是什么让美国的医疗体系如此昂贵?（四）
正文翻译
What makes the US healthcare system so expensive?
是什么让美国的医疗体系如此昂贵?
是什么让美国的医疗体系如此昂贵?
评论翻译
Dr. Balaji Viswanathan
What's wrong with the US healthcare system?
I have been admitted in US hospitals a few times — twice for ACL reconstruction surgeries after an accident, once for my wife’s pregnancy and a few more times for relative who was dying of cancer. I have also been in Indian hospitals a lot. I also have doctor friends in both countries.
While people blame it all on universal healthcare coverage, there are more fundamental issues.
Here are based on my experiences:
Getting basic healthcare is complicated: Getting a bag of chips and coke at any time of the day is so easy in the US, but getting treated for fever or a headache is super complicated. People don’t even question that. There are no simple clinics, where you can walk in and out in 10 minutes, paying only a few dollars to treat simple illnesses. Getting 5 minutes of a doctor’s time should not be more expensive than a haircut or an oil change and should not require an insurance — but it is not. That means people wait for illnesses to get big and then pay for super expensive emergency room treatments.
Lack of family support means old people spend too long in hospitals. The biggest cost for the health care system comes in the last few months of living. Medicare allows for longer than necessary stays in the hospital and without families the patients are more reluctant to go back home. There is no big uptake for hospice unlike Europe.
美国的医疗体系出了什么问题？
在美国，我曾几次入住医院——两次是在事故后进行前交叉韧带重建手术，一次是因为我妻子怀孕，还有几次是因为死于癌症的亲戚。我也去过印度的医院很多次，我在两国都有医生朋友。
虽然人们把这一切归咎于全民医疗保险，但还有更根本的问题。
以下观点是基于我的经验：
获得基本的医疗保险很复杂：在美国，一天中的任何时候都可以很容易地获得一袋薯片和可乐，但要治疗发烧或头痛却非常复杂。人们甚至没质疑这一点。没有这种简单的诊所——你可以在10分钟内进出，只需支付几美元就可以治疗简单的疾病。看医生，才5分钟时间，是不应该比理发或换油更贵的，也不应该需要保险的——但事实并非如此。这意味着人们等待疾病发展，然后支付超昂贵的急诊室治疗费用。
缺乏家庭支持意味着老年人在医院待的时间过长。医疗保健系统的最大成本来自最后几个月的生活。医疗保险允许在医院停留的时间超过必要停留的时间，如果没有家人，患者更是不愿意回家的。与欧洲不同，临终关怀的需求并不大。
What's wrong with the US healthcare system?
I have been admitted in US hospitals a few times — twice for ACL reconstruction surgeries after an accident, once for my wife’s pregnancy and a few more times for relative who was dying of cancer. I have also been in Indian hospitals a lot. I also have doctor friends in both countries.
While people blame it all on universal healthcare coverage, there are more fundamental issues.
Here are based on my experiences:
Getting basic healthcare is complicated: Getting a bag of chips and coke at any time of the day is so easy in the US, but getting treated for fever or a headache is super complicated. People don’t even question that. There are no simple clinics, where you can walk in and out in 10 minutes, paying only a few dollars to treat simple illnesses. Getting 5 minutes of a doctor’s time should not be more expensive than a haircut or an oil change and should not require an insurance — but it is not. That means people wait for illnesses to get big and then pay for super expensive emergency room treatments.
Lack of family support means old people spend too long in hospitals. The biggest cost for the health care system comes in the last few months of living. Medicare allows for longer than necessary stays in the hospital and without families the patients are more reluctant to go back home. There is no big uptake for hospice unlike Europe.
美国的医疗体系出了什么问题？
在美国，我曾几次入住医院——两次是在事故后进行前交叉韧带重建手术，一次是因为我妻子怀孕，还有几次是因为死于癌症的亲戚。我也去过印度的医院很多次，我在两国都有医生朋友。
虽然人们把这一切归咎于全民医疗保险，但还有更根本的问题。
以下观点是基于我的经验：
获得基本的医疗保险很复杂：在美国，一天中的任何时候都可以很容易地获得一袋薯片和可乐，但要治疗发烧或头痛却非常复杂。人们甚至没质疑这一点。没有这种简单的诊所——你可以在10分钟内进出，只需支付几美元就可以治疗简单的疾病。看医生，才5分钟时间，是不应该比理发或换油更贵的，也不应该需要保险的——但事实并非如此。这意味着人们等待疾病发展，然后支付超昂贵的急诊室治疗费用。
缺乏家庭支持意味着老年人在医院待的时间过长。医疗保健系统的最大成本来自最后几个月的生活。医疗保险允许在医院停留的时间超过必要停留的时间，如果没有家人，患者更是不愿意回家的。与欧洲不同，临终关怀的需求并不大。
Fear of lawsuits mean doctors test a lot. A roommate went for a throat infection and they did a X-ray and many more things costing $1000. In India, the solution would have been Crocin and gargling.
