单选题 Reform and Medical Costs A. Americans are deeply concerned about the relentless rise in health care costs and health insurance premiums. They need to know if reform will help solve the problem. The answer is that no one has an easy fix for rising medical costs. The fundamental fix—reshaping how care is delivered and how doctors are paid in a wasteful, abnormal system—is likely to be achieved only through trial and error and incremental (渐进的) gains. B. The good news is that a bill just approved by the House and a bill approved by the Senate Finance Committee would implement or test many reforms that should help slow the rise in medical costs over the long term. As a report in The New England Journal of Medicine concluded, 'Pretty much every proposed innovation found in the health policy literature these days is contained in these measures.' C. Medical spending, which typically rises faster than wages and the overall economy, is propelled by two things: the high prices charged for medical services in this country and the volume of unnecessary care delivered by doctors and hospitals, which often perform a lot more tests and treatments than a patient really needs. D. Here are some of the important proposals in the House and Senate bills to try to address those problems, and why it is hard to know how well they will work. E. Both bills would reduce the rate of growth in annual Medicare payments to hospitals, nursing homes and other providers by amounts comparable to the productivity savings routinely made in other industries with the help of new technologies and new ways to organize work. This proposal could save Medicare more than $100 billion over the next decade. If private plans demanded similar productivity savings from providers, and refused to let providers shift additional costs to them, the savings could be much larger. Critics say Congress will give in to lobbyists and let inefficient providers off the hook (放过). That is far less likely to happen if Congress also adopts strong 'pay-go' roles requiring that any increase in payments to providers be offset by new taxes or budget cuts. F. The Senate Finance bill would impose an excise tax (消费税) on health insurance plans that cost more than $8,000 for an individual or $21,000 for a family. It would most likely cause insurers to redesign plans to fall beneath the threshold. Enrollees would have to pay more money for many services out of their own pockets, and that would encourage them to think twice about whether an expensive or redundant test was worth it. Economists project that most employers would shift money from expensive health benefits into wages. The House bill has no similar tax. The final legislation should. G. Any doctor who has wrestled with multiple forms from different insurers, or patients who have tried to understand their own parade of statements, know that simplification ought to save money. When the health insurance industry was still cooperating in reform efforts, its trade group offered to provide standardized forms for automated processing. It estimated that step would save hundreds of billions of dollars over the next decade. The bills would lock that pledge into law. H. The stimulus package provided money to convert the inefficient, paper-driven medical system to electronic records that can be easily viewed and transmitted. This requires open investments to help doctors convert. In time it should help restrain costs by eliminating redundant tests, preventing drug interactions, and helping doctors find the best treatments. I. Virtually all experts agree that the fee-for-service system—doctors are rewarded for the quantity of care rather than its quality or effectiveness—is a primary reason that the cost of care is so high. Most agree that the solution is to push doctors to accept fixed payments to care for a particular illness or for a patient's needs over a year. No one knows how to make that happen quickly. The bills in both houses would start pilot projects within Medicare. They include such measures as accountable care organizations to take charge of a patient's needs with an eye on both cost and quality, and chronic disease management to make sure the seriously ill, who are responsible for the bulk of all health care costs, are treated properly. For the most part, these experiments rely on incentive payments to get doctors to try them. J. Testing innovations do no good unless the good experiments are identified and expanded and the bad ones are dropped. The Senate bill would create an independent commission to monitor the pilot programs and recommend changes in Medicare's payment policies to urge providers to adopt reforms that work. The changes would have to be approved or rejected as a whole by Congress, making it hard for narrow-interest lobbies to bend lawmakers to their will. K. The bills in both chambers would create health insurance exchanges on which small businesses and individuals could choose from an array of private plans and possibly a public option. All the plans would have to provide standard benefit packages that would be easy to compare. To get access to millions of new customers, insurers would have a strong incentive to lower their prices, perhaps by accepting slimmer profit margins or demanding better deals from providers. L. The final legislation might throw a public plan into the competition, but thanks to the fierce opposition of the insurance industry and Republican critics, it might not save much money. The one in the House bill would have to negotiate rates with providers, rather than using Medicare rates, as many reformers wanted. M. The president's stimulus package is pumping money into research to compare how well various treatments work. Is surgery, radiation or careful monitoring best for prostate (前列腺) cancer? Is the latest and most expensive cholesterol-lowering drug any better than its common competitors? The pending bills would spend additional money to accelerate this effort. N. Critics have charged that this sensible idea would lead to rationing of care. (That would be true only if you believed that patients should have an unrestrained right to treatments proven to be inferior.) As a result, the bills do not require, as they should, that the results of these studies be used to set payment rates in Medicare. O. Congress needs to find the courage to allow Medicare to pay preferentially for treatments proven to be superior. Sometimes the best treatment might be the most expensive. But overall, we suspect that spending would come down through elimination of a lot of unnecessary or even dangerous tests and treatments. P. The House bill would authorize the secretary of health and human services to negotiate drug prices in Medicare and Medicaid. Some authoritative analysts doubt that the secretary would get better deals than private insurers already get. We believe negotiation could work. It does in other countries. Q. Missing from these bills is any serious attempt to rein in malpractice costs. Malpractice awards do drive up insurance premiums for doctors in high-risk specialties, and there is some evidence that doctors engage in 'defensive medicine' by performing tests and treatments primarily to prove they are not negligent should they get sued.

