If health-care reform lags slightly behind American Idol as a water-cooler topic in your office, it might be because you're one of the 160 million — or 3 out of 5 non-elderly Americans — whose employers pony up for your insurance. That cushy deal is changing, thanks to Americans' Oreo-eating, couch-hugging, nicotine-clinging ways. Soon the boss may tell employees to get healthy — or get lost.
如果卫生保健改革这个话题在你办公室里已像冷却水器一样被抛到“美国偶像”之后（美国著名选秀节目），这可能是因为你是一亿六千万个由老板付保险金的职员之一，或者说属于3/5还算年轻的美国人。而多亏了美国窝在沙发上、大嚼甜食、狂吸尼古丁，这些本来轻松的行为正在发生变化。很快，老板就会告诉你要么就保持健康，要么就卷铺盖走人。
The health-care contract between American workers and their employers began when Franklin D. Roosevelt left health care out of his New Deal. Labor restrictions, tax breaks and accounting rules induced employers to offer private health insurance to workers. In 1940, 21 million Americans were enrolled in company-sponsored health plans; by 1950, 142 million. Privatized health insurance seemed like a glorious triumph for capitalism. Keep government out; let industry thrive!
美国工人和他们的雇主之间签订的健康保健合同源于富兰克林罗斯福的健康保健新政。劳动限制、减免税收和会计规则使得雇主得为他的员工支付私人健康保险。1940年，210万美国人在公司资助的健康计划中注册；到了1950年，1.42亿的私人化健康保险可以看做是资本主义的显赫战功。让政府出局，企业昌盛。
Then costs exploded. Health-care expenditures in the U.S. totaled $27 billion in 1960; in 2005, $2 trillion. Oh, workers paid their part, in the form of premiums and co-pays. But as benefits grew more generous, employees' contributions shrank, from 48% of all health-care costs in 1960 to 15% in 2000, according to the New England Journal of Medicine. Employers balked. So, along came managed care, as well as a jumble of other cost-tamping innovations, including high-deductible plans and health-savings accounts.
然后成本暴增。1960年美国保健支出额是27亿；2005年上升到了2万亿。当然，员工以奖金和差别补贴（ co-pays）*1的方式支付他们的那部分。但是随着津贴的上涨，员工支付的部分正在缩水。依照《新英格兰医药杂志》的统计，员工在保健花销上支付比例从1960年的48%降到了2000娘的15%。雇主们开始停步不前。所以，又出台一系列管理办法和名目繁多的福利保险革新，包括高额扣除保健计划和健康储蓄帐户。
The latest innovation may wind up having the biggest impact of all: a crackdown on workers' poor health habits involving both the carrot and the (cancer) stick. See, American workers today are about as fit as caged hamsters with all-day access to the nut bowl. Our collective obesity, inactivity and refusal to part with the smokes have led to diabetes, heart disease and cancer. Who foots the bill? The boss. Who gets the blame? The boss. More than half of us cite work demands for our refusal to put down the Ho Hos and do a push-up. Eighty-four percent of Americans say we'd get healthy — honest — if only the boss insisted.
最近的革新可能会掀起一次极大的冲击:遏制员工恶劣的健康习惯，其中包括蜜糖加大棒政策。可以看看，今天员工的健康状况和那些常年关在笼子里守着食盆的大型啮齿类动物无异。集体性肥胖、长期处于精止状态及不肯戒烟的生活习惯已引发糖尿病、心脏病和癌症。谁会为这些买单？老板。谁成责骂的众矢之的？还是老板。我们中有超过一半的人把工作需要作为不肯戒掉高脂甜食（Ho Hos ——Hostess company 食品公司生产的一种高热量高脂肪蛋糕）反而变本加厉的借口。84%的美国人说如果他们老板坚持原则的话，他们肯定能保持健康的。
The boss is insisting. Verizon Wireless, Microsoft and Dow Chemical dangle cash bonuses for workers who lose weight or stop smoking. A growing number of employers assign "health coaches" to monitor workers' diets and lifestyles. Two-thirds of companies offer so-called wellness programs. Office-furniture maker Steelcase is marketing a treadmill equipped with a computer: a hamster wheel with e-mail.
老板坚持原则了
Verizon无线、微软和道琼斯化工制定奖励政策，为那些减肥和戒烟的员工提供现金分红。越来越多的雇主实施了“保健指导”项目，以监控员工饮食和生活习惯。2/3的公司提供所谓的健康工程。办公室家具制造商Steelcase 时下也推出了一种带电脑的脚踏车：于是员工就成了脚踏e-mail轮的大老鼠。
Some bosses are done being nice. They're firing workers for smoking, and they're screening job applicants for nicotine. Your home is no haven: Gary Ross of San Francisco was canned by a telecommunications company for using legal, medically prescribed marijuana to ease chronic back pain from injuries sustained in the Air Force. In December, a state court upheld the firing. With costs rising, count on employers to keep truffling for ways to save a buck. Count on higher premiums and deductibles, tighter restrictions on treatments, more intrusive screening and monitoring. Don't be gobsmacked if genetic testing figures into employment sooner or later. Or if want ads begin to ask for — along with fluency in Java — a clean bill of health.
有些老板采用了更行之有效的办法。他们会以吸烟为由解雇员工，给求职者放映有关尼古丁的教育片。你这儿可不是天堂：旧金山的Gary Ross 被一家通信公司解雇，就因为他使用合法、有医生处方的大麻来减缓在空军部队服役时遗留的伤痛。12月，国家法院支持这些解雇条款。而员工为了保住饭碗不得不戒掉甜点，随着较高的津贴和扣除保健保险计划、加大限制力度和教育放映屏及监视器的投入，在保健上的成本越来越高。有着一日就算基因检测指数用到员工雇佣系统也不必大惊小怪。或者随着Java 语言的普及，可能广告也在找寻一种清洁的健康证书。
译注1：A type of insurance policy where the insured pays a specified amount of out-of-pocket expenses for health-care services such as doctor visits and prescriptions drugs at the time the service is rendered, with the insurer paying the remaining costs. However, unlike coinsurance where the insured is required to pay a certain percentage of the covered costs, co-pay plans require the insured to pay a specified dollar amount.
译注2：A High Deductible Health Plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is sometimes referred to as a catastrophic health insurance plan.