Hospitals are over-luxurious. When I got my wife in a private room for her delivery, my mother-in-law could not believe it was a hospital. The room was massive and more like a luxury hotel than a place we have come to get a painful job done. I spent days walking through cancer wards and the frivolous expenditures on needless infrastructure was painful. In those obscenely carved marble pathways, I saw so many women crying alone for their loved ones, probably unable to pay for key treatments.
Getting a medicine degree is way too long and expensive. It takes probably 10–15 years to become a doctor and that is way too much complicated. If we can design bridges (that will carry thousands every hour) with just a 4 year degree, why cannot a GP treat a cold with a 4–5 year degree? Medical doctors don’t hold more lives at stake than engineers and a lot of family medicine might not require unusually complicated stuff (that should go to the specialists). Why make it too long, expensive and painful — requiring a huge salary in the end?
对诉讼的恐惧意味着医生要做很多测试。一位室友去做了喉咙感染检查，他们做了X光检查和其他很多检查，花费了1000美元。在印度，解决方案应该是藏红花素和漱口。
医院非常豪华，当我把我的妻子送到一个私人房间分娩时，我的岳母简直不敢相信这是一家医院。房间很大，更像是一家豪华酒店，而不像一个我们来完成痛苦分娩工作的地方。我曾花了几天的时间在癌症病房里走动，在不必要的基础设施上的无谓支出令人痛苦。在那些雕刻得很难看的大理石小路上，我看到很多女人独自为她们的亲人哭泣，可能无法支付关键的治疗费用。
获得医学学位既费时又代价高昂。成为一名医生可能需要10到15年的时间，这太复杂了。如果我们只需4年的学位就可以设计桥梁（每小时可承载数千人），为什么全科医生不能花4-5年的时间获得能治疗感冒的学位？医生不会比工程师有更多的生命危险，许多家庭医学可能不需要异常复杂的东西（应该交给专家）。为什么要让这个时间变得太长、太贵、太痛苦——最终需要巨额薪水？
Hospitals are over-luxurious. When I got my wife in a private room for her delivery, my mother-in-law could not believe it was a hospital. The room was massive and more like a luxury hotel than a place we have come to get a painful job done. I spent days walking through cancer wards and the frivolous expenditures on needless infrastructure was painful. In those obscenely carved marble pathways, I saw so many women crying alone for their loved ones, probably unable to pay for key treatments.
Getting a medicine degree is way too long and expensive. It takes probably 10–15 years to become a doctor and that is way too much complicated. If we can design bridges (that will carry thousands every hour) with just a 4 year degree, why cannot a GP treat a cold with a 4–5 year degree? Medical doctors don’t hold more lives at stake than engineers and a lot of family medicine might not require unusually complicated stuff (that should go to the specialists). Why make it too long, expensive and painful — requiring a huge salary in the end?
对诉讼的恐惧意味着医生要做很多测试。一位室友去做了喉咙感染检查，他们做了X光检查和其他很多检查，花费了1000美元。在印度，解决方案应该是藏红花素和漱口。
医院非常豪华，当我把我的妻子送到一个私人房间分娩时，我的岳母简直不敢相信这是一家医院。房间很大，更像是一家豪华酒店，而不像一个我们来完成痛苦分娩工作的地方。我曾花了几天的时间在癌症病房里走动，在不必要的基础设施上的无谓支出令人痛苦。在那些雕刻得很难看的大理石小路上，我看到很多女人独自为她们的亲人哭泣，可能无法支付关键的治疗费用。
获得医学学位既费时又代价高昂。成为一名医生可能需要10到15年的时间，这太复杂了。如果我们只需4年的学位就可以设计桥梁（每小时可承载数千人），为什么全科医生不能花4-5年的时间获得能治疗感冒的学位？医生不会比工程师有更多的生命危险，许多家庭医学可能不需要异常复杂的东西（应该交给专家）。为什么要让这个时间变得太长、太贵、太痛苦——最终需要巨额薪水？
There is no real transparency on pricing. US hospitals are super opaque. Any procedure or stuff can cost anything from $0.10 to $1 million. It is just a wild, wild world. There must be some brackets that must be standardized. More complex things in the world are standardized and you cannot be serious to not standardise the rate of stuff used in a hospital — from bandages to medicines.
