Health Cares 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.

>< Vocabulary .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, providing health insurance coverage to people who are aged ;< and over, or who meet other special criteria. )he medicare program also funds residency training programs for the vast maCority of physicians in the 4nited $tates. &edicare operates as a single2payer health care system. )he $ocial $ecurity #ct of :D;< was passed by Congress in :0<late2spring of :D;< and signed into law on +uly 90, :D;<, by -resident Eyndon /. +ohnson as amendments to $ocial $ecurity legislation. #t the bill2signing ceremony -resident +ohnson enrolled former -resident Farry $. )ruman as the first &edicare beneficiary and presented him with the first &edicare card.

Medicaid ::0 is the 4nited $tates health program for eligible individuals and families with low incomes and resources. (t is a means2tested program that is Cointly funded by the states and federal government, and is managed by the states. #mong the groups of people served by &edicaid are certain eligible 4.$. citi5ens and resident aliens, including low2income adults and their children, and people with certain disabilities. -overty alone does not necessarily 1ualify an individual for &edicaid. (t is estimated that appro imately ;0 percent of ::<poor #mericans are not covered by &edicaid. &edicaid is the largest source of funding for medical and health2related services for people with limited income in the 4nited $tates. /ecause of the aging /aby /oomer population, the fastest growing aspect of &edicaid is nursing home coverage.

:20Scheduled health insurance plans are an e panded form of Fospital (ndemnity plans. (n recent years, these plans have taken the name mini2 med plans or association plans. )hese plans may provide benefits for hospitali5ation, surgical, and physician services. Fowever, they are not meant to replace a traditional comprehensive health insurance plan. $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, but these benefits will be limited and are not meant to be effective for catastrophic events. -ayments are based upon the planGs Hschedule of benefitsH and are usually paid directly to the service provider. . )hese plans cost much less than comprehensive health insurance. #nnual benefit ma imums for a typical scheduled health insurance plan may range from $:,000 to $2<,000. :90Medical care ratio A&CIB, also known as medical cost ratio, medical loss ratio, and medical benefit ratio, is a metric used in managed health care and health insurance to measure medical costs as a percentage of premium revenues. (t is calculated by dividing those premiums allocated for fully insured or self2funded health care coverage into the total e penses for inpatient, professional Aphysicians and other licensed providersB, outpatient, and :9<pharmacy. A/riefly, &CI J CostsK-remiums.B #s a general rule, a medical cost ratio of ><L or less is desirable. $ome insurers now call &CI Hbenefit cost ratioH A/CIB. (n the 4nited $tates, the term is &edical Eoss Iatio.

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. EM0 It is too early to say whether insurance premiums will be affected. :=<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, the federal2 state program for the poor, especially families with children Can purchase private insurance on individual market, but premiums are likely to be too costly n Fospital emergency rooms must treat all comers without regard to ability to pay. $ome :,200 federally funded community health centers offer low2cost basic care. Everyone with income up to :99L of federal poverty level will be eligible for &edicaid. A-overty level for individual is $:0,>90 in 20:0.B -eople with income between :99L and =00L of poverty level will be eligible for subsidi5ed health insurance. -remiums are capped at 2L of income for those at the lowest end of that scale and D.<L of income at the highest end. #dditional $:: billion spent on community health centers

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$appels rammaire# au%iliaires de modalit&s

Modal be able to

Nature possibilit possibilit, capacit

Exemples (formes + et -) I was(not) able to prevent the theft. I was unable to arrest the thief. Birds can fly; monkeys cannot. Can I watch TV !o, yo" can't. Could there be a vir"s in this file !o, there couldn't; I ran the anti#vir"s. &e could have taken a different road% &e could have called me ' Could I open the window !o, yo" can not. (o" had better )et movin), if yo" don*t want to be late. (o" had better not be late. You needn't hurry; there's plenty of time I have to pay my ta,es before the end of -arch. Origine externe. les lois de l*tat. / is bi))er than B which is bi))er than 0, so / must be bi))er than 0. 0 cannot be bi))er than /. It must be late as it is already dark. &e must have washed the car, it+s )leamin) ' &e cant/couldnt(ils sont ici synonymes) have for)otten ' It must be free1in) o"tside, look at the frost on the window ' It cant be rainin) ' Teacher to p"pil. 2(o" must come to school on time; yo" must not be late2. Origine interne. le professe"r 3"i parle dcide. It may (not) rain tomorrow. &e may (not) have )ot the messa)e, I+m not s"re. May I speak to -rs 8, please !o, yo" may/can not, she*s not in. I might come to yo"r party if I can )et off work on time. &e might have missed the b"s. (o" might have told me '

