牛。其中一个是中年妇女。另一个还很年轻,穿着一件斗篷。加布里埃尔看不见她的脸。
   (14)“姑妈,我想她很快就会好的,”年轻一些的女人说道。“早上我可以再来喂她。多可惜,我在来这儿的路上弄丢了帽子!”就在这时,这位姑娘脱掉了斗篷,她的长发落在红色短上衣的肩上。加布里埃尔认出这位姑娘就是那位黄色马车上照镜子的姑娘,就是那位欠他两便士的姑娘。两个女人离开了木棚屋,加布里埃尔也回到自己的羊群中。
   (15)当第二天早晨太阳升起时,加布里埃尔在他的棚屋外等着,直到他看见那位年轻女士骑马上山。她以常见的女士姿势侧坐在马上。他突然想起了她弄丢的那顶帽子,就去寻找,然后在地上的落叶中发现了帽子。他正打算走上前把帽子还给那位姑娘,突然她做了一件很特别的事。骑到一棵树的矮枝下时,她向后平躺在马背上,双脚搭在马肩上。然后,她先向四周看了看,确信无人注视后,她又坐直了身体,并把裙子拉至膝盖,两条腿分别放在马的两侧。这明显骑起马来更容易一些,但不太像淑女所为。加布里埃尔对她的行为感到既惊奇又有趣。他一直等到她从姑妈的棚屋回来,才走到她面前的路上。
   PASSAGE TWO
   (1)“就像文艺复兴时期的佛罗伦萨。”这是人们对硅谷生活感受的常见描述。这座美国科技之都,对世界的经济、股市和文化均有巨大的影响。从圣何塞到旧金山这一小部分土地,就是全球市值最高的五大公司其中三家的总部所在地。像苹果、脸谱网、谷歌和网飞这些巨头都声称硅谷是其发源地和总部所在地,像爱彼迎、特斯拉和优步这些行业先驱也是如此。旧金山湾区拥有世界上第十九大经济体,名列瑞士和沙特阿拉伯之上。
   (2)硅谷不仅仅是一个地方。它还是一种理念。自从大约80年前比尔·休利特和戴维·帕卡德在一间车库里创业以来,硅谷就已成为创新和独创性的代名词。它已是数次熊彼特的破坏与复兴周期的中心,历经硅芯片、个人电脑、软件和互联网服务的技术革新。它有些发明是荒唐可笑的:联网的茶壶,或者出售自助洗衣店硬币的应用程序。但其他发明却举世无双:微处理器芯片、数据库和智能手机均能追溯源头至硅谷。
   (3)工程专业技术、蓬勃发展的商业网络、庞大的资金池、实力强劲的大学和冒险文化结合在一起,让硅谷无法被复制,尽管许多地方试图这么做。还没有可靠的对手能撼动它作为世界杰出创新中心的地位。但有迹象表明,硅谷的影响力正在触顶。如果这仅仅是其他地方出现更伟大创新的征兆,那将是一件值得欢呼的事。但真相却令人担忧。
   (4)首先,有证据表明情况正在发生变化。去年离开旧金山县的美国人比到那里的人要多。根据最近的一项调查,46%的受访者表示他们计划在未来几年内离开湾区,此数据高于2016年的34%。如此多的初创公司正朝着新地方拓展业务,以至于这股潮流有了一个“离谷潮”的名字。彼得·蒂尔或许是硅谷知名度最高的风险投资家,他就是搬离者之一。那些留下的人眼界更开阔:2013年,硅谷投资者将其一半资金投入位于湾区之外的初创公司;如今投资金额已接近三分之二。
   (5)这一转变的原因是多方面的,但其中最主要的是硅谷的巨额开销。其生活费用位列世界之最。一位创始人估算,初创公司在湾区的运营费用比在其他大部分美国城市至少高四倍。从量子计算到合成生物学这样的新技术,提供的利润低于互联网服务,这使得节约资金对于这些新兴领域的初创企业而言更加重要。这一切还没有考虑湾区生活的糟糕特征:拥挤不堪的交通、随地丢弃的注射器和骇人听闻的不平等。
   (6)结果就是,其他城市的相对重要性正在提高。一家追踪企业家的非营利组织考夫曼基金会,根据初创公司和新企业家的密集程度,目前将迈阿密—劳德代尔堡地区列为全美创业活动的最佳地点。蒂尔先生将搬往洛杉矶,那里拥有充满活力的科技行业。菲尼克斯和匹兹堡已成为自动驾驶汽车中心;纽约成为媒体初创公司中心;伦敦成为金融科技中心;深圳成为硬件中心。所有这些地方,仅靠自己无法与硅谷匹敌;但它们却表明创新的分布更为广泛。