No free market. A lot of medical procedures are not of emergency type. People have both time and flexibility to move. Why cannot someone easily shop for prices for a root canal or a meniscus tear or a heart stent, just as we do black friday shopping? Again, dealing with doctors are not a one time thing, but often can be a continuous experience — repeat purchases and flexibility should allow for a freer market.
Without fixing the fundamental problems that balloon up the expenses, things are not going to get fixed with just insurance. You don’t need an insurance to get a haircut with a professional for about $25. A doctor might spend a lot less time with you than the stylist and why should the doctor visit cost more and require more paperwork?
定价没有真正的透明度。美国的医院非常不透明。任何程序或东西的费用从0.10美元到100万美元不等。这只是一个缺乏根据的世界。必须要标准化才行。世界上更复杂的事情都是标准化的，医院里从绷带到药物的使用都不执行标准化，这是不可能的。
没有自由市场，很多医疗程序都不是紧急类型的。人们既有时间，也能灵活移动。为什么人们不能像我们在黑色星期五购物一样，购买根管、半月板撕裂或心脏支架时给价格做好分类？再者，与医生打交道不是一次性的事情，而是一种持续的体验——重复购买和灵活性应该允许市场更加自由。
如果不解决导致开支激增的根本问题，仅靠保险是无法解决问题的。你不需要保险就可以花25美元要求专业理发师给你理发。医生和你在一起的时间可能比发型师少得多，为什么看医生要花更多的钱，为什么需要更多的文书工作呢?
No free market. A lot of medical procedures are not of emergency type. People have both time and flexibility to move. Why cannot someone easily shop for prices for a root canal or a meniscus tear or a heart stent, just as we do black friday shopping? Again, dealing with doctors are not a one time thing, but often can be a continuous experience — repeat purchases and flexibility should allow for a freer market.
Without fixing the fundamental problems that balloon up the expenses, things are not going to get fixed with just insurance. You don’t need an insurance to get a haircut with a professional for about $25. A doctor might spend a lot less time with you than the stylist and why should the doctor visit cost more and require more paperwork?
定价没有真正的透明度。美国的医院非常不透明。任何程序或东西的费用从0.10美元到100万美元不等。这只是一个缺乏根据的世界。必须要标准化才行。世界上更复杂的事情都是标准化的，医院里从绷带到药物的使用都不执行标准化，这是不可能的。
没有自由市场，很多医疗程序都不是紧急类型的。人们既有时间，也能灵活移动。为什么人们不能像我们在黑色星期五购物一样，购买根管、半月板撕裂或心脏支架时给价格做好分类？再者，与医生打交道不是一次性的事情，而是一种持续的体验——重复购买和灵活性应该允许市场更加自由。
如果不解决导致开支激增的根本问题，仅靠保险是无法解决问题的。你不需要保险就可以花25美元要求专业理发师给你理发。医生和你在一起的时间可能比发型师少得多，为什么看医生要花更多的钱，为什么需要更多的文书工作呢?
Marian Davis
Hospitals Are Profit Centers
The expenditures associated with hospital treatment make up 31% of the total cost of healthcare in the country.
A research that was published in 2019 in the journal Health Affairs found that between 2007 and 2014, the cost of inpatient and outpatient hospital treatment increased at a far quicker rate than the cost of physician care.
In 2020, hospital expenses reached $1.27 trillion, representing a 6.4% increase from the previous year.
The costs of surgical operations performed in hospitals in the United States are significantly higher than those in other nations. In the Netherlands, the usual cost of an angioplasty to unblock a blocked blood artery is $6,390, whereas in Switzerland and the United States, the cost is $7,370 and $32,230 respectively. In a similar vein, the cost of a cardiac bypass procedure in Switzerland is $32,010 whereas it is $78,100 in the United States.
Today, the financial stability of a significant number of hospitals is precarious. In addition, due of the coronavirus lockdown, elective surgeries have stopped, and the number of patients seeing their doctors has dropped significantly. Both of these factors are to blame for a significant portion of the loss in the general economy.
