TED Residency
Jeanne Pinder: What if all US health care costs were transparent?
珍妮．平德: 如果所有的美國健康照護成本都能透明化，會如何？
Filmed:
Readability: 3.7
1,875,298 views
在美國，同一項血液檢測在一間診所只要19美金，到幾個街區外的另一間診所就要522美金——在收到帳單之前，沒有人知道這差別。記者珍妮．平德說，其實不必如此。她建立了一個平台，將醫療處理的真實價格做群眾外包，讓資料公開，揭露出健康照護定價的秘密。來了解一下，事先知道各項目的成本如何能讓我們更健康，幫我們省錢——並協助修復有問題的體制。
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，
00:14
members of my family
had three bits of minor surgery,
had three bits of minor surgery,
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我的家人動了三次小手術，
00:17
about a half hour each,
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每次約一個半小時，
00:19
and we got three sets of bills.
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我們收到了三組帳單。
00:22
For the first one, the anesthesia bill
alone was 2,000 dollars;
alone was 2,000 dollars;
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第一組中，光是麻醉帳單
就要兩千美金；
就要兩千美金；
00:26
the second one, 2,000 dollars;
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第二組，兩千美金；
00:28
the third one, 6,000 dollars.
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第三組，六千美金。
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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我是記者，所以我心想，
這是怎麼回事？
這是怎麼回事？
00:37
I found out that I was actually,
for the expensive one,
for the expensive one,
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針對比較貴的帳單，我發現其中
00:40
being charged 1,419 dollars
for a generic anti-nausea drug
for a generic anti-nausea drug
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一項非專利的抗嘔吐藥物
就要 1419 美金，
就要 1419 美金，
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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但我其實可以在網路上
用 2.49 美金就買到。
用 2.49 美金就買到。
00:50
I had a long and unsatisfactory
argument with the hospital,
argument with the hospital,
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我向醫院、保險公司，
及我的僱主力爭了很久，
及我的僱主力爭了很久，
00:53
the insurer and my employer.
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結果也不讓我滿意。
00:56
Everybody agreed
that this was totally fine.
that this was totally fine.
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大家都同意這樣的做法
完全沒問題。
完全沒問題。
但它讓我去想一件事，
且我越和大家聊，就越了解到：
且我越和大家聊，就越了解到：
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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沒人知道在健康照護
當中的東西要多少錢。
當中的東西要多少錢。
01:03
nobody has any idea
what stuff costs in health care.
what stuff costs in health care.
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01:06
Not before, during or after
that procedure or test
that procedure or test
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在手術或檢測之前、當中、之後，
01:09
do you have any idea
what it's going to cost.
what it's going to cost.
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都不知道它會花多少錢。
01:11
It's only months later that you get
an "explanation of benefits"
an "explanation of benefits"
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只有在幾個月之後，
你會收到「保險給付說明」，
你會收到「保險給付說明」，
01:15
that explains exactly nothing.
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它其實什麼也沒說明。
01:17
So this came back to me
a little while later.
a little while later.
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一陣子之後，我又想起了此事。
01:20
I had volunteered for a buyout
from the New York Times,
from the New York Times,
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在紐約時報當了二十年記者之後，
01:23
where I had worked for more than
20 years as a journalist.
20 years as a journalist.
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我接受了他們的
有條件自願離職計畫。
有條件自願離職計畫。
01:26
I was looking for my next act.
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我在尋找我的下一個階段。
01:28
It turned out that next act
was to build a company
was to build a company
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結果，下一個階段
是去建立一間公司，
是去建立一間公司，
01:31
telling people what stuff costs
in health care.
in health care.
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來告訴大家在健康照護中
各項目的費用。
各項目的費用。
01:34
I won a "Shark Tank"-type
pitch contest to do just that.
pitch contest to do just that.
