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　Bagehot
　　
　　英国事务（专栏名称）（后面有说明）
　　
　　Physician, heal thyself
　　
　　医生，救人先救已
　　
　　Jeremy Hunt’s battle with junior doctors exposes an awkward truth: Britons donot love the NHS
　　
　　Jeremy Hunt（英卫生大臣）与初级医疗工作者的争端揭露了英国人不待见其国民医疗服务体系的尴尬事实
　　
　　MEDICS are not in the habit of applauding their prosecutors. But cheer they did in their thousands at a demonstration in London on October 17th as Peter Stefanovic, amedical-negligence lawyer, rasped his disapproval of the health secretary’s plans to reform junior doctors’ contracts:“Mr Hunt seems to believe that if he says the samething over again, even if it’s bollocks, we’ll all believe it.” Many of these practical,mustn’t-grumble types—scrubson, stethoscopes around their necks and children on their arm—had never demonstrated before. “The change in attitude has been astounding,” one obstetrician told Bagehot: “people who would never have discussed politics before are fired up.”
　　
　　医生们并没有为他们的公诉人欢呼喝彩的习惯。但是在10月17号的伦敦示威中，他们中数千人为医疗事故律师Peter Stanfanovic怒反卫生部长改革医疗者工作合同的计划而欢呼。“Hunt先生似乎认为只要他一再地重复，即便是胡说八道，我们也会相信。”他们中有很多是埋头实干从不抱怨的类型，之前从未示威游行过。如今，脖子上挂着听诊器，胳膊上抱着孩子地加入了游行。一位产科医师告诉本专栏：“从不讨论政治的一群人也无法淡定了。”
　　
　　Something has snapped in the medical profession. Junior doctors (a misleading term encompassing quite senior medicswell into their 30s) work punishing hours in Britain’s strained National Health Service (NHS) and fret about making bleary-eyed mistakes. Burnout is common. Unlike their counterparts elsewhere,they must pay for their own training, indemnity insurance, car parking and even hot drinks at work. Many are leaving forAustraliaandNew Zealand,where conditions are better. For others, Jeremy Hunt’s proposals—under which “normal” working time will include evenings and Saturdays, reducing the top-up pay for antisocial hours—are the final straw.The British Medical Association (BMA), the doctors’trade union, is balloting for a strike.
　　
　　医疗领域中爆发了一些事件。初级医师（一个容易误导人的术语，包含了30多岁相当资深的医师）在英国紧张的NHS体制下，每天需要工作的时长让人精疲力尽，并且因超负荷工作导致的失误而烦恼。精疲力竭已是稀松平常。比起其他地方的同行，他们需要自己承担培训、赔偿保险、停车甚至工作中一杯热饮的费用。很多从业者都已前往澳大利亚和新西兰，那里的工作状况要好一些。对于留下来的那些人，Jeremy Hunt的提议是压死骆驼的最后一根稻草。提议中的“正常”工作时间包括晚上和周六，并且缩减加班补偿费用。英国医学协会（British Medical Association），即医生工会，正为罢工进行投票。
　　
　　Neither side, it is fair, has acquitted itself perfectly. The BMA has pulled out of netiations with the vernment without providing a decent justification for doing so and appears, at points,to have exaggerated the likely effect of the contract changes. Calling for the mild-mannered health secretary to resign, as its members do, is not constructive.
　　
　　无论哪一方都别想完全脱身，这样看来也是公平的。英国医疗协会已经退出了与政府的谈判，且并没有就退出提供一个像样的理由，并由此夸大了合同变更可能产生的影响。如同其成员做的一样，他们要求温和派的卫生部长辞职并没有助益。
　　
　　On the central points, however, the junior doctors are right. Mr Hunt has scare mongered about the higher death ratein the NHS at weekends and his talk of a “seven-day NHS” has needlessly insulted doctors who already work seven-day weeks.He wants to get more work out of the same workforce (“anunusually productive part of the public sector”, notes Andrew Haldenby of Reform, a pro-market think-tank) and for the same overallcost. Though the vernment is vague about the precise effect of the revisedcontracts, independent analysis suggests that pay cuts could hit most juniordoctors and will almost certainly affect those in high-pressure fields with abnormalhours, such as accident and emergency, obstetrics and anaesthetics. Yet thedoctors should not just blame the health secretary. On a deeper level, their beef is with the British public.
　　
　　然而更重要的是，初级医生们是对的。亨特先生危言耸听地说，周末时卫生服务体系下病人的死亡率变得更高，而他七天工作制的谈论也冤煞了那些接连几周都没有休息日的医生们。他想相同的成本得到更多的劳动力（公营部门不同寻常地创造经济价值的方法，改革，一个亲市场智囊团中的Andrew Haldenby指出。）尽管政府对修订后合同的确切效果十分含糊其辞，但独立分析表明，减薪会影响大多数初级医生，也几乎肯定会影响到高压科室工作者异常情况下的表现，比如急诊室，妇产科和麻醉科等。然而，医生不该只是指责卫生部长。在更深层次上，他们的薪水是与英国公众相关的。
　　
　　Though the health budget has been spared the cuts of the past years, it has remained flat at a time of rising pressures: the population is becoming older and fatter. Waiting lists have hit seven-year highs. Austerity in other areas, most not ably social care, has leftfolk in expensive hospital beds who should be at home. A year a Simon Stevens, the chief executive of NHS England, published an ambitious plan of reforms to do more with less, most of which involve stopping people from getting ill in the first place and diagnosing their problems faster. Another solution, propounded by Sir Bruce Keogh, the NHS medical director, is to expand evening and weekend services in order to cut waiting lists and make better use of operating the a tres. Some of this can be done by procedural changes like those already in practice in “seven-day” trusts such as Salford.