医院是利润中心
与住院治疗相关的支出占该国医疗保健总费用的31%。
2019年发表在《健康事务》杂志上的一项研究发现，在2007年至2014年间，住院和门诊医院治疗费用的增长速度远快于医生护理费用。
2020年，医院费用达到1.27万亿美元，比前一年增长6.4%。
美国医院的外科手术费用明显高于其他国家。在荷兰，疏通阻塞的血管的血管成形术的通常费用为6390美元，而在瑞士和美国，费用分别为7370美元和32230美元。同样，瑞士的心脏搭桥手术费用为32010美元，而美国为78100美元。
在美国，相当多医院的财务稳定性岌岌可危。此外，由于新冠肺炎疫情封锁，选择性手术已经停止，就诊人数大幅减少。这两个因素都是造成整体经济损失的主要原因。
Hospitals Are Profit Centers
The expenditures associated with hospital treatment make up 31% of the total cost of healthcare in the country.
A research that was published in 2019 in the journal Health Affairs found that between 2007 and 2014, the cost of inpatient and outpatient hospital treatment increased at a far quicker rate than the cost of physician care.
In 2020, hospital expenses reached $1.27 trillion, representing a 6.4% increase from the previous year.
The costs of surgical operations performed in hospitals in the United States are significantly higher than those in other nations. In the Netherlands, the usual cost of an angioplasty to unblock a blocked blood artery is $6,390, whereas in Switzerland and the United States, the cost is $7,370 and $32,230 respectively. In a similar vein, the cost of a cardiac bypass procedure in Switzerland is $32,010 whereas it is $78,100 in the United States.
Today, the financial stability of a significant number of hospitals is precarious. In addition, due of the coronavirus lockdown, elective surgeries have stopped, and the number of patients seeing their doctors has dropped significantly. Both of these factors are to blame for a significant portion of the loss in the general economy.
医院是利润中心
与住院治疗相关的支出占该国医疗保健总费用的31%。
2019年发表在《健康事务》杂志上的一项研究发现，在2007年至2014年间，住院和门诊医院治疗费用的增长速度远快于医生护理费用。
2020年，医院费用达到1.27万亿美元，比前一年增长6.4%。
美国医院的外科手术费用明显高于其他国家。在荷兰，疏通阻塞的血管的血管成形术的通常费用为6390美元，而在瑞士和美国，费用分别为7370美元和32230美元。同样，瑞士的心脏搭桥手术费用为32010美元，而美国为78100美元。
在美国，相当多医院的财务稳定性岌岌可危。此外，由于新冠肺炎疫情封锁，选择性手术已经停止，就诊人数大幅减少。这两个因素都是造成整体经济损失的主要原因。
The Healthcare System in the United States Employs Defensive Medicine
As a result of the shared goal of protecting themselves against legal action held by hospitals and doctors, patients may be subjected to further exams and scans "just in case." And the costs of these testing might vary. The average cost of a CT scan in the United States is $896, which is significantly more than the cost of merely $97 in Canada and $500 in Australia.
The average cost of an MRI scan in the United Kingdom is around $450, compared to $1,420 in the United States. Researchers have come to the conclusion that the reason why it is so expensive to be sick in the United States is not due to the vast number of tests and treatments but rather the high cost of each one.
The prices in the United States are quite variable.
As a result of the complexities of the system and the absence of predetermined rates for medical services, service providers are at liberty to charge whatever prices the market is willing to pay. It is possible for the amount that is paid for the same healthcare treatment to differ dramatically depending on the payer (i.e. private insurance or government programs, such as Medicare or Medicaid) and the geographical location in which the service is provided.
美国的医疗保健系统采用防御性医疗
由于保护自己免受医院和医生法律诉讼的共同目标，“以防万一”，患者可能会接受进一步的检查和扫描。这些检查的费用可能会有所不同。在美国，CT扫描的平均花费为896美元，远远高于加拿大仅97美元和澳大利亚500美元的费用。
英国核磁共振扫描的平均费用约为450美元，而美国为1420美元。研究人员得出的结论是，在美国生病后的花费高昂的原因不是因为大量的检查和治疗，而是每项检查和治疗的花费都很高。
美国医疗的价格变化很大。
由于系统的复杂性和医疗服务没有预先确定的费率，服务提供者可以自由地收取市场愿意支付的任何价格。根据付款人（即私人保险或政府计划，如医疗保险或医疗补助）和提供服务的地理位置，为相同的医疗保健支付的金额可能会有很大差异。
As a result of the shared goal of protecting themselves against legal action held by hospitals and doctors, patients may be subjected to further exams and scans "just in case." And the costs of these testing might vary. The average cost of a CT scan in the United States is $896, which is significantly more than the cost of merely $97 in Canada and $500 in Australia.
