是什么让美国的医疗体系如此昂贵?(下)
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
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.
美国的医疗费用为何如此昂贵？
因为美国没有实行全民医保。在20世纪40年代，当其他富裕国家开始通过政府项目为所有人提供医疗服务时，一些美国健康保险公司联合起来，成功地在美国抵制了这一做法。在接下来的几十年里，这些保险公司不仅规模越来越大，而且力量也越来越强，他们继续反对全民医保的理念，并通过公关活动成功说服了大量美国人（以及更多的立法者）相信私营医疗是唯一的选择。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
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.
美国的医疗费用为何如此昂贵？
因为美国没有实行全民医保。在20世纪40年代，当其他富裕国家开始通过政府项目为所有人提供医疗服务时，一些美国健康保险公司联合起来，成功地在美国抵制了这一做法。在接下来的几十年里，这些保险公司不仅规模越来越大，而且力量也越来越强，他们继续反对全民医保的理念，并通过公关活动成功说服了大量美国人（以及更多的立法者）相信私营医疗是唯一的选择。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
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)
现在，我要指出你的数字是错误的，但你的基本前提是完全正确的。根据不同的数据来源，美国在医疗保健上的人均支出是英国的2到3倍，比瑞士（在医辽费用方面，排美国之后最昂贵的主要国家）高出50%。（来源：各国人均医疗总支出列表）
现在，我要指出你的数字是错误的，但你的基本前提是完全正确的。根据不同的数据来源，美国在医疗保健上的人均支出是英国的2到3倍，比瑞士（在医辽费用方面，排美国之后最昂贵的主要国家）高出50%。（来源：各国人均医疗总支出列表）
There are a lot of reasons why this is, but most of them are directly connected to our privatized healthcare system. Hospitals, health insurance companies, and pharmaceutical companies are all private, profit-making entities. They're not incentivized to provide the most healthcare at the lowest cost, they're incentivized to maximum income. Pharma companies have a variety of strategies to get the most profitable drugs into the hands of consumers, hospitals are incentivized to fill beds, and insurance companies have to take a big chunk off the top as well. And beyond their profit margin, there are a whole bunch of inefficiencies when you have all of these companies working at cross-purposes. American hospitals and doctor's offices have to have billing departments, and often full-time employees specifically hired to work with the byzantine system of billing and collecting. That means that a staggering 30% of healthcare costs in America are spent, not on healthcare, but on overhead.
造成这种情况的原因有很多，但大多数都与我们的私营医疗体系直接相关。医院、健康保险公司和制药公司都是以盈利为目的的私营企业。它们的目标不是以最低成本提供最多的医疗服务，而是最大化收入。制药公司采取各种策略将利润最高的药物推向市场，医院则鼓励病人住院治疗，保险公司也要从中抽取相当一部分利润。他们除了要利润之外，当这些公司各自为政时，还会产生许多效率低下的问题。美国医院和诊所需要设立计费部门，并且经常需要雇佣专门人员来处理复杂的计费和收款系统。这意味着美国医疗成本中有高达30%并非用于医疗服务本身，而是用于管理开销。
造成这种情况的原因有很多，但大多数都与我们的私营医疗体系直接相关。医院、健康保险公司和制药公司都是以盈利为目的的私营企业。它们的目标不是以最低成本提供最多的医疗服务，而是最大化收入。制药公司采取各种策略将利润最高的药物推向市场，医院则鼓励病人住院治疗，保险公司也要从中抽取相当一部分利润。他们除了要利润之外，当这些公司各自为政时，还会产生许多效率低下的问题。美国医院和诊所需要设立计费部门，并且经常需要雇佣专门人员来处理复杂的计费和收款系统。这意味着美国医疗成本中有高达30%并非用于医疗服务本身，而是用于管理开销。
There are a bunch of other effects, too. Insurances companies insulate people from the direct costs of individual procedures. The benefits are individualized, but the costs are spread out to the entire company, which is a recipe for costs going out of control. No one has a motive to decide whether procedures and drugs are actually necessary or not. At the same time, the litigious culture in America, with limited protections for doctors and hospitals results in what's known as "defensive medicine"; doctor's feel compelled to recommend every possible treatment and test so they don't risk getting sued if they miss something.
It's a lousy system, but the political structure of the United States makes it exceptionally difficult to change it. So, here we are.
