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JeannePinder_2018S-_假如美国医疗费用变得透明化会怎样?_
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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. |
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。 |
minor:adj.未成年的; n.未成年人; vi.副修; surgery:n.外科;外科手术;手术室;诊疗室;
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For the first one, the anesthesia bill alone was 2,000 dollars; the second one, 2,000 dollars; the third one, 6,000 dollars. |
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。 |
anesthesia:n.麻醉;麻木(等于anaesthesia);
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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? |
journalist:n.新闻工作者;报人;记日志者;
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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. |
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。 |
generic:adj.类的;一般的;属的;非商标的; anti-nausea:抗呕吐;
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I had a long and unsatisfactory argument with the hospital, the insurer and my employer . |
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。 |
unsatisfactory:adj.不令人满意的;不满足的;不符合要求的; insurer:n.保险公司;承保人; employer:n.雇主,老板;
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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: nobody has any idea what stuff costs in health care . |
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。 |
stuff:n.东西:物品:基本特征:v.填满:装满:标本: health care:n.卫生保健;
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Not before, during or after that procedure or test do you have any idea what it's going to cost. |
在手术或检测之前、当中、之后, 都不知道它会花多少钱。 |
procedure:n.步骤;手术;(商业、法律或政治上的)程序;
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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, where I had worked for more than 20 years as a journalist. |
在纽约时报当了二十年记者之后, 我自愿买断工龄离职。 |
volunteered:v.自愿做;义务做;自愿参军;(volunteer的过去分词和过去式) buyout:n.全部买下(市上产品);
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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 telling people what stuff costs in health care. |
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。 |
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。 |
pitch:v.抛:用力扔:针对:触地:n.场地:程度:力度:推销的话:纵摇:
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Health costs ate up almost 18 percent of our gross domestic product last year, but nobody has any idea what stuff costs. |
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。 |
gross domestic product:na.国内生产总值;
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But what if we did know? |
但是,如果我们知道呢? |
what if:如果…怎么办?
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So we started out small. |
我们从小规模做起。 |
We called doctors and hospitals and asked them what they would accept as a cash payment for simple procedures . |
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。 |
accept as:把...视作; payment:n.付款;支付;收款;款项;报答; procedures:n.程序;规程(procedure的复数);
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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, you could get an echocardiogram for 200 dollars in Brooklyn or for 2,150 dollars in Manhattan, just a few miles away. |
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。 |
echocardiogram:n.[内科]超声波心动图,心回波图;
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New Orleans , the same simple blood test , 19 dollars over here, 522 dollars just a few blocks away. |
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。 |
Orleans:n.奥尔良(法国城市); blood test:n.验血;vi.作血液检查;
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San Francisco, the same MRI, 475 dollars or 6,221 dollars just 25 miles away. |
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。 |
These pricing variations existed for all the procedures and all the cities that we surveyed . |
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。 |
variations:n.变奏曲,变更;[生物]变种(variation的复数形式); surveyed:v.调查,俯视(survey的过去式和过去分词形式);考察,调研;
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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, we asked women to tell us the prices of their mammograms . |
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。 |
partnership:n.合伙;[经管]合伙企业;合作关系;合伙契约; mammograms:n.乳房X线照片;
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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。 |
personal:adj.个人的;身体的;亲自的;n.人事消息栏;人称代名词;
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But in the space of three weeks, 400 women told us about their prices. |
但在三个星期内, 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 into our online searchable database. |
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。 |
searchable:adj.可被搜查的;透过搜查能找到的;
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(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 with top newsrooms nationwide -- in New Orleans, Philadelphia , |
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、 |
crowdsourcing:众包;群众外包;众包模式; partnerships:n.伙伴关系;合伙;(partnership的复数) newsrooms:n.新闻编辑部;报刊阅览室; Philadelphia:n.费城(美国宾夕法尼亚州东南部港市);
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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 and how to avoid that suffering, to avoid that " gotcha " bill. |
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。 |
gotcha:int.明白了(等于gotyou);
