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

翻译人员: Lipeng Chen 校对人员: Maggie Wang

So, a little while ago,

不久前，

members of my family had three bits of minor surgery,

我的家人动了三次小手术，

about a half hour each,

每次手术约一个半小时，

and we got three sets of bills.

我们收到了三份帐单。

For the first one, the anesthesia bill alone was 2,000 dollars;

第一份账单上，光是麻醉 就要两千美金；

the second one, 2,000 dollars;

第二份账单，两千美金；

the third one, 6,000 dollars.

第三份账单，六千美金。

So I'm a journalist. I'm like, what's up with that?

我是记者，所以我很好奇， 这些费用是怎么来的？

I found out that I was actually, for the expensive one,

在比较贵的帐单上，我发现其中

being charged 1,419 dollars for a generic anti-nausea drug

一项非专利的抗呕吐药物 就要1419美金，

that I could buy online for two dollars and forty-nine cents.

但其实我在网络上 用2.49美金就能买到。

I had a long and unsatisfactory argument with the hospital,

我向医院、保险公司 以及我的雇主力争了很久，

the insurer and my employer.

但结果并不让我满意。

Everybody agreed that this was totally fine.

大家都同意这样的做法 完全没问题。

But it got me thinking, and the more I talked to people, the more I realized:

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：

nobody has any idea what stuff costs in health care.

没人知道在医疗保健系统中的 各项费用是多少。

Not before, during or after that procedure or test

在手术或检测之前、当中、之后，

do you have any idea what it's going to cost.

都不知道它会花多少钱。

It's only months later that you get an "explanation of benefits"

只有在几个月之后， 你会收到《保险福利说明》，

that explains exactly nothing.

但它其实什么也没说清楚。

So this came back to me a little while later.

一阵子之后，我又想起了此事。

I had volunteered for a buyout from the New York Times,

在纽约时报当了二十年记者之后，

where I had worked for more than 20 years as a journalist.

我自愿买断工龄离职。

I was looking for my next act.

我在寻找我的下一个阶段。

It turned out that next act was to build a company

结果，下一个阶段 是去建立一间公司，

telling people what stuff costs in health care.

来告诉大家在医疗保健中 各个项目的费用。

I won a "Shark Tank"-type pitch contest to do just that.

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。

Health costs ate up almost 18 percent of our gross domestic product last year,

去年，健康支出占用了 将近18%的国民生产总值，

but nobody has any idea what stuff costs.

但没有人知道钱到底怎么花的。

But what if we did know?

但是，如果我们知道呢？

So we started out small.

我们从小规模做起。

We called doctors and hospitals

我们打电话给医生和医院，

and asked them what they would accept as a cash payment for simple procedures.

问他们如果简单的医疗处理 可以用现金支付，价格是多少。

Some people were helpful.

有些人很配合。

A lot of people hung up on us.

很多人直接挂我们电话。

Some people were just plain rude.

有些人就是很没礼貌。

They said, "We don't know,"

他们说：“我们不知道。”

or, "Our lawyers won't let us tell you that,"

或，“我们的律师 不允许我们告诉你。”

though we did get a lot of information.

不过我们依然得到了许多信息。

We found, for example, that here in the New York area,

比如，我们发现，在纽约地区，

you could get an echocardiogram for 200 dollars in Brooklyn

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。

or for 2,150 dollars in Manhattan, just a few miles away.

New Orleans, the same simple blood test,

新奥尔良，同样简单的血液检测，

19 dollars over here,

在这里是19美金，

522 dollars just a few blocks away.

几个街区之外就是522美金。

San Francisco, the same MRI,

旧金山，同样的磁共振成像，

475 dollars

475美元，

or 6,221 dollars just 25 miles away.

在25英里之外就要6221美元。

These pricing variations existed for all the procedures

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。

and all the cities that we surveyed.

Then we started to ask people to tell us their health bills.

接着，我们开始请大家 告诉我们他们的医疗账单。

In partnership with public radio station WNYC here in New York,

我们和纽约的公共广播电台WNYC合作，

we asked women to tell us the prices of their mammograms.

请女性告诉我们她们做 乳房X光成像的价格。

People told us nobody would do that, that it was too personal.

别人都跟我们说，没有人会 这样做的，这些信息太私人化了。

But in the space of three weeks,

但在三个星期内，

400 women told us about their prices.

有四百位女性为我们提供了这项信息。

Then we started to make it easier for people to share their data

接着，我们制作了线上可搜索数据库，

into our online searchable database.

让大家用更简便的方式 把数据分享给我们。

It's sort of like a mash-up of Kayak.com and the Waze traffic app for health care.

很像医疗领域Kayak.com 和Waze交通应用的融合版。

(Laughter)

（笑声）

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。

Our survey and crowdsourcing work grew into partnerships

我们的调查和群众外包工作

with top newsrooms nationwide --

发展为和全国顶尖的 新闻编辑部合作——

in New Orleans, Philadelphia,

包括在新奥尔良、费城、

San Francisco, Los Angeles, Miami and other places.

旧金山、洛杉矶、 迈阿密，以及其他地方。

We used the data to tell stories about people who were suffering

我们用资料来讲述 人们所经受的苦难，

and how to avoid that suffering, to avoid that "gotcha" bill.