还有其他一些影响因素。保险公司使人们不受个别医疗程序直接费用的影响。 但成本却分摊给了整个公司，这很容易导致成本失控。没有人有动机去判断治疗和药物是否真的必要。同时，美国的诉讼文化以及对医生和医院保护不足，导致了所谓的“防御性医疗”；医生们感到必须推荐所有可能的治疗和检查，以防万一漏诊而被起诉。
这是一个糟糕的体系，但美国的政治结构使得改变它非常困难。因此，我们仍然处于这种状况。
It's a lousy system, but the political structure of the United States makes it exceptionally difficult to change it. So, here we are.
还有其他一些影响因素。保险公司使人们不受个别医疗程序直接费用的影响。 但成本却分摊给了整个公司，这很容易导致成本失控。没有人有动机去判断治疗和药物是否真的必要。同时，美国的诉讼文化以及对医生和医院保护不足，导致了所谓的“防御性医疗”；医生们感到必须推荐所有可能的治疗和检查，以防万一漏诊而被起诉。
这是一个糟糕的体系，但美国的政治结构使得改变它非常困难。因此，我们仍然处于这种状况。
DR David Charles
The US healthcare system is expensive due to administrative inefficiencies, high prices for medical services and pharmaceuticals, fragmentation of care, defensive medicine practices, a significant uninsured population, and the prence of chronic diseases.
美国的医疗保健系统之所以成本高昂，是因为存在以下因素：行政效率不高、医疗服务和药品价格昂贵、医疗护理分散、防御性医疗行为普遍、有相当数量的人口没有保险，以及慢性疾病的普遍性。
The US healthcare system is expensive due to administrative inefficiencies, high prices for medical services and pharmaceuticals, fragmentation of care, defensive medicine practices, a significant uninsured population, and the prence of chronic diseases.
美国的医疗保健系统之所以成本高昂，是因为存在以下因素：行政效率不高、医疗服务和药品价格昂贵、医疗护理分散、防御性医疗行为普遍、有相当数量的人口没有保险，以及慢性疾病的普遍性。
1-Administrative Costs: The US healthcare system has a complex administrative structure involving multiple insurance providers, billing systems, and administrative overhead. This complexity leads to higher administrative costs compared to systems with simpler administrative structures, such as single-payer systems High Prices for Medical Services and Pharmaceuticals: Medical services and prescxtion drugs tend to be more expensive in the US compared to other countries. This can be attributed to various factors, including the lack of price controls on medical services and pharmaceuticals, as well as the significant costs associated with research and development in the pharmaceutical industry.
行政成本：美国的医疗体系包含多个保险公司、计费系统和行政开销，构成了一个复杂的行政管理架构。这种复杂性使得其行政成本高于那些采用单一支付者制度的国家。
医疗服务和药品价格高昂：美国的医疗服务和处方药物价格通常高于其他国家，这主要是由于缺乏对医疗服务和药品价格的管制，以及制药行业在研发上的高额投入所致。
行政成本：美国的医疗体系包含多个保险公司、计费系统和行政开销，构成了一个复杂的行政管理架构。这种复杂性使得其行政成本高于那些采用单一支付者制度的国家。
医疗服务和药品价格高昂：美国的医疗服务和处方药物价格通常高于其他国家，这主要是由于缺乏对医疗服务和药品价格的管制，以及制药行业在研发上的高额投入所致。
2-Fragmentation of Care: The US healthcare system is highly fragmented, with many different providers, insurers, and healthcare facilities operating independently. This fragmentation can lead to inefficiencies, duplication of services, and difficulty coordinating care, all of which contribute to higher costs.
医疗护理分散：美国医疗体系中存在众多独立运作的医疗服务提供者、保险公司和医疗机构，这种分散化导致了效率低下、服务重复和协调困难，进而增加了成本。
医疗护理分散：美国医疗体系中存在众多独立运作的医疗服务提供者、保险公司和医疗机构，这种分散化导致了效率低下、服务重复和协调困难，进而增加了成本。
3-Defensive Medicine: Due to concerns about medical malpractice lawsuits, healthcare providers may engage in defensive medicine by ordering unnecessary tests and procedures to protect themselves from legal liability. This practice can drive up healthcare costs without necessarily improving patient outcomes. Uninsured and Underinsured Populations: A significant portion of the US population lacks health insurance or has inadequate coverage. When uninsured or underinsured individuals receive medical care, the costs may be shifted onto those with insurance through higher premiums and healthcare costs, further exacerbating the overall expense of the system.