   (7)如果伟大的创意能在更多地方涌现,那一定是喜闻乐见的。人们有理由认为,创新的竞争环境确实正在升级。世界各地的人才变得更容易获得资本:科技投资家越来越多地在全球网罗热门创意,而不是仅仅局限于加利福尼亚。与过去相比,如今很难再有理由让单一区域成为科技中心。位于硅谷的公司生产了从智能手机到视频通话,再到即时通讯应用等工具,得益于此,团队可以在不同的办公室和不同的地方高效工作。结果之一可能是财富分配更加平均,另一个则是思想更加多元化。硅谷在许多方面都表现得极为出色,但却险些变成白人技术男主导的一元化社会。去年,由女性创立的公司仅获得风险投资家所发放资金的2%。
   (8)问题是,更大范围内的创新竞争环境也在恶化。其中一个原因就是科技巨头的主导地位。初创公司,尤其是那些从事消费互联网业务的初创公司,在谷歌母公司、苹果和脸谱网等科技巨头的阴影下,越来越难吸引资本。2017年,美国首轮融资的公司数量比2012年下降了约22%。谷歌母公司和脸谱网付给其员工的薪水如此丰厚,以至于初创公司很难吸引人才(脸谱网的平均年薪是24万美元)。当初创公司成功的概率更为渺茫,而所得回报又与巨头企业中稳定岗位的工资相差不大时,创新活力就会受损——这并非仅仅发生在硅谷。中国的情况也与此类似,阿里巴巴、百度和腾讯占据了中国国内近一半的风险投资,这使三大巨头在潜在竞争对手的未来上拥有很大的发言权。
   (9)导致创新水平下降的第二个原因是西方国家越来越不友好的政策。日益高涨的反移民情绪,以及由唐纳德·特朗普总统推行的更为严格的此类签证制度,对整体经济都产生了影响;美国大约25%的新公司都是由外国企业家创立的。硅谷最初的繁荣,很大程度上是因为政府的慷慨解囊。但自2007—2008年金融危机以来,整个欧美地区的国家在公立大学上的开支已在下降。为基础研究提供的资金不足——2015年美国联邦政府的研发支出占GDP的0.6%,是1964年的三分之一——而且正在朝着错误的方向发展。
   (10)如果硅谷的相对衰落预示着全球科技中心网络的崛起,那就值得庆祝一番,这些科技中心蓬勃发展,都是硅谷的竞争对手。不幸的是,硅谷的触顶看起来更像是一种警告:世界各地的创新变得越来越难。
   PASSAGE THREE
   (1)在东京的卫星城国立市,一处小公寓的向阳房间里躺着Yasuyuki Ibaraki,双眼紧闭,呼吸费力。他的医生Yukio Miyazaki,每两周从当地诊所前来问诊,怀疑他所剩时间无几:他的大脑由于脑梗受损,消化系统长有肿瘤,还无法吞咽和说话。他的妻子Reiko通过一条通向胃部的软管给他喂食,并且清除他喉咙里的痰。“他来自一个关系亲密的家庭,是一个安静的人,所以我认为对他而言,待在这里比在医院更好一些,”她一边喝绿茶吃葡萄,一边说道。
   (2)日本的预期寿命是全世界最高的,达到了84岁。这对于该国人民来说是一个好消息,但这也意味着老年人所占的人口比例越来越高。足足有28%的日本人年龄超过65岁,而这一比例在美国和德国分别是15%和21%。更多的老人,反过来,意味着更高的医疗保健费用。去年,政府为医疗保健和护理编制的预算是15兆日元(1,380亿美元,或者是其总支出的15%),这还不包括政府对公共医疗保险计划征收的费用。由于公共债务已是GDP的250%,并且还本付息进一步消耗了24%的支出,政府正在拼命寻找削减成本的方法。它认为在家照顾老人是其最佳选择之一。
