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PJParmar_2018X-_医生如何帮助低收入病人（且仍能盈利）_
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| Colfax Avenue , here in Denver , Colorado , was once called the longest, wickedest street in America. |
科尔法克斯大道位于科罗拉多州丹佛市, 曾被称为美国“最长,最邪恶的街道”。 |
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Avenue:n.途径;(城镇的)大街;林荫道(尤指通往大住宅者);选择; Denver:n.丹佛(地名,美国城市); Colorado:n.科罗拉多;[城]科罗拉多州;科罗拉多河; wickedest:坏的;邪恶的;缺德的(wicked的最高级);
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| My office is there in the same place -- it's a medical desert. |
我的办公室就在那儿—— 那片医疗资源极度匮乏的地区。 |
| There are government clinics and hospitals nearby , but they're not enough to handle the poor who live in the area. |
虽然附近有政府诊所和医院, 但根本不够医治这个地区的穷人。 |
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clinics:n.诊所(clinic的复数形式); nearby:adj.附近的,邻近的;adv.在附近;prep.在…附近; handle:n.[建]把手;柄;手感;口实;v.处理;操作;运用;买卖;触摸;
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| By poor, I mean those who are on Medicaid . |
我所说的穷人是指 那些接受医疗补助的人。 |
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Medicaid:n.(美)医疗补助计划;
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| Not just for the homeless; 20 percent of this country is on Medicaid. |
不仅指无家可归的人; 美国有20%的人都接受医疗补助。 |
| If your neighbors have a family of four and make less than $33,000 a year, then they can get Medicaid. |
如果你邻居家有四口人, 年收入不到33,000美元, 那么他们就能获得医疗补助。 |
| But they can't find a doctor to see them. |
然而他们却找不到医生治病。 |
| A study by Merritt Hawkins found that only 20 percent of the family doctors in Denver take any Medicaid patients . |
梅里特霍金斯公司做的 一个研究发现, 丹佛只有20%的家庭医生 接受使用医疗补助的病人。 |
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patients:n.接受治疗者,病人;(patient的复数)
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| And of those 20 percent, some have caps, like five Medicaid patients a month. |
在这20%的医生中,有的有数量限制, 比如一个月看5位医疗补助病人。 |
| Others make Medicaid patients wait months to be seen, but will see you today, if you have Blue Cross. |
有些医生则让使用医疗补助的 病人等上几个月, 但如果你有蓝十字医疗险, 你今天就能接受治疗。 |
| This form of classist discrimination is legal and is not just a problem in Denver. |
这种阶级歧视是合法的, 并且不仅丹佛存在这个问题。 |
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classist:adj.实行阶级歧视的;有阶级偏见的;n.阶级歧视者; discrimination:n.歧视;区别,辨别;识别力; legal:adj.法律的;合法的;法定的;
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| Almost half the family doctors in the country refuse to see Medicaid patients. |
几乎一半的美国家庭医生 都拒绝接收使用医疗补助的病人。 |
| Why? |
为什么？ |
| Well, because Medicaid pays less than private insurance and because Medicaid patients are seen as more challenging. |
因为医疗补助支付的金额比私人保险低, 而且人们总觉得接收 使用医疗补助的病人更麻烦。 |
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insurance:n.保险;保险业;保险费;保费;adj.胜券在握的;
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| Some show up late for appointments , some don't speak English and some have trouble following instructions. |
他们有些人会迟到,有些人不会说英语, 有些人在遵循医嘱上也存在困难。 |
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appointments:n.约会;预约;约定;任命;委任;职位;(appointment的复数)
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| I thought about this while in medical school. |
在医学院时我就想过这些问题。 |
| If I could design a practice that caters to low-income folks instead of avoiding them, then I would have guaranteed customers and very little competition . |
如果我能设计出一个适合低收入人群 而非拒绝他们的医疗模式 那么我的客源就有保证,而且竞争很小。 |
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caters:v.(为社交活动)提供饮食,承办酒席;(cater的第三人称单数) guaranteed:adj.必然的; v.保证; competition:n.竞争;比赛,竞赛;
