TED Residency
Jeanne Pinder: What if all US health care costs were transparent?
珍妮·平得: 假如美国医疗费用变得透明化会怎样？
Filmed:
Readability: 3.7
1,875,298 views
在美国，同样的血检在一个诊所可能只要19美元，但在几个街区外的诊所却要收522美元——而且只有在几周后收到账单时，人们才知道其中的差别。记者珍妮·平得说道，事情并不一定要这样。她建立了一个平台，通过大众的力量让医疗的真实成本和数据公开化，揭示了医疗保健定价的秘密。提前知道医疗成本如何能让我们更健康，如何帮我们省下更多的钱——以及如何来修复一个崩溃的系统。
Jeanne Pinder - Journalist
Jeanne Pinder asks why it's so hard to make sense of US healthcare bills -- and suggests what we might do about it. Full bio
Jeanne Pinder asks why it's so hard to make sense of US healthcare bills -- and suggests what we might do about it. Full bio
Double-click the English transcript below to play the video.
00:12
So, a little while ago,
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不久前，
我的家人动了三次小手术，
00:14
members of my family
had three bits of minor surgery,
had three bits of minor surgery,
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每次手术约一个半小时，
00:17
about a half hour each,
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我们收到了三份帐单。
00:19
and we got three sets of bills.
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00:22
For the first one, the anesthesia bill
alone was 2,000 dollars;
alone was 2,000 dollars;
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第一份账单上，光是麻醉
就要两千美金；
就要两千美金；
第二份账单，两千美金；
00:26
the second one, 2,000 dollars;
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第三份账单，六千美金。
00:28
the third one, 6,000 dollars.
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00:32
So I'm a journalist.
I'm like, what's up with that?
I'm like, what's up with that?
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我是记者，所以我很好奇，
这些费用是怎么来的？
这些费用是怎么来的？
00:37
I found out that I was actually,
for the expensive one,
for the expensive one,
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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，
就要1419美金，
00:40
being charged 1,419 dollars
for a generic anti-nausea drug
for a generic anti-nausea drug
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但其实我在网络上
用2.49美金就能买到。
用2.49美金就能买到。
00:45
that I could buy online
for two dollars and forty-nine cents.
for two dollars and forty-nine cents.
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00:50
I had a long and unsatisfactory
argument with the hospital,
argument with the hospital,
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我向医院、保险公司
以及我的雇主力争了很久，
以及我的雇主力争了很久，
但结果并不让我满意。
00:53
the insurer and my employer.
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00:56
Everybody agreed
that this was totally fine.
that this was totally fine.
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大家都同意这样的做法
完全没问题。
完全没问题。
00:59
But it got me thinking, and the more
I talked to people, the more I realized:
I talked to people, the more I realized:
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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：
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。
各项费用是多少。
01:03
nobody has any idea
what stuff costs in health care.
what stuff costs in health care.
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在手术或检测之前、当中、之后，
01:06
Not before, during or after
that procedure or test
that procedure or test
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都不知道它会花多少钱。
01:09
do you have any idea
what it's going to cost.
what it's going to cost.
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只有在几个月之后，
你会收到《保险福利说明》，
你会收到《保险福利说明》，
01:11
It's only months later that you get
an "explanation of benefits"
an "explanation of benefits"
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但它其实什么也没说清楚。
01:15
that explains exactly nothing.
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01:17
So this came back to me
a little while later.
a little while later.
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一阵子之后，我又想起了此事。
在纽约时报当了二十年记者之后，
01:20
I had volunteered for a buyout
from the New York Times,
from the New York Times,
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我自愿买断工龄离职。
01:23
where I had worked for more than
20 years as a journalist.
20 years as a journalist.
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01:26
I was looking for my next act.
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我在寻找我的下一个阶段。
01:28
It turned out that next act
was to build a company
was to build a company
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结果，下一个阶段
是去建立一间公司，
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。
各个项目的费用。
01:31
telling people what stuff costs
in health care.
in health care.
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01:34
I won a "Shark Tank"-type
pitch contest to do just that.
pitch contest to do just that.
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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。
商业计划比赛中赢得了这个机会。
01:37
Health costs ate up almost 18 percent
of our gross domestic product last year,
of our gross domestic product last year,
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去年，健康支出占用了
将近18%的国民生产总值，
将近18%的国民生产总值，
但没有人知道钱到底怎么花的。
01:42
but nobody has any idea what stuff costs.
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01:45
But what if we did know?
