So, a little while ago,
members of my familyhad three bits of minor surgery,
about a half hour each,
and we got three sets of bills.
For the first one, the anesthesia billalone was 2,000 dollars;
the second one, 2,000 dollars;
the third one, 6,000 dollars.
So I’m a journalist.
I’m like, what’s up with that?
I found out that I was actually,for the expensive one,
being charged 1,419 dollarsfor a generic anti-nausea drug
that I could buy onlinefor two dollars and forty-nine cents.
I had a long and unsatisfactoryargument with the hospital,
the insurer and my employer.
Everybody agreedthat this was totally fine.
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:
nobody has any ideawhat stuff costs in health care.
Not before, during or afterthat procedure or test
do you have any ideawhat it’s going to cost?
It’s only months later that you getan”explanation of benefits”
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.
I had volunteered for a buyoutfrom the New York Times,
where I had worked for more than 20 years as a journalist.
I was looking for my next act.
It turned out that next actwas to build a company
telling people what stuff costsin health care.
I won a”Shark Tank”-typepitch contest to do just that.
Health costs ate up almost 18 percent of our gross domestic product last year,
but nobody has any idea what stuff costs.
But what if we did know?
So we started out small.
We called doctors and hospitals
and asked them what they would accept as a cash payment for simple procedures.
Some people were helpful.
A lot of people hung up on us.
Some people were just plain rude.
They said,”We don’t know,”
or,”Our lawyers won’tlet us tell you that,”
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,
you could get an echocardiogramfor 200 dollars in Brooklyn
or for 2,150 dollars in Manhattan,just a few miles away.
New Orleans, the same simple blood test,
19 dollars over here,
522 dollars just a few blocks away.
San Francisco, the same MRI,
475 dollars or 6,221 dollars just 25 miles away.
These pricing variations existedfor all the procedures
and all the cities that we surveyed.
Then we started to ask people to tell us their health bills.
In partnership with public radio stationWNYC here in New York,
we asked women to tell usthe prices of their mammograms.
People told us nobody would do that, that it was too personal.
But in the space of three weeks,
400 women told us about their prices.
Then we started to make it easier
for people to share their data into our online searchable database.
It’s sort of like a mash-up
of Kayak.com and the Waze traffic app for health care.
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,
San Francisco, Los Angeles,Miami and other places.
We used data to tell stories about people who were suffering
and how to avoid that suffering,to avoid that”gotcha” bill.
A woman in New Orleans saved nearly 4,000 dollars using our data.
A San Francisco contributorsaved nearly 1,300 dollars
by putting away his insurance card and paying cash.
There are a lot of people who are going to in-network hospitals
and getting out-of-network bills.
And then there was the hospital that continued to bill a dead man.
We learned that thousands of people wanted to tell us their prices.
They want to learn what stuff costs, find out how to argue a bill,
help us solve this problem that’s hurting them and their friends and families.
We talked to people who had to sell
a car to pay a health bill,
go into bankruptcy, skip a treatment because of the cost.
Imagine if you could afford the diagnosis
but not the cure.
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,
or as we like to call them, people.
We changed policy.
A consumer protection bill that had been stalled in the Louisiana legislature for 10 years
passed after we launched.
Let’s face it:
this huge, slow-rolling public health crisis
is a national emergency.
And I don’t think government’s going to help us out anytime soon.
But what if the answer was really simple:
make all the prices public all the time.
Would our individual bills go down?Our health premiums?
Be really clear about this: this is a United States problem.
In most of the restof the developed world,
sick people don’t haveto worry about money.
It’s also true that price transparencywill not solve every problem.
There will still be expensive treatments,
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.
And not everything is shoppable.
Not everybody wants the cheapest appendectomy or the cheapest cancer care.
But when we talkabout these clear effects,
we’re looking at a real issuethat’s actually very simple.
When we first started calling for prices,
we actually felt like we were going to be arrested.
It seemed kind of transgressive to talk about medicine and health care in the same breath,
and yet it became liberating,
because we found not only data
but also good and honest peopleout there in the system
who want to help folks get the care they need at a price they can afford.
And it got easier to ask.
So I’ll leave you with some questions.
What if we all knew what stuff cost in health care in advance?
What if, every timeyou Googled for an MRI,
you got drop-downs telling you where to buy and for how much,
the way you do when you Google for a laser printer?
What if all of the time and energy and money
that’s spent hiding prices was squeezed out of the system?
What if each one of us could pick the $ 19 test every time
instead of the $522 one?
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.
And you might save a ton of money.
And I’ve got to think that a lot of us
and the system itself would be a lot healthier.