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| (Laughter) |
（笑声） |
| So after residency , I opened up shop, doing underserved medicine. |
所以在住院医生实习结束后,我开了 一家服务低医疗服务水平人群的诊所。 |
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residency:n.住处;住院医生实习期; underserved:adj.服务不周到的;服务水平低下的;
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| Not as a nonprofit , but as a private practice . |
不是非盈利组织,而是私人诊所。 |
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nonprofit:adj.非赢利的;不以赢利为目的的; private practice:n.私人开业;私人医生开业;
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| A small business seeing only resettled refugees . |
一个小生意,只为重新安置的难民看病。 |
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resettled:vi.重新定居;vt.使重新定居; refugees:n.避难者;逃亡者;难民;(refugee的复数)
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| That was six years ago, and since then, we've served 50,000 refugee medical visits. |
那是在6年前, 自那之后,我们已经为 5万难民提供了医疗服务。 |
| (Applause) |
（鼓掌） |
| Ninety percent of our patients have Medicaid, and most of the rest, we see for free. |
我们的病人中90%有医疗补助, 对其他剩下的大部分人, 我们提供免费诊疗。 |
| Most doctors say you can't make money on Medicaid, but we're doing it just fine. |
很多医生说你无法 在使用医疗补助的病人身上赚钱, 但我们的收入还不错。 |
| How? |
如何做到的呢？ |
| Well, if this were real capitalism , then I wouldn't tell you, because you'd become my competition. |
如果这是资本主义,我可不会告诉你, 因为你们会成为我的竞争对手。 |
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capitalism:n.资本主义;
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| (Laughter) |
(笑声) |
| But I call this " bleeding-heart " capitalism. |
但我把这称为“软心肠”的资本主义。 |
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bleeding-heart:荷包牡丹;
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| (Laughter) |
（笑声） |
| And we need more people doing this, not less, so here's how. |
我们需要更多的人参与进来, 我们是这么做的。 |
| We break down the walls of our medical maze by taking the challenges of Medicaid patients, turning them into opportunities, and pocketing the difference. |
我们把服务使用医疗补助的病人的 挑战转化为机会, 并从中赚取差价,来解开我们的医疗谜题。 |
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maze:n.迷宫;迷惑;糊涂;vt.迷失;使混乱;使困惑;
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| The nuts and bolts may seem simple, but they add up. |
螺母和螺栓看起来很简单, 但它们加起来却能发挥巨大的作用。 |
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bolts:n.[机]螺栓;[机]螺钉(bolt的复数);膨胀锚钉;角钢螺丝;毛边书;
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| For example, we have no appointments. |
比如,我们无需预约。 |
| We're walk-in only. |
我们采取即到即诊的模式。 |
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walk-in:n.轻易获得的胜利;可供人走进之物;adj.未经预约而来的;
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| Of course, that's how it works at the emergency room , at urgent cares and at Taco Bell. |
也就是说,急诊室和 塔可钟（墨西哥快餐品牌） 采用了相同的模式。 |
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emergency room:n.急诊室; urgent:adj.紧急的;急迫的; Taco:n.墨西哥煎玉米卷;墨西哥人;
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| (Laughter) |
（笑声） |
| But not usually at family doctor's offices. |
但这些在家庭医生的办公室并不常见。 |
| Why do we do it? |
我们为什么要这样做？ |
| Because Nasra can't call for an appointment. |
因为像纳斯拉这样的人没法预约。 |
| She has a phone, but she doesn't have phone minutes. |
她有电话,但她没钱付话费。 |
| She can't speak English, and she can't navigate a phone tree. |
她不会说英语,也不会查询通讯录。 |
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navigate:vt.驾驶,操纵;使通过;航行于;vi.航行,航空;
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| And she can't show up on time for an appointment because she doesn't have a car, she takes the bus, and she takes care of three kids plus her disabled father. |
