You shouldn't have to choose between filling your prescriptions and paying bills | Kiah Williams

譯者: Bruce Sung 審譯者: Cris Jin

Every day in this country,

在這個國家，每一天

都有許多家庭被迫

families are forced to make impossible choices

在醫療上做艱困的抉擇。

when it comes to their health care.

Like Kimberly, who said,

像是金柏莉所描述的：

"There was times I had to choose between my food and my pills.

「有時候，在食物和藥物 兩者之間，我只能選一樣。

It wasn't luxury stuff, because I didn't make that much.

我並不是在選奢侈品， 我沒賺那麼多。

It was like, 'Can I get shampoo or conditioner?'

而更是像衡量著：『我可以 買洗髮精或潤絲精嗎？』

Things you take for granted."

那種大家認為理所當然的東西。」

And Debbie, who said,

還有黛比，她說：

"You put your medicine in one hand,

「這邊是必須吃的藥所需要的錢，

your living costs in the other.

那邊是生活費。

OK. Well, what am I going to do?

好，你說我該怎麼選？

Am I going to get my medicine

我是要買這些藥

or am I going to pay my bills?

還是要付清帳單？

Well, I can't live without my medicine,

沒這些藥我活不了，

but I can't live if I don't pay my bills."

但要是不付帳單， 我也生活不下去。」

Ten thousand people die every month in this country,

這個國家每個月有一萬人

because they don't take the medicine that they need.

死於沒吃他們所需要的藥物。

More people die from not taking medications

死於沒吃藥的人數

than opioid overdoses and car accidents combined.

多過死於吸食鴉片類藥物過量 加上死於車禍的人數的總和。

But you can't take medicine if you can't afford it.

然而你若是負擔不起，便沒藥可吃。

Today, the average household spends 3,000 dollars a year

現今一個家庭每年 平均花 3,000 美元

on medications.

在藥物上。

About a third of folks who are uninsured

沒醫療保險的人中，大約有三分之一

said that they stopped taking medicine as prescribed

說他們已經不再按照 醫囑吃處方藥，

because of cost.

因為花費太高。

Even folks with insurance,

即使是有保險的人，

if they make under 35,000 dollars a year,

如果他們的年收入低於 3 萬 5 千美元，

half of them report skipping the medications

有一半的人也說他們不吃

if their insurance doesn't cover it.

保險沒給付的藥。

So there are 10 million adults like Kimberly and like Debbie

因此有一千萬個像金柏莉 及黛比那樣的成年人，

who are forced to make impossible choices every day.

每天被迫要做很艱難的抉擇。

We all know that prescription drug prices are too high.

大家都知道處方藥的價格太高。

And our health care system,

而我們的醫療系統，

that makes some folks uninsured and other folks underinsured,

這個讓一些人沒保險、 而另一些人保險涵蓋範圍不足的系統，

doesn't prioritize people who need access now

不會優先照顧需要馬上看病

and need medications now.

和需要馬上用藥的人。

Ten million -- it's a big number,

一千萬是個很大的數字，

but it's also a solvable number,

但它也是個解決得了的數字，

because there's also 10 billion dollars

因為有價值一百億美元

of perfectly good, unused medication

完好且沒使用過的藥物

that goes to waste.

被白白浪費掉。

So this is an injustice on two sides:

因此有兩個方面的不公平：

people not getting the medicine that they need to survive and to thrive,

一方面有人得不到他們 賴以生存和發展的藥物，

and that very same medication being sent to a medical waste incinerator

而另一方面，同樣的藥物 正被送進醫療廢料焚化爐

to be destroyed.

去銷毀。

This waste is unconscionable, but it also offers an opportunity.

這樣的浪費不合情理， 但它也給了我們一個契機。

I started SIRUM,

我開辦了 SIRUM，

a not-for-profit technology company, with my cofounders Adam and George,

我與和亞當及喬治共同 創辦了這一家非營利科技公司，

to turn discarded medications into a lifeline,

將廢棄的藥品轉為救人的生命線，

just like the medications in this warehouse.

這個庫房裡的這些藥品就是例子。

We may not be able to fix

我們也許沒法修好

all the ways in which our health care system is failing us,

醫療系統裡所有的失敗之處，

but we can fix this one.

但我們可以解決這一個問題。

Medications come from manufacturers and wholesalers who have safety stock,

這些藥品來自製藥廠 和批發商的安全庫存。

and when it's short-dated, they destroy it.

當有效期快到了， 藥品便會被銷毀 。

It also comes from health care facilities

也有些藥品來自醫療單位，

like hospitals, pharmacies and nursing homes,

像是醫院、藥局，以及療養院。

who end up with surplus when a patient stops taking medication

有多餘的藥物是因為 病人停用這些藥物了

or when they pass away.

或者病人已經去世。

我們可以利用這個 未開發的藥品來源，

We can use this untapped source of medications

to supply all 10 million people who need medications.

來提供給需要這些藥的一千萬人。

And we can do this today.

而且我們今天就做得到。

SIRUM gets surplus medications

SIRUM 取得剩餘藥品的方式

by putting recycling bins into these hundreds of facilities

是在有剩餘藥品的數百家機構

放置回收容器。

that have surplus.

They fill the bin, and when the box is full,

他們將剩餘藥品放入容器。

當容器滿了，SIRUM 便派快遞 去收回這些藥品，

SIRUM initiates a courier pickup to pick up that medication,

and we handle the shipping, the tracking, the manifests and the tax receipt.

