Directions: In the following text, some sentences have been removed. For Questions (41-45), choose the most suitable one from the list A-G to fit into each of the numbered blank. There are two extra choices, which do not fit in any of the gaps. Mark your answers on ANSWER SHEET 1. (10 points)
Canada's premiers (the leaders of provincial governments), if they have any breath left after complaining about Ottawa at their late July annual meeting, might spare a moment to do something, together, to reduce health-care costs.
They're all groaning about soaring health budgets, the fastestgrowing components of which are pharmaceutical costs.
What to do? Both the Romanow commission and the Kirby committee on health care-to say nothing of reports from other experts-recommended the creation of a national drug agency. Instead of each province having its own list of approved drugs, bureaucracy, procedures and limited bargaining power, all would pool resources, work with Ottawa, and create a national institution.
But "national" doesn't have to mean that "National" could mean interprovincial-provinces combining efforts to create one body.
Either way, one benefit of a "national" organization would be to negotiate better prices, if possible, with drug manufacturers. Instead of having one province-or a series of hospitals within a province-negotiate a price for a given drug on the provincial list, the national agency would negotiate on behalf of all provinces.
Rather than, say, Quebec, negotiating on behalf of seven million people, the national agency would negotiate on behalf of 31 million people. Basic economics suggests the greater the potential consumers, the higher the likelihood of a better price.
A small step has been taken in the direction of a national agency with the creation of the Canadian Co-coordinating office for Health Technology Assessment, funded by Ottawa and the provinces. Under it, a Common Drug Review recommends to provincial lists which new drugs should be included. Predictably, and regrettably, Quebec refused to join.
A few premiers are suspicious of any federal-provincial deal-making. They (particularly Quebec and Alberta) just want Ottawa to fork over additional billions with few, if any strings attached. That's one reason why the idea of a national list hasn't gone anywhere, while drug costs keep rising fast.
Premiers love to quote Mr. Romanow's report selectively, especially the parts about more federal money. Perhaps they should read what he had to say about drugs: "A national drug agency would provide governments more influence on pharmaceutical companies in order to try to constrain the ever-increasing cost of drugs."
So when the premiers gather in Niagara Falls to assemble their usual complaint list, they should also get cracking about something in their jurisdiction that would help their budgets and patients.
[A] Quebec's resistance to a national agency is provincialist ideology. One of the first advocates for a national list was a researcher at Laval University. Quebec's Drug Insurance Fund has seen its costs skyrocket with annual increases from 14.3 percent to 26.8 per cent!
[B] Or they could read Mr. Kirby's report: "The substantial buying power of such an agency would strengthen the public prescription-drug insurance plans to negotiate the lowest possible purchase prices from drug companies."
[C] What does "notional" mean? Roy Romanow and Senator Michael Kirby recommended a federalprovincial body much like the recently created National Health Council.
[D] The problem is simple and stark health-care costs have been, are, and will continue to increase faster than government revenues.
[E] According to the Canadian Institute for Health Information, prescription drug costs have risen since 1997 at twice the rate of overall healthcare spending. Part of the increase comes from drugs being used to replace other kinds of treatments. Part of it arises from new drugs costing more than older kinds. Part of it is higher prices.
[F] So, if the provinces want to run the healthcare show, they should prove they can run it, starting with an interprovincial health list that would end duplication, save administrative costs, prevent one province from being played off against another, and bargain for better drug prices.
[G] Of course, the pharmaceutical companies will scream. They like divided buyers, they can lobby better that way. They can use the threat of removing jobs from one province to another. They can hope that, if one province includes a drug on its list, the pressure will cause others to include it on theirs. They wouldn't like a national agency, but selfinterest would lead them to deal with it.
41.【解析】[E]空白前的一段说：They're all groaning about soaring health budgets, the fastest-growing components of which are pharmaceutical costs(省长们都在抱怨医疗成本飞涨，其中涨得最快的就是药品的费用)。在这句话中，谈论的关键是pharmaceutical cost(医药成本)，同时我们注意到文章的第一段谈论的主题也是关于health costs(医疗成本)的问题，因此可以判断文章下一段谈论的话题一定围绕"药品成本"展开，也就是"药品成本"这个概念会在下面的一段文字中复现。对比选项，只有选项[E]中出现了关于"药品成本"(drug costs)的论述，同时从内容上来看，试题前面的句子说"药品的成本飞涨"，选项[E]对前面的句子作了补充说明，解释了药品上涨的原因(Part of the increase comes from drugs being used to replace other kinds of treatments. Part of it arises from new drugs costing more than older kinds. Part of it is higher prices)。
42.【解析】[C]试题前的一段提到了要成立全国性的机构(create a national institution)，并讲到了它的特点。空白后的一段以But 开头，解释national 的含义："National" could mean interprovincial-provinces combining efforts to create one body("全国性"也可以说是省际间的，也就是说，各省可以共同努力成立一个机构)， 试题的前后都出现了关于national的信息，由此可以判断，要填入的句子中一定会复现关于national的内容，比较选项可以发现选项[A]和选项[C]中出现了关于national的复现信息，但选项[A]讲的是Quebec's resistance to a national agency(Quebec对国家医疗机构的抵制)，作者对national的定义还没有交代清楚之前，不可能出现选项[A]中的信息，因此选项[C]是正确答案。
43.【解析】[G]试题前的一段讲到the national agency would negotiate on behalf of 31 million people. Basic economics suggests the greater the potential consumers, the higher the likelihood of a better price(全国的机构是代表3100万人去谈判，潜在的顾客的人数越多，得到底价的可能性越高)。通过这段话可以得知，建立全国性机构后，医药的价格会下降，医药公司会做出反应，即上一个段落和本题之间是因果关系。因此选项[G]是正确答案。选项[G]中的of course 起承上启下的作用，表达了某种因果关系，从of course后面的语义来看，表达的正是关于医药公司的内容：Of course, the pharmaceutical companies will scream，这儿的scream 原作"尖叫"解，在这里作"高声抱怨"解。因此选项[G]是正确答案。
同时，本题还可以根据和后面一个段落之间的关系做出选择。从后面一个段落的第一句话A small step has been taken in the direction of a national agency来看，讨论的是如何解决国家机构的问题，这是一个表示结果的句子，由此可以推知要填入的试题中一定会出现关于如何对待national agency的论述。选项[G]的最后一句话They wouldn't like a national agency, but selfinterest would lead them to deal with it表达的正是这个含义，不论从内容上，还是从措辞上和下文的内容非常的衔接，因此是正确答案。
44.【解析】[F]从上下文的篇章逻辑发展来看，上文语段11中出现了关于原因的问题，而此选项中的"So"，能够与上文构成因果逻辑发展关系。其二，从上下文的概念一致性来看，选项中的"provinces"，"healthcare"，"interprovincial"，"costs"，"better drug prices"在原文上下文中反复出现，可构成较好的一致性。其三，本选项与第一自然段在情感、逻辑、概念上构成了最好的一致性，与下文语段13构成了很好的连贯性。至少从以上三个角度来看，本选项为12语段的最佳选择。