The average cost of an MRI scan in the United Kingdom is around $450, compared to $1,420 in the United States. Researchers have come to the conclusion that the reason why it is so expensive to be sick in the United States is not due to the vast number of tests and treatments but rather the high cost of each one.
The prices in the United States are quite variable.
As a result of the complexities of the system and the absence of predetermined rates for medical services, service providers are at liberty to charge whatever prices the market is willing to pay. It is possible for the amount that is paid for the same healthcare treatment to differ dramatically depending on the payer (i.e. private insurance or government programs, such as Medicare or Medicaid) and the geographical location in which the service is provided.
美国的医疗保健系统采用防御性医疗
由于保护自己免受医院和医生法律诉讼的共同目标，“以防万一”，患者可能会接受进一步的检查和扫描。这些检查的费用可能会有所不同。在美国，CT扫描的平均花费为896美元，远远高于加拿大仅97美元和澳大利亚500美元的费用。
英国核磁共振扫描的平均费用约为450美元，而美国为1420美元。研究人员得出的结论是，在美国生病后的花费高昂的原因不是因为大量的检查和治疗，而是每项检查和治疗的花费都很高。
美国医疗的价格变化很大。
由于系统的复杂性和医疗服务没有预先确定的费率，服务提供者可以自由地收取市场愿意支付的任何价格。根据付款人（即私人保险或政府计划，如医疗保险或医疗补助）和提供服务的地理位置，为相同的医疗保健支付的金额可能会有很大差异。
The Crux of the Matter
The majority of other industrialized nations keep healthcare costs under control in part by giving their governments a more active role in the process of price negotiation. Their medical care systems do not necessitate the substantial administrative expenses that are a major contributor to price increases in the United States.
Because these governments are the worldwide overseers of their countries' systems, they have the ability to negotiate cheaper pricing for pharmaceuticals, medical equipment, and hospitals. They have the capacity to affect the therapies that are administered, as well as the patients' access to experts and their ability to pay for more expensive treatments. Even though consumers may have fewer options, expenditures are kept under control.
A lack of political support in the United States has precluded the federal government from playing a more significant role in limiting the rising costs of medical care. The Affordable Care Act prioritized expanding access to medical care while preserving the existing system in order to foster healthy competition among health insurance companies and medical service providers.
The costs associated with the healthcare crisis of 2020 and 2021 threatened to overwhelm both the healthcare system and the finances of the government. As a result, individuals need to undertake their own research in order to sext the health insurance provider that is most suited to meet their requirements.
问题的关键
大多数其他工业化国家在一定程度上通过让政府在价格谈判过程中发挥更积极的作用来控制医疗成本。他们的医疗保健系统不需要大量的行政费用，而行政费用是美国物价上涨的主要原因。
因为这些政府是其国家医疗系统的全球监督者，他们有能力为药品、医疗设备和医院协商更便宜的价格。他们有能力影响所实施的治疗，也有能力影响患者接触专家的机会，以及他们支付更昂贵治疗费用的能力。尽管消费者的选择可能更少，但支出仍在控制之中。
在美国，由于缺乏政治支持，联邦政府无法在限制医疗费用上涨方面发挥更重要的作用。《平价医疗法案》优先考虑扩大医疗服务的可及性，同时保留现有制度，以促进医疗保险公司和医疗服务提供商之间的良性竞争。
与2020年和2021年医疗危机相关的成本可能会使医疗体系和政府财政不堪重负。因此，个人需要自行研究，以选择最适合满足其要求的医疗保险提供商。
The majority of other industrialized nations keep healthcare costs under control in part by giving their governments a more active role in the process of price negotiation. Their medical care systems do not necessitate the substantial administrative expenses that are a major contributor to price increases in the United States.
Because these governments are the worldwide overseers of their countries' systems, they have the ability to negotiate cheaper pricing for pharmaceuticals, medical equipment, and hospitals. They have the capacity to affect the therapies that are administered, as well as the patients' access to experts and their ability to pay for more expensive treatments. Even though consumers may have fewer options, expenditures are kept under control.
A lack of political support in the United States has precluded the federal government from playing a more significant role in limiting the rising costs of medical care. The Affordable Care Act prioritized expanding access to medical care while preserving the existing system in order to foster healthy competition among health insurance companies and medical service providers.
The costs associated with the healthcare crisis of 2020 and 2021 threatened to overwhelm both the healthcare system and the finances of the government. As a result, individuals need to undertake their own research in order to sext the health insurance provider that is most suited to meet their requirements.