以及要如何避免那些苦难， 避免那些负担不起的帐单。

A woman in New Orleans saved nearly 4,000 dollars using our data.

新奥尔良的一位女子 用我们的资料省下了近四千美元。

A San Francisco contributor saved nearly 1,300 dollars

一位旧金山的民众说 他省下了近1300美元，

by putting away his insurance card

而他只是不使用保险卡，

and paying cash.

改用现金支付。

There are a lot of people who are going to in-network hospitals

有很多人都会去 保险机构指定的医院，

and getting out-of-network bills.

却收到了不能被报销的帐单。

And then there was the hospital that continued to bill a dead man.

还有医院会一直给死去的人寄账单。

We learned that thousands of people wanted to tell us their prices.

我们发现，有上千人 想要告诉我们他们支付的价格。

They want to learn what stuff costs,

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，

find out how to argue a bill,

help us solve this problem that's hurting them and their friends and families.

以协助我们解决这个 在伤害他们家人朋友的问题。

We talked to people who had to sell a car to pay a health bill,

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、

go into bankruptcy,

破产的人、

skip a treatment because of the cost.

因为费用太高 而无法接受治疗的人。

Imagine if you could afford the diagnosis

想像一下，如果 你能负担得起诊断，

but not the cure.

却负担不起治疗会怎样。

We set off a huge conversation about costs

我们引发了关于成本的热烈讨论，

involving doctors and hospitals, yes, but also their patients,

参与的人有医生、医院， 是的，还有他们的病人，

or as we like to call them, people.

或者，我们直接称他们为老百姓。

(Laughter)

（笑声）

We changed policy.

我们改变了政策。

A consumer protection bill that had been stalled

在路易斯安纳有一个 消费者保护法案

已经停滞了十年，

in the Louisiana legislature for 10 years

passed after we launched.

在我们开始行动之后，就通过了。

Let's face it:

让我们面对现实吧：

this huge, slow-rolling public health crisis

这个巨大的、推动缓慢的公共健康危机

is a national emergency.

是全国性的紧急事件。

And I don't think government's going to help us out anytime soon.

我想短期内政府不会协助我们。

But what if the answer was really simple:

但是如果答案其实很简单呢：

make all the prices public all the time.

让所有的医疗价格常年公开。

Would our individual bills go down? Our health premiums?

我们个人的帐单金额 会下降吗？保费呢？

Be really clear about this:

大家要很清楚一点：

this is a United States problem.

这是美国的问题。

In most of the rest of the developed world,

在大多数其他的发达国家中，

sick people don't have to worry about money.

生病的人不用担心钱的问题。

It's also true that price transparency will not solve every problem.

的确，价格透明 并不会解决所有问题。

There will still be expensive treatments,

仍然会有昂贵的治疗存在，

huge friction from our insurance system.

保险系统会有很大的阻力。

There will still be fraud

仍然会有诈欺，

and a massive problem with overtreatment and overdiagnosis.

也会有过度治疗 与过度诊断的重大问题。

And not everything is shoppable.

不是所有东西都是可以比价的。

Not everybody wants the cheapest appendectomy

并不是所有人都想要 最便宜的阑尾切除手术，

or the cheapest cancer care.

或最便宜的癌症护理。

But when we talk about these clear effects,

但是，当我们谈到 这些清楚的效果时，

we're looking at a real issue that's actually very simple.

我们在看的其实是 很简单的真实议题。

When we first started calling for prices,

我们在刚开始向大家询问价格的时候，

we actually felt like we were going to be arrested.

真的觉得我们会被逮捕。

It seemed kind of transgressive to talk about medicine and health care

同时谈及医学和医疗保健，

in the same breath,

似乎是有点越界，

and yet it became liberating,

但后来我们释然了，

because we found not only data

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，

but also good and honest people out there in the system

who want to help folks get the care they need

他们想要协助大家 获得他们所需的照料，

at a price they can afford.

并且是以他们付担得起的价格。

And it got easier to ask.

然后开口询问也变得容易了。

So I'll leave you with some questions.

所以，我想留给各位一些问题。

What if we all knew what stuff cost in health care in advance?

如果我们都事先知道医疗保健 各个项目的成本，那会怎样？

What if, every time you Googled for an MRI,

如果说每次你用谷歌 搜寻磁共振成像，

you got drop-downs telling you where to buy and for how much,

就会得到列表， 告诉你在哪里可购买、多少钱，

the way you do when you Google for a laser printer?

就像你在网上搜寻 激光打印机那样一目了然呢？

What if all of the time and energy and money that's spent hiding prices

如果把花在隐藏价格上的 所有时间、精力、金钱

was squeezed out of the system?

都从系统中排除出去呢？

What if each one of us could pick the $19 test every time

如果我们每个人每次都能 选择19美元的检测，

instead of the $522 one?

而不是522美元的呢？

Would our individual bills go down?

我们个人的帐单金额会下降吗？

Our premiums?

保费呢？

I don't know, but if you don't ask, you'll never know.

我不知道，但如果你不问， 就永远不会知道。

And you might save a ton of money.

你可能可以省下一大笔钱。

And I've got to think that a lot of us and the system itself

我认为，我们很多人以及体制本身

would be a lot healthier.

都会变得更健康。

Thank you.

谢谢。

(Applause)

（掌声）