can permission possibilit, capacti could $ossibilit (pass)% reproche permission had better neednt have to, have got to conseil absence d+obli)ation obli)ation (ori)ine e,terne)

forte probabilit must obli)ation (ori)ine interne) $robabilit 456 may permission, re3"7te possibilit (faible) $ossibilit faible pass reproche

might

permission devoir, conseil ought to dd"ction lo)i3"e conseil should dd"ction lo)i3"e

Might I borrow yo"r laptop !o yo" may/can not. (o" ought to apolo)i1e to yo"r sister for havin) h"rt her feelin)s. (o" ought not to tell her. That ought to be eno")h petrol to last "s "ntil we )et to 9yons. (o" should spend more time on yo"r homework. &e shouldnt spend his money so carelessly ' :4 should be eno")h to leave as a tip.

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Ee tableau ci2dessus nGest 1uGun rOsumO des au iliaires modau . En voici les dOtails des diffOrents modau 0

Can, Could & Be Able to

220Can est employO pour parler de ce 1ui est possible. Could, le prOtOrit de can, est aussi employO pour parler du possible, soit maintenant AoP il a la valeur dGun conditionnelB soit dans le passO. Eors1uGon emploie could pour parler de ce 1ui est possible maintenant, il a un sens plus attOnuO 1ue can AGpourraitG plutQt 1ue GpeutGB. Be able to a le mRme sens 1ue can mais il a cette diffOrence 1uGon ne lGemploie pas pour parler dGune capacitO, seulement dGune action 1ui peut Rtre accompli S un certain moment. (l sGemploie S tous les temps. 22<,n peut employer can et could aussi pour la permission.

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He can play the piano. Il pe"t ;o"er d" piano. (<e parle de sa capacit.) could beat you at chess. <e po"rrais vo"s battre dans "ne partie d*checs. (<e parle de ce 3"i est possible maintenant.) !hen was younger, could run for miles without getting out of breath . 9ors3"e ;*tais pl"s ;e"ne, ;e po"vais co"rir des miles sans 7tre hors d*haleine. (<e parle de ce dont ;*tais capable dans le pass.) !hen it stops raining, we will be able to go out for a wal" . 9ors3"*il s*arr7tera de ple"voir, no"s po"rrons sortir no"s promener. (<e parle de ce 3"i sera possible bient=t # dans l*avenir.) Can borrow your newspaper# $"is#;e empr"nter votre ;o"rnal (<e demande la permission. Could serais pl"s so"ten"; ;e po"rrais a"ssi employer may.)

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May & Might

May est employO pour parler de la possibilitO. Ee prOtOrit, might, est employO aussi pour la possibilitO lors1ue les chances sont moindres. Ees deu , may et might, sont employOs aussi pour parler de la permission ou pour faire une re1uRte 2 might Otant plus soutenu 1ue may. 2=0

t may rain. Il se pe"t 3"*il ple"ve. (>n parle d*"ne possibilit.) !e might win the lotto. !o"s po"rrions, pe"t#7tre, )a)ner le lotto. (0*est possible, mais pas probable # donc might pl"t=t 3"e may.) May spea" to Mr Connell# $"is#;e parler avec -onsie"r 0onnell (<e demande la permission . Can et could sont )alement possible ici.) Might borrow your laptop# $o"rrais#;e empr"nter votre ordinate"r portable (<e demande la permission ; ;*emploie la fa?on pl"s so"ten"e. 0*est asse1 rare d*employer might comme cela a";o"rd*h"i; cela pe"t 7tre considr comme prtentie", o" sarcasti3"e.)

