PASSAGE 36

　　Health Care Reform

　　This fall the country will be talking health care again-or at least should be talking about it-as Congress moves to change the principles on which Medicare and Medicaid were established 30 years ago. A writer with a taste for irony could scarcely conceive a better plot, and as one of those who wrote the Clinton plan, I confess it strikes me as more than ironic.

　　Two years ago, Republicans were denouncing the secrecy surrounding the President's health care task force. This summer, Republicans have been meeting "behind closed doors" on a Medicare proposal scheduled to be released later this month, only a few weeks before Congress votes on it, thereby avoiding independent analysis of the costs, mobilization by opponents and other inconvenient aspects of a long national debate. Two years ago, the Republicans rang alarms about the Clinton plan's emphasis on managed care. Now the Republicans' own plans for Medicare and Medicaid emphasize managed care.

　　But superficial similarities are deceiving. The reform plans of 1993 generally aimed to extend rights to health coverage and health care; The Republican proposals this year would retract rights that already exist. The debate two years ago reflected a widespread belief that the health care system needed reform. The Republicans, like many in the business world, now begin with the happy thought that the system is reforming itself and that Government needs to be more like the private sector.

　　The health care system is certainly going through profound change. Health maintenance organizations and other forms of managed care are expanding rapidly. As managed care grows, demand for hospital care shrinks. Hospitals are merging, closing beds and cutting jobs; some new buildings stand vacant. The incomes of specialists in some areas are dropping, and primary-care practitioners are in demand. Once stubbornly independent physicians are selling their practices to hospitals and insurers or taking a fixed payment per enrolled patient and accepting the discipline of the corporation.

　　1. What is the writer's attitude towards the Congress's move to change the principles on which Medicare and Medicaid were established 30 years ago?

　　A) Ironic

　　B) Humorous.

　　C) Sympathetic

　　D) Critical.

　　2. The phrase "behind closed doors" in the second paragraph could best be replaced by which of the following?

　　A) At home

　　B) In secret

　　C) In a room secure from attack

　　D) In prison

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