TED2018
Lucy Marcil: Why doctors are offering free tax prep in their waiting rooms
露西馬希爾: 為什麼醫生要在候診室提供免費的報稅服務
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超過 90% 的美國孩童一年至少看醫生一次，也就是說，父母要花費數小時在候診室中。如果那些時間能被用來做像省錢之類更有生產力的事呢？小兒科醫生及 TED 會員露西馬希爾透過她的組織 StreetCred 直接在候診室中為父母提供免費的報稅服務，讓「看醫生」有了全新的觀念，協助家庭脫離貧困。來聽聽這場演說，進一步了解免費納稅籌劃和指導如何能成為美國最好的貧困處方。
Lucy Marcil - Pediatrician, social entrepreneur
Lucy Marcil is providing fiscal services to low-income families in the doctor’s waiting room. Full bio
Lucy Marcil is providing fiscal services to low-income families in the doctor’s waiting room. Full bio
Double-click the English transcript below to play the video.
00:12
How many of you have had
your doctor ask you about sex?
your doctor ask you about sex?
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在座有多少人曾經被醫生
問過你的性生活？
問過你的性生活？
00:16
Your mental health?
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你的婚姻狀況？
00:18
Alcohol use?
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酒精使用？
00:19
These questions are almost universal.
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這些問題幾乎可說是很普遍的。
00:22
But how many of you have had
your doctor ask you about money?
your doctor ask you about money?
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但在座有多少人曾經
被醫生問過錢的問題？
被醫生問過錢的問題？
00:27
Most of us haven't.
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大部分人沒有。
00:29
But that is strange, because
compared to most high-income countries,
compared to most high-income countries,
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但那很奇怪，因為和
大部分高收入國家相比，
大部分高收入國家相比，
00:33
child poverty is an epidemic
in the United States.
in the United States.
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在美國，兒童貧窮問題非常流行。
00:38
It creates conditions that may elevate
stress hormone levels
stress hormone levels
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它所造成的症狀，
可能會提高壓力荷爾蒙的量，
可能會提高壓力荷爾蒙的量，
00:42
and impair brain development.
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傷害大腦發展。
00:44
Poor children in the US are one and a half
times more likely to die
times more likely to die
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在美國，和中產階級孩童
相比，貧窮孩童的
相比，貧窮孩童的
00:50
and twice as likely to be hospitalized
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死亡機率是 1.5 倍，
00:53
as their middle-class counterparts.
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住院機率是 2 倍。
00:55
So my colleague Dr. Michael Hole
and I started asking moms about money.
and I started asking moms about money.
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我和我的同事麥可荷爾醫生
開始問母親關於錢的問題。
開始問母親關於錢的問題。
01:03
We knew we needed to reimagine
what a doctor's visit looks like,
what a doctor's visit looks like,
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對於「看醫生」應該是什麼
樣子的，我們得要有新的觀念，
樣子的，我們得要有新的觀念，
01:07
to get kids out of poverty
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來讓孩子們能脫離貧困，
01:08
and to give them a fair shot
at a healthy life.
at a healthy life.
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讓他們也有公平機會，
過著健康的人生。
過著健康的人生。
01:13
Our questions led
to a surprising solution:
to a surprising solution:
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我們的問題帶出了
一個讓人吃驚的解決方案：
一個讓人吃驚的解決方案：
01:16
tax credits.
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稅額扣抵。
01:17
It turns out, the earned income
tax credit, or EITC,
tax credit, or EITC,
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結果發現，EITC，
也就是勞動所得稅扣抵制，
也就是勞動所得稅扣抵制，
01:22
is the best poverty prescription
we have in the US.
we have in the US.
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是美國最好的貧窮處方。
01:26
The average mom gets two to three
thousand dollars a year from it.
thousand dollars a year from it.
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一般的母親每年能從 EITC
得到 $2000~3000。
得到 $2000~3000。
01:31
When families get it,
moms and babies are healthier:
moms and babies are healthier:
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當家庭能得到扣抵，
母親和寶寶都會比較健康：
母親和寶寶都會比較健康：
01:34
fewer depressed moms,
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比較少憂鬱的母親，
01:36
babies weighing more at birth.