她无法在预约时间准时出现, 因为她没有私家车,她需要乘坐公车, 并且她需要照顾3个小孩 外加她残疾的父亲。 |
| So we have no appointments; she shows up when she wants, but usually waits less than 15 minutes to be seen. |
所以我们不提供预约服务; 她想来的时候就来, 通常等待不到15分钟就能就诊。 |
| She then spends as much time with us as she needs. |
我们会充分保证她的就诊时长。 |
| Sometimes that's 40 minutes, usually it's less than five. |
有时候是40分钟,但通常不到5分钟。 |
| She loves this flexibility . |
她喜欢这种弹性。 |
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flexibility:n.灵活性;弹性;适应性;
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| It's how she saw doctors in Somalia. |
她在索马里就是这样看医生的。 |
| And I love it, because I don't pay staff to do scheduling, and we have a zero no-show rate and a zero late-show rate. |
这也让我很开心,因为我不需要 额外雇人负责预约事项, 我们的爽约率和迟到率为零。 |
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no-show:n.放弃预定座位的客人;不能如约出席的人;
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| (Laughter) |
（笑声） |
| (Applause) |
（鼓掌） |
| It makes business sense. |
这很有商业价值。 |
| Another difference is our office layout . |
另一个不同是我们办公室的布局。 |
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layout:n.布局;规划;设计;版面设计;
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| Our exam rooms open right to the waiting room , our medical providers room their own patients, and our providers stay in one room instead of alternating between rooms. |
我们的检查室和候诊室相通, 每个医生都和他们自己的 病人独享一个房间, 我们的服务人员集中在一个房间里, 而不需要在两个房间之间来回穿梭。 |
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waiting room:na.候车室; providers:n.供应者;提供者;供养人;(provider的复数) alternating:adj.交替的;交互的;v.使交替;依次(alternate的ing形式);
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| Cutting steps cuts costs and increases customer satisfaction . |
削减流程降低了成本,提高了客户满意度。 |
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satisfaction:n.满意,满足;赔偿;乐事;赎罪;
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| We also hand out free medicines, right from our exam room: over-the-counter ones and some prescription ones, too. |
我们还在诊室分发免费药品: 非处方药和一些处方药。 |
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over-the-counter:adj.不通过交易所而直接售给顾客的;不需处方可以出售的; prescription:n.处方;药方;医生开的药;开处方;
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| If Nasra's baby is sick, we put a bottle of children's Tylenol or amoxicillin right in her hand. |
如果纳斯拉的孩子病了, 我们会直接给她一瓶 儿童泰诺或阿莫西林。 |
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Tylenol:n.泰勒诺,泰诺(药品扑热息痛的一种品牌); amoxicillin:n.阿莫西林;羟氨苄青霉素;
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| She can take that baby straight back home instead of stopping at the pharmacy . |
她可以直接带孩子回家, 而无需再去药店。 |
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pharmacy:n.药房;配药学,药剂学;制药业;一批备用药品;
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| I don't know about you, but I get sick just looking at all those choices. |
我不知道你们怎么想, 但我一见到这一大堆药就头晕。 |
| Nasra doesn't stand a chance in there. |
纳斯拉根本没法在这里买药。 |
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stand a chance:有希望;有可能;
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| We also text patients. |
我们也给病人发短信。 |
| We're open evenings and weekends. |
我们晚上和周末都营业。 |
| We do home visits. |
我们做家访。 |
| We've jumped dead car batteries . |
我们把汽车电池都跑到没电了。 |
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batteries:n.电池;炮组;炮列;[法]殴打;(batteries是battery的复数)
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| (Laughter) |
（笑声） |
| With customer satisfaction so high, we've never had to advertise , yet are growing at 25 percent a year. |