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但是，如果我们知道呢？
01:48
So we started out small.
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我们从小规模做起。
我们打电话给医生和医院，
01:49
We called doctors and hospitals
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问他们如果简单的医疗处理
可以用现金支付，价格是多少。
可以用现金支付，价格是多少。
01:51
and asked them what they would accept
as a cash payment for simple procedures.
as a cash payment for simple procedures.
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01:57
Some people were helpful.
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有些人很配合。
很多人直接挂我们电话。
01:58
A lot of people hung up on us.
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有些人就是很没礼貌。
02:00
Some people were just plain rude.
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02:02
They said, "We don't know,"
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他们说：“我们不知道。”
或，“我们的律师
不允许我们告诉你。”
不允许我们告诉你。”
02:04
or, "Our lawyers won't
let us tell you that,"
let us tell you that,"
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02:07
though we did get a lot of information.
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不过我们依然得到了许多信息。
02:10
We found, for example,
that here in the New York area,
that here in the New York area,
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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，
就可以做心脏超声波检查，
02:12
you could get an echocardiogram
for 200 dollars in Brooklyn
for 200 dollars in Brooklyn
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在仅仅几英里外的曼哈顿
却要2150美金。
却要2150美金。
02:17
or for 2,150 dollars in Manhattan,
just a few miles away.
just a few miles away.
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02:22
New Orleans, the same simple blood test,
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新奥尔良，同样简单的血液检测，
在这里是19美金，
02:25
19 dollars over here,
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几个街区之外就是522美金。
02:27
522 dollars just a few blocks away.
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02:31
San Francisco, the same MRI,
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旧金山，同样的磁共振成像，
475美元，
02:34
475 dollars
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在25英里之外就要6221美元。
02:36
or 6,221 dollars just 25 miles away.
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02:42
These pricing variations existed
for all the procedures
for all the procedures
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所有的医疗程序
都存在这样的价格差异，
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。
02:46
and all the cities that we surveyed.
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02:49
Then we started to ask people
to tell us their health bills.
to tell us their health bills.
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接着，我们开始请大家
告诉我们他们的医疗账单。
告诉我们他们的医疗账单。
02:52
In partnership with public radio station
WNYC here in New York,
WNYC here in New York,
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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。
乳房X光成像的价格。
02:56
we asked women to tell us
the prices of their mammograms.
the prices of their mammograms.
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02:59
People told us nobody would do that,
that it was too personal.
that it was too personal.
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别人都跟我们说，没有人会
这样做的，这些信息太私人化了。
这样做的，这些信息太私人化了。
03:03
But in the space of three weeks,
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但在三个星期内，
有四百位女性为我们提供了这项信息。
03:05
400 women told us about their prices.
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03:09
Then we started to make it easier
for people to share their data
for people to share their data
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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。
把数据分享给我们。
03:12
into our online searchable database.
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很像医疗领域Kayak.com
和Waze交通应用的融合版。
和Waze交通应用的融合版。
03:15
It's sort of like a mash-up of Kayak.com
and the Waze traffic app for health care.
and the Waze traffic app for health care.
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（笑声）
03:20
(Laughter)
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我们称它是由社区
共创出来的健康成本指南。
共创出来的健康成本指南。
03:21
We call it a community-created
guide to health costs.
guide to health costs.
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我们的调查和群众外包工作
03:24
Our survey and crowdsourcing work
grew into partnerships
grew into partnerships
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发展为和全国顶尖的
新闻编辑部合作——
新闻编辑部合作——
03:26
with top newsrooms nationwide --
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包括在新奥尔良、费城、
03:28
in New Orleans, Philadelphia,
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旧金山、洛杉矶、
迈阿密，以及其他地方。
迈阿密，以及其他地方。
03:30
San Francisco, Los Angeles,
Miami and other places.
Miami and other places.
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03:35
We used the data to tell stories
about people who were suffering
about people who were suffering
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我们用资料来讲述
人们所经受的苦难，
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。
避免那些负担不起的帐单。
03:39
and how to avoid that suffering,
to avoid that "gotcha" bill.
to avoid that "gotcha" bill.
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03:44
A woman in New Orleans saved
nearly 4,000 dollars using our data.
nearly 4,000 dollars using our data.