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我在一個類似「創智贏家」的
提案比賽中贏得了這個機會。
提案比賽中贏得了這個機會。
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，我們的國民生產毛額
有近 18% 被健康成本給吃掉，
有近 18% 被健康成本給吃掉，
01:42
but nobody has any idea what stuff costs.
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但沒有人知道什麼東西要多少錢。
01:45
But what if we did know?
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但，如果我們知道，會如何？
所以，我們從小規模做起。
01:48
So we started out small.
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01:49
We called doctors and hospitals
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我們打電話給醫生和醫院，
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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問他們如果收現金做簡單的醫療
處理，他們能接受的金額是多少。
處理，他們能接受的金額是多少。
01:57
Some people were helpful.
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有些人很幫忙。
01:58
A lot of people hung up on us.
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很多人直接掛我們電話。
02:00
Some people were just plain rude.
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有些人就只是很沒禮貌。
02:02
They said, "We don't know,"
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他們說：「我們不知道。」
02:04
or, "Our lawyers won't
let us tell you that,"
let us tell you that,"
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或「我們的律師
不會允許我們告訴你。」
不會允許我們告訴你。」
02:07
though we did get a lot of information.
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不過我們仍然得到了許多資訊。
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，我們發現，在紐約地區，
02:12
you could get an echocardiogram
for 200 dollars in Brooklyn
for 200 dollars in Brooklyn
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在布魯克林，花兩百美金
就可以做心臟超音波檢查，
就可以做心臟超音波檢查，
02:17
or for 2,150 dollars in Manhattan,
just a few miles away.
just a few miles away.
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在僅僅幾英里外的曼哈頓
卻要 2150 美金。
卻要 2150 美金。
02:22
New Orleans, the same simple blood test,
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紐奧良，同樣簡單的血液檢測，
02:25
19 dollars over here,
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在這裡是 19 美金，
02:27
522 dollars just a few blocks away.
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幾個街區之外就是 522 美金。
舊金山，同樣的磁共振造影，
02:31
San Francisco, the same MRI,
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02:34
475 dollars
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475 美元，
02:36
or 6,221 dollars just 25 miles away.
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或在 25 英里之外
就要 6221 美元。
就要 6221 美元。
02:42
These pricing variations existed
for all the procedures
for all the procedures
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所有的醫療處理
都有這樣的價格差異，
都有這樣的價格差異，
02:46
and all the cities that we surveyed.
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且在我們調查的所有城市中都有。
接著，我們開始請大家
告訴我們他們的健保帳單。
告訴我們他們的健保帳單。
02:49
Then we started to ask people
to tell us their health bills.
to tell us their health bills.
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02:52
In partnership with public radio station
WNYC here in New York,
WNYC here in New York,
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我們和紐約的
公共廣播電台 WNYC 合作，
公共廣播電台 WNYC 合作，
02:56
we asked women to tell us
the prices of their mammograms.
the prices of their mammograms.
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我們請女性告訴我們
她們做乳房 X 光攝影的價格。
她們做乳房 X 光攝影的價格。
02:59
People told us nobody would do that,
that it was too personal.
that it was too personal.
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別人都跟我們說，沒有人會
這樣做的，這些資訊太個人化了。
這樣做的，這些資訊太個人化了。
但在三個星期期間，
03:03
But in the space of three weeks,
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有四百位女性
把她們的價格告訴我們。
把她們的價格告訴我們。
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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接著，我們開始用比較容易的方式
來讓大家分享資料，
來讓大家分享資料，
03:12
into our online searchable database.
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把資料放到我們
可搜尋的線上資料庫。
可搜尋的線上資料庫。
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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它有一點像是 Kayak.com
和 Waze 交通應用程式的融合版，
和 Waze 交通應用程式的融合版，
供健康照護用。（笑聲）
03:20
(Laughter)
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03:21
We call it a community-created
guide to health costs.
guide to health costs.