问题的关键
大多数其他工业化国家在一定程度上通过让政府在价格谈判过程中发挥更积极的作用来控制医疗成本。他们的医疗保健系统不需要大量的行政费用，而行政费用是美国物价上涨的主要原因。
因为这些政府是其国家医疗系统的全球监督者，他们有能力为药品、医疗设备和医院协商更便宜的价格。他们有能力影响所实施的治疗，也有能力影响患者接触专家的机会，以及他们支付更昂贵治疗费用的能力。尽管消费者的选择可能更少，但支出仍在控制之中。
在美国，由于缺乏政治支持，联邦政府无法在限制医疗费用上涨方面发挥更重要的作用。《平价医疗法案》优先考虑扩大医疗服务的可及性，同时保留现有制度，以促进医疗保险公司和医疗服务提供商之间的良性竞争。
与2020年和2021年医疗危机相关的成本可能会使医疗体系和政府财政不堪重负。因此，个人需要自行研究，以选择最适合满足其要求的医疗保险提供商。
John Oyston
What do foreigners admire about the American healthcare system? What do they wish about their healthcare was more like America’s?
I am a Canadian. I recently went to Johns Hopkins in Baltimore, USA, for a second opinion.
The medical care was excellent. I had a number of tests done by kind caring and competent technicians, on a range of machines ranging from archaic to state of the art.
After the testing I went to a room where a technician displayed all my test results on three large screen monitors.
A very pleasant, highly articulate, well dressed young physician went over the test results carefully and in great detail. He explained the significance of each finding. He talked briefly about his own leading edge research in related areas. He ended up with the same diagnosis, prognosis and treatment plan as my Canadian physician.
I could not have been more impressed with the medical aspects of my care.
外国人对美国的医疗体系有什么欣赏之处?他们希望自己的医疗保健更像美国的医疗保健吗?
我是加拿大人。我最近去了美国巴尔的摩的约翰霍普金斯大学，寻求第二种意见。
那里的医疗服务非常好。我让热心能干的技术人员在各种机器（从老式的到最先进）上做了很多测试。
测试结束后，我去了一个房间，技术人员在三个大屏幕显示器上显示了我的所有测试结果。
一位非常愉快、口齿清晰、穿着得体的年轻医生仔细而详细地检查了检查结果。他解释了每一项发现的意义。他简要介绍了自己在相关领域的前沿研究。他的诊断、预后和治疗方案与我的加拿大医生相同。
我对医疗方面的护理印象非常深刻。
What do foreigners admire about the American healthcare system? What do they wish about their healthcare was more like America’s?
I am a Canadian. I recently went to Johns Hopkins in Baltimore, USA, for a second opinion.
The medical care was excellent. I had a number of tests done by kind caring and competent technicians, on a range of machines ranging from archaic to state of the art.
After the testing I went to a room where a technician displayed all my test results on three large screen monitors.
A very pleasant, highly articulate, well dressed young physician went over the test results carefully and in great detail. He explained the significance of each finding. He talked briefly about his own leading edge research in related areas. He ended up with the same diagnosis, prognosis and treatment plan as my Canadian physician.
I could not have been more impressed with the medical aspects of my care.
外国人对美国的医疗体系有什么欣赏之处?他们希望自己的医疗保健更像美国的医疗保健吗?
我是加拿大人。我最近去了美国巴尔的摩的约翰霍普金斯大学，寻求第二种意见。
那里的医疗服务非常好。我让热心能干的技术人员在各种机器（从老式的到最先进）上做了很多测试。
测试结束后，我去了一个房间，技术人员在三个大屏幕显示器上显示了我的所有测试结果。
一位非常愉快、口齿清晰、穿着得体的年轻医生仔细而详细地检查了检查结果。他解释了每一项发现的意义。他简要介绍了自己在相关领域的前沿研究。他的诊断、预后和治疗方案与我的加拿大医生相同。
我对医疗方面的护理印象非常深刻。
The financial aspect were disastrously incompetent. As expected, I paid several thousands of dollars for tests, most of which I had previously had done in Canada for free.
The problem I had was that it took ages to work out what the fees should be. Originally the hospital quoted one fee for consultation and tests. I asked what tests were included but they did not seem to know. Eventually they corresponded with one of their physicians and we agreed on what tests were needed. It took them days to work out what these tests would cost. The accounting department apparently did not have a list of what the hospital bills for each test! Finally I got a list of what tests would be provided for how much, and went ahead with the consultation.