单选题 北京观光客自然都会游览故宫和长城，这是因为故宫和长城是举世闻名的旅游景点。然而，对于北京第三大旅游场所——北京世界公园，人们却知之甚少。北京世界公园于20世纪90年代初竣工，占地面积46.7公顷，分为17处风景区，收集了各个洲的主要名胜景点。北京世界公园的规模雄踞亚洲同类公园之冠，所收微缩(miniature)复制品的数量也堪称亚洲之最。世界七大奇观以及50个国家的约100处历史名胜和自然景观均以微缩模型展出。

单选题 话题：要勇于面对挑战We should face challenges bravely Directions: For this part, you are allowed 30 minutes to write an essay on facing challenges by referring to the saying 'You cannot change what you refuse to confront.' You can give examples to illustrate your point and then explain how you will react to challenges in your life. You should write at least 150 words but no more than 200 words.

单选题 Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care. The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how healthcare dollars are spent. In practical terms, the new guidelines being developed could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment—at the end of life, for example—is too expensive. In the extreme, some critics have said that making treatment decisions based on cost is a form of rationing. Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions, even though there's no obligation to follow them. Medical society guidelines are also used by insurance companies to help determine reimbursement (报销) policies. Some doctors see a potential conflict in trying to be both providers of patient care and financial overseers. 'There should be forces in society who should be concerned about the budget, but they shouldn't be functioning simultaneously as doctors,' said Dr. Martin Samuels at a Boston hospital. He said doctors risked losing the trust of patients if they told patients, 'I'm not going to do what I think is best for you because I think it's bad for the healthcare budget in Massachusetts.' Doctors can face some grim trade-offs. Studies have shown, for example, that two drugs are about equally effective in treating macular degeneration, and eye disease. But one costs $50 a dose and the other close to $2000. Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug, Avastin, instead of the costlier one, Lucentis. But the Food and Drug Administration has not approved Avastin for use in the eye, and using it rather than the alternative, Lucentis, might carry an additional, although slight, safety risk. Should doctors consider Medicare's budget in deciding what to use? 'I think ethically (在道德层面上) we are just worried about the patient in front of us and not trying to save money for the insurance industry or society as a whole,' said Dr. Donald Jensen. Still, some analysts say that there's a role for doctors to play in cost analysis because not many others are doing so. 'In some ways,' said Dr. Daniel Sulmasy, 'it represents a failure of wider society to take up the issue.'

单选题 Questions2-5 are based on the conversation you have just heard.

单选题 Directions: For this part, you are allowed 30 minutes to write a short essay entitled College Students' Starting Their Own Undertakings After Graduation following the outline given below. You should write at least 150 words but no more than 200 words. 1. 现在有不少大学生毕业后开始自主创业； 2. 分析产生这一现象的原因； 3. 我认为…… College Students' Starting Their Own Undertakings After Graduation

单选题 Now listen to the following recording and answer questions16-18.

