听力课堂TED音频栏目主要包括TED演讲的音频MP3及中英双语文稿，供各位英语爱好者学习使用。本文主要内容为演讲MP3+双语文稿:你无需在买药还是支付生活开销之间做选择，希望你会喜欢！

【演讲者及介绍】Kiah Williams

凯·威廉姆斯是SIRUM的联合创始人和总监，SIRUM是一家解决美国高药品成本问题的社会企业。

【演讲主题】你无需在买药还是支付生活开销之间做选择 You shouldn't have to choose between filling your prescriptions and paying bills

【中英文字幕】翻译者Shu Fei Chow 校对者Yolanda Zhang

Every day in this country, families are forced to make impossible choices when it comes to their health care. Like Kimberly, who said, "There was times I had to choose between my food and my pills. It wasn't luxury stuff, because I didn't make that much. It was like, 'Can I get shampoo or conditioner?' Things you take for granted." And Debbie, who said, "You put your medicine in one hand, your living costs in the other. OK. Well, what am I going to do? Am I going to get my medicine or am I going to pay my bills? Well, I can't live without my medicine, but I can't live if I don't pay my bills."

在这个国家的每一天， 很多家庭在医疗上都要 被迫做出艰难的抉择。 就像金伯利所说， “有时候我得在 食物与药物之间做出抉择。 这些都不是奢侈品， 因为我的收入没那么多。 这问题的性质就像： ‘我该买洗发剂还是护发素？’ ——本该是理所当然的事情。” 黛比也说： “一边是不得不吃的药， 另一边是不得不花费的生活开销。 好吧，那我该怎么做才对？ 我是该按时吃药， 还是先支付生活开销？ 的确，我无法在 没有药物的情况下生存， 但我也无法在不支付 生活开销的前提下生存。”

Ten thousand people die every month in this country, because they don't take the medicine that they need. More people die from not taking medications than opioid overdoses and car accidents combined. But you can't take medicine if you can't afford it.

在这个国家， 每个月都有多达一万人 死于没有及时服用必需的药物。 因缺乏药物治疗的死亡人数 远远超过服用过量阿片类药物， 以及死于车祸意外的人数总和。 但你确实无法获得 你负担不起的药物。

Today, the average household spends 3,000 dollars a year on medications. About a third of folks who are uninsured said that they stopped taking medicine as prescribed because of cost. Even folks with insurance, if they make under 35,000 dollars a year, half of them report skipping the medications if their insurance doesn't cover it. So there are 10 million adults like Kimberly and like Debbie who are forced to make impossible choices every day.

如今，每个家庭每年在医药方面 平均要花费 3000 美元。 大约三分之一的人 没有医疗保险， 并因无法负担昂贵的药费 而不得不停止服药。 即使是有医疗保险的人们， 如果他们的年收入 低于 3.5 万美元， 且医疗保险没有 覆盖长期的药物费用， 一半的人也会选择不吃药物。 有一千万成年人 正像金伯利、黛比一样， 被迫每天做出这样的艰难取舍。

We all know that prescription drug prices are too high. And our health care system, that makes some folks uninsured and other folks underinsured, doesn't prioritize people who need access now and need medications now.

众所周知，当今的药物价格过于高昂。 而我们的医疗体系 并没有给予那些没有医疗保险 或是投保不足的人们 优先接受治疗 或是优先服用药物的便利。

Ten million -- it's a big number, but it's also a solvable number, because there's also 10 billion dollars of perfectly good, unused medication that goes to waste. So this is an injustice on two sides: people not getting the medicine that they need to survive and to thrive, and that very same medication being sent to a medical waste incinerator to be destroyed. This waste is unconscionable, but it also offers an opportunity.

一千万是个天文数字， 但也是个可解的数字， 因为与此同时， 有价值一百亿美元 完好无损且未使用过的药物 被白白浪费了。 这造成了两个方面的不公： 一方面，人们无法得到他们 赖以生存的药物； 另一方面，同样的药物 将会被送去医疗废料焚化炉， 进行销毁。 这样的药物浪费是不合情理的， 但同时也为我们提供了一个契机。

I started SIRUM, a not-for-profit technology company, with my cofounders Adam and George, to turn discarded medications into a lifeline, just like the medications in this warehouse. We may not be able to fix all the ways in which our health care system is failing us, but we can fix this one.

我与另外两位合伙人，亚当和乔治 共同成立了 SIRUM 这家非盈利科技公司， 目标是将废弃的药物 转化为救人的生命线， 就像这个仓库中的药物。 我们也许没办法解决 医疗系统里的所有问题， 但至少我们可以解决这个问题。

Medications come from manufacturers and wholesalers who have safety stock, and when it's short-dated, they destroy it. It also comes from health care facilities like hospitals, pharmacies and nursing homes, who end up with surplus when a patient stops taking medication or when they pass away. We can use this untapped source of medications to supply all 10 million people who need medications. And we can do this today.

一部分药物来自制造商 和批发商的安全仓库， 一旦有效期将至， 它们就会被销毁。 还有一部分药物来自医疗机构， 如医院、药局和疗养院， 尤其是病人 因停止服用或是去世后 所剩下的那部分。 我们可以利用这些 未开发的药物来源， 满足那一千万人的药物需求。 而今天我们做到了。

SIRUM gets surplus medications by putting recycling bins into these hundreds of facilities that have surplus. They fill the bin, and when the box is full, SIRUM initiates a courier pickup to pick up that medication, and we handle the shipping, the tracking, the manifests and the tax receipt.