　　
　　尽管在过去的几年里卫生预算一直没被削减，但压力不断上升，如人口老龄化、肥胖化，它也一直保持相同水平。候诊名单已经达到了7年新高。其他领域都在紧缩，尤其是社会保健，这使得那些本应该呆在家里的人们都躺在了医院昂贵的病床上。一年之前，英国NHS的首席执行官西蒙·史蒂文森（SimonStevens）发表了一个雄心勃勃的“少花钱多办事”改革计划。其中大部分都涉及第一时间预防疾病和快速诊断。NHS的医疗主任布鲁斯·基奥爵士（Sir BruceKeogh）提出了另一个解决方案，那就是扩大晚上和周末服务时间来削减等候名单，并优化手术室的使用。其中一些可以通过程序变化来进行，像那已经在索尔福特实行的“7日”信托。
　　
　　But as both Sir Bruce and the board advising the vernment on NHS pay have argued, it will also cost more money.Of that there is little. In England, the service faces a £30 billion ($46 billion)shortfall by 2020. The vernment is increasing spending by £8 billion—details of which will emerge next month—but that still leaves £22 billion of savings to be made. So the health secretary has to netiate seven-day working with no extra money to oil the wheels.
　　
　　但是就像Bruce先生和董事会对政府的NHS花费建议中指出，这将提升费用。这笔钱可不是小数目。到2020年英国该服务面临300亿英镑（460亿美元）的差额，政府决定增加支出80亿英镑，具体细节将在下月推出，但是仍然有220亿需要补全。因此使得卫生局长在七天的谈判工作中连加油的钱都够呛。
　　
　　The apathy that dare not speak its name
　　
　　冷漠不敢言其名
　　
　　The question is: isBritainwilling to pony up? It is acliché to talk of the NHS as the country’s secular religion, a service still adored in the context of the post-war era in which it was born. But as the collectivist after glow of that age fades, each generation is less misty-eyed than the last. Like a tired marriage held together only by the tax benefits, Britons’ purported love affair with the NHS has become transactional. They are horrified by America’s private insurance system and like the services that they and their nearest use, but less out of “love” than out of a baser enthusiasm: for od stuff at low cost. ThusBritainspends relatively little on health as a share of its GDP, and ever-less in comparison with other rich countries. The essential fact circumscribing Mr Huntis that, according to the Kings Fund, a health think-tank, 72% of Britons think the NHS should provide all drugs and treatment at any cost, but only 38% are willing to pay more tax for it. The junior doctors are caught between those figures.
　　
　　问题在于：英国是否愿意掏钱付帐呢？这对于NHS来说是老生常谈了，诞生于二战后的它在那个年代犹如这个国家的世俗宗教一般。然而，正如集体主义者在那个正在消逝的时代的残阳下苦苦支撑的那样，每一代都越来越不理解老一代对NHS的深切感情。正如一段只能靠税收方面的利益来维持的疲倦婚姻那样，，英国人与NHS的恋情已是过往云烟。他们被美国的私人保险体制惊吓到，更喜欢他们和他们附近国家所使用的服务，但是这种喜欢更多的是出于不纯正的热情，而不是出于热爱：为了物美价廉。况且，英国在健康方面所花费的GDP比重很少，跟其他富裕的国家相比就更少。根据一个健康智囊团——国王基金会的统计，限制亨特先生最重要的事实是，72%的英国人认为，NHS无论花费什么代价都应该提供所有药物和治疗，然而却只有38%的受访者愿意为之缴纳更多的税。初级医师受困于这样的数据之中。
　　
　　A reality check is thus long overdue.The new Conservative vernment has a majority and faces a Labour oppositionineffectual in most respects and especially on health (on which it screeches about privatisation irrespective of what the vernment actually does). So letMr Hunt, along with the prime minister and chancellor of the exchequer,confront voters with the truth: if Britons love their tax-funded health systemso much and want it to work, they will have to pay more for it. And if not,they should start considering the alternatives: probably a social insurance system akin to that used elsewhere in Europe.The objection to such a shift—that the tax payer-funded model is more efficient—is correct, but counts for little if the status quo is politically unworkable. It may be that a more individualistic, consumerist country simply needs a more individualistic,consumerist health service; one of personal accounts, more choice and clearer rights and responsibilities. Perhaps it is time for that divorce.
　　
　　现状核实因此长期缺失。保守党政府拥有更多席位，使得对立的工党在很多方面都反对无效，尤其是健康方面（无论政府实际所做，它只管尖喊着民营化）。因此让享特先生、首相和财政大臣以事实面对选民：如果英国人如此喜欢这种基于税收的健康系统并且想要让它持续运行，他们就得缴纳更多的税。然而并不喜欢，他们就应该开始考虑备选方案：可能是一个跟欧洲其他地方相似的社保系统。对于这样的转变的反对意见是是正确的，因为税收出资的模式更为有效，但是对于现状来说，它很可能在政治上行不通。这很可能只是一个更加个体化、更加消费主义的国家需要一个更加个体化、更加消费主义的卫生服务;个人账户中的一个，更多选择和更加清晰的权责。或许是时候割舍了。
　　
　　白芝浩（Walter Bagehot），英国最著名的经济学家、政治社会学家和公法学家之一。后人认为，白芝浩是《经济学人》历史上最伟大的主编，“或许是《经济学人》的编辑们永远试图接近但无法超越的楷模”。为纪念他的卓越贡献，后来闻名于全世界的《经济学人》将其有关英国政治的专栏命名为“白芝浩专栏”。

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