After I was back in Canada I got a request to allow the hospital to charge my credit card a few hundred dollars more than we had agreed. They were strangely vague about why. Maybe I had had an extra test done which was not included? Or the price of one test had gone up? All they really knew is that they would like a few hundred more dollars from me.
It was as if I had been to a restaurant and the next day they called to say, “By the way, the price of steak has gone up so you owe us ten bucks” or as if I had taken my car in for a service and, after it was back in my driveway, the garage called and said, “Oh, your brakes needed fixing so you owe us another $200.”
I could not believe that the financial department of Johns Hopkins could be so inefficient. I said that if they wanted to do this I would never come back to them, as next time they might demand thousands of dollars more than we had agreed in advance.
In summary - love the medical bit of US health care, hate the financial bit.
财政方面是灾难性的无能状态。不出所料，我花了数千美元进行测试，我以前在加拿大时，其中大部分项目是免费进行的。
我遇到的问题是，我花了很长时间才弄清楚费用应该是多少。最初医院的咨询和检测费用是一笔。我问他们包括哪些测试，但他们似乎不知道。最终，他们与他们的一位医生进行了沟通，我们就需要进行哪些测试达成了一致。他们花了几天时间才计算出这些测试的费用。会计部门显然没有医院每次检查的账单清单！最后，我还是得到了一份清单，列出了将提供的测试费用，并继续进行咨询。
回到加拿大后，我收到了一个请求，允许医院向我的信用卡收取比我们同意的要多几百美元的费用。奇怪的是，他们对原因含糊其辞。也许我做了一个不包括在内的额外测试？还是某一次测试的价格上涨了？他们真正知道的是，他们想要我再给他们几百美元。
就好像我去了一家餐馆，第二天他们打电话说：“顺便说一句，牛排的价格上涨了，所以你欠我们10美元”，或者就好像我把我的车送去维修，当它回到车道上后，维修厂打电话说，“哦，你的刹车做了必要的修理，所以你还欠我们200美元。”
我简直不敢相信约翰霍普金斯大学的财务部门竟然如此低效。我说，如果他们想这样做，我永远不会再找他们了，因为下次他们要求的费用可能比我们事先商定的多出数千美元。
总之，喜欢美国医疗保健的医疗部分，但不喜欢财政部分。
The problem I had was that it took ages to work out what the fees should be. Originally the hospital quoted one fee for consultation and tests. I asked what tests were included but they did not seem to know. Eventually they corresponded with one of their physicians and we agreed on what tests were needed. It took them days to work out what these tests would cost. The accounting department apparently did not have a list of what the hospital bills for each test! Finally I got a list of what tests would be provided for how much, and went ahead with the consultation.
After I was back in Canada I got a request to allow the hospital to charge my credit card a few hundred dollars more than we had agreed. They were strangely vague about why. Maybe I had had an extra test done which was not included? Or the price of one test had gone up? All they really knew is that they would like a few hundred more dollars from me.
It was as if I had been to a restaurant and the next day they called to say, “By the way, the price of steak has gone up so you owe us ten bucks” or as if I had taken my car in for a service and, after it was back in my driveway, the garage called and said, “Oh, your brakes needed fixing so you owe us another $200.”
I could not believe that the financial department of Johns Hopkins could be so inefficient. I said that if they wanted to do this I would never come back to them, as next time they might demand thousands of dollars more than we had agreed in advance.
In summary - love the medical bit of US health care, hate the financial bit.
财政方面是灾难性的无能状态。不出所料，我花了数千美元进行测试，我以前在加拿大时，其中大部分项目是免费进行的。
我遇到的问题是，我花了很长时间才弄清楚费用应该是多少。最初医院的咨询和检测费用是一笔。我问他们包括哪些测试，但他们似乎不知道。最终，他们与他们的一位医生进行了沟通，我们就需要进行哪些测试达成了一致。他们花了几天时间才计算出这些测试的费用。会计部门显然没有医院每次检查的账单清单！最后，我还是得到了一份清单，列出了将提供的测试费用，并继续进行咨询。
回到加拿大后，我收到了一个请求，允许医院向我的信用卡收取比我们同意的要多几百美元的费用。奇怪的是，他们对原因含糊其辞。也许我做了一个不包括在内的额外测试？还是某一次测试的价格上涨了？他们真正知道的是，他们想要我再给他们几百美元。
就好像我去了一家餐馆，第二天他们打电话说：“顺便说一句，牛排的价格上涨了，所以你欠我们10美元”，或者就好像我把我的车送去维修，当它回到车道上后，维修厂打电话说，“哦，你的刹车做了必要的修理，所以你还欠我们200美元。”
我简直不敢相信约翰霍普金斯大学的财务部门竟然如此低效。我说，如果他们想这样做，我永远不会再找他们了，因为下次他们要求的费用可能比我们事先商定的多出数千美元。
总之，喜欢美国医疗保健的医疗部分，但不喜欢财政部分。
Geoffrey Thorndyke
Why is the American healthcare system the best in the world?