SIRUM 将在上百间医疗机构 放置回收箱， 来收集这些剩余药物。 当回收箱装满剩余药物后， SIRUM 便派快递公司 前去领取这些药物， 而运送、追踪货单及税务事宜 都由我们自己处理。

Medicine donors want to donate because it's actually cheaper and easier than the highly regulated medicine destruction process. And there are strong tax incentives to actually donate. We then deliver those donated medications to people who need it. A new prescription comes in, and our platform matches that patient need with the inventory that's available. Our platform then generates a warehouse pick list, the medications are picked and the prescriptions filled. We are building the 21st-century pharmacy experience that low-income families deserve. Patients can register in under five minutes and have access to over 500 different medications, a stable list of medications for everything from heart disease to mental health conditions, actually representing over 75 percent of all prescriptions prescribed in the United States today.

药物捐赠者之所以愿意捐赠， 是因为这相较于管控严格的 药物销毁过程来得更加便宜、方便。 再加之，药品捐赠者 能享有更多的税务津贴。 然后，我们将这些捐赠药物 送给那些有需要的人们。 每收到一份新的药方， 我们都会对病患的需求 和平台现有的药物存量进行匹配， 提供仓库药物提取清单， 并依照药方来配药给病患。 我们正在打造 一个为低收入家庭服务的 21 世纪药局。 患者只需不到 5 分钟的时间 便能完成注册， 搜索超过 500 多种药物， 包括了从心脏病到 身心健康的一系列药物清单， 其中囊括了 全美国超过 75% 的药方。

We also partner with a network of doctors, nurses and case managers at community health centers and free clinics that refer patients to the service. We make it as easy for these health care providers to have a prescription filled with donated medications as it is to send a prescription to a local pharmacy. And patients can pick up medications on-site at one of our partners or have medications delivered directly to their home. By circumventing the traditional supply chain, we're able to offer flat, transparent pricing -- about two dollars for a month's supply of most medications. And that allows a predictable, affordable price that folks can actually budget for.

我们还与社区卫生中心和免费诊所的 医生、护士和病例管理人员 组成的网络合作， 向患者推广我们的服务。 我们也为医护人员提供便利， 让他们用这些捐赠药物 为病患开药方， 几乎与将药方发送给 当地的药房无异。 患者可直接通过我们 其中一方合作伙伴领取药物， 或者要求把药物递送到家。 通过规避传统的药物供应链， 我们的收费平价又透明—— 大部分药物的一个月收费 大约只有两美金。 如此一来，就能提供一个 可预测且相当实惠的价格， 让人们能将医药费用 列入日常花销。

We've already supplied enough medication for 150,000 people. But we can do more. Our goal is to reach one million people with approaching a billion dollars of unused medicine in the next five years, scaling our program to 12 states. At this scale, we can actually cover communities that are home to 40 percent of the 10 million people who lack consistent, affordable access. Our direct service to one million people will drive price competition for so many more.

我们已经满足了 15 万人的药物需求。 但我们能做的还有很多。 我们的目标是在接下来的五年， 将价值十亿美元的未使用药物 提供给一百万人， 并将这个计划 扩大至十二个州。 这一规模让我们得以覆盖 那些缺乏持续且可负担药物供应的 一千万人口社区中 40% 的患者。 我们为这一千万人所提供的服务 会引发更多的药物价格竞争。

Walmart launched one of the only price innovations in pharmacy in 2006, by offering a limited list of medications for a flat fee of four dollars. This sparked incredible change. It sparked competitors to offer other lists and price match guarantees. By targeting transparent, affordable medications into these new states, we can actually drive regional price competition that drives down the prices for entire low-income communities.

沃尔玛曾于 2006 年 推出了极其罕见的 药物创新价格活动， 只需支付四美元的固定费用， 就可以购买有限种类的药物。 这引发了令人难以置信的变革， 也激起了同行竞争者相继推出 平价且具有品质保证的药物， 除了将这些价格实惠、透明的药物 引进这些新的州， 实际上就推动了 地区性的价格竞争， 从而降低了药物价格， 让整个低收入群体获益。

Our health care system is complex. It is daunting. It feels impossible to make headway. But we can completely reimagine medicine access. By using surplus medications as a beachhead to force change into this multibillion dollar industry, we can create radical access to medications based on a fundamental belief that people who live in one of the wealthiest nations in the world can and should have access to medicine that they need to survive and to thrive.

我们的医疗体系非常复杂， 令人望而却步， 任何改变似乎都遥不可及。 但我们完全可以重塑供药环节。 除了通过使用剩余药物作为立足点， 迫使这个价值数十亿美元的产业 进行改革， 我们也可以凭借一个基本信念， 即一个最富裕国家的人民 有能力、也有资格获取 他们所需的药物 来维系生命和健康—— 来创造一个激进的药物供给体系。

I do not pretend to have all of the answers to fix all of the problems in our health care system. But getting medications to the millions of people who need it to live a healthy life, saving medicine to save lives -- that is something we can do today.

我并不是说，我们有办法解决 我们医疗保健系统中所有的问题。 但为数百万人提供药物， 让他们能够活得健康， 避免药物被销毁的同时 又能拯救生命—— 这就是我们今天能做到的事情。

Thank you.

谢谢。