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Almost everyone agrees that America’s health-care system has the incentives all wrong. Under the present system, doctors and hospitals get paid for doing more, even if added tests, operations and procedures have little chance of improving patients’ health. So what happens when someone proposes that we alter the incentives to reward better care, not more care Well, Rep. Paul Ryan and Republicans found out. No surprise: Democrats slammed them for "ending Medicare as we know it. "This predictably partisan reaction preying upon the anxieties of retirees—must depress anyone who cares about the country’s future. It is only a slight exaggeration to say that unless we end Medicare "as we know it," America "as we know it" will end. Spiraling health spending is the crux of our federal budget problem. In 1965—the year Congress created Medicare and Medicaid—health spending was 2.6 percent of the budget. In 2010, it was 26.5 percent. The Obama administration estimates it will be 30.3 percent in 2016. By contrast, defense spending is about 20 percent; scientific research and development is 4 percent.Uncontrolled health spending isn’t simply crowding out other government programs; it’s also dampening overall living standards. Health economists Michael Chernew, Richard Hirth and David Cutler recently reported that higher health costs consumed 35.7 percent of the increase in per capita income from 1999 to 2007. They also project that, under reasonable assumptions, it could absorb half or more of the gain between now and 2083.Ryan proposes to change that. Beginning in 2022, new (not existing) Medicare beneficiaries would receive a voucher, valued initially at about $ 8,000. The theory is simple. Suddenly empowered, Medicare beneficiaries would shop for lowest-cost, highest-quality insurance plans providing a required package of benefits. The health-care delivery system would be forced to restructure by reducing costs and improving quality. Doctors, hospitals and clinics would form networks; there would be more "coordination" of care, helped by more investment in information technology; better use of deductibles and co-payments would reduce unnecessary trips to doctors’ offices or clinics.It’s shock therapy. Would it work No one knows, but two things are clear. First, as Medicare goes, so goes the entire health-care system. Medicare is the nation’s largest insurance program, with 48 million recipients and spending last year of $ 520 billion. Second, few doubt that today’s health-care system has much waste: medical care that does no good.Under Ryan’s plan, incentives would shift. Medicare would no longer be an open ATM; the vouchers would limit total spending. Providers would face pressures to do more with less; there would certainly be charges that essential care was being denied. The Obama administration argues that better results can be achieved by modifying incentives within the existing system. Perhaps. But history suggests skepticism. It’s Ryan’s radicalism vs. President Obama’s remedy policy. Which is realistic and which is wishful thinking Burdened by runaway spending, Medicare "as we know it" is going to end. The only questions are when and on whose terms. What is the main problem with the current health-care system（）
Despite decades of scientific research, no one yet knows how much damage human activity is doing to the environment. Humans are thought to be responsible for a whole host of environmental problems, ranging from global warning to ozone depletion. What is not in doubt, however, is the devastating effect humans are having on the animal and plant life of the planet.Currently, an estimated 50,000 species become extinct every year. If this carries on, the impact on all living creatures is likely to be profound, says Dr. Nick Middleton, a geographer at Oxford University. " All species depend in some way on each other to survive. And the danger is that, if you remove one species from this very complex web of interrelationships, you have very little idea about the knock-on effects of other extinctions. "Complicating matters is the fact that there are no obvious solutions to the problem. Unlike global warning and ozone depletion—which, if the political will was there, could be reduced by cutting gas emissions—preserving biodiversity remains an intractable problem.The latest idea is " sustainable management " , which is seen as a practical and economical way of protecting species from extinction. This means humans should be able to use any species of animal or plant for their benefit, provided enough individuals of that species are left alive to ensure its continued existence.For instance, instead of depending on largely ineffective laws against poaching, it gives local people a good economic reason to preserve plants and animals. In Zimbabwe, there is a sustainable management project elephants. Foreign tourists pay large sums of money to kill these animals for sport. This money is then given to the inhabitants of the area where the hunting takes place. In theory, locals will be encouraged to protect elephants, instead of poaching them—or allowing others to poach them—because of the economic benefit involved.This sounds like a sensible strategy, but it remains to be seen whether it will work. With corruption endemic in many developing countries, some observers are skeptical that the money will actually reach the people it is intended for．