演讲MP3+双语文稿:如果美国的医保费用全部都透明化会怎么样呢？

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:如果美国的医保费用全部都透明化会怎么样呢？，希望你会喜欢！

【演讲者及介绍】Jeanne Pinder

记者Jeanne Pinder问道，为什么美国的医保法案很难有意义---并提出了我们可以做的事情。

【演讲主题】如果美国的医保费用全部都透明化会怎么样呢？

What if all US health care costs were transparent?

【中英文字幕】

翻译者Lipeng Chen 校对者Maggie 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， 我的家人动了三次小手术， 每次手术约一个半小时， 我们收到了三份帐单。 第一份账单上，光是麻醉 就要两千美金； 第二份账单，两千美金； 第三份账单，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.

我是记者，所以我很好奇， 这些费用是怎么来的？ 在比较贵的帐单上，我发现其中 一项非专利的抗呕吐药物 就要1419美金， 但其实我在网络上 用2.49美金就能买到。 我向医院、保险公司 以及我的雇主力争了很久， 但结果并不让我满意。 大家都同意这样的做法 完全没问题。 但它让我不断去思考一件事， 而且我越和大家聊，就越了解到： 没人知道在医疗保健系统中的 各项费用是多少。 在手术或检测之前、当中、之后， 都不知道它会花多少钱。 只有在几个月之后， 你会收到《保险福利说明》， 但它其实什么也没说清楚。

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.

一阵子之后，我又想起了此事。 在纽约时报当了二十年记者之后， 我自愿买断工龄离职。 我在寻找我的下一个阶段。 结果，下一个阶段 是去建立一间公司， 来告诉大家在医疗保健中 各个项目的费用。 我在一个类似“创智赢家”的 商业计划比赛中赢得了这个机会。

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 将近18%的国民生产总值， 但没有人知道钱到底怎么花的。 但是，如果我们知道呢？ 我们从小规模做起。 我们打电话给医生和医院， 问他们如果简单的医疗处理 可以用现金支付，价格是多少。 有些人很配合。 很多人直接挂我们电话。 有些人就是很没礼貌。 他们说：“我们不知道。” 或，“我们的律师 不允许我们告诉你。” 不过我们依然得到了许多信息。 比如，我们发现，在纽约地区， 在布鲁克林，花200美金 就可以做心脏超声波检查， 在仅仅几英里外的曼哈顿 却要2150美金。 新奥尔良，同样简单的血液检测， 在这里是19美金， 几个街区之外就是522美金。 旧金山，同样的磁共振成像， 475美元， 在25英里之外就要6221美元。 所有的医疗程序 都存在这样的价格差异， 而且在我们调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.

接着，我们开始请大家 告诉我们他们的医疗账单。 我们和纽约的公共广播电台WNYC合作， 请女性告诉我们她们做 乳房X光成像的价格。 别人都跟我们说，没有人会 这样做的，这些信息太私人化了。 但在三个星期内， 有四百位女性为我们提供了这项信息。 接着，我们制作了线上可搜索数据库， 让大家用更简便的方式 把数据分享给我们。 很像医疗领域Kayak.com 和Waze交通应用的融合版。

03:08

(Laughter)

（笑声）

03:09

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

我们称它是由社区 共创出来的健康成本指南。

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.

我们的调查和群众外包工作 发展为和全国顶尖的 新闻编辑部合作—— 包括在新奥尔良、费城、 旧金山、洛杉矶、 迈阿密，以及其他地方。 我们用资料来讲述 人们所经受的苦难， 以及要如何避免那些苦难， 避免那些负担不起的帐单。 新奥尔良的一位女子 用我们的资料省下了近四千美元。 一位旧金山的民众说 他省下了近1300美元， 而他只是不使用保险卡， 改用现金支付。 有很多人都会去 保险机构指定的医院， 却收到了不能被报销的帐单。 还有医院会一直给死去的人寄账单。

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.

我们发现，有上千人 想要告诉我们他们支付的价格。 他们想要知道各个项目的价格， 以及如何针对帐单进行申诉， 以协助我们解决这个 在伤害他们家人朋友的问题。 我们交谈的对象包括必须要 通过卖车来支付医疗账单的人、 破产的人、 因为费用太高 而无法接受治疗的人。 想像一下，如果 你能负担得起诊断， 却负担不起治疗会怎样。

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.

我们引发了关于成本的热烈讨论， 参与的人有医生、医院， 是的，还有他们的病人， 或者，我们直接称他们为老百姓。

04:25

(Laughter)

（笑声）

04:29

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

我们改变了政策。 在路易斯安纳有一个 消费者保护法案 已经停滞了十年， 在我们开始行动之后，就通过了。

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?

让我们面对现实吧： 这个巨大的、推动缓慢的公共健康危机 是全国性的紧急事件。 我想短期内政府不会协助我们。 但是如果答案其实很简单呢： 让所有的医疗价格常年公开。 我们个人的帐单金额 会下降吗？保费呢？

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.

大家要很清楚一点： 这是美国的问题。 在大多数其他的发达国家中， 生病的人不用担心钱的问题。 的确，价格透明 并不会解决所有问题。 仍然会有昂贵的治疗存在， 保险系统会有很大的阻力。 仍然会有诈欺， 也会有过度治疗 与过度诊断的重大问题。 不是所有东西都是可以比价的。 并不是所有人都想要 最便宜的阑尾切除手术， 或最便宜的癌症护理。 但是，当我们谈到 这些清楚的效果时， 我们在看的其实是 很简单的真实议题。

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.

我们在刚开始向大家询问价格的时候， 真的觉得我们会被逮捕。 同时谈及医学和医疗保健， 似乎是有点越界， 但后来我们释然了， 因为我们找到的不仅仅是数据， 还有在体制中的好人、正直的人， 他们想要协助大家 获得他们所需的照料， 并且是以他们付担得起的价格。 然后开口询问也变得容易了。

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，我想留给各位一些问题。 如果我们都事先知道医疗保健 各个项目的成本，那会怎样？ 如果说每次你用谷歌 搜寻磁共振成像， 就会得到列表， 告诉你在哪里可购买、多少钱， 就像你在网上搜寻 激光打印机那样一目了然呢？ 如果把花在隐藏价格上的 所有时间、精力、金钱 都从系统中排除出去呢？ 如果我们每个人每次都能 选择19美元的检测， 而不是522美元的呢？ 我们个人的帐单金额会下降吗？ 保费呢？

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，但如果你不问， 就永远不会知道。 你可能可以省下一大笔钱。 我认为，我们很多人以及体制本身 都会变得更健康。

06:45

Thank you.

谢谢。

06:46

(Applause)

（掌声）