单选题 Questions25-27 are based on the recording you have just heard.

单选题 South Africa has 11 official languages. If you want to say hello, it's 'sawubona' in Zulu, and 'hallo' in Afrikaans. Now, South Africa's school children may start using 'ni hao' to say hello. The country's education minister says, the nation is adding the Mandarin language teaching in some schools. Mandarin is the official spoken language of China. That country is a major trading power for South Africa. A recent agreement between the two nations centres on five areas of cooperation. They include development in basic education, school books and lessons, mathematics and science, teacher training and career education and research. South Africa officials have not said how much they teaching Mandarin will cost. Troy Martens is an official with South Africa's Ministry of Basic Education. She says the new partnership is extremely valuable. 'So it is very exciting and both countries have indicated that for them education is a high priority, and that is why education is high on the agenda of collaboration between the two countries,' said Martens. The part of the plan that has garnered the most attention is the inclusion of the Mandarin language in schools. A public opinion study last year found that South Africans have mixed feelings about China. The survey showed 46 percent of South Africans do not like the spread of Chinese ideas and customs in their country, the results also showed that 60 percent dislike Chinese music, movies and television. But Ms Martens said Chinese trade is more important than those feelings. She said it is extremely helpful to learners in South Africa to study Mandarin as well as Chinese culture. And she said not every school will offer Mandarin. 'Now this will not be compulsory, it will not be for every school, and it will not be for every child. But for schools that feel they have the capacity to offer Mandarin as a subject, we think it is a great opportunity for South African learners to be exposed to this international type of language,' said Martens. South Africa's population studies do not say how many native Chinese speakers are among its nearly 51 million people. Lisette Noonan heads the 80-year-old Pretoria Chinese School in South Africa's capital. The school serves about 500 students from kindergarten to grade 12. Every student studies Mandarin. Ms Noonan says the school welcomes the new cooperation between South Africa and China. She said it is in the best interests of children to study Mandarin. She said that especially true with China becoming what she called 'a huge economic power in the world'.

单选题 Is it any wonder that America is also a country of dangerously overweight people? According to a recent study by the National Centre for Health Statistics, the number of adults characterized as overweight in the United States has jumped to an astonishing one-third of the population. Overweight in this case means being about 20 percent or more above a person's desirable weight. Since the figures for 'desirable weight' have moved upward over the last decade or so, total poundage—even at 20 percent over—may be considerable. So are the attendant health risks. Excess weight has been linked to cardiovascular disease, hypertension, adult-onset diabetes and some forms of cancer, among other diseases. Once, when work and school and the grocery store were a two-mile hike away, Americans could afford the calories they consume. But not now, not when millions spend four or five hours a day in front of a TV set—along with a bag of chips, a bowl of buttered popcorn and a six-pack—and there's a car or two in every driveway. 'There is no commitment to obesity as a public health problem,' said Dr. William Dietz, director of clinical nutrition at the New England Medical Centre in Boston. 'We've ignored it, and blamed it on gluttony and sloth.' If one definition of a public health problem is its cost to the nation, then obesity qualifies. According to a study done by Dr. Graham A. Colditz, who teaches at Harvard Medical School, it cost America an estimated $68.8 billion in 1990. But what's wrong blaming it on gluttony and sloth? True, some unfortunate overweight people have an underlying physical or genetic problem. But for most Americans, the problem is with two of the seven deadly sins. Losing weight is a desperately difficult business. Preventing gain, however, is not. Consumer information is everywhere and there can be few adults who truly believe that hot dogs, fries, a soda and a couple of Twinkies make a good lunch. But they eat them anyway. As more and more Americans became educated to the risks of smoking, more and more Americans gave up the habit. Now it appears that Americans need an intensive education in the risks of stuffing themselves and failing to exercise as well. Given the seductiveness of chocolate and cheese, the couch and the car, that habit will be hard to break. But if an ounce of prevention can obviate a pound of fat, it is well worth the struggle.

单选题 Questions10-12 are based on the passage you have just heard.