有这么高的客户满意度, 我们根本不用打广告, 还能以每年25%的速度增长。 |
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advertise:v.做广告;登广告;(在报纸、公共场所公告牌、互联网等上)公布;展现;
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| And we've become real good at working with Medicaid, since it's pretty much the only insurance company we deal with. |
我们变得很熟悉Medicaid的业务, 因为它几乎是我们 唯一合作的保险公司。 |
| Other doctor's offices chase 10 insurance companies just to make ends meet . |
其他医生的诊所同时 与10家保险公司合作 以实现收支平衡, |
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make ends meet:收支相抵;量入为出;
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| That's just draining . |
但收效甚微。 |
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draining:v.排空;(使)流光;放干;喝光;喝干;(drain的现在分词)
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| A single-payer system is like monogamy : it just works better. |
单一支付方制度就像一夫一妻制: 它就是效果更好。 |
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monogamy:n.一夫一妻制;[动]单配偶,[动]单配性;
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| (Laughter) |
（笑声） |
| (Applause) |
（鼓掌） |
| Of course, Medicaid is funded by tax payers like you, so you might be wondering, "How much does this cost the system?" |
当然,医疗补助计划由像 你们这样的纳税人资助, 所以你们可能会好奇, “这个系统要花多少钱？” |
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funded:adj.提供资金的;v.提供资金;积存;提供资金偿付的本息;(fund的过去式); payers:n.付款人;支付者;
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| Well, we're cheaper than the alternatives . |
我们比主流方案便宜。 |
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alternatives:n.可供选择的事物;(alternative的复数)
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| Some of our patients might go to the emergency room, which can cost thousands, just for a simple cold. |
我们有些病人去急诊室, 仅仅一个简单的感冒, 就要花数千美元。 |
| Some may stay home and let their problems get worse. |
有些人则呆在家中,坐等问题恶化。 |
| But most would try to make an appointment at a clinic that's part of the system called the Federally Qualified Health Centers. |
但是大多数人会尝试在 属于联邦授权医疗中心的 一个诊所预约。 |
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Federally:adv.联邦地;联邦政府地;同盟地; Qualified:adj.有资格的; v.合格; (qualify的过去分词和过去式)
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| This is a nationwide network of safety-net clinics that receive twice as much government funding per visit than private doctors like me. |
这是一个覆盖全国的诊所安全网络, 每次看病得到的政府资助 是像我这样的私人医生的两倍。 |
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funding:n.基金;资金;提供资金;v.为…提供资金;拨款给;(fund的现在分词)
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| Not only they get more money, but by law, there can only be one in each area. |
他们不仅收取更高的费用, 根据法律,每个地区只能有一个。 |
| That means they have a monopoly on special funding for the poor. |
这意味着他们垄断了为穷人 提供的特殊资金。 |
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monopoly:n.垄断;垄断者;专卖权;
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| And like any monopoly, there's a tendency for cost to go up and quality to go down. |
跟任何垄断一样, 总是成本会上升,质量会下降。 |
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tendency:n.倾向,趋势;癖好;
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| I'm not a government entity; I'm not a nonprofit. |
我不是政府实体,我不是非盈利组织。 |
| I'm a private practice. |
我是个私人诊所。 |
| I have a capitalist drive to innovate . |
我有资本主义的创新动力。 |
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capitalist:n.资本家;资本主义者;adj.资本主义的;资本家的; innovate:vi.创新;改革;革新;vt.改变;创立;创始;引人;
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| I have to be fast and friendly. |
我必须高效和友好。 |