   (3)所有的日本人每个月都要向公共保险计划缴纳保费,要么是通过雇主,要么是通过当地市政当局。作为回报,他们有权享有公立和私立医生及医院的治疗和药物,尽管他们还必须支付一部分治疗费用(按美国的说法就是“共同付费”),这笔费用有上限。2000年,日本引入了一项附加的公共保险计划,针对65岁以上人士的长期护理,参保人员必须从40岁开始缴费。其运作原理一样。保费和共同付费足以支付约60%的服务费用;政府支付其余的费用。正是老人花费得最高,日本政府估计,75岁以上人士的医疗保健年均费用是942,000日元,而其他人仅仅是221,000日元。
   (4)东京圣路加国际大学的Naoki Ikegami表示,按照老龄化国家的标准,日本在控制医疗费用方面已经做得很好了。政府设置服务费用来降低成本(尽管这鼓励了供应者进行非必要的治疗来赚取更多的钱:相对于其人口而言,日本拥有的扫描仪数量比其他国家都要多)。这还推广了更为廉价的仿制药的使用。
   (5)尽管如此,在经济合作与发展组织的医疗保健占GDP比例的排名中,日本已缓慢上升至第六位,仅次于法国和美国,但领先于意大利和韩国——另外两个老龄化国家。这并不仅仅是老年人的人数在增加;人均支出也在增加,因为阿尔茨海默症和糖尿病等疾病的患者寿命延长了。
   (6)日本已推广家庭护理多年了,但现在更是加大了力度推动。例如,考虑到日本的平均住院时间是荷兰的三倍,这个政策尤其有利。厚生劳动省估计,2025年将有100万人接受家庭护理——是目前总人数的1.5倍。专供出诊的特殊护理单位数量已从2014年的7,473个增至2018年的10,418个。
   (7)去年,一个政府的专家小组建议提高支付给医生的出诊费金额,以及使通过视频会议服务进行咨询符合资格。它还建议了一些新规则来鼓励在家护理。例如,当医院让病人出院时,它们应该有义务与社会服务机构进行交谈。
   (8)一些市政当局已在社区提供良好的护理。尾道市就是其中之一,这个位于东京以外地区的小城市,历史甚至比整个国家都更悠久。它的医疗机构能召开15分钟的“护理会议”,与医生、护士、家庭成员甚至牙医讨论他们将如何开始照顾病人。“过去医院想让病人回家往往很难,因为没有家庭护理的系统;但情况已有所改变,”医生Hisashi Katayama说道。
   (9)针对特定疾病的社区护理也正在改善。以老年痴呆为例,该病目前影响着500万日本人(占人口的4%),到2030年将有6%—7%的日本人患有这种疾病。有些城镇,比如东京东北部的松户市,已经开设了咖啡馆,为病人及其护理者提供建议和陪伴,而不是仅仅提供机构护理和医疗。为照顾年长亲属的家庭提供喘息的日托中心也很常见。还有更多的事情可以做:只有13%的日本人在家中过世,尽管大多数人表示他们想要这么做。
   (10)但更为普遍的家庭护理还不足以使日本人负担得起医疗保健。安倍晋三政府想要改进社会保障体系,它认为这将有助于降低医疗保健费用。例如,提高退休年龄会让人们积极活跃、更加健康、纳税时间更长。政府还想尽量降低某些疾病的发病率,这些疾病是老年人才患有的,但其根源又在于他们年轻时的行为。“我们倾向于关注老年人,但我们也需要关注年轻人来预防疾病,”经济产业省的Kazumi Nishikawa说道。他尤其侧重于向人们提供更多关于日本发病率上升的糖尿病病因的信息,或者是关于能阻止老年痴呆进展的锻炼的信息。
   (11)人们可能也得为医疗保健支付更多的费用。在75岁以上的老年人当中,许多人的共同付费比例仅为10%,相比之下,其他所有人的比例为30%。政府应该首先将这个比例翻倍至20%,国家健康保险组合联合会的总经理Shigefumi Kawamoto说道。“有些老年人没有收入来源,但许多人都有,”他肯定地说。政府可以将某些项目移出承保范围,比如非处方药,他表示。
   (12)同时,回到国立市,Miyazaki医生与Reiko谈论她丈夫的情况。她表示,自己担心丈夫的病情正在恶化,并且在医生出诊的间隔期间非常焦虑。这位医生承诺从现在起每周都来。