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我們稱它是由社區
創造出來的健康成本指南。
創造出來的健康成本指南。
03:24
Our survey and crowdsourcing work
grew into partnerships
grew into partnerships
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我們的調查和群眾外包工作
03:26
with top newsrooms nationwide --
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發展到和全國頂尖的
新聞編輯部合作——
新聞編輯部合作——
03:28
in New Orleans, Philadelphia,
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包括在紐奧良、費城、
03:30
San Francisco, Los Angeles,
Miami and other places.
Miami and other places.
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舊金山、洛杉磯、
邁阿密，及其他地方。
邁阿密，及其他地方。
03:35
We used the data to tell stories
about people who were suffering
about people who were suffering
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我們用資料來說受苦的人的故事，
03:39
and how to avoid that suffering,
to avoid that "gotcha" bill.
to avoid that "gotcha" bill.
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以及要如何避免那些苦難，
避免那些「逮到你了」帳單。
避免那些「逮到你了」帳單。
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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紐奧良的一位女子用我們的資料
省下了近四千美元。
省下了近四千美元。
一位舊金山的民眾說
他省下了近 1300 美元，
他省下了近 1300 美元，
03:49
A San Francisco contributor
saved nearly 1,300 dollars
saved nearly 1,300 dollars
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03:52
by putting away his insurance card
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他只是不使用保險卡，
改支付現金。
改支付現金。
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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有很多人都會去
保險機構網內的醫院，
保險機構網內的醫院，
03:59
and getting out-of-network bills.
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卻收到網外的帳單。
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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還有醫院會持續寄帳單給死人。
04:05
We learned that thousands of people
wanted to tell us their prices.
wanted to tell us their prices.
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我們發現，有上千人
想要告訴我們他們的價格。
想要告訴我們他們的價格。
他們想要知道各項目的價格，
及如何針對帳單做申訴，
及如何針對帳單做申訴，
04:08
They want to learn what stuff costs,
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04:10
find out how to argue a bill,
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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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他們協助我們解決這個
在傷害他們家人朋友的問題。
在傷害他們家人朋友的問題。
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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我們談過的對象包括必須要
賣車來支付健康帳單的人、
賣車來支付健康帳單的人、
破產的人、
04:18
go into bankruptcy,
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04:20
skip a treatment because of the cost.
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因為費用太高
而沒接受醫療處理的人。
而沒接受醫療處理的人。
04:23
Imagine if you could afford the diagnosis
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想像一下，如果
你能負擔得起診斷，
你能負擔得起診斷，
04:25
but not the cure.
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卻負擔不起治療。
04:29
We set off a huge conversation about costs
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我們引起關於成本的熱烈討論，
04:31
involving doctors and hospitals, yes,
but also their patients,
but also their patients,
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參與的人有醫生、醫院，
是的，還有他們的病人，
是的，還有他們的病人，
04:35
or as we like to call them, people.
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或者，我們直接稱他們為「人們」。
04:37
(Laughter)
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（笑聲）
我們改變了政策。
04:41
We changed policy.
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04:42
A consumer protection bill
that had been stalled
that had been stalled
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在路易斯安納有一個
消費者保護法案
消費者保護法案
04:45
in the Louisiana legislature for 10 years
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被擺放了十年，
04:47
passed after we launched.
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在我們推出之後，就通過了。
04:50
Let's face it:
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咱們面對現實吧：
04:51
this huge, slow-rolling
public health crisis
public health crisis
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這個轉動緩慢的巨大公共健康危機
04:54
is a national emergency.
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是全國性的急迫事件。
我想短期內政府不會協助我們。
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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但，如果答案其實很簡單呢：
05:00
But what if the answer was really simple:
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05:02
make all the prices public all the time.
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隨時都讓所有的價格公開。
05:06
Would our individual bills go down?
Our health premiums?
Our health premiums?
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我們個人的帳單金額
會下降嗎？健保費呢？
會下降嗎？健保費呢？
05:11
Be really clear about this:
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大家要很清楚一點：
05:13
this is a United States problem.