防御性医疗行为：由于对医疗事故诉讼的担忧，医疗提供者可能会进行不必要的检查和治疗，以保护自己免受法律责任，这种做法增加了医疗成本，但并不一定能改善患者的治疗效果。
没有保险和保险险种不足的人群:：美国有相当一部分人没有健康保险或保险覆盖不足。这些人群在接受医疗时，其成本可能会转嫁给有保险的人，通过提高保险费和医疗费用，进一步增加了整个医疗体系的负担。
防御性医疗行为：由于对医疗事故诉讼的担忧，医疗提供者可能会进行不必要的检查和治疗，以保护自己免受法律责任，这种做法增加了医疗成本，但并不一定能改善患者的治疗效果。
没有保险和保险险种不足的人群:：美国有相当一部分人没有健康保险或保险覆盖不足。这些人群在接受医疗时，其成本可能会转嫁给有保险的人，通过提高保险费和医疗费用，进一步增加了整个医疗体系的负担。
4-Chronic Disease Management: The prence of chronic diseases in the US, such as diabetes, heart disease, and obesity, leads to higher healthcare costs. Managing chronic conditions requires ongoing medical care, medications, and sometimes hospitalization, all of which contribute to the overall expense of the healthcare system.
慢性疾病管理成本高：美国慢性疾病如糖尿病、心脏病和肥胖症的普遍性，导致了更高的医疗成本。管理这些慢性疾病需要持续的医疗服务、药物治疗，有时还需要住院，这些都对医疗体系的总成本有显著贡献。
慢性疾病管理成本高：美国慢性疾病如糖尿病、心脏病和肥胖症的普遍性，导致了更高的医疗成本。管理这些慢性疾病需要持续的医疗服务、药物治疗，有时还需要住院，这些都对医疗体系的总成本有显著贡献。
Scott Welch
Why is healthcare in the USA so expensive compared to other countries?
Well, the quick answer is that sick people will pay almost anything for a cure. And when the sick person is your child, you can add another zero on to that.
I will always remember a discussion I had with a colleague of mine when I was working in Mountain View in 1986. She was Russian, and in those days that was really, really rare — I think she defected from some sports team.
Anyhow we were discussing something about the health care system, medical bankruptcies I think, and I said “I can’t believe that a civilized country treats its citizens this way.”
为什么美国的医疗费用比其他国家高那么多？
简单来说，生病的人几乎愿意为治疗付出任何代价，如果是自己的孩子生病，他们甚至愿意多付十倍。
我记得1986年在山景城（美国加州）工作时，我和一位同事——她是俄罗斯人，那时候很少见，我想她可能是从某个运动队逃出来的——讨论过医疗保险系统的问题，可能是关于医疗破产的话题。我说：“我真不敢相信一个文明国家会这样对待它的公民。”
Why is healthcare in the USA so expensive compared to other countries?
Well, the quick answer is that sick people will pay almost anything for a cure. And when the sick person is your child, you can add another zero on to that.
I will always remember a discussion I had with a colleague of mine when I was working in Mountain View in 1986. She was Russian, and in those days that was really, really rare — I think she defected from some sports team.
Anyhow we were discussing something about the health care system, medical bankruptcies I think, and I said “I can’t believe that a civilized country treats its citizens this way.”
为什么美国的医疗费用比其他国家高那么多？
简单来说，生病的人几乎愿意为治疗付出任何代价，如果是自己的孩子生病，他们甚至愿意多付十倍。
我记得1986年在山景城（美国加州）工作时，我和一位同事——她是俄罗斯人，那时候很少见，我想她可能是从某个运动队逃出来的——讨论过医疗保险系统的问题，可能是关于医疗破产的话题。我说：“我真不敢相信一个文明国家会这样对待它的公民。”
She got a very serious look on her face and then said something I’ve remembered all these years:
“Scott. You must always be remembering: This is not a civilized country.”
Viewed through this lens, there are a lot of things about America that make more sense.
她的表情突然变得非常严肃，然后对我说了一番话，我至今记忆犹新：“斯科特，你必须永远记住：这个国家并不是一个文明国家。”
从这个视角来看，美国的很多事情就更加容易理解了。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
“Scott. You must always be remembering: This is not a civilized country.”
