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

譯者: Lilian Chiu 審譯者: Bruce Sung

So, a little while ago,

不久前，

members of my family had three bits of minor surgery,

我的家人動了三次小手術，

about a half hour each,

每次約一個半小時，

and we got three sets of bills.

我們收到了三組帳單。

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

第一組中，光是麻醉帳單 就要兩千美金；

the second one, 2,000 dollars;

第二組，兩千美金；

the third one, 6,000 dollars.

第三組，六千美金。

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

我是記者，所以我心想， 這是怎麼回事？

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

針對比較貴的帳單，我發現其中

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

一項非專利的抗嘔吐藥物 就要 1419 美金，

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

但我其實可以在網路上 用 2.49 美金就買到。

I had a long and unsatisfactory argument with the hospital,

我向醫院、保險公司， 及我的僱主力爭了很久，

the insurer and my employer.

結果也不讓我滿意。

Everybody agreed that this was totally fine.

大家都同意這樣的做法 完全沒問題。

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

但它讓我去想一件事， 且我越和大家聊，就越了解到：

nobody has any idea what stuff costs in health care.

沒人知道在健康照護 當中的東西要多少錢。

Not before, during or after that procedure or test

在手術或檢測之前、當中、之後，

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

都不知道它會花多少錢。

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

只有在幾個月之後， 你會收到「保險給付說明」，

that explains exactly nothing.

它其實什麼也沒說明。

So this came back to me a little while later.

一陣子之後，我又想起了此事。

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

在紐約時報當了二十年記者之後，

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

我接受了他們的 有條件自願離職計畫。

I was looking for my next act.

我在尋找我的下一個階段。

It turned out that next act was to build a company

結果，下一個階段 是去建立一間公司，

telling people what stuff costs in health care.

來告訴大家在健康照護中 各項目的費用。

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

我在一個類似「創智贏家」的 提案比賽中贏得了這個機會。

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

去年，我們的國民生產毛額 有近 18% 被健康成本給吃掉，

but nobody has any idea what stuff costs.

但沒有人知道什麼東西要多少錢。

But what if we did know?

但，如果我們知道，會如何？

所以，我們從小規模做起。

So we started out small.

We called doctors and hospitals

我們打電話給醫生和醫院，

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

問他們如果收現金做簡單的醫療 處理，他們能接受的金額是多少。

Some people were helpful.

有些人很幫忙。

A lot of people hung up on us.

很多人直接掛我們電話。

Some people were just plain rude.

有些人就只是很沒禮貌。

They said, "We don't know,"

他們說：「我們不知道。」

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

或「我們的律師 不會允許我們告訴你。」

though we did get a lot of information.

不過我們仍然得到了許多資訊。

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

比如，我們發現，在紐約地區，

you could get an echocardiogram for 200 dollars in Brooklyn

在布魯克林，花兩百美金 就可以做心臟超音波檢查，

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

在僅僅幾英里外的曼哈頓 卻要 2150 美金。

New Orleans, the same simple blood test,

紐奧良，同樣簡單的血液檢測，

19 dollars over here,

在這裡是 19 美金，

522 dollars just a few blocks away.

幾個街區之外就是 522 美金。

San Francisco, the same MRI,

舊金山，同樣的磁共振造影，

475 dollars

475 美元，

or 6,221 dollars just 25 miles away.

或在 25 英里之外 就要 6221 美元。

These pricing variations existed for all the procedures

所有的醫療處理 都有這樣的價格差異，

and all the cities that we surveyed.

且在我們調查的所有城市中都有。

接著，我們開始請大家 告訴我們他們的健保帳單。

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

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

我們和紐約的 公共廣播電台 WNYC 合作，

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

我們請女性告訴我們 她們做乳房 X 光攝影的價格。

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

別人都跟我們說，沒有人會 這樣做的，這些資訊太個人化了。

But in the space of three weeks,

但在三個星期期間，

400 women told us about their prices.

有四百位女性 把她們的價格告訴我們。

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

接著，我們開始用比較容易的方式 來讓大家分享資料，

into our online searchable database.

把資料放到我們 可搜尋的線上資料庫。

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

它有一點像是 Kayak.com 和 Waze 交通應用程式的融合版，

供健康照護用。（笑聲）

(Laughter)

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

我們稱它是由社區 創造出來的健康成本指南。

Our survey and crowdsourcing work grew into partnerships

我們的調查和群眾外包工作

with top newsrooms nationwide --

發展到和全國頂尖的 新聞編輯部合作——

in New Orleans, Philadelphia,

包括在紐奧良、費城、

San Francisco, Los Angeles, Miami and other places.

