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　　Section C

　　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 treatment, 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, an eye disease. But one costs $50 a dose and the other close to $2,000. 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."

　　57.【题干】What do some most influential medical groups recommend doctors do?

　　【选项】

　　A.Reflect on the responsibilities they are supposed to take.

　　B.Pay more attention to the effectiveness of their treatments.

　　C.Take costs into account when making treatment decisions.

　　D.Readjust their practice in view of the cuts in health care.

　　【答案】C

　　【解析】第一段第一句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 treatment。

　　58.【题干】What were doctors mainly concerned about in the past?

　　【选项】

　　A.Specific medicines to be used.

　　B.Professional advancement.

　　C.Effects of medical treatment.

　　D.Patients' trust.

　　【答案】C

　　【解析】从第二段开头The shift可以看到，让医生更关注治疗成本是一种转变，那么就说明以前医生关注更多的是医疗效果。

　　59.【题干】What may the new guidelines being developed lead to?

　　【选项】

　　A.The redefining of doctors' roles.

　　B.Conflicts between doctors and patients.

　　C.Overuse of less effective medicines.

　　D.The prolonging of patients' suffering.

　　【答案】A

　　【解析】第二段The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, f可以看出是A选项，医生所扮演的角色也被重新下定义。

　　60.【题干】What risk do doctors see in their dual role as patient care providers and financial overseers?

　　【选项】

　　A.They may be involved in a conflict of interest.

　　B.They may be forced to divide their attention.

　　C.They may have to use less effective drugs.

　　D.They may lose the respect of patients.

　　【答案】D

　　【解析】由第六段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."可得知是D选项。

　　61.【题干】What do some experts say about doctors' involvement in medical cost analysis?

　　【选项】

　　A.It may add to doctors' already heavy workloads.

　　B.It will help to save money for society as a whole.

　　C.It results from society's failure to tackle the problem.

　　D.It raises doctors' awareness of their social responsibilities.

　　【答案】C

　　【解析】最后一段最后一句话"it represents a failure of wider society to take up the issue."可看出答案是C。

　　Passage Two

　　Questions 61 to 65 are based on the following passage.

　　Economic inequality is the "defining challenge of our time," President Barack Obama declared in a speech last month to the Center for American Progress. Inequality is dangerous, he argued, not merely because it doesn't look good to have a large gap between the rich and the poor, but because inequality itself destroy upward mobility, making it harder for the poor to escape from poverty. "Increased inequality and decreasing mobility pose a fundamental threat to the American Dream," he said.

　　Obama is only the most prominent public figure to declare inequality Public Enemy NO.1 and the greatest threat to reducing poverty in American. A number of prominent economists have also argued that it's harder for the poor to climb the economic ladder today because the rungs(横档)in that ladder have grown father apart.

　　For all the new attention devoted to the I percent, a new datast from the Equality of Opportunity Projector at Harvard and Berkeley suggests that, if we care about upward mobility overall, we're vastly exaggerating the dangers of the rich-poor gap. Inequality itself is not a particularly strong predictor of economic mobility, as sociologist Scott Winship noted in a recent article based on his analysis of this data.

　　So what factors, at the community level, do predict if poor children will move up the economic ladder as adults? What explains, for instance, why the Salt Lake City metro area is one of the least likely?

　　Harvard economist Raj Chetty has pointed to economic and racial segregation, community density, the size of a community's middle class, the quality of schools, community religiosity, and family structure, which he calls the "single strongest correlate of upward mobility." Chetty finds that communities like Salt Lake City, with high levels of two-parent families and religiosity, are much more likely to see poor children get ahead than communities like Atlanta, with high levels of racial and economic segregation.

　　Chetty has not yet issued a comprehensive analysis of the relative predictive power of each of these factors. Based on my analyses of the data, of the factors that Chetty has highlighted, the following three seem to be most predictive of upward mobility in a given community:

　　1.per-capita(年均)income growth

　　2.Prevalence of single mothers (where correlation is strong, but negative)

　　3.per-capita local government spending

　　In other words, communities with high levels of per-capita income growth, high percentages of two-parent families, and high local government spending——which may stand for good schools——are the most likely to help poor children relive Horatio Alger's rags-to-riches story.

　　62.【题干】How does Obama view economic inequality?

　　【选项】

　　A.It is the biggest obstacle to social mobility.

　　B.It is the greatest threat to social stability.

　　C.It is the No.1 enemy of income growth.

　　D.It is the most malicious social evil of our time.

　　【答案】A

　　【解析】第一段最后一句Increased inequality and decreasing mobility pose a fundamental threat to the American Dream," he said可看出奥巴马的观点。

　　63.【题干】What do we learn about the inequality gap from Scott Winship's data analysis?

　　【选项】

　　A.It is fast widening across most parts of America.

　　B.It is not a reliable indicator of economic mobility.

　　C.It is not correctly interpreted.

　　D.It is overwhelmingly ignored.

　　【答案】B

　　【解析】第三段最后一句Inequality itself is not a particularly strong predictor (指示器)of economic mobility, as sociologist Scott Winship noted in a recent article based on his analysis of this data.

　　64.【题干】Compared with Atlanta, metropolitan Salt Lake City is said to_____.

　　【选项】

　　A.have placed religious beliefs above party politics

　　B.have bridged the gap between the rich and the poor

　　C.offer poor children more chances to climb the social ladder

　　D.suffer from higher levels of racial and economic segregation

　　【答案】C

　　【解析】根据第五段最后一句Chetty finds that communities like Salt Lake City, with high levels of two-parent families and religiosity, are much more likely to see poor children get ahead than communities like Atlanta, with high levels of racial and economic segregation.可以看出C符合题意。

　　65.【题干】What is strongly correlated with social mobility according to economist Raj Chetty?

　　【选项】

　　A.Family structure.

　　B.Racial equality

　　C.School education.

　　D.Community density.

　　【答案】A

　　【解析】根据第五段第一句的后半句and family structure, which he calls the "single strongest correlate of upward mobility."得知家庭结构是与社会流动性最相关的一个因素。

　　66.【题干】What does the author seem to suggest?

　　【选项】

　　A.It is important to increase the size of the middle class.

　　B.It is highly important to expand the metropolitan areas.

　　C.It is most imperative to focus our efforts on the elimination of income inequality.

　　D.It is better to start from the community to help poor children move up the social ladder.

　　【答案】D

　　【解析】根据第五段可以看出作者对盐湖城地区的社团组织帮助儿童的方法表示认同，因此推断答案为D。

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