Others wonder how effective the locals will be at stopping poachers.There are also questions about whether sustainable management is practical when it comes to protecting areas of great-bio-diversity such as the world’s tropical forests. In theory, the principle should be the same as with elephants—allow logging companies to cut down a certain number of trees, but not so many as to completely destroy the forest.Sustainable management of forests requires controls on the number of trees which are cut down, as well as investment in replacing them. But because almost all tropical forests are located in countries which desperately need revenue from logging, there are few regulations to do this. Moreover, unrestricted logging is so much more profitable that wood prices from managed forests would cost up to five times more—an increase that consumers, no matter how " green " , are unlikely to pay.For these reasons, sustainable management of tropical forests is unlikely to become widespread in the near future. This is disheartening news. It’s estimated these forests contain anything from 50 to 90 percent of all animal and plant species on Earth. In one study of a five-square-kilometer area of rain forest in Peru, for instance, scientists counted 1,300 species of butterfly and 600 species of bird. In the entire continental United States, only 400 species of butterfly and 700 species of bird have been recorded.Scientist Professor Norman Myers sees this situation as a gigantic " experiment we’re conducting with our planet " . " We don’t know what the outcome will be. If we make a mess of it, we can’t move to another planet…It’s a case of one planet, one experiment. What is an effective way to preserve biodiversity（）
The discovery of life beyond Earth would transform not only our science but also our religions, our belief systems and our entire world-view. For in a sense, the search for extraterrestrial life is really a search for ourselves--who we are and what our place is in the grand sweep of the cosmos.Contrary to popular belief, speculation that we are not alone in the universe is as old as philosophy itself. The essential steps in the reasoning were based on the atomic theory of the ancient Greek philosopher Democritus. Yet philosophy is one thing, filling in the physical details is another. Although astronomers increasingly suspect that biofriendly planets may be abundant in the universe, the chemical steps leading to life remain largely mysterious.Traditionally, biologists believed that life is a freak--the result of a zillion-to-one accidental concatenation of molecules. It follows that the likelihood of its happening again elsewhere in the cosmos is infinitesimal. This viewpoint derives from the second law of thermodynamics, which predicts that the universe is dying--slowly and inexorably degenerating toward a state of total chaos. And similar reasoning applies to evolution. According to the orthodox view, Darwinian selection is utterly blind. Any impression that the transition from microbes to man represents progress is pure chauvinism of our part. The path of evolution is merely a random walk through the realm of possibilities.If this is right, there can be no directionality, no innate drive forward; in particular, no push toward consciousness and intelligence. Should Earth be struck by an asteroid, destroying all higher life-forms, intelligent beings would almost certainly not arise next time around. There is, however, a contrary view--one that is gaining strength and directly challenges orthodox biology. It is that complexity can emerge spontaneously through a process of self- organization. If matter and energy have an inbuilt tendency to amplify and channel organized complexity, the odds against the formation of life and the subsequent evolution of intelligence could be drastically shortened.Historically, Bertrand Russell argued that a universe under a death sentence from the second law of thermodynamics rendered human life ultimately futile. All our achievements, all our struggles, "all the noonday brightness of human genius," as he put it, would, in the final analysis, count for nothing if the very cosmos itself is doomed. But what if, in spite of the second law of thermodynamics, there can be systematic progress alongside decay For those who hope for a deeper meaning or purpose beneath physical existence, the presence of extraterrestrial life-forms would provide a spectacular boost, implying that we live in a universe that is in some sense getting better and better rather than worse and worse. It is the belief of orthodox biology that Darwinian evolutionism（）
Selection to participate in a top executive-education program is an important rung on the ladder to top corporate jobs. U. S. corporations (1) billions of dollars in this form of management development -- and use it to (2) and train fast-track managers. Yet one (3) of executive education found that less than 5% of the managers (4) to these high-profile programs are women -- and minorities are terribly (5) as well.The numbers are (6) . In regular business (7) usually paid for by the participant, not an employer -- there are plenty of women and minorities. Women, for example, (8) for about 30% of MBA candidates. Yet in the (9) programs paid for by corporations that round out a manager’s credentials at a (10) career point, usually at age 40 or 45, companies are making only a (11) investment in developing female and minority executives. A case (12) point: Only about 30% of the 180 executives in Stanford’s recent (13) management program were women.Most companies say these days they are (14) hiring and promoting women and minorities-- and there are some (15) trends in overall employment and pay levels so why are companies (16) the ball when it (17) executive education The schools (18) that they are neither the cause of nor the cure for the problem. A Harvard Business School dean figures that companies are (19) of sending their female executives (20) they don’t want to lose them to competitors. 8（）
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