Viewed through this lens, there are a lot of things about America that make more sense.
她的表情突然变得非常严肃，然后对我说了一番话，我至今记忆犹新：“斯科特，你必须永远记住：这个国家并不是一个文明国家。”
从这个视角来看，美国的很多事情就更加容易理解了。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Len Gould
I’ve long held that view. Economically successful yes, but since the 1980’s not civilized.
[Edit] Perhaps relevant is the thought that the “wild west” mentality common in many US citizens is evidence of never having been civilized.
我一直持有这种观点。美国经济上确实成功，但自1980年代以来，它并不算是一个文明的国家。
编辑：或许值得一提的是，许多美国公民普遍存在的“狂野西部”心态，这表明他们从未真正文明过。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
I’ve long held that view. Economically successful yes, but since the 1980’s not civilized.
[Edit] Perhaps relevant is the thought that the “wild west” mentality common in many US citizens is evidence of never having been civilized.
我一直持有这种观点。美国经济上确实成功，但自1980年代以来，它并不算是一个文明的国家。
编辑：或许值得一提的是，许多美国公民普遍存在的“狂野西部”心态，这表明他们从未真正文明过。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Kosta
This is what you get when you have a country founded by business men who were upset about taxes.
当你的国家是由一群对税收不满的商人建立时，你就会得到这样的结果。
This is what you get when you have a country founded by business men who were upset about taxes.
当你的国家是由一群对税收不满的商人建立时，你就会得到这样的结果。
Sandeep Albert Mathias
To be fair, they were not upset about taxes, but rather about them not having a say in those taxes. If I remember correctly, the slogan was “No taxation without representation,” not “No taxation. Period.”
公平地说，他们不满的不是税收本身，而是他们对税收没有发言权。如果我没记错的话，当时的口号是“无代表，不纳税”，而不是“坚决不纳税”。
To be fair, they were not upset about taxes, but rather about them not having a say in those taxes. If I remember correctly, the slogan was “No taxation without representation,” not “No taxation. Period.”
公平地说，他们不满的不是税收本身，而是他们对税收没有发言权。如果我没记错的话，当时的口号是“无代表，不纳税”，而不是“坚决不纳税”。
Scott Welch
I believe it was Benjamin Franklin who said “Americans are fundamentally opposed to taxation without representation, and they are not very fond of taxation with representation either.”
我认为是本杰明·富兰克林说过：“美国人基本上反对没有代表权的税收，不过即使有了代表权，他们对税收也没什么好感。”
I believe it was Benjamin Franklin who said “Americans are fundamentally opposed to taxation without representation, and they are not very fond of taxation with representation either.”
我认为是本杰明·富兰克林说过：“美国人基本上反对没有代表权的税收，不过即使有了代表权，他们对税收也没什么好感。”
Prum Chhangsreng
Keep is just going to keep the big company stay big and prevent any creative startup from happening. At the end of the day, big company still going to find a way to cheat tax while only the small and inexperience company suffer.
这样只会让大公司继续壮大，阻止任何创新的创业公司出现。最终，大公司总能找到逃税的方法，而只有小公司和没有经验的公司会遭受损失。
Keep is just going to keep the big company stay big and prevent any creative startup from happening. At the end of the day, big company still going to find a way to cheat tax while only the small and inexperience company suffer.
这样只会让大公司继续壮大，阻止任何创新的创业公司出现。最终，大公司总能找到逃税的方法，而只有小公司和没有经验的公司会遭受损失。
Ernest Brejtfus
Did you hear that loud noise? that was my mind blowing up.
你听到那个巨响了吗？那是我脑海中的震撼。
Did you hear that loud noise? that was my mind blowing up.
你听到那个巨响了吗？那是我脑海中的震撼。
Richard Couture
Because of the lobbying of pharmaceutical company and the physicians and others healtcare professional. So far in 2018 they spent over 421 millions. If it become government mamage like let say UK, Australia or Canada their profit will plummet.
这是因为制药公司和医生以及其他医疗专业人士的游说。截至2018年，他们在游说上花费了超过4.21亿美元。如果医疗行业像英国、澳大利亚或加拿大那样由政府管理，他们的利润将会大幅下降。
Because of the lobbying of pharmaceutical company and the physicians and others healtcare professional. So far in 2018 they spent over 421 millions. If it become government mamage like let say UK, Australia or Canada their profit will plummet.