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Must & Have to

2<0Must est employO pour les obligations dites GinternesG, cGest2S2dire 1ue lGobligation vient de celui 1ui parle ou Ocrit0 il est lGautoritO. $on contraire est mustn't. ave to, en revanche, est employO pour les obligations dites Ge ternesG, cGest2S2dire 1ue lGobligation vient dGune autoritO e terne, comme les lois dGun Otat, le rTglement dGune Ocole, ou des parents. $on contraire est do!does not have to. Must est aussi employO pour parler de la nOcessitO ou dGune forte probabilitOU son contraire, dans ce cas, est can't. 2<<

$eacher% &You must do your homewor" for ne't $hursday&( $rofesse"r. 2Il fa"t 3"e vo"s fassie1 le devoir po"r ;e"di prochain2. (Obligation interne. 9e professe"r est l*a"torit; l*obli)ation vient de l"i.) )upil% & have to do my homewor" for ne't $hursday&( @lAve. 2<e dois faire mon devoir po"r ;e"di prochain2. (Obligation externe. 0*est to";o"rs le professe"r 3"i est l*a"torit; l*lAve parle d*"ne obli)ation 3"i l"i a t impose. Il en informe ses parents, par e,emple.) t must be late as it's already dar"( Il doit 7tre tard p"is3"*il fait noir d;B. (Ncessit. Il est ncessairement tard p"is3"*il fait noir; o" c*est fortement probable.)

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You mustn't be late( Vo"s ne devre1 pas 7tre en retard. (Obligation ngative. 0el"i 3"i parle est l*ori)ine de l*obli)ation.) You don't have to wor" on *undays( Vo"s n*7tes pas obli) de travailler le dimanche. (Absence d'obligation . 0el"i 3"i parle n*est pas l*ori)ine de l*obli)ation, il en parle simplement. >n pe"t a"ssi employer needn't.) t can't be +, o'cloc" because the sun is still shining( Il ne pe"t pas 7tre CCh55 p"is3"e le soleil brille to";o"rs. ( mpossibilit ou improbabilit . D*aprAs cel"i 3"i parle, il n*est pas possible 3"*il soit CCh55; o" c*est trAs pe" probable.)

(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, tandis 1ue le dernier parle de lGabsence dGune obligation A1uel1ue chose 1uGon nGest pas obligO de faire.B

Ought to & Should

-our donner un conseil, on emploie soit ought to, soit should. Ea diffOrence entre eu est 1ue le premier est 28<plutQt moralisateurU on insiste plus sur la vertu de ce 1ui est conseillO. Ees deu sont aussi employOs pour parler de la probabilitO.

2>0
You ought to save your money instead of spending every penny you earn( T" devrais conomiser ton ar)ent a" lie" de dpenser cha3"e so" 3"e t" )a)nes. (!onseil. Ici le ton est pl"t=t moralisate"r.) You should brush your teeth after every meal, if possible( T" devrais te brosser les dents aprAs cha3"e repas, si cela est possible. (!onseil. 0*est ;"ste "n bon conseil; il n*y a"c"ne notion de moralit.) $his boo" ought to -should. be heavy enough to "eep the door open( 0e livre doit 7tre asse1 lo"rd po"r )arder la porte o"verte. ("robabilit. <*estime 3"e le livre est asse1 lo"rd po"r 7tre plac contre la porte de fa?on B l*emp7cher de se fermer.)

2><Had better & Needn't -our donner un conseil, on peut employer had better. Eors1uGon veut signaler 1ue 1uel1ue action nGest pas obligatoire, on peut employer needn't.

You had better hurry, or you'll be late( Vo"s ferie1 mie", de vo"s presser, sinon vo"s sere1 en retard. (!onseil. >n pe"t a"ssi employer should et ought to.) You needn't hurry; there's plenty of time( 0e n*est pas la peine de vo"s prcipiter; il reste bea"co"p de temps. (Absence d'obligation. >n pe"t a"ssi dire don't have to.)

2D0

2D< (h)me rammatical :. '"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. 2. Ea directive de 20:: stipule 1ue les assureurs devraient dOpenser au moins ><L de leurs revenus pour prodiguer des soins mOdicau 9. (l est impossible 1ue tant de gens dans un pays aussi riche 1ue les Etats24nis n"aient pas touCours pas de couverture sociale satisfaisante. =. Ce n"Otait vraiment pas la peine 1ue &. ,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. <. En fait, 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. ;. ,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

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