Reading Passage 1

The real cost of drugs

A. On the television, via email, in newspapers and magazines – in almost every form of media you will find advertising and promotion for pharmaceutical drugs. However, unless they are subsidised at a government level, many of these drugs can be extremely expensive and prices are rising quickly. Americans alone now spend a staggering $200 billion a year on prescription drugs, and that figure is growing at a rate of approximately 12 percent a year. According to Medical Administrator Susan Miller, prescription drugs are the fastest-growing portion of the overall health care bill in the United States. Ms Miller explains that the increase in spending on pharmaceuticals reflects, in almost equal parts, the fact that society is taking significantly more prescription drugs than previous generations, that those pharmaceuticals are more likely to be expensive new ones rather than older, cheaper ones, and that the prices of the most heavily prescribed drugs are routinely increased by industry, sometimes as often as several times a year.

B. Pharmaceutical company Chairman Simon Bell defends the high price of prescription drugs as inevitable in the light of research and development costs being enormous, and the high costs justifiable, since innovative medicines are vital as they lengthen life, improve quality of life and counteract the need for more expensive health care. But why, opponents of the pharmaceutical corporate argue, do prices of the more popular drugs need to be increased by so much and so often? Before its patent ran out, for example, the price of Schering-Plough’s top-selling allergy pill, Claritin, was raised thirteen times over five years, for a cumulative increase of more than 50 percent—over four times the rate of general inflation. Spokeswoman for one of the corporates accused of over-pricing, Lynne Bennett, explains that high prices and regular price hikes on the more popular products is not a sign of greed, but an opportunity to bring in higher revenue which can then be utilised for research and development of treatments for less common ailments and conditions.

C. Janet Abbotts, a prominent social services specialist believes that covering the cost of prescription drugs is no longer a problem of the ‘poor’ alone. The shape of healthcare provision in America – who is now paying for what – has inevitably changed as a result of economic recession, and the current situation now means that an even higher proportion of the population may struggle to obtain the pharmaceuticals they need. Abbotts believes that in times of economic difficulty, health insurance provision by employers will inevitably shrink. As one of the means of tightening overall corporate budgets, Janet says that there has been a definite trend towards employers requiring their staff to pay more towards the costs of healthcare themselves. In fact, Abbotts says, many businesses are going as far as dropping health benefits for workers altogether. Since prescription drug costs are rising so quickly, the current payers of the overall medical insurance bill – employers, are particularly eager to shift such costs to individuals. The result is that even where medical insurance bills are part of the employment contract, more and more companies are moving towards clauses where individuals have to pay a greater fraction of their drug bills themselves.

D. Many observers believe that the sector of society most often adversely affected by higher pharmaceutical prices are retired people with no, or restricted, earning potential and an often increased need for medical intervention. Naturally, the elderly tend to need more prescription drugs than younger people—mainly for chronic conditions like arthritis, diabetes, high blood pressure, and elevated cholesterol which are more prevalent in old age. Medical improvements and developments have actually widened the gulf between this group’s needs for and actual access to the pharmaceuticals required says Peter Stantham, founder of Age Today, a leading charity supporting the elderly.

E. He explained that when Medicare was introduced in the USA in 1965, people in general took far fewer prescription drugs and that the pharmaceuticals they did take were cheap – senior citizens at that time could generally afford to buy whatever they were prescribed, without the need for payment by an insurance company. How times have changed, says Stantham. Currently research estimates that only approximately half to two thirds of America’s elderly have supplementary insurance that partly covers prescription drugs, and for future generations it is anticipated that percentage will drop even more significantly, as employers and insurers move away from providing the comprehensive cover enjoyed by previous generations. Stantham references one study which was conducted as far back as 2001 in the U.S. which disclosed that nearly one in four senior citizens reported that they deliberately skipped some doses of their medication or did not even take prescriptions given to them by doctors to pharmacies for pick up at all because of the cost.

F. Susan Miller, objects most strongly to a pharmaceutical industry pricing practice that she believes actively disadvantages the elderly and other groups who have the greatest need for pharmaceutical products but can least afford them. The practice means that Medicare recipients without supplementary insurance (this group being most highly represented by the elderly and the poor) pay much more for pharmaceuticals than favoured customers, such as large HMOs (health maintenance organisations which provide medical healthcare coverage) or the Veterans Affairs (VA) system (which provides medical healthcare coverage for ex-military personnel). Because such concerns purchase in bulk, Miller explains, they are able to bargain for significant discounts or rebates. On the other hand, people without insurance have no bargaining power and so they pay the highest prices.

Reading Passage 1

You should spend about 20 minutes on Questions 1 – 15 which are based on Reading Passage 1.

