考研英语阅读命题思路透析和真题揭秘(57)

It is said that in England death is pressing, in Canada inevitable and in California optional. Small wonder. Americans' life expectancy has nearly doubled over the past century. Failing hips can be replaced, clinical depression controlled, cataracts removed in a 30-minuts surgical procedure. Such advances offer the aging population a quality of life that was unimaginable when I entered medicine 50 years ago. But not even a great health-care system can cure death-and our failure to confront that reality now threatens this greatness of ours.

Death is normal; we are genetically programmed to disintegrate and perish, even under ideal conditions. We all understand that at some level, yet as medical consumers we treat death as a problem to be solved. Shielded by third-party payers from the cost of our care, we demand everything that can possibly be done for us, even if it's useless. The most obvious example is late-stage cancer care. Physicians-frustrated by their inability to cure the disease and fearing loss of hope in the patient-too often offer aggressive treatment far beyond what is scientifically justified.

In1950, the U.S. spent .7 billion on health care. In 2002, the cost will be billion. Anyone can see this trend is unsustainable. Yet few seem willing to try to reverse it. Some scholars conclude that a government with finite resources should simply stop paying for medical care that sustains life beyond a certain age-----say 83 or so. Former Colorado governor Richard Lamm has been quoted as saying that the old and infirm "have a duty todie and get out of the way", so that younger, healthier people can realize their potential.

I would not go that far. Energetic people now routinely work through their 60s and beyond, and remain dazzlingly productive. At 78, Viacom chairman Sumner Redstone jokingly claims to be 53.Supreme Court Justice Sandra Day O'Connor is in her 70s, and former Surgeon General C.Everett Koop chairs an Internet start-up in his 80s.These leaders are living proof that prevention works and that we can manage the health problems that come naturally with age. As a mere 68-year-old, I wish to age as productively as they have.

Yet there are limits to what a society can spend in this pursuit. Ask a physician, I know the most costly and dramatic measures may be ineffective and painful. I also know that people in Japan and Sweden, countries that spend far less on medical care, have achieved longer, healthier lives than we have. As a nation, we may be overfunding the quest for unlikely cures while underfunding research on humbler therapies that could improve people's lives.

据说，在英国死亡是很紧迫的，在加拿大死亡是不可避免的，在加利福尼亚死亡则是可以选择的。也难怪，在过去的一个世纪里，美国人的平均寿命几乎比上个世纪翻了一番。髋骨坏了可以更换，忧郁症得到了控制，白内障仅用30分钟手术便可以切除。这些进步给老年人带来高质量生的活，这在50年前我刚进入医学行业时是不可想像的。但是即使有一个伟大的医疗卫生体系，死亡也是无法战胜的--而我们不能面对这个现实，正危及我们自身的伟大。

死亡是正常的；我们的基因决定我们即使在最理想的环境里也会解体和灭亡。我们所有人在某种程度上都懂得这一点，但是作为医疗消费者，我们常常将死亡视为一个可以解决的问题。由于医疗费用由第三方支付，我们常常要求用尽所有的医疗手段为我们治疗，哪怕这些治疗不起任何作用。最明显的例子是晚期癌症的治疗。医生由于缺乏回天之力，同时又担心病人失去希望，常常采用极端大胆的治疗方法，这些方法远远超出了科学上合理的范围。

1950年，美国在医疗卫生方面的开支是127亿美元。2002年，这项开支将达到15400亿。任何人都明白这个趋势不可以持续下去，但是很少有人愿意想办法扭转这种趋势。有些学者总结说，如果政府资金有限，它应该停止支付为延缓某一个年龄以上人群寿命的医疗费用--比如83岁左右。据说，科罗拉多州前州长理查德·拉姆曾经说，老年多病者"有责任死去和让位"，以让更年轻、更健康的人们去发挥他们的潜能。

我不会说得这么绝对，毕竟现在精力充沛的人们通常能工作到60岁，甚至更久老当益壮。78岁的Viacom公司总裁萨姆勒·雷斯顿开玩笑说他只有53岁。最高法院法官桑德拉·欧康奈现在已70有余，前卫生局医务主任C·库普80来岁还出任了一个互联网公司的总裁。这些领导人就是活生生的证据，证明预防是有意义的，证明我们能够对付年龄带来的健康问题。作为一名年仅68岁的人，我希望像他们一样在老龄阶段仍然保持创造力。

然而在这样的追求中，一个社会能够承担的费用是有限的。作为一名医生，我深知最昂贵和最激进的手段也可能是无效的和痛苦的。我也深知在医疗开销少得多的日本和瑞典，人们不仅活得比我们久，而且还比我们健康。作为一个国家，我们可能在寻求无法奏效的治疗方法上花钱太多，而在研究能提高人们生活质量的简单方法上投入太少。