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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 by putting away his insurance card and paying cash. |
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。 |
contributor:n.贡献者;投稿者;捐助者; insurance:n.保险;保险业;保险费;保费;adj.胜券在握的;
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There are a lot of people who are going to in-network hospitals and getting out-of-network bills. |
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。 |
out-of-network:网络外;
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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, find out how to argue a bill, help us solve this problem that's hurting them and their friends and families. |
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。 |
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. |
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。 |
bankruptcy:n.破产; treatment:n.治疗;疗法;对待;处理;讨论;
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Imagine if you could afford the diagnosis but not the cure. |
想像一下,如果 你能负担得起诊断, 却负担不起治疗会怎样。 |
afford:v.给予,提供;买得起; diagnosis:n.诊断;
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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。 |
involving:v.包含;需要;牵涉;牵连;影响;(使)参加;(involve的现在分词) patients:n.接受治疗者,病人;(patient的复数)
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(Laughter) |
(笑声) |
We changed policy . |
我们改变了政策。 |
policy:n.政策,方针;保险单;
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A consumer protection bill that had been stalled in the Louisiana legislature for 10 years passed after we launched . |
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。 |
consumer:n.[经]消费者;[生,生态]消费者; stalled:失速的; Louisiana:n.美国路易斯安那州; legislature:n.立法机关;立法机构; launched:v.发射;发起;开展;开始;(launch的过去式和过去分词)
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Let's face it: this huge, slow-rolling public health crisis is a national emergency . |
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。 |
crisis:n.危机;危险期;决定性时刻;adj.危机的;用于处理危机的; emergency:n.紧急情况;突发事件;非常时刻;adj.紧急的;备用的;
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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: make all the prices public all the time. |
但是如果答案其实很简单呢: 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? |
individual:n.个人;有个性的人;adj.单独的;个别的; premiums:n.赠品,保险费;额外费用(premium复数);
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Be really clear about this: this is a United States problem. |
大家要很清楚一点: 这是美国的问题。 |
United:adj.联合的; v.联合,团结; (unite的过去分词和过去式)
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In most of the rest of the developed world, sick people don't have to worry about money. |
在大多数其他的发达国家中, 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。 |
transparency:n.透明,透明度;幻灯片;有图案的玻璃;
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There will still be expensive treatments , huge friction from our insurance system. |
仍然会有昂贵的治疗存在, 保险系统会有很大的阻力。 |
treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数) friction:n.摩擦,[力]摩擦力;
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There will still be fraud and a massive problem with overtreatment and overdiagnosis . |
仍然会有诈欺, 也会有过度治疗 与过度诊断的重大问题。 |
fraud:n.欺骗;骗子;诡计; massive:adj.大量的;巨大的,厚重的;魁伟的; overtreatment:过度处理;治疗过度; overdiagnosis:过度诊断;诊断过滥;诊断过度;
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And not everything is shoppable. |
不是所有东西都是可以比价的。 |
Not everybody wants the cheapest appendectomy or the cheapest cancer care. |
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。 |
appendectomy:n.[外科]阑尾切除术; cancer:n.癌症;恶性肿瘤;
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But when we talk about these clear effects, we're looking at a real issue that's actually very simple. |
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。 |
issue:n.重要议题;争论的问题;v.宣布;公布;发出;发行;
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When we first started calling for prices, we actually felt like we were going to be arrested. |
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。 |
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 |
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, |
transgressive:超亲的;海浸的;逾越的; in the same breath:同时; liberating:v.解放;使自由;使摆脱约束(或限制);(liberate的现在分词)
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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. |
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。 |
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? |
in advance:adv.预先,提前;
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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 ? |
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? |
Googled:vt.在谷歌上搜索;(google的过去式和过去分词) drop-downs:下拉列表框; laser printer:n.激光打印机;
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What if all of the time and energy and money that's spent hiding prices was squeezed out of the system? |
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? |
squeezed:v.挤压;捏;榨出,挤出,拧出;挤入;(squeeze的过去分词和过去式)
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What if each one of us could pick the $19 test every time instead of the $522 one? |
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? |
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 would be a lot healthier. |
我认为,我们很多人以及体制本身 都会变得更健康。 |
Thank you. |
谢谢。 |
(Applause) |
(掌声) |