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嬰兒在出生時的體重比較重。
01:38
But one out of five families
who could get it doesn't,
who could get it doesn't,
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但每五個可以得到扣抵的家庭
當中就有一個沒有得到，
當中就有一個沒有得到，
01:43
and most who do
lose of hundreds of dollars
lose of hundreds of dollars
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且大部分得到扣抵的家庭
還要花費數百元，
還要花費數百元，
01:46
to the for-profit
tax-preparation industry.
tax-preparation industry.
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錢到了營利報稅產業的口袋裡。
01:51
One day, a mom asked us
why we couldn't do her taxes
why we couldn't do her taxes
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有一天，有位母親問我們，
為什麼我們不能幫她報稅，
為什麼我們不能幫她報稅，
01:55
while she waited for the doctor.
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當時她正在等著看醫生。
01:56
(Laughter)
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（笑聲）
01:57
We all know that purgatory.
Why not make good use of that time?
Why not make good use of that time?
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我們都知道那根本是煉獄。
為什麼不好好利用那時間呢？
為什麼不好好利用那時間呢？
02:02
So we started StreetCred,
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所以我們開始了 StreetCred，
02:04
an organization prescribing
tax preparation in clinics serving kids.
tax preparation in clinics serving kids.
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它是個組織，在兒童診所中
開「報稅服務」。
開「報稅服務」。
02:09
This is a brand-new approach
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這是個全新的方法，
02:11
and one that left some
questioning our sanity.
questioning our sanity.
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不過也讓一些人懷疑
我們頭殼有沒有壞去。
我們頭殼有沒有壞去。
02:15
After all, we're doctors, not accountants.
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畢竟，我們是醫生，不是會計師。
02:17
But we have something accountants don't:
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但我們有會計師所沒有的：
02:21
access to families.
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我們能接觸家庭。
02:24
Over 90 percent of kids in the US
see a doctor at least once a year.
see a doctor at least once a year.
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美國有超過 90% 的孩子，
每年至少要看醫生一次。
每年至少要看醫生一次。
02:29
Their parents trust us
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他們的父母相信我們，
02:31
and will do anything
to give them a better life.
to give them a better life.
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且願意做任何事
來讓孩子過更好的生活。
來讓孩子過更好的生活。
02:36
Doctors in every clinic around the country
could be doing this work, too --
could be doing this work, too --
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美國各地每個診所的醫生
也都可以做這項工作——
也都可以做這項工作——
02:40
it's simple, really.
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它其實很簡單。
02:42
The hospital registers
as a tax-preparation site,
as a tax-preparation site,
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醫院掛號處可以當作報稅站，
02:44
and everyone, from medical
students to retirees,
students to retirees,
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每個人，從醫學系學生到退休者，
02:48
can volunteer as a tax preparer
after passing an IRS exam.
after passing an IRS exam.
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只要通過國稅局的考試
就可以當報稅義工。
就可以當報稅義工。
02:53
It's not as hard as it sounds, I promise.
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我保證，它沒有聽起來那麼難。
02:56
I certainly never thought
I would be doing other people's taxes,
I would be doing other people's taxes,
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我肯定從來沒有想過
我會幫別人報稅，
我會幫別人報稅，
02:59
but here I am.
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但我現在就在做了。
03:01
We're nearing the end of our third year.
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我們已經到了第三年尾聲。
03:05
In the first two, we returned
1.6 million dollars
1.6 million dollars
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前兩年，光在波士頓，
我們就為 750 個家庭
我們就為 750 個家庭
03:09
to 750 families in Boston alone.
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得到了 160 萬元的退稅。
03:12
This year --
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今年——
03:14
(Applause)
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（掌聲）
03:19
This year, we've expanded
to nine sites in four states.
to nine sites in four states.
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今年，我們擴展到
在四個州有九個站點。
在四個州有九個站點。
03:23
Sixty-three percent of our families
have never heard of the EITC.
have never heard of the EITC.
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我們服務的家庭中，
有 63% 從來沒有聽過 EITC。
有 63% 從來沒有聽過 EITC。
03:28
How can you claim something
you haven't heard of?
you haven't heard of?