这是因为制药公司和医生以及其他医疗专业人士的游说。截至2018年，他们在游说上花费了超过4.21亿美元。如果医疗行业像英国、澳大利亚或加拿大那样由政府管理，他们的利润将会大幅下降。
Scott Welch
Of course those self-same people are slapping tarries on steel and subsidizing farmers to the tune of a couple billon per month.
The mind boggles.
当然，正是这些人正在对钢铁征收关税，并每月补贴农民数十亿美元。
真是让人难以置信。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Of course those self-same people are slapping tarries on steel and subsidizing farmers to the tune of a couple billon per month.
The mind boggles.
当然，正是这些人正在对钢铁征收关税，并每月补贴农民数十亿美元。
真是让人难以置信。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Chris Everett
Why are healthcare costs in the United States so incredibly expensive?
Imagine this. You go shopping for groceries.
There are no prices on any items.
Adding certain things to your cart will add other things to your cart, but you won't know about it until checkout.
为什么美国的医疗费用会如此之高？
试想这样一个场景：你去超市购物。
货架上的商品没有任何价格标签。
当你把某些商品放入购物车时，会有其他商品自动被放进来，但你直到结账时才会发现。
Why are healthcare costs in the United States so incredibly expensive?
Imagine this. You go shopping for groceries.
There are no prices on any items.
Adding certain things to your cart will add other things to your cart, but you won't know about it until checkout.
为什么美国的医疗费用会如此之高？
试想这样一个场景：你去超市购物。
货架上的商品没有任何价格标签。
当你把某些商品放入购物车时，会有其他商品自动被放进来，但你直到结账时才会发现。
When you check out, you will get a bill, but it will have no real connection with what you pay, as some random discount between 0% and 100% will be applied.
If you go back to the same store, you can't use your prior trip as a guideline, as every element will be totally different. The prices, the discounts, etc.
That's the first problem with pricing. There's almost no incentive in the system for consumers to save money, and even if they want to, there's no way they can even tell what things cost. A fundamental aspect of a free market is price transparency. The US healthcare system has NONE of that. This really breaks the demand side of the supply and demand curve.
结账时，你会收到一张账单，但账单上的金额与你实际支付的金额可能毫无关联，因为会有一个0%到100%之间的随机折扣被应用。
如果你再次光顾同一家店，你无法以之前的经历作为参考，因为每一次的价格、折扣等都完全不同。
这就是定价的第一个问题所在。在这个体系中，几乎没有激励消费者节省开支的因素，即使他们想节省，也无法了解商品的实际成本。价格透明是自由市场的基本要素，而美国医疗体系在这方面做得非常差，这严重破坏了供需关系中的需求端。
If you go back to the same store, you can't use your prior trip as a guideline, as every element will be totally different. The prices, the discounts, etc.
That's the first problem with pricing. There's almost no incentive in the system for consumers to save money, and even if they want to, there's no way they can even tell what things cost. A fundamental aspect of a free market is price transparency. The US healthcare system has NONE of that. This really breaks the demand side of the supply and demand curve.
结账时，你会收到一张账单，但账单上的金额与你实际支付的金额可能毫无关联，因为会有一个0%到100%之间的随机折扣被应用。
如果你再次光顾同一家店，你无法以之前的经历作为参考，因为每一次的价格、折扣等都完全不同。
这就是定价的第一个问题所在。在这个体系中，几乎没有激励消费者节省开支的因素，即使他们想节省，也无法了解商品的实际成本。价格透明是自由市场的基本要素，而美国医疗体系在这方面做得非常差，这严重破坏了供需关系中的需求端。
The supply side of the curve is broken by the excessive costs of training doctors, building facilities, and by the fact that consumers are totally shielded from this problem.
Into this mix, we throw in health insurers, who have little incentive to fix it all.
IMHO, we need to divorce health insurance from employment, while keeping the individual mandate created by the ACA. (But without the huge list of minimum requirements), and removing the demand that hospitals treat all comers, even if they can't pay/don't have insurance, while creating an expansion of medicade.
We would also do well by mandating an open system of medical records.
