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如果所有美国医疗保健费用都是透明的? – 译学馆
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如果所有美国医疗保健费用都是透明的?

What if all US health care costs were transparent? | Jeanne Pinder

前不久
So, a little while ago,
我家里人做了三个小手术
members of my familyhad three bits of minor surgery,
大概每个手术半小时左右
about a half hour each,
我们拿到了三沓账单
and we got three sets of bills.
第一个手术 单是麻醉费用就要2000美元
For the first one, the anesthesia billalone was 2,000 dollars;
第二个手术 2000美元
the second one, 2,000 dollars;
第三个手术 6000美元
the third one, 6,000 dollars.
我是个新闻工作者
So I’m a journalist.
我会想 为什么会这样?
I’m like, what’s up with that?
我发现 实际上最贵的那个
I found out that I was actually,for the expensive one,
是一种常规抗恶心药物 要了我1419美元
being charged 1,419 dollarsfor a generic anti-nausea drug
而这种药物在网上买 只需要2美元49美分
that I could buy onlinefor two dollars and forty-nine cents.
我和医院 保险公司和老板吵了很久
I had a long and unsatisfactoryargument with the hospital,
结果也不太令人满意
the insurer and my employer.
每个人都觉得这很正常
Everybody agreedthat this was totally fine.
但这让我深思
But it got me thinking,
并且 和别人说得越多 越能让我意识到:
and the more I talked to people, the more I realized:
没有人对卫生保健材料成本有概念
nobody has any ideawhat stuff costs in health care.
至少以前没有 在手术或检测中或检测后
Not before, during or afterthat procedure or test
你对会花费多少钱有没有概念?
do you have any ideawhat it’s going to cost?
几个月后 你才会收到“福利解释”
It’s only months later that you getan”explanation of benefits”
但那实际上什么都没说清楚
that explains exactly nothing.
所以 一段时间过后 我又想起这件事
So this came back to mea little while later.
我自愿接受《纽约时报》的买断
I had volunteered for a buyoutfrom the New York Times,
我在《纽约时报》当了超过20年的记者
where I had worked for more than 20 years as a journalist.
我在想下一步该干什么
I was looking for my next act.
结果证明 下一步就是建立一家公司
It turned out that next actwas to build a company
来告诉大家卫生保健材料成本
telling people what stuff costsin health care.
赢得“鲨鱼坦克”演讲比赛让我能做这件事
I won a”Shark Tank”-typepitch contest to do just that.
保健成本去年约占GDP的18%
Health costs ate up almost 18 percent of our gross domestic product last year,
但大家对其材料成本都没什么概念
but nobody has any idea what stuff costs.
但如果我们知道会怎样呢?
But what if we did know?
于是我们从小事做起
So we started out small.
我们给医生 医院打电话
We called doctors and hospitals
问他们对现金付款的简单小手术 会收多少钱
and asked them what they would accept as a cash payment for simple procedures.
有些人乐心帮助
Some people were helpful.
很多人因我们而神色不安
A lot of people hung up on us.
有些人非常粗鲁无礼
Some people were just plain rude.
他们说:“我们不知道”
They said,”We don’t know,”
或者是“我们的律师不会让我们说的”
or,”Our lawyers won’tlet us tell you that,”
但我们还是得到了很多信息
though we did get a lot of information.
我们发现 比如 在纽约这个地方
We found, for example,that here in the New York area,
你可以花200美元在布鲁克林区做心回波图
you could get an echocardiogramfor 200 dollars in Brooklyn
但几英里外的曼哈顿区就要2150美元
or for 2,150 dollars in Manhattan,just a few miles away.
在新奥尔良 同样简单的血液测试
New Orleans, the same simple blood test,
这边是19美元
19 dollars over here,
几个街区外就是522美元
522 dollars just a few blocks away.
旧金山 同样是核磁共振成像检查
San Francisco, the same MRI,
仅25英里的距离就有475美元和6221美元两个价
475 dollars or 6,221 dollars just 25 miles away.
所有我们调查的手术和城市
These pricing variations existedfor all the procedures
都存在定价不同的问题
and all the cities that we surveyed.
接着我们开始询问一些人的保健账单
Then we started to ask people to tell us their health bills.
我们与纽约的公共无线电台WNYC合作
In partnership with public radio stationWNYC here in New York,
我们询问女士她们的乳房X照照片价格
we asked women to tell usthe prices of their mammograms.
大家都说没人会告诉我们 那话题太过隐私了
People told us nobody would do that, that it was too personal.
但三周内
But in the space of three weeks,
400位女士告诉了我们价格
400 women told us about their prices.
接着我们让人们在我们
Then we started to make it easier
在线搜索数据库分享数据 这样事情就更简单了
for people to share their data into our online searchable database.
这就像是卫生保健中
It’s sort of like a mash-up
Kayak.com和Waze交通app的混合体
of Kayak.com and the Waze traffic app for health care.
[笑]
[Laughter]
我们称之为社区创建的保健成本指南
We call it a community-createdguide to health costs.
我们在调查和众包工作中 与新奥尔良 费城
Our survey and crowdsourcing workgrew into partnerships
旧金山 洛杉矶 迈阿密还有其他地方的
with top newsrooms nationwide — in New Orleans, Philadelphia,
国内顶尖新闻编辑部成为合作伙伴关系
San Francisco, Los Angeles,Miami and other places.
我们用数据来讲述人们被宰的故事
We used data to tell stories about people who were suffering
并告诉人们避免被所谓“明白”账单宰的方法
and how to avoid that suffering,to avoid that”gotcha” bill.