| I have to be cost-effective and culturally sensitive . |
我得有成本效益和文化敏感性。 |
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cost-effective:adj.划算的;成本效益好的(等于cost-efficient); culturally:adv.从文化角度,文化意义上;在人文学方面; sensitive:adj.敏感的;感觉的;易受影响的;n.敏感的人;有灵异能力的人;
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| I have to be tall, dark and handsome. |
我必须又高又黑又帅。 |
| (Laughter) |
（笑声） |
| (Applause) |
（鼓掌） |
| And if I'm not, I'm going out of business . |
如果不具备这些,我的生意就会垮掉。 |
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out of business:破产;歇业;停业;倒闭;
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| I can innovate faster than a nonprofit, because I don't need a meeting to move a stapler . |
我比非盈利组织在创新方面更高效, 因为我不需要开个会 来决定是否拆除缝合器。 |
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stapler:n.[轻]订书机;主要商品批发商;把羊毛分级的人;
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| (Applause) |
（鼓掌） |
| Really, none of our innovations are new or unique -- we just put them together in a unique way to help low-income folks while making money. |
我们的创新都不是新的或独创的—— 我们只是用一种独特的方法 把它们组合在一起, 在帮助低收入人群的同时还赚钱。 |
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innovations:n.创新(innovation的复数);改革; unique:adj.独特的,稀罕的;[数]唯一的;n.独一无二的人或物;
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| And then, instead of taking that money home, |
然后,我会把这些钱投入难民社区 |
| I put it back into the refugee community as a business expense . |
作为商业支出,而不是拿回家。 |
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community:n.社区;[生态]群落;共同体;团体; expense:n.费用;开支;花费;开销;
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| This is Mango House. |
这是芒果屋。 |
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Mango:n.芒果;
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| My version of a medical home. |
我创建的医疗之家。 |
| In it, we have programs to feed and clothe the poor, an after-school program, English classes, churches, dentist, legal help, mental health and the scout groups. |
在那里,我们为穷人提供食物和衣服, 提供课外项目,英语课, 教堂,牙医,法律援助, 心理辅导和童子军等项目。 |
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after-school:放学后 mental:adj.精神的;脑力的;疯的;n.精神病患者; scout:n.童子军活动; v.侦察,搜寻(某处);
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| These programs are run by tenant organizations and amazing staff, but all receive some amount of funding form profits from my clinic. |
这些项目由承租组织 和出色的员工运作, 但他们都从我的诊所获得了一些资金。 |
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tenant:n.房客;租户;佃户;v.(作为租赁者)居住; organizations:n.组织,构造,有机体(organization的复数);组织机构; profits:n.利润; v.获益; (profit的第三人称单数和复数)
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| Some call this social entrepreneurship . |
有人称之为社会企业家精神。 |
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entrepreneurship:n.企业家精神;
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| I call it social-service arbitrage . |
我称之为社会服务套利。 |
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arbitrage:n.套汇,套利;仲裁;
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| Exploiting inefficiencies in our health care system to serve the poor. |
利用我们卫生保健系统的 低效率为穷人服务。 |
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Exploiting:v.利用…为自己谋利;剥削;压榨;运用;发挥;(exploit的现在分词) inefficiencies:无能; health care:n.卫生保健;
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| We're serving 15,000 refugees a year at less cost than where else they would be going. |
我们每年服务15,000位难民, 且比其他地方花费更少。 |
| Of course, there's downsides to doing this as a private business, rather than as a nonprofit or a government entity . |
