演講MP3+雙語文稿:如果美國(guó)的醫(yī)保費(fèi)用全部都透明化會(huì)怎么樣呢？

聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學(xué)習(xí)使用。本文主要內(nèi)容為演講MP3+雙語文稿:如果美國(guó)的醫(yī)保費(fèi)用全部都透明化會(huì)怎么樣呢？，希望你會(huì)喜歡！

【演講者及介紹】Jeanne Pinder

記者Jeanne Pinder問道，為什么美國(guó)的醫(yī)保法案很難有意義---并提出了我們可以做的事情。

【演講主題】如果美國(guó)的醫(yī)保費(fèi)用全部都透明化會(huì)怎么樣呢？

What if all US health care costs were transparent?

【中英文字幕】

翻譯者Lipeng Chen 校對(duì)者M(jìn)aggie Wang

00:00

So, a little while ago, members of my family had three bits of minor surgery, about a half hour each, and we got three sets of bills. For the first one, the anesthesia bill alone was 2,000 dollars; the second one, 2,000 dollars; the third one, 6,000 dollars.

不久前， 我的家人動(dòng)了三次小手術(shù)， 每次手術(shù)約一個(gè)半小時(shí)， 我們收到了三份帳單。 第一份賬單上，光是麻醉 就要兩千美金； 第二份賬單，兩千美金； 第三份賬單，六千美金。

00:20

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 dollars for a generic anti-nausea drug that I could buy online for two dollars and forty-nine cents. I had a long and unsatisfactory argument with the hospital, the insurer and my employer. Everybody agreed that this was totally fine. But it got me thinking, and the more I talked to people, the more I realized: nobody has any idea what stuff costs in health care. Not before, during or after that procedure or test do you have any idea what it's going to cost. It's only months later that you get an "explanation of benefits" that explains exactly nothing.

我是記者，所以我很好奇， 這些費(fèi)用是怎么來的？ 在比較貴的帳單上，我發(fā)現(xiàn)其中 一項(xiàng)非專利的抗嘔吐藥物 就要1419美金， 但其實(shí)我在網(wǎng)絡(luò)上 用2.49美金就能買到。 我向醫(yī)院、保險(xiǎn)公司 以及我的雇主力爭(zhēng)了很久， 但結(jié)果并不讓我滿意。 大家都同意這樣的做法 完全沒問題。 但它讓我不斷去思考一件事， 而且我越和大家聊，就越了解到： 沒人知道在醫(yī)療保健系統(tǒng)中的 各項(xiàng)費(fèi)用是多少。 在手術(shù)或檢測(cè)之前、當(dāng)中、之后， 都不知道它會(huì)花多少錢。 只有在幾個(gè)月之后， 你會(huì)收到《保險(xiǎn)福利說明》， 但它其實(shí)什么也沒說清楚。

01:05

So this came back to me a little while later. I had volunteered for a buyout from 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 act was to build a company telling people what stuff costs in health care. I won a "Shark Tank"-type pitch contest to do just that.

一陣子之后，我又想起了此事。 在紐約時(shí)報(bào)當(dāng)了二十年記者之后， 我自愿買斷工齡離職。 我在尋找我的下一個(gè)階段。 結(jié)果，下一個(gè)階段 是去建立一間公司， 來告訴大家在醫(yī)療保健中 各個(gè)項(xiàng)目的費(fèi)用。 我在一個(gè)類似“創(chuàng)智贏家”的 商業(yè)計(jì)劃比賽中贏得了這個(gè)機(jī)會(huì)。

01:25

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't let us tell you that," though we did get a lot of information. We found, for example, that here in the New York area, you could get an echocardiogram for 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 existed for all the procedures and all the cities that we surveyed.