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新奥尔良的一位女子
用我们的资料省下了近四千美元。
用我们的资料省下了近四千美元。
03:49
A San Francisco contributor
saved nearly 1,300 dollars
saved nearly 1,300 dollars
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一位旧金山的民众说
他省下了近1300美元，
他省下了近1300美元，
而他只是不使用保险卡，
03:52
by putting away his insurance card
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改用现金支付。
03:54
and paying cash.
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03:56
There are a lot of people
who are going to in-network hospitals
who are going to in-network hospitals
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有很多人都会去
保险机构指定的医院，
保险机构指定的医院，
却收到了不能被报销的帐单。
03:59
and getting out-of-network bills.
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04:01
And then there was the hospital
that continued to bill a dead man.
that continued to bill a dead man.
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还有医院会一直给死去的人寄账单。
我们发现，有上千人
想要告诉我们他们支付的价格。
想要告诉我们他们支付的价格。
04:05
We learned that thousands of people
wanted to tell us their prices.
wanted to tell us their prices.
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他们想要知道各个项目的价格，
04:08
They want to learn what stuff costs,
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以及如何针对帐单进行申诉，
04:10
find out how to argue a bill,
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以协助我们解决这个
在伤害他们家人朋友的问题。
在伤害他们家人朋友的问题。
04:11
help us solve this problem that's hurting
them and their friends and families.
them and their friends and families.
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04:15
We talked to people who had
to sell a car to pay a health bill,
to sell a car to pay a health bill,
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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、
通过卖车来支付医疗账单的人、
破产的人、
04:18
go into bankruptcy,
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因为费用太高
而无法接受治疗的人。
而无法接受治疗的人。
04:20
skip a treatment because of the cost.
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04:23
Imagine if you could afford the diagnosis
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想像一下，如果
你能负担得起诊断，
你能负担得起诊断，
却负担不起治疗会怎样。
04:25
but not the cure.
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04:29
We set off a huge conversation about costs
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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，
是的，还有他们的病人，
04:31
involving doctors and hospitals, yes,
but also their patients,
but also their patients,
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或者，我们直接称他们为老百姓。
04:35
or as we like to call them, people.
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（笑声）
04:37
(Laughter)
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04:41
We changed policy.
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我们改变了政策。
在路易斯安纳有一个
消费者保护法案
消费者保护法案
04:42
A consumer protection bill
that had been stalled
that had been stalled
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已经停滞了十年，
04:45
in the Louisiana legislature for 10 years
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在我们开始行动之后，就通过了。
04:47
passed after we launched.
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04:50
Let's face it:
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让我们面对现实吧：
这个巨大的、推动缓慢的公共健康危机
04:51
this huge, slow-rolling
public health crisis
public health crisis
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是全国性的紧急事件。
04:54
is a national emergency.
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04:56
And I don't think government's
going to help us out anytime soon.
going to help us out anytime soon.
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我想短期内政府不会协助我们。
05:00
But what if the answer was really simple:
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但是如果答案其实很简单呢：
让所有的医疗价格常年公开。
05:02
make all the prices public all the time.
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05:06
Would our individual bills go down?
Our health premiums?
Our health premiums?
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我们个人的帐单金额
会下降吗？保费呢？
会下降吗？保费呢？
05:11
Be really clear about this:
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大家要很清楚一点：
这是美国的问题。
05:13
this is a United States problem.
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在大多数其他的发达国家中，
05:15
In most of the rest
of the developed world,
of the developed world,
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生病的人不用担心钱的问题。
05:17
sick people don't have
to worry about money.
to worry about money.
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的确，价格透明
并不会解决所有问题。
并不会解决所有问题。
05:20
It's also true that price transparency
will not solve every problem.
will not solve every problem.
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仍然会有昂贵的治疗存在，
05:24
There will still be expensive treatments,
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保险系统会有很大的阻力。
05:27
huge friction from our insurance system.
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仍然会有诈欺，
05:29
There will still be fraud
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也会有过度治疗
与过度诊断的重大问题。
与过度诊断的重大问题。
05:31
and a massive problem
with overtreatment and overdiagnosis.
with overtreatment and overdiagnosis.
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05:35
And not everything is shoppable.
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不是所有东西都是可以比价的。
并不是所有人都想要
最便宜的阑尾切除手术，
最便宜的阑尾切除手术，
05:38
Not everybody wants
the cheapest appendectomy
the cheapest appendectomy
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或最便宜的癌症护理。
05:40
or the cheapest cancer care.