当然,作为私人企业, 既非非盈利组织,也非政府实体, 做这个也有不利的一面。 |
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downsides:下降趋势;消极面,缺点(downside的复数); entity:n.实体;存在;本质;
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| There's taxes and legal exposures . |
有税收和法律风险。 |
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exposures:暴露;[摄]曝光;揭露;陈列(exposure的复数);
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| There's changing Medicaid rates and specialists who don't take Medicaid. |
有不断变化的医疗补助率和 不接受医疗补助病人的专家。 |
| And there's bomb threats. |
还有炸弹威胁。 |
| Notice there's no apostrophes , it's like, "We were going to blow up all you refugees!" |
请注意,这里少了个标点符号, 所以表达的意思就变成了, “我们本来要炸掉你们这些难民！” |
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apostrophes:n.省略符号;
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| (Laughter) |
（笑声） |
| '"We were going to blow up all you refugees, but then we went to your English class, instead." |
“我们本来要炸掉你们这些难民, 但后来我们去上了你们的英语课。” |
| (Laughter) |
（笑声） |
| (Applause) |
（鼓掌） |
| Now, you might be thinking, "This guy's a bit different." |
现在,你可能在想, “这家伙的确有一套。” |
| (Laughter) |
（笑声） |
| Uncommon . |
罕见。 |
|
Uncommon:adj.不寻常的;罕有的;adv.非常地;
|
| (Laughter) |
（笑声） |
| A communal narcissist ? |
一个公共自恋者？ |
|
communal:adj.公共的;公社的; narcissist:n.自我陶醉者;
|
| (Laughter) |
（笑声） |
| A unicorn , maybe, because if this was so easy, then other doctors would be doing it. |
也许还是独角兽, 但如果这么简单的话, 其他医生也会这样做。 |
|
unicorn:n.独角兽;麒麟;
|
| Well, based on Medicaid rates, you can do this in most of the country. |
根据医疗补助率,你可以在 全国大部分地区这样做。 |
| You can be your own boss, help the poor and make good money doing it. |
你可以做自己的老板, 帮助穷人并赚大钱。 |
| Medical folks, you wrote on your school application essays that you wanted to help those less fortunate . |
医学院的人 可能在申请学校时说过 你想帮助那些不幸的人。 |
|
application:n.应用;申请;应用程序;敷用; fortunate:adj.幸运的;交好运的;吉利的;
|
| But then you had your idealism beaten out of you in training. |
但你的理想情怀在训练过程中丢掉了。 |
|
idealism:n.唯心主义,理想主义;理念论;
|
| Your creativity bred out of you. |
你的创造力不复存在了。 |
|
bred:v.交配繁殖;培育(动植物);孕育;导致;(breed的过去分词和过去式)
|
| It doesn't have to be that way. |
你们本可以做得更好。 |
| You can choose underserved medicine as a lifestyle specialty . |
你可以选择医疗服务不足的 领域作为毕生专业。 |
|
specialty:n.专业,专长;特产;特性;招牌菜;adj.特色的;专门的;独立的;
|
| Or you can be a specialist who cuts cost in order to see low-income folks. |
或者你可以选择成为 降低成本,为低收入人群看病的专家。 |
| And for the rest of you, who don't work in health care, what did you write on your applications? |
对不从事医疗保健行业的其他人来讲, 你的申请表是怎么写的？ |
| Most of us wanted to save the world, to make a difference . |
我们大部分人想要 拯救世界,改变现状。 |
|
make a difference:有影响,有关系;
|
| Maybe you've been successful in your career but are now looking for that meaning? |
你们也许在你们的职业中已足够成功, 现在正在寻找生活的意义？ |
|
career:n.职业;事业;生涯;经历;
|
| How can you get there? |
你如何能够实现那个目标？ |
| I don't just mean giving a few dollars or a few hours; |
我指的不是捐献一些钱或几个小时; |
| I mean how can you use your expertise to innovate new ways of serving others. |
我的意思是你如何使用你的专业技能, 以新的方式去服务他人？ |
|
expertise:n.专门知识;专门技术;专家的意见;
|
| It might be easier than you think. |
这可能没你想的那么难。 |
| The only way we're going to bridge the underserved medicine gap is by seeing it as a business opportunity. |
我们能够弥补医疗服务不足的唯一方法 是将其视为商业机会。 |
|
gap:n.差距;间隙;缺口;间隔;v.使豁裂;豁开;
|
| The only way we're going to bridge the inequality gap is by recognizing our privileges and using them to help others. |
我们缩小不平等差距的唯一途径 是认识到我们的特权, 并利用这些特权帮助他人。 |
|
recognizing:v.认识;认出;承认;接受,赞成(recognize的现在分词) privileges:n.[计]特权(privilege的复数); v.给与…特权(privilege的第三人称单数形式);
|
| (Applause) |
（鼓掌） |