Because they employ the finest Salespeople, the most expert lawyers, the best accounts clerks, the most persistant debt collectors, and the largest insurance companies in their constant search to ensure the US Healthcare System is far and away the most profitable in the whole wide world.
为什么美国的医疗体系是世界上最好的?
因为他们雇佣了最优秀的销售人员、最专业的律师、最优秀的会计人员、最坚持不懈的讨债员和最大的保险公司，以确保美国的医疗保健系统在全世界范围内遥遥领先。
Why is the American healthcare system the best in the world?
Because they employ the finest Salespeople, the most expert lawyers, the best accounts clerks, the most persistant debt collectors, and the largest insurance companies in their constant search to ensure the US Healthcare System is far and away the most profitable in the whole wide world.
为什么美国的医疗体系是世界上最好的?
因为他们雇佣了最优秀的销售人员、最专业的律师、最优秀的会计人员、最坚持不懈的讨债员和最大的保险公司，以确保美国的医疗保健系统在全世界范围内遥遥领先。
Geoffrey Widdison
Why is healthcare so expensive in the USA?
Because the America doesn't have universal healthcare. Back in the 1940's when other wealthy countries started creating government programs to provide healthcare to everyone, a group of American health insurance companies got together and successfully lobbied against it here. Over the subsequent decades, they've only grown bigger, fatter and stronger, and continue to push against the idea, and their public relations campaign has helped to convince a large chunk of the country (and a larger chunk of the legislature) that privatized medicine is the only way to go.
Now, I'll point out that your numbers are off, but your basic premise is entirely correct. Depending on whose numbers you believe, the US spends 2-3 times more per capita on healthcare than the UK, and 50% more than Switzerland, which is the next most expensive major country. (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)
为什么医疗保健在美国如此昂贵？
因为美国没有全民医疗。早在20世纪40年代，当其他富裕国家开始创建政府项目，为每个人提供医疗保健时，一群美国医疗保险公司聚集在一起，就这方面成功地做到了反对的游说工作。在随后的几十年里，他们变得越来越大、越来越庞大、越来越强壮，并继续反对这一想法，他们的公关活动帮助说服了全国大部分人（以及立法机构的大部分人）——医疗私有化是唯一的出路。
现在，我要指出，你的数据是错误的，但你的基本前提是完全正确的。根据你相信的数字，美国在医疗保健方面的人均支出是英国的2-3倍，比瑞士高50%，瑞士是第二昂贵的主要国家。(https://en.wikipedia.org/wiki/list_of_countries_by_total_health_expenditure_per_capita)
Why is healthcare so expensive in the USA?
Because the America doesn't have universal healthcare. Back in the 1940's when other wealthy countries started creating government programs to provide healthcare to everyone, a group of American health insurance companies got together and successfully lobbied against it here. Over the subsequent decades, they've only grown bigger, fatter and stronger, and continue to push against the idea, and their public relations campaign has helped to convince a large chunk of the country (and a larger chunk of the legislature) that privatized medicine is the only way to go.
Now, I'll point out that your numbers are off, but your basic premise is entirely correct. Depending on whose numbers you believe, the US spends 2-3 times more per capita on healthcare than the UK, and 50% more than Switzerland, which is the next most expensive major country. (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)
为什么医疗保健在美国如此昂贵？
因为美国没有全民医疗。早在20世纪40年代，当其他富裕国家开始创建政府项目，为每个人提供医疗保健时，一群美国医疗保险公司聚集在一起，就这方面成功地做到了反对的游说工作。在随后的几十年里，他们变得越来越大、越来越庞大、越来越强壮，并继续反对这一想法，他们的公关活动帮助说服了全国大部分人（以及立法机构的大部分人）——医疗私有化是唯一的出路。
现在，我要指出，你的数据是错误的，但你的基本前提是完全正确的。根据你相信的数字，美国在医疗保健方面的人均支出是英国的2-3倍，比瑞士高50%，瑞士是第二昂贵的主要国家。(https://en.wikipedia.org/wiki/list_of_countries_by_total_health_expenditure_per_capita)
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