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這是美國的問題。
05:15
In most of the rest
of the developed world,
of the developed world,
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在大多數其他的已開發國家中，
05:17
sick people don't have
to worry about money.
to worry about money.
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生病的人不用擔心錢的問題。
05:20
It's also true that price transparency
will not solve every problem.
will not solve every problem.
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的確，價格透明度
並不會解決所有問題。
並不會解決所有問題。
05:24
There will still be expensive treatments,
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仍然會有昂貴的治療存在，
05:27
huge friction from our insurance system.
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保險系統會有很大的磨擦。
05:29
There will still be fraud
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仍然會有詐欺，
05:31
and a massive problem
with overtreatment and overdiagnosis.
with overtreatment and overdiagnosis.
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也會有過度治療
與過度診斷的重大問題。
與過度診斷的重大問題。
05:35
And not everything is shoppable.
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不是所有東西都是可以比價的。
05:38
Not everybody wants
the cheapest appendectomy
the cheapest appendectomy
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並不是所有人都想要
最便宜的闌尾切除手術，
最便宜的闌尾切除手術，
05:40
or the cheapest cancer care.
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或最便宜的癌症照護。
05:43
But when we talk
about these clear effects,
about these clear effects,
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但，當我們談到
這些清楚的效應時，
這些清楚的效應時，
05:45
we're looking at a real issue
that's actually very simple.
that's actually very simple.
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我們在看的其實是
很簡單的真實議題。
很簡單的真實議題。
05:50
When we first started calling for prices,
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我們剛開始向大家詢問價格時，
05:52
we actually felt like
we were going to be arrested.
we were going to be arrested.
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真的覺得我們會被逮捕。
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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同時談及醫學和健康照護，
似乎有點逾距，
05:58
in the same breath,
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06:00
and yet it became liberating,
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但，後來卻變得很自由，
06:01
because we found not only data
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因為我們找到的不只是資料，
06:04
but also good and honest people
out there in the system
out there in the system
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還有在體制中的好人、誠實的人，
06:06
who want to help folks
get the care they need
get the care they need
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他們想要協助大家
取得他們需要的照護，
取得他們需要的照護，
06:08
at a price they can afford.
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且是他們付擔得起的價格。
06:11
And it got easier to ask.
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開口詢問也變容易了。
06:13
So I'll leave you with some questions.
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所以，我想留給各位一些問題。
06:15
What if we all knew what stuff cost
in health care in advance?
in health care in advance?
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如果我們都事先知道健康照護
各項目的成本，會如何？
各項目的成本，會如何？
06:19
What if, every time
you Googled for an MRI,
you Googled for an MRI,
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如果每次你用 Google
搜尋磁共振造影，
搜尋磁共振造影，
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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就會得到列表，列出
在哪裡可購買、多少錢，
在哪裡可購買、多少錢，
06:26
the way you do when
you Google for a laser printer?
you Google for a laser printer?
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就像你在 Google
搜尋雷射印表機一樣，如何？
搜尋雷射印表機一樣，如何？
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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如果把花在隱藏價格的
所有時間、精力、金錢
所有時間、精力、金錢
06:34
was squeezed out of the system?
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都從體制中擠出來，如何？
06:37
What if each one of us could pick
the $19 test every time
the $19 test every time
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如果我們每個人每次都能
選擇 19 美元的檢測，
選擇 19 美元的檢測，
06:40
instead of the $522 one?
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而不是 522 美元的，會如何？
06:43
Would our individual bills go down?
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我們個人的帳單金額
會下降嗎？保費呢？
會下降嗎？保費呢？
06:45
Our premiums?
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06:46
I don't know, but if you don't ask,
you'll never know.
you'll never know.
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我不知道，但如果你不問，
就永遠不會知道。
就永遠不會知道。
你可能可以省下一大筆錢。
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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我認為，我們很多人以及體制本身
06:55
would be a lot healthier.
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都會變得更健康。
06:57
Thank you.
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謝謝。
06:58
(Applause)
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（掌聲、歡呼聲）
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