舊金山、洛杉磯、 邁阿密，及其他地方。

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

我們用資料來說受苦的人的故事，

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

以及要如何避免那些苦難， 避免那些「逮到你了」帳單。

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

紐奧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，

A San Francisco contributor saved nearly 1,300 dollars

by putting away his insurance card

他只是不使用保險卡， 改支付現金。

and paying cash.

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

有很多人都會去 保險機構網內的醫院，

and getting out-of-network bills.

卻收到網外的帳單。

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

還有醫院會持續寄帳單給死人。

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

我們發現，有上千人 想要告訴我們他們的價格。

They want to learn what stuff costs,

他們想要知道各項目的價格， 及如何針對帳單做申訴，

find out how to argue a bill,

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

他們協助我們解決這個 在傷害他們家人朋友的問題。

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

我們談過的對象包括必須要 賣車來支付健康帳單的人、

go into bankruptcy,

破產的人、

skip a treatment because of the cost.

因為費用太高 而沒接受醫療處理的人。

Imagine if you could afford the diagnosis

想像一下，如果 你能負擔得起診斷，

but not the cure.

卻負擔不起治療。

We set off a huge conversation about costs

我們引起關於成本的熱烈討論，

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

參與的人有醫生、醫院， 是的，還有他們的病人，

or as we like to call them, people.

或者，我們直接稱他們為「人們」。

(Laughter)

（笑聲）

We changed policy.

我們改變了政策。

A consumer protection bill that had been stalled

在路易斯安納有一個 消費者保護法案

in the Louisiana legislature for 10 years

被擺放了十年，

passed after we launched.

在我們推出之後，就通過了。

Let's face it:

咱們面對現實吧：

this huge, slow-rolling public health crisis

這個轉動緩慢的巨大公共健康危機

is a national emergency.

是全國性的急迫事件。

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

我想短期內政府不會協助我們。

But what if the answer was really simple:

但，如果答案其實很簡單呢：

make all the prices public all the time.

隨時都讓所有的價格公開。

Would our individual bills go down? Our health premiums?

我們個人的帳單金額 會下降嗎？健保費呢？

Be really clear about this:

大家要很清楚一點：

this is a United States problem.

這是美國的問題。

In most of the rest of the developed world,

在大多數其他的已開發國家中，

sick people don't have to worry about money.

生病的人不用擔心錢的問題。

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

的確，價格透明度 並不會解決所有問題。

There will still be expensive treatments,

仍然會有昂貴的治療存在，

huge friction from our insurance system.

保險系統會有很大的磨擦。

There will still be fraud

仍然會有詐欺，

and a massive problem with overtreatment and overdiagnosis.

也會有過度治療 與過度診斷的重大問題。

And not everything is shoppable.

不是所有東西都是可以比價的。

Not everybody wants the cheapest appendectomy

並不是所有人都想要 最便宜的闌尾切除手術，

or the cheapest cancer care.

或最便宜的癌症照護。

But when we talk about these clear effects,

但，當我們談到 這些清楚的效應時，

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

我們在看的其實是 很簡單的真實議題。

When we first started calling for prices,

我們剛開始向大家詢問價格時，

we actually felt like we were going to be arrested.

真的覺得我們會被逮捕。

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

同時談及醫學和健康照護，

in the same breath,

似乎有點逾距，

and yet it became liberating,

但，後來卻變得很自由，

because we found not only data

因為我們找到的不只是資料，

but also good and honest people out there in the system

還有在體制中的好人、誠實的人，

who want to help folks get the care they need

他們想要協助大家 取得他們需要的照護，

at a price they can afford.

且是他們付擔得起的價格。

And it got easier to ask.

開口詢問也變容易了。

So I'll leave you with some questions.

所以，我想留給各位一些問題。

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

如果我們都事先知道健康照護 各項目的成本，會如何？

What if, every time you Googled for an MRI,

如果每次你用 Google 搜尋磁共振造影，

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

就會得到列表，列出 在哪裡可購買、多少錢，

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

就像你在 Google 搜尋雷射印表機一樣，如何？

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

如果把花在隱藏價格的 所有時間、精力、金錢

was squeezed out of the system?

都從體制中擠出來，如何？

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

如果我們每個人每次都能 選擇 19 美元的檢測，

instead of the $522 one?

而不是 522 美元的，會如何？

Would our individual bills go down?

我們個人的帳單金額 會下降嗎？保費呢？

Our premiums?

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

我不知道，但如果你不問， 就永遠不會知道。

And you might save a ton of money.

你可能可以省下一大筆錢。

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

我認為，我們很多人以及體制本身

would be a lot healthier.

都會變得更健康。

Thank you.

謝謝。

(Applause)

（掌聲、歡呼聲）