供给端的问题在于，培养医生的成本过高，建设医疗设施的成本高昂，而且消费者对这些问题几乎没有任何了解。
在这种多重因素下，我们还引入了健康保险公司，它们也没有太多动力去解决这些问题。
在我看来，我们需要将健康保险与就业脱钩，同时保留《平价医疗法案》（ACA）所设立的个人强制购买保险的要求（但要去掉那些繁琐的最低要求），并取消医院必须无条件接收所有病人的要求——即使他们无力支付或没有保险，同时扩大医疗补助计划的覆盖范围。
我们还可以通过强制建立一个开放的医疗记录系统来做得很好。
Into this mix, we throw in health insurers, who have little incentive to fix it all.
IMHO, we need to divorce health insurance from employment, while keeping the individual mandate created by the ACA. (But without the huge list of minimum requirements), and removing the demand that hospitals treat all comers, even if they can't pay/don't have insurance, while creating an expansion of medicade.
We would also do well by mandating an open system of medical records.
供给端的问题在于，培养医生的成本过高，建设医疗设施的成本高昂，而且消费者对这些问题几乎没有任何了解。
在这种多重因素下，我们还引入了健康保险公司，它们也没有太多动力去解决这些问题。
在我看来，我们需要将健康保险与就业脱钩，同时保留《平价医疗法案》（ACA）所设立的个人强制购买保险的要求（但要去掉那些繁琐的最低要求），并取消医院必须无条件接收所有病人的要求——即使他们无力支付或没有保险，同时扩大医疗补助计划的覆盖范围。
我们还可以通过强制建立一个开放的医疗记录系统来做得很好。
Marti LaChance
The grocery store is an excellent metaphor. In my experience, the HSA model does increase incentive for patients to do price comparisons, but it can take days to discover how much a service will cost, and sometimes you need services immediately.
超市真是个绝佳的比喻。以我的经验来看，健康储蓄账户（HSA）模型确实鼓励患者进行价格比较，但要弄清楚某项服务究竟要多少钱，可能需要几天时间，而有时候你可能急需这项服务。
The grocery store is an excellent metaphor. In my experience, the HSA model does increase incentive for patients to do price comparisons, but it can take days to discover how much a service will cost, and sometimes you need services immediately.
超市真是个绝佳的比喻。以我的经验来看，健康储蓄账户（HSA）模型确实鼓励患者进行价格比较，但要弄清楚某项服务究竟要多少钱，可能需要几天时间，而有时候你可能急需这项服务。
Jacob VanWagoner
The only problem with the HSA model is that hospitals and other providers mark up everything like crazy, and in most states if you haven't met your deductible yet, then you have little to no protection against outrageous prices.
In Utah, Arizona and Idaho, though, if you're on an HSA you get the insurance-negotiated price before your deductible is met. Interestingly enough, those three states are among the lowest costs and both have very high quality care.
HSA模型的唯一问题是，医院和其他医疗服务提供者会无节制地提高价格，而且在大多数州，如果你还没有达到免赔额，那么你几乎没有任何保护措施来应对离谱的价格。
不过，在犹他州、亚利桑那州和爱达荷州，如果你有HSA账户，即使你的免赔额还未用完，你也能享受到保险公司协商后的价格。有趣的是，这三个州的医疗费用是最低的，而且医疗服务质量非常高。
The only problem with the HSA model is that hospitals and other providers mark up everything like crazy, and in most states if you haven't met your deductible yet, then you have little to no protection against outrageous prices.
In Utah, Arizona and Idaho, though, if you're on an HSA you get the insurance-negotiated price before your deductible is met. Interestingly enough, those three states are among the lowest costs and both have very high quality care.
HSA模型的唯一问题是，医院和其他医疗服务提供者会无节制地提高价格，而且在大多数州，如果你还没有达到免赔额，那么你几乎没有任何保护措施来应对离谱的价格。
不过，在犹他州、亚利桑那州和爱达荷州，如果你有HSA账户，即使你的免赔额还未用完，你也能享受到保险公司协商后的价格。有趣的是，这三个州的医疗费用是最低的，而且医疗服务质量非常高。
Marti LaChance
I don't care for the HSA. It's a pain in the ass. Still, I use a cost comparison tool that lets you hone in on costs. An X-ray I priced ranged from $50 to $300. Ha! You still have to cross your fingers when the bill comes, though. Sigh.
