民主党人乔什·图雷克将爱荷华州不断上升的癌症发病率作为其参议院竞选的核心议题。他明显的策略是什么？恐吓选民，以推动政府扩大对医疗保健的控制。这最终将损害癌症患者的利益。
Democrat Josh Turek has made Iowa’s rising cancer rates a focal point of his Senate campaign. His apparent strategy? Scare voters in service of expanding government control over healthcare. This would ultimately hurt cancer patients.
爱荷华州人理所当然地担忧，“鹰眼州”拥有全美第二高的年龄调整后新发癌症率。从2000年到2013年，爱荷华州的总体癌症发病率大致与美国平均水平持平，但此后爱荷华州的发病率持续上升，而全国水平却在下降。
Iowans are understandably concerned that the Hawkeye State has the second-highest age-adjusted rate of new cancers among states. Iowa’s overall cancer incidence roughly tracked the U.S. average from 2000 to 2013, but rates have since risen in Iowa while declining nationwide.
[音频] 德克萨斯州参议院竞选的结案陈词 作为州众议员的图雷克将责任归咎于受污染的农田水体径流，尽管支持其理论的证据薄弱。“真正的问题是水和硝酸盐，”图雷克最近在与癌症患者的圆桌会议上表示。“每一位爱荷华人都理应在打开水龙头时，确信流出的水是洁净的，不会致癌。”几乎没有证据表明硝酸盐或农药正在推高爱荷华州的癌症发病率。
[audio] Closing Arguments in the Texas Senate Race Mr. Turek, a state representative, blames polluted farm water runoff despite the thin evidence for his theory. “The real issue is the water and the nitrates,” Mr. Turek said at a recent roundtable with cancer patients. “Every Iowan deserves when they turn on the tap to ensure that their water is clean and not giving them cancer.”There’s scant evidence that nitrates or pesticides are driving Iowa’s rising cancer rates.
爱荷华大学上月发表的一项研究发现，行为和人口统计学因素占爱荷华州成年人五大最常见癌症（乳腺癌、前列腺癌、肺癌、结直肠癌和黑色素瘤）较高癌症负担的76%。
A study by the University of Iowa published last month found that behavioral and demographic factors accounted for 76% of Iowa’s higher cancer burden among adults for the state’s five most common cancers (breast, prostate, lung, colorectal and melanoma).
与全美整体相比，爱荷华州的肥胖率和酗酒率更高。这两者都会增加患乳腺癌、结直肠癌及其他癌症的风险。当研究人员将爱荷华州与具有相似人口统计特征和行为风险因素的州（明尼苏达州、内布拉斯加州、北达科他州、南达科他州和威斯康星州）进行比较时，爱荷华州不再是一个显著的异常值。
Iowa has higher obesity and binge-drinking rates than the U.S. as a whole. Both increase the risk of breast, colorectal and other cancers. When researchers compare Iowa with states that have similar demographics and behavioral risk factors (Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin), Iowa is less of an outlier.
该研究发现，爱荷华州较高的肺癌发病率主要可归因于其较高的氡暴露水平，氡是仅次于吸烟的肺癌第二大诱因。氡是由土壤和岩石中铀的自然衰变产生的。这种无色无味的气体可通过地基渗入住宅。
The study found that Iowa’s higher lung cancer rate could mostly be attributed to its higher radon exposure, which is the second leading cause of lung cancer, after smoking. Radon occurs as a result of the natural breakdown of uranium in soil and rock. The invisible and odorless gas can seep into homes through the foundation.
报告指出，爱荷华州“因其地质原因，拥有全美最高的平均氡浓度”。“个人可以通过检测和治理家庭环境来降低风险。”政客若能向选民解释这一点，将是一项公共服务。他们或许还能让家长放心，爱荷华州的儿童癌症发病率大致与全美其他地区持平。
Iowa has “the highest average radon concentration in the U.S. because of its geology,” the report notes. “Individuals can reduce their risk by testing and mitigating their homes.”Politicians would do a public service by explaining this to voters. They might also reassure parents that Iowa’s childhood cancer rate is roughly on par with the rest of the U.S.
然而，图雷克先生却试图利用癌症恐吓选民，以推动其争取对医疗保健拥有更多政治控制权的竞选活动。“如果我在联邦参议院只能成就一件事，我希望能实现公共保险选项，让每一位美国人、每一位爱荷华人都能获得医疗服务，”他在8月举行的美国癌症协会癌症行动网络论坛上表示。这对患者并无助益。
Instead, Mr. Turek is trying to scare voters about cancer to drive his campaign for more political control over healthcare. “If I only got one thing done in the U.S. Senate, I would love to arrive at a public option so every American, every Iowan has access to care,” he said at an American Cancer Society Cancer Action Network forum in August. This won’t help patients.
爱荷华州的医疗保险覆盖率已位居全美第六高，仅约5%的居民缺乏保险。该研究指出，爱荷华州更广泛的保险覆盖和筛查渠道，可能通过增加对早期生长缓慢肿瘤的检出（其中一些可能并非致命），从而导致其癌症发病率上升。
Iowa already boasts the sixth-highest health-insurance rate in the country, with only about 5% of residents lacking coverage. The study noted that Iowa’s broader coverage and access to screenings could be contributing to its rising cancer rates by increasing detection of slow-growing tumors at earlier stages, some of which may not be lethal.
过去十年间，爱荷华州局限性癌症（癌细胞局限于体内某部位）发病率上升，但转移性癌症发病率未增。其癌症死亡率也与全美整体水平持平。爱荷华大学研究称，这“表明与癌症检测、筛查和诊断实践相关的因素，可能是导致观察到的发病率上升的部分原因”。
While Iowa’s rate of cancers localized in the body increased last decade, metastatic cancers didn’t. Its cancer death rate is also on par with the U.S. as a whole. This “suggests that factors related to cancer detection, screening, and diagnostic practices may contribute to some of the observed increases,” the University of Iowa study says.
在奥巴马医改辩论期间，温和派担心政府主导医疗会引发政治反弹，民主党人因此放弃了公共保险选项。然而，公共选项如今却成了图雷克先生这类自诩温和派的立场。不要被迷惑。公共选项不过是通往单一支付者制度道路上的一个驿站。
During the ObamaCare debate, Democrats jettisoned a public insurance option because moderates worried about a political backlash against government-run healthcare. Yet a public option is now the position of self-styled moderates like Mr. Turek. Don’t be fooled. A public option is merely a rest stop on the march to a single-payer system.
由政府补贴和费率制定权支持的公共选项，将把私营保险公司挤出市场。科罗拉多州实施公共选项后，私营保险公司便从该市场撤退。科罗拉多州的公共计划由私营机构管理，目前占该州个人市场的一半。
A public option, backed by government subsidies and rate-setting power, would drive private insurers from the market. After Colorado implemented its public option, private insurers pulled back from the market. Colorado’s public plans, which are privately administered, now account for half of the state individual market.
参议院民主党人提出了多种构建公共选项的方式，包括让患者以极低成本加入医疗补助计划。但医疗补助患者经常面临就医延误。一项近期研究发现，医疗补助患者等待一个月以上才能接受治疗的可能性，比私营保险患者高出多达 42%。
Senate Democrats have proposed various ways to structure a public option, including by letting patients buy into Medicaid at de minimis cost. But Medicaid patients routinely face delays in care. A recent study found that Medicaid patients are up to 42% more likely than privately insured patients to wait more than a month for treatment.
爱荷华州人和其他美国人真的想让官僚来决定他们能接受什么癌症治疗吗？
Do Iowans and other Americans really want bureaucrats deciding what cancer treatments they can get?
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