所有的運送、追蹤、貨單， 及稅務收據都由我們處理。

Medicine donors want to donate because it's actually cheaper and easier

有剩餘藥品的人會更願意捐贈，

因為相較於管制嚴格的藥品銷毀過程， 捐贈藥品實際上更便宜又方便，

than the highly regulated medicine destruction process.

And there are strong tax incentives to actually donate.

而且捐贈又有引人的稅務優惠。

We then deliver those donated medications to people who need it.

其後我們將這些捐贈來的 藥品遞送給需要的人。

A new prescription comes in,

每收到一份新處方，

and our platform matches that patient need with the inventory that's available.

我們的平台便在現有庫存中去匹配。

Our platform then generates a warehouse pick list,

平台輸出一份庫房配藥單後，

the medications are picked and the prescriptions filled.

這些藥便被挑出來配好處方。

We are building the 21st-century pharmacy experience

我們創建的是低收入家庭所應享有的

that low-income families deserve.

21 世紀藥局的體驗。

Patients can register in under five minutes

病人只需花不到 5 分鐘來註冊，

and have access to over 500 different medications,

便可以取得超過 500 種不同的藥物。

a stable list of medications for everything from heart disease

穩定供應的藥品中，

從心臟病到心理病症的藥都有。

to mental health conditions,

actually representing over 75 percent of all prescriptions prescribed

實際上包括了

超過 75% 現今全美國開出的處方藥。

in the United States today.

We also partner with a network of doctors, nurses and case managers

我們合作夥伴有一整個網路的 醫生、護士，和個案負責人。

at community health centers and free clinics

他們在社區健康中心和免費診所

that refer patients to the service.

將病人轉介到我們的服務。

We make it as easy for these health care providers

我們為這些醫護人員提供方便，

to have a prescription filled with donated medications

讓他們使用捐來的藥品配處方，

as it is to send a prescription to a local pharmacy.

就像讓當地的藥局配處方一樣容易。

And patients can pick up medications on-site at one of our partners

病人可以在我們的 合作夥伴那裡取藥，

or have medications delivered directly to their home.

或者讓藥直接送到他們家裡。

By circumventing the traditional supply chain,

因為繞過了傳統供應鏈，

we're able to offer flat, transparent pricing --

我們的收費平價又透明──

about two dollars for a month's supply of most medications.

大部分藥物一個月份 只要大約 2 美元。

And that allows a predictable, affordable price

這樣清楚又容易負擔的價格

that folks can actually budget for.

讓大家都可以輕易 把藥品放進預算。

We've already supplied enough medication for 150,000 people.

我們已經給 15 萬人 供應了足夠多的藥品，

But we can do more.

但我們能做的不只如此。

Our goal is to reach one million people

我們的目標是要 在接下來 5 年內，

with approaching a billion dollars of unused medicine

把將近十億元未使用的藥

in the next five years,

提供給一百萬人，

scaling our program to 12 states.

並將規模擴大到 12 個州。

At this scale, we can actually cover communities that are home

在那個規模，我們涵蓋的社區將包含

to 40 percent of the 10 million people

現在沒有，但是需要穩定可負擔藥物的

who lack consistent, affordable access.

一千萬人中的 40%。

Our direct service to one million people

而我們對一百萬人提供的直接服務，

will drive price competition for so many more.

也會引發價格競爭， 而有助於更多的人。

Walmart launched one of the only price innovations in pharmacy

沃爾瑪曾推出藥局極其罕見的 價格創新活動之一。

in 2006,

那是在 2006 年，

by offering a limited list of medications

他們將有限幾樣藥物的價格

for a flat fee of four dollars.

定在一律 4 美元。

This sparked incredible change.

這引發了難以置信的改變。

It sparked competitors to offer other lists

競爭者也開始推出自己的平價藥物，

and price match guarantees.

並且有價格保護保證。

By targeting transparent, affordable medications

我們將透明又可負擔的藥品

into these new states,

推進這些新的州內，

we can actually drive regional price competition

實際上可以推動地區性的競價，

that drives down the prices for entire low-income communities.

從而降低整個低收入地區的價格。

Our health care system is complex.

我們的醫療系統很複雜，

It is daunting.

令人望而生畏，

It feels impossible to make headway.

讓人覺得根本搞不過它，

But we can completely reimagine medicine access.

但我們可以重新構思取藥的這部分。

By using surplus medications as a beachhead to force change

利用剩餘藥品作為改革的灘頭堡，

我們可以推動這個數十億美元的 產業進行改革。

into this multibillion dollar industry,

we can create radical access to medications

憑著一個根本的信念，

based on a fundamental belief

我們可以創造藥業的激變。

這個信念就是住在全世界 最富裕國家之一的人

that people who live in one of the wealthiest nations in the world

can and should have access to medicine that they need

都應該能取得他們所需的藥物

to survive and to thrive.

來生存發展。

I do not pretend to have all of the answers

我不會假裝我有所有的方案

to fix all of the problems in our health care system.

來解決我們醫療系統所有的問題。

But getting medications to the millions of people

但為數百萬人提供藥品，

who need it to live a healthy life,

讓他們能夠活得健康，

saving medicine to save lives --

救回要被扔掉的藥物來救人──

that is something we can do today.

這是我們今天就能做得到的。

Thank you.

謝謝大家。