Reading Passage 2

The Golden Gate Bridge

A. The Golden Gate Bridge stretches across the Golden Gate – the opening of the San Francisco Bay onto the Pacific Ocean. It was first named Chrysopylae, meaning golden gate, by Captain John C. Fremont in 1846. It is a suspension bridge that is crossed by thousands of cars, bicycles and people each day, and links San Francisco with Marin County. Marin Headlands is a place where people enjoy the views that stretch from Golden Gate Park to Alcatraz Island, the latter being the home of the famous prison that each year attracts thousands of tourists from around the world.

B. Alcatraz Island, often referred to as the Rock, is located 2.4 km offshore from San Francisco. The small island early-on served initially as a lighthouse, then later a military fortification, a military prison, and most famously as a federal prison until 1963. Later, in 1972, Alcatraz became a national recreation area, and now the island is a recognised historic site operated by the National Park Service as part of the Golden Gate National Recreation Area and is open to tours. Visitors can reach the island by ferry ride from Pier 33, near Fisherman’s Wharf in San Francisco.

C. The United States Disciplinary Barracks on Alcatraz was acquired by the United States Department of Justice on October 12, 1933, and the island became a federal prison in August 1934. Over the years of its operation, the jail held many famous criminals including the infamous Al Capone, and Robert Franklin Stroud (later depicted in the movies as the Birdman of Alcatraz). The island also provided housing for the Bureau of Prison staff and their families. During its 29 years of operation, the jail claimed no prisoners had ever successfully escaped. Prisoners are recorded to have been involved in only fourteen escape attempts, two men trying twice. Twenty three would-be escapees were caught, six were shot and killed during their escape, and three were lost at sea and never found. The most violent incident occurred on May 2, 1946 when a failed escape attempt by six prisoners led to the so-called Battle of Alcatraz.

D. Joseph Baermann Strauss, who would go on to become the Chief Engineer involved in construction of the Golden Gate Bridge, spent his life envisaging building a bridge that could stretch across the Golden Gate. Strauss was an engineer born in Cincinnati, famous for building bridges in the US, and decided to make his dream a reality. The Golden Gate Bridge was completed after four years of construction work. The final cost to build it was $35 million US dollars. Only eleven lives were lost during construction of the bridge, a new safety record for the time. In the 1930s, bridge builders expected one fatality per $1 million in construction costs, thus builders expected 35 people to die while building the Golden Gate Bridge. One of the bridge’s safety innovations was a net suspended under the floor. The Golden Gate Bridge opened to the public in 1937 and at 12 o’clock noon President Roosevelt pressed a telegraph key in the White House announcing the event. Though Strauss lived to achieve his engineering ambition, he died one year subsequent to completion of the project.

E. The Golden Gate Bridge has helped to build fame for San Francisco and is today the city’s biggest icon. It was built based on an Art Deco theme. Wide ribbing on the horizontal tower bracing emphasises the sun’s light on the bridge. The tower stands 500 feet above the road. The architect Irving Morrow was hired by Strauss to paint the bridge orange to match the setting and surroundings of the bridge, whilst still being easy to see for passing ships. There were a total of 38 painters that worked on the bridge, along with 17 ironworkers who replaced corroding steel and rivets.

F. The Golden Gate bridge is a 5 lane bridge which stands at around 400 feet in height. Tolls are collected but only on the way in (going south). Before the bridge existed, the only way to travel between San Francisco and Marin County was by ferry boat. The ferry service began for purposes of transporting water to San Francisco. The Sausalito Land And Ferry Company launched in 1867 and then became the Golden Gate Ferry Company. It took approximately 20 minutes to cross and cost $1.00, the price was later dropped to compete with the second travel option of the new bridge. The Golden Gate Bridge was the bridge with the longest span in the world from its completion until the Verrazano Narrows Bridge was built in New York in 1964. Today, it still has the seventh-longest main span in the world.

G. At the southern most end of the Golden Gate Bridge is Fort Point. Fort Point was designated a National Historic Monument on October 16, 1970. It was made from brick in 1853–1861 at the beginning of the Civil War to protect San Francisco from attack by sea. Spain had built an adobe structure on top of a white cliff at Fort Point’s current location in 1793–94. A number of other locations on both sides of the golden gate were developed as gun batteries for later conflicts such as WWII. Fort Point was also used as a base of operations for building the Golden Gate.

H. About 40 million crossings over the Golden Gate Bridge are made per year, counting both north- and southbound crossings, compared to 33 million crossing the first year it was open. An unbelievable amount of visitors and each day the list continues to grow as tourists flock to visit San Francisco’s Golden Gate Bridge.

Reading Passage 2

You should spend about 20 minutes on Questions 16 – 28 which are based on Reading Passage 2.

Reading Passage 3

Reading Passage 3

You should spend about 20 minutes on Questions 29 –40 which are based on Reading Passage 3.

33.

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36.