我对HSA并不感冒。它真是让人头疼。尽管如此，我还是使用了一个成本比较工具，它能让你精确地了解各项服务的成本。比如，我比较过的X光检查，价格从50美元到300美元不等。哈哈！不过，即便如此，当你收到账单时，你还是得祈祷一切顺利，唉。
I don't care for the HSA. It's a pain in the ass. Still, I use a cost comparison tool that lets you hone in on costs. An X-ray I priced ranged from $50 to $300. Ha! You still have to cross your fingers when the bill comes, though. Sigh.
我对HSA并不感冒。它真是让人头疼。尽管如此，我还是使用了一个成本比较工具，它能让你精确地了解各项服务的成本。比如，我比较过的X光检查，价格从50美元到300美元不等。哈哈！不过，即便如此，当你收到账单时，你还是得祈祷一切顺利，唉。
Martha LeDuc
Great summary. I completely agree, we need to divorce health insurance from employment. This made sense 50 years ago when costs were minimal. This system is so broken, it will ever get fixed. I remember when I worked for a firm and had some very minor medical test done. It was listed on the bill and I was exclaiming to everyone how expensive it was. Someone said, 'who cares, it's paid for.' Precisely why we are in this mess, and why employers shouldn't fund health care. It ought to be reasonable enough for individuals to purchase, as it once was. Never gonna happen again in my lifetime, though.
总结得太好了。我完全赞同，我们需要将健康保险与就业分开。50年前，当医疗费用还很低的时候，这种做法是有意义的。但现在这个系统已经支离破碎，恐怕永远无法修复了。我记得我曾在一家公司工作，做了一些非常小的医疗检查。当我看到账单上列出的费用时，我向每个人抱怨它有多贵。有人说，”谁在乎，反正已经付了。“这正是我们陷入这种困境的原因，也是为什么雇主不应该资助医疗保险。它本应足够合理，让个人购买，就像以前一样。不过，在我的有生之年，这种情况再也不会发生了。
Great summary. I completely agree, we need to divorce health insurance from employment. This made sense 50 years ago when costs were minimal. This system is so broken, it will ever get fixed. I remember when I worked for a firm and had some very minor medical test done. It was listed on the bill and I was exclaiming to everyone how expensive it was. Someone said, 'who cares, it's paid for.' Precisely why we are in this mess, and why employers shouldn't fund health care. It ought to be reasonable enough for individuals to purchase, as it once was. Never gonna happen again in my lifetime, though.
总结得太好了。我完全赞同，我们需要将健康保险与就业分开。50年前，当医疗费用还很低的时候，这种做法是有意义的。但现在这个系统已经支离破碎，恐怕永远无法修复了。我记得我曾在一家公司工作，做了一些非常小的医疗检查。当我看到账单上列出的费用时，我向每个人抱怨它有多贵。有人说，”谁在乎，反正已经付了。“这正是我们陷入这种困境的原因，也是为什么雇主不应该资助医疗保险。它本应足够合理，让个人购买，就像以前一样。不过，在我的有生之年，这种情况再也不会发生了。
The Magnificent Jadzia Dax
I agree. I have worked for 40 years and in those years I have had employer based health insurance for only 12 years. I was working all for smaller employers or contract most of that time.
I love the fact that Canadians or Uk citizens can work at any job they like without worrying about company sponsored health insurance. They have already paid for their health care in their taxes and don’t have to pay again and again when they see a doctor.
我赞同。我工作了40年，在这期间，我只享受了12年的雇主提供的医疗保险。我大部分时间都是为小老板工作或做合同工。
我喜欢这样一个事实:加拿大或英国公民可以从事任何他们喜欢的工作，而不用担心公司是否给交医疗保险。他们已经用税款支付了医疗保健费用，看病时不必再一次地付钱。
I agree. I have worked for 40 years and in those years I have had employer based health insurance for only 12 years. I was working all for smaller employers or contract most of that time.
I love the fact that Canadians or Uk citizens can work at any job they like without worrying about company sponsored health insurance. They have already paid for their health care in their taxes and don’t have to pay again and again when they see a doctor.
我赞同。我工作了40年，在这期间，我只享受了12年的雇主提供的医疗保险。我大部分时间都是为小老板工作或做合同工。
我喜欢这样一个事实:加拿大或英国公民可以从事任何他们喜欢的工作，而不用担心公司是否给交医疗保险。他们已经用税款支付了医疗保健费用，看病时不必再一次地付钱。
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