去年，健康支出占用了 將近18%的國(guó)民生產(chǎn)總值， 但沒有人知道錢到底怎么花的。 但是，如果我們知道呢？ 我們從小規(guī)模做起。 我們打電話給醫(yī)生和醫(yī)院， 問他們?nèi)绻?jiǎn)單的醫(yī)療處理 可以用現(xiàn)金支付，價(jià)格是多少。 有些人很配合。 很多人直接掛我們電話。 有些人就是很沒禮貌。 他們說：“我們不知道?！?或，“我們的律師 不允許我們告訴你?！?不過我們依然得到了許多信息。 比如，我們發(fā)現(xiàn)，在紐約地區(qū)， 在布魯克林，花200美金 就可以做心臟超聲波檢查， 在僅僅幾英里外的曼哈頓 卻要2150美金。 新奧爾良，同樣簡(jiǎn)單的血液檢測(cè)， 在這里是19美金， 幾個(gè)街區(qū)之外就是522美金。 舊金山，同樣的磁共振成像， 475美元， 在25英里之外就要6221美元。 所有的醫(yī)療程序 都存在這樣的價(jià)格差異， 而且在我們調(diào)查的所有城市中都有。

02:37

Then we started to ask people to tell us their health bills. In partnership with public radio station WNYC here in New York, we asked women to tell us the 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.

接著，我們開始請(qǐng)大家 告訴我們他們的醫(yī)療賬單。 我們和紐約的公共廣播電臺(tái)WNYC合作， 請(qǐng)女性告訴我們她們做 乳房X光成像的價(jià)格。 別人都跟我們說，沒有人會(huì) 這樣做的，這些信息太私人化了。 但在三個(gè)星期內(nèi)， 有四百位女性為我們提供了這項(xiàng)信息。 接著，我們制作了線上可搜索數(shù)據(jù)庫(kù)， 讓大家用更簡(jiǎn)便的方式 把數(shù)據(jù)分享給我們。 很像醫(yī)療領(lǐng)域Kayak.com 和Waze交通應(yīng)用的融合版。

03:08

(Laughter)

（笑聲）

03:09

We call it a community-created guide to health costs.

我們稱它是由社區(qū) 共創(chuàng)出來的健康成本指南。

03:12

Our survey and crowdsourcing work grew into partnerships with top newsrooms nationwide -- in New Orleans, Philadelphia, San Francisco, Los Angeles, Miami and other places. We used the 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 contributor saved 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.

我們的調(diào)查和群眾外包工作 發(fā)展為和全國(guó)頂尖的 新聞編輯部合作—— 包括在新奧爾良、費(fèi)城、 舊金山、洛杉磯、 邁阿密，以及其他地方。 我們用資料來講述 人們所經(jīng)受的苦難， 以及要如何避免那些苦難， 避免那些負(fù)擔(dān)不起的帳單。 新奧爾良的一位女子 用我們的資料省下了近四千美元。 一位舊金山的民眾說 他省下了近1300美元， 而他只是不使用保險(xiǎn)卡， 改用現(xiàn)金支付。 有很多人都會(huì)去 保險(xiǎn)機(jī)構(gòu)指定的醫(yī)院， 卻收到了不能被報(bào)銷的帳單。 還有醫(yī)院會(huì)一直給死去的人寄賬單。

03:53

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.

我們發(fā)現(xiàn)，有上千人 想要告訴我們他們支付的價(jià)格。 他們想要知道各個(gè)項(xiàng)目的價(jià)格， 以及如何針對(duì)帳單進(jìn)行申訴， 以協(xié)助我們解決這個(gè) 在傷害他們家人朋友的問題。 我們交談的對(duì)象包括必須要 通過賣車來支付醫(yī)療賬單的人、 破產(chǎn)的人、 因?yàn)橘M(fèi)用太高 而無法接受治療的人。 想像一下，如果 你能負(fù)擔(dān)得起診斷， 卻負(fù)擔(dān)不起治療會(huì)怎樣。

04:17

We set off a huge conversation about costs involving doctors and hospitals, yes, but also their patients, or as we like to call them, people.

