For all it flaws, medical care in the United States has been reformed gigantically over the past several decades. Deaths from heart disease have fallen by 40 percent since 1970. thanks to better detection and treatment, cancer advances have helped to raise U.S. life expectancy from an average of 68 years in 1950 to 77 years today.
　　Not only have American lives grown longer, but their quality has improved. The proportion of people over 65 with one or more chronic disabilities—such as the inability to walk, or to get dressed, without aid—declined from greater than 25 percent in 1982 to less than 20 percent in 1999. and the development of vision-correction surgery, among many other drugs and procedures, has allowed many Americans to prolong pleasures historically with youth.
　　Of course, not all the recent improvements in American health and longevity can be directly attributed to our health-care system; some are as much the result of adopting healthier habits( exercise, better diet) or of dropping unhealthy ones (smoking, too much alcohol-drinking). Still, better medical care is the principal cause of improvements in American health and life span over the past 50 years.
　　But the problem is that since 1960 health-care spending has grown significantly faster than the economy, meaning that we’re spending an ever larger portion of our incomes on medical core. In 1960 health care constituted 5.1 percent of the U.S. economy; in 1980 it constituted 8.8 percent; today it constitutes 13.3 percent. Meanwhile, private health-insurance premiums—which rose by 14 percent last year alone —are becoming unaffordable for ever Americans. The number of things we can do to pay for them. 41 millions of our citizens are now uninsured. So the key question is not whether health care should be rationed in the United States; it already is. Rather the question is how health care should be rationed. How should the potential benefits of reduced pain, improved quality of life, or extended life be weighted against the high costs of the medications or procedures involved? And who should weigh them? These are hard questions with high moral stakes. But we do hope that the health-care system will cover more people.
　　参考译文:
　　因为存在缺陷，所以美国的医疗保健在过去几十年里进行了重大改革。心脏疾病导致的死亡自1970年以来下降了40%。由于较先进的监测和治疗，癌症死亡率自1990年以来一直处于下降趋势。总的来看，医疗进步使美国人均寿命从1950的68岁提高到现在的77岁。
　　美国人不仅提高了寿命，而且还提高了生活质量。65岁以上患有至少一种长期残疾——如在无人帮助下不能独立行走，或不能自己穿衣——的比例从1982年的20%以上下降到1990年的20%以下。视力矫正手术的发展，以及其他药品和治疗程序的发展，使得许多美国人历史性地延长了与年轻有关的生活乐趣。
　　当然，并不是美国人健康和长寿方面取得的所有进步都直接归功于我们的医疗保健系统。有些是养成健康习惯(锻炼身体、合理饮食)或戒除不健康习惯(吸烟、过量饮酒)的直接结果。然而，良好的医疗保健依旧是过去50多年来产美国人健康改善和生命延长的主要因素。
　　但问题是，自1960年以来，医疗保健费用的增长速度远远超过了经济增长速度，这意味着我们的收入中用于医疗保健上的比例越来越大。1960年医疗保健费用占美国经济的5.1%;到1980年的时候，就升高到了8.8%;而现在已达到13.3%了。与此同时，私人健康保险费用——仅去年一年就上升了14%——让越来越多的美国人感到难以承受。我们为健康而采取措施的数量已经超过了美国人的承受能力。目前有4100万人口还没有上医疗保险。因此，关键问题不是在于美国医疗保健是否应该定量配给，因为我们已经实现了这个目标，而是在于医疗保健怎样定量配给。美国人民在痛苦减少、生活质量改善或寿命延长等方面所获得的潜在益处，怎样才能抵消伴随而来的药品或就医高消费呢?谁来负责平衡呢?没有很高的道德责任，这些问题是难以解决的。但是，我们还是希望医疗保健系统能够涵盖更多的人。