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05:43
But when we talk
about these clear effects,
about these clear effects,
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但是，当我们谈到
这些清楚的效果时，
这些清楚的效果时，
我们在看的其实是
很简单的真实议题。
很简单的真实议题。
05:45
we're looking at a real issue
that's actually very simple.
that's actually very simple.
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05:50
When we first started calling for prices,
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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。
05:52
we actually felt like
we were going to be arrested.
we were going to be arrested.
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05:55
It seemed kind of transgressive
to talk about medicine and health care
to talk about medicine and health care
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同时谈及医学和医疗保健，
似乎是有点越界，
05:58
in the same breath,
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但后来我们释然了，
06:00
and yet it became liberating,
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因为我们找到的不仅仅是数据，
06:01
because we found not only data
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还有在体制中的好人、正直的人，
06:04
but also good and honest people
out there in the system
out there in the system
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他们想要协助大家
获得他们所需的照料，
获得他们所需的照料，
06:06
who want to help folks
get the care they need
get the care they need
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并且是以他们付担得起的价格。
06:08
at a price they can afford.
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06:11
And it got easier to ask.
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然后开口询问也变得容易了。
所以，我想留给各位一些问题。
06:13
So I'll leave you with some questions.
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如果我们都事先知道医疗保健
各个项目的成本，那会怎样？
各个项目的成本，那会怎样？
06:15
What if we all knew what stuff cost
in health care in advance?
in health care in advance?
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06:19
What if, every time
you Googled for an MRI,
you Googled for an MRI,
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如果说每次你用谷歌
搜寻磁共振成像，
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，
告诉你在哪里可购买、多少钱，
06:23
you got drop-downs telling you
where to buy and for how much,
where to buy and for how much,
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就像你在网上搜寻
激光打印机那样一目了然呢？
激光打印机那样一目了然呢？
06:26
the way you do when
you Google for a laser printer?
you Google for a laser printer?
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06:30
What if all of the time and energy
and money that's spent hiding prices
and money that's spent hiding prices
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如果把花在隐藏价格上的
所有时间、精力、金钱
所有时间、精力、金钱
都从系统中排除出去呢？
06:34
was squeezed out of the system?
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06:37
What if each one of us could pick
the $19 test every time
the $19 test every time
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如果我们每个人每次都能
选择19美元的检测，
选择19美元的检测，
而不是522美元的呢？
06:40
instead of the $522 one?
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06:43
Would our individual bills go down?
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我们个人的帐单金额会下降吗？
保费呢？
06:45
Our premiums?
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我不知道，但如果你不问，
就永远不会知道。
就永远不会知道。
06:46
I don't know, but if you don't ask,
you'll never know.
you'll never know.
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你可能可以省下一大笔钱。
06:49
And you might save a ton of money.
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06:51
And I've got to think that a lot of us
and the system itself
and the system itself
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我认为，我们很多人以及体制本身
都会变得更健康。
06:55
would be a lot healthier.
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06:57
Thank you.
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谢谢。
（掌声）
06:58
(Applause)
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ABOUT THE SPEAKER
Jeanne Pinder - JournalistJeanne Pinder asks why it's so hard to make sense of US healthcare bills -- and suggests what we might do about it.
Why you should listen
Lifelong journalist Jeanne Pinder is founder and CEO of ClearHealthCosts, a digital media startup that demands price transparency from the US healthcare system. After taking a buyout from the New York Times, where she worked for more than 20 years, she won a Shark Tank-style competition with her ClearHealthCosts pitch and hasn't looked back.
Since its founding in 2011, ClearHealthCosts has won a slew of journalism grants and prizes and has reported on and crowdsourced health price data in partnership with prestigious newsrooms in New Orleans, Philadelphia, Miami, San Francisco, Los Angeles, New York and elsewhere. This work has won numerous journalism prizes -- a national Edward R. Murrow award, a Society for Professional Journalists public service gold medal and a spot as a finalist for a Peabody Award, among others.
Pinder and the company have won grants from the John S. and James L. Knight Foundation, the International Women's Media Foundation, the Tow Center for Digital Journalism at Columbia University, the Tow-Knight Center for Entrepreneurial Journalism at the CUNY Graduate School of Journalism and others.
Previously, in her native Iowa, Pinder worked at The Des Moines Register and the Grinnell Herald-Register, a twice-weekly newspaper that her grandfather bought in 1944.
Pinder speaks fluent but rusty Russian. In a previous lifetime, she lived in what was then the Soviet Union, a place almost as mysterious as the US healthcare marketplace.
Jeanne Pinder | Speaker | TED.com