我們引發(fā)了關(guān)于成本的熱烈討論， 參與的人有醫(yī)生、醫(yī)院， 是的，還有他們的病人， 或者，我們直接稱他們?yōu)槔习傩铡?/p>

04:25

(Laughter)

（笑聲）

04:29

We changed policy. A consumer protection bill that had been stalled in the Louisiana legislature for 10 years passed after we launched.

我們改變了政策。 在路易斯安納有一個(gè) 消費(fèi)者保護(hù)法案 已經(jīng)停滯了十年， 在我們開始行動(dòng)之后，就通過了。

04:38

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?

讓我們面對(duì)現(xiàn)實(shí)吧： 這個(gè)巨大的、推動(dòng)緩慢的公共健康危機(jī) 是全國(guó)性的緊急事件。 我想短期內(nèi)政府不會(huì)協(xié)助我們。 但是如果答案其實(shí)很簡(jiǎn)單呢： 讓所有的醫(yī)療價(jià)格常年公開。 我們個(gè)人的帳單金額 會(huì)下降嗎？保費(fèi)呢？

04:59

Be really clear about this: this is a United States problem. In most of the rest of the developed world, sick people don't have to worry about money. It's also true that price transparency will not solve every problem. There will still be expensive treatments, huge friction from our insurance system. 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 talk about these clear effects, we're looking at a real issue that's actually very simple.

大家要很清楚一點(diǎn)： 這是美國(guó)的問題。 在大多數(shù)其他的發(fā)達(dá)國(guó)家中， 生病的人不用擔(dān)心錢的問題。 的確，價(jià)格透明 并不會(huì)解決所有問題。 仍然會(huì)有昂貴的治療存在， 保險(xiǎn)系統(tǒng)會(huì)有很大的阻力。 仍然會(huì)有詐欺， 也會(huì)有過度治療 與過度診斷的重大問題。 不是所有東西都是可以比價(jià)的。 并不是所有人都想要 最便宜的闌尾切除手術(shù)， 或最便宜的癌癥護(hù)理。 但是，當(dāng)我們談到 這些清楚的效果時(shí)， 我們?cè)诳吹钠鋵?shí)是 很簡(jiǎn)單的真實(shí)議題。

05:38

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 people out 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.

我們?cè)趧傞_始向大家詢問價(jià)格的時(shí)候， 真的覺得我們會(huì)被逮捕。 同時(shí)談及醫(yī)學(xué)和醫(yī)療保健， 似乎是有點(diǎn)越界， 但后來我們釋然了， 因?yàn)槲覀冋业降牟粌H僅是數(shù)據(jù)， 還有在體制中的好人、正直的人， 他們想要協(xié)助大家 獲得他們所需的照料， 并且是以他們付擔(dān)得起的價(jià)格。 然后開口詢問也變得容易了。

06:01

So I'll leave you with some questions. What if we all knew what stuff cost in health care in advance? What if, every time you 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?

所以，我想留給各位一些問題。 如果我們都事先知道醫(yī)療保健 各個(gè)項(xiàng)目的成本，那會(huì)怎樣？ 如果說每次你用谷歌 搜尋磁共振成像， 就會(huì)得到列表， 告訴你在哪里可購(gòu)買、多少錢， 就像你在網(wǎng)上搜尋 激光打印機(jī)那樣一目了然呢？ 如果把花在隱藏價(jià)格上的 所有時(shí)間、精力、金錢 都從系統(tǒng)中排除出去呢？ 如果我們每個(gè)人每次都能 選擇19美元的檢測(cè)， 而不是522美元的呢？ 我們個(gè)人的帳單金額會(huì)下降嗎？ 保費(fèi)呢？

06:34

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.

我不知道，但如果你不問， 就永遠(yuǎn)不會(huì)知道。 你可能可以省下一大筆錢。 我認(rèn)為，我們很多人以及體制本身 都會(huì)變得更健康。

06:45

Thank you.

謝謝。

06:46

(Applause)

（掌聲）