一位新奥尔良女士使用我们的数据后节省了将近4000美元
A woman in New Orleans saved nearly 4,000 dollars using our data.
一位来自旧金山的投稿者通过放弃使用保险卡
A San Francisco contributorsaved nearly 1,300 dollars
选择付现的方式 节省了将近1300美元
by putting away his insurance card and paying cash.
很多人去医保网络内的医院
There are a lot of people who are going to in-network hospitals
结果拿到了网络外的账单
and getting out-of-network bills.
而且还有医院一直给死人开账单
And then there was the hospital that continued to bill a dead man.
我们发现成千上万的人想告诉我们他们的费用
We learned that thousands of people wanted to tell us their prices.
他们想要知道材料成本 知道如何讨价还价
They want to learn what stuff costs, find out how to argue a bill,
帮助我们解决这个同样困扰着他们及亲朋好友的问题
help us solve this problem that’s hurting them and their friends and families.
我们和那些需要卖掉汽车
We talked to people who had to sell
来支付医疗账单
a car to pay a health bill,
因为医疗费用破产 放弃治疗的人聊了聊
go into bankruptcy, skip a treatment because of the cost.
想象一下 如果你能支付诊断费用
Imagine if you could afford the diagnosis
但却付不起治疗费用的情况
but not the cure.
我们引发了关于成本的广泛讨论
We set off a huge conversation about costs
包括医生和医院 是的 还有他们的病人
involving doctors and hospitals, yes,but also their patients,
或者我们更喜欢称他们为“人”
or as we like to call them, people.
[笑]
[Laughter]
我们改变了政策
We changed policy.
一个在路易斯安那州立法机构停滞了10年的
A consumer protection bill that had been stalled in the Louisiana legislature for 10 years
消费者保护法案 在我们发起之后通过了
passed after we launched.
面对现实吧:
Let’s face it:
这个巨大的 慢慢升级的保健危机
this huge, slow-rolling public health crisis
已成为国家急需解决的问题
is a national emergency.
并且我认为政府近期没有帮我们解决的打算
And I don’t think government’s going to help us out anytime soon.
但是如果答案真的很简单:
But what if the answer was really simple:
始终公开所有价格 会怎样?
make all the prices public all the time.
我们的个人开支会下降吗?健康保险费呢?
Would our individual bills go down?Our health premiums?
我们非常清楚:这是全美国的问题
Be really clear about this: this is a United States problem.
在绝大多数其他发达国家
In most of the restof the developed world,
病人不需要为钱操心
sick people don’t haveto worry about money.
确实 价格透明不能解决所有问题
It’s also true that price transparencywill not solve every problem.
还是会有高昂的治疗
There will still be expensive treatments,
还是会有和保险体系的大摩擦
huge friction from our insurance system.
还会有骗子 会有大量过度治疗 过度诊断的问题
There will still be fraud and a massive problem with overtreatment and overdiagnosis.
并非所有东西都能用钱买到
And not everything is shoppable.
不是每个人都想要最便宜的阑尾切除术和癌症护理
Not everybody wants the cheapest appendectomy or the cheapest cancer care.
但当我们谈到这些清楚的效果
But when we talkabout these clear effects,
我们正着眼于一个实际上非常简单的现实问题
we’re looking at a real issuethat’s actually very simple.
当我们第一次要求价格透明
When we first started calling for prices,
我们事实上觉得自己将会被逮捕入狱
we actually felt like we were going to be arrested.
似乎同时谈医药和保健护理某种程度上是违法的
It seemed kind of transgressive to talk about medicine and health care in the same breath,
但它变得自由了
and yet it became liberating,
因为我们不仅发现了数据
because we found not only data
也发现这个体系中善良而诚实的人们
but also good and honest peopleout there in the system
他们想帮助人们以自己付得起的价格获得需要的护理
who want to help folks get the care they need at a price they can afford.
这使要求变得容易起来
And it got easier to ask.
所以 我想给大家留些问题
So I’ll leave you with some questions.
如果我们都提前知道保健护理的材料成本会如何?
What if we all knew what stuff cost in health care in advance?
如果 你每次用谷歌搜索核磁共振成像检查
What if, every timeyou Googled for an MRI,
都像你用谷歌搜索激光打印机那样
you got drop-downs telling you where to buy and for how much,
有下拉框告诉你去哪里购买 多少钱会怎样?
the way you do when you Google for a laser printer?
如果所有花在隐藏价格的时间 精力和金钱
What if all of the time and energy and money
都被挤出了体系 那会怎样?
that’s spent hiding prices was squeezed out of the system?
如果我们每人每次都能选择19美元的测试
What if each one of us could pick the $ 19 test every time
而非522美元的测试 会怎样?
instead of the $522 one?
我们的个人开支会下降吗?保险费呢?
Would our individual bills go down? Our premiums?
我不知道 但是如果你不问 你永远不会知道
I don’t know, but if you don’t ask,you’ll never know.
并且你自己还会省下一大笔钱
And you might save a ton of money.
而且我认为 我们很多人
And I’ve got to think that a lot of us
还有医疗系统本身都将更“健康”
and the system itself would be a lot healthier.
谢谢
Thank you.
[掌声]
[Applause]

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视频概述

医疗保健费用都是透明的会怎样?

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翻译译者

Zeitgeist

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审核员 V

视频来源

https://www.youtube.com/watch?v=ZjeZ8r7yWOk

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