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如果你沒聽過，
怎麼可能會要求退稅呢？
怎麼可能會要求退稅呢？
03:32
And half have never used
free tax preparation.
free tax preparation.
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半數人沒用過免費的協助報稅服務。
03:35
That two to three thousand dollars a year
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若一年能得 $2000~3000 的退稅，
03:38
goes a long way.
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可以用很長一段時間。
03:40
Take hunger.
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比如飢餓。
03:41
An adequately nutritious, low-cost diet
for a mom and two young kids
for a mom and two young kids
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一位母親和兩位小孩若要吃
營養適當且花費低的飲食，
營養適當且花費低的飲食，
03:46
costs 477 dollars a month.
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一個月要花 $477。
03:50
With EITC money, that family
can eat for five to six months.
can eat for five to six months.
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若有 EITC 的錢，就夠讓
那個家庭吃五到六個月。
那個家庭吃五到六個月。
03:54
Or think about medical care.
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或是，想想醫療照護。
03:56
Twenty million children in the US
lack access to care
lack access to care
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美國有兩千萬孩童無法取得
符合現代小兒科標準的照護。
04:00
meeting modern pediatric standards.
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04:04
And yet, the average cost of that care
is only 400 dollars per kid per year.
is only 400 dollars per kid per year.
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然而，那種照護的成本，
一位孩童一年只要 $400。
一位孩童一年只要 $400。
04:11
EITC money can help fix
this access problem.
this access problem.
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EITC 的錢能用來處理這問題。
04:15
Perhaps most powerfully of all,
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還有個可能是最強大的用途，
04:17
this money gives moms hope.
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這筆錢能給予母親希望。
04:20
One mom used her refund
for her son to study abroad in Spain.
for her son to study abroad in Spain.
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有一位母親把她的退稅用來
讓兒子出國到西班牙讀書。
讓兒子出國到西班牙讀書。
04:25
She was struggling to pay her rent,
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她要付房租都很辛苦，
04:27
but she saw EITC money
as his shot at a better future.
as his shot at a better future.
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但她把 EITC 的錢視為是個機會，
能讓她兒子有更美好的未來。
能讓她兒子有更美好的未來。
04:32
We have an opportunity,
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身為醫生和公民，我們有個機會
04:33
as doctors and as citizens,
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能從根源處理這個問題。
04:36
to get to the root of this problem.
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04:38
We can reimagine health care
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我們能改變健康照護的觀念，
04:40
as a place addressing
the causes of poor health,
the causes of poor health,
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讓它能夠處理不良健康的成因，
04:44
be it infections
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不論這成因是感染
04:45
or finances.
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或是財務。
04:47
Thank you.
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謝謝。
04:48
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Lucy Marcil - Pediatrician, social entrepreneurLucy Marcil is providing fiscal services to low-income families in the doctor’s waiting room.
Why you should listen
Lucy Marcil, MD MPH, creates innovative solutions buffering kids from the adversity they face growing up with economic stress and poverty. As a pediatrician, she cares for children at Boston Medical Center. She co-founded StreetCred, a nonprofit addressing the health impact of financial stress by providing fiscal services to low-income families in the the doctor’s waiting room. StreetCred increases access to critical anti-poverty tax credits such as the Earned Income Tax Credit by integrating tax preparation services into pediatric clinics; it has returned over $3.2 million to 1700 clients at 9 sites in 4 states since its inception in 2016. StreetCred is now bundling tax services with enrollment in other economic mobility services to create greater financial stability.
Internationally, Dr. Marcil has undertaken pediatric health-systems strengthening. As a HIV/AIDS & Community Health Peace Corps volunteer in Namibia, she leveraged public-private partnerships to create a comprehensive orphan care program and girls’ leadership camps. In Bangladesh, she identified community engagement methods to build maternal-child healthcare systems in urban slums. In Kenya, she consulted for Jacaranda Health to transform newborn care systems.
For her work, Dr. Marcil has been recognized with the American Academy of Pediatrics Anne E. Dyson Child Advocacy Award and the Jack Kent Cooke Foundation Quinn Prize, and has been named a Café 100, Davidson College Game Changer and 2018 TED Fellow.
Lucy Marcil | Speaker | TED.com