【社会】是什么让美国的医疗体系如此昂贵?

【来源龙腾网】

评论原创翻译：

David Chan

Why is healthcare in the United States so expensive when compared to other countries which provide treatment of comparable or better quality?

There is a long list of reasons but here's a start.

美国的医疗费用为何远高于其他国家，尤其是考虑到其他国家提供的医疗服务质量相当甚至更好？这里有很多原因，以下是一些主要的解释：

1. Americans won't permit or accept healthcare rationing. America spends much more for care in the last 6 months of life than any other country. By a lot.

Walk through any ICU and you'll routinely see some people in vegetative conditions with virtually no chance of getting better. Yet they are receiving a full court press with anything and everything that can be done from the standpoint of medical technology.

美国人通常不接受医疗服务的配给制度。美国人在生命最后6个月的医疗费用比其他任何国家都要高,高出好多。

走过任何一个重症监护室，你都会经常看到一些人处于植物人状态，几乎没有好转的机会，但他们仍然在接受医疗技术所允许的一切手段，进行全面而竭尽全力的治疗。

Some of the push for this care comes from families who are adamant against witholding or withdrawing care. But doctors are also guilty of over-treatment. We all know some crazy doctors who believe that miracles can happen daily in the ICU regardless of how hopeless the situation may be.

这种对治疗的坚持部分源自那些坚决反对减少或停止治疗的家庭成员。同时，医生们也难辞其咎，他们有时会过度治疗。我们都听说过一些医生，他们坚信在重症监护室里，不管情况多么绝望，总有奇迹发生。

The expense is enormous and American families are divorced from it. If the patient is uninsured, the costs are absorbed by the treating hospital and the doctors. If the patient is insured, the deductible has been met and the rest is paid for by insurance or via the taxpayers .

这笔开销极为庞大，美国家庭却往往与之脱节。若患者未投保，相关费用便由治疗医院和医生承担。若患者已投保，一旦满足了免赔额，剩余费用便由保险公司承担，或者通过纳税人资金支付。

You won't see this in any other country with a national health service. Elderly patients don't get started on dialysis in the NHS in England. They die of kidney failure. You won't see 75 or 80 year olds getting quadruple bypass surgery either. Cancer patients in Canada and England routinely don't get $10,000 a month drugs for cancer treatment that prolongs life by several months (on average). The drugs either aren't available at all like in Canada (where some cancer drugs never get approved), or they are made virtually unavailable through a lottery in England.

在其他国家的国家卫生服务体系中，你不会见到这样的做法。例如，在英国的国家卫生服务（NHS）中，老年患者通常不会开始接受透析治疗，而是会因肾功能衰竭而去世。同样，你也不会看到七八十岁的老人接受四重搭桥手术。在加拿大和英国，癌症患者通常无法获得每月高达1万美元、平均只能延长几个月生命的昂贵抗癌药物。这些药物在加拿大可能根本无从获得（因为有些抗癌药物从未获得批准），或者在英国，它们通过一种抽签制度几乎变得不可及。

2. Americans pay much more for pharmaceuticals than anyone else in the world. The American government, under pressure from the Big Pharma lobby, refuses to negotiate discount rates for Medicare. So Americans pay 30% to 300% more than Canadians for the identical drug made in New Jersey or California.

美国在药品上的花费远高于世界其他国家。在美国政府受到大型制药业游说团体的影响下，拒绝为联邦医疗保险（Medicare）提供折扣价格谈判。因此，美国人为同样的药物支付的费用比加拿大人高出30%至300%——尽管这些药物可能是在新泽西或加利福尼亚制造的。

3. There is gigantic waste and fraud in Medicaid and Medicare programs. Billing is electronic and payment is automatic. Auditing is very expensive and apparently very rarely occurs. It's so lucrative and easy to skim hundreds of millions of dollars per scheme that organized crime is now involved.

在美国联邦医疗保险（Medicare）和 联邦医疗补助（Medicaid）项目中，存在着巨大的浪费和欺诈问题。账单是电子化的，支付是自动完成的。审计过程不仅成本高昂，而且显然很少执行。由于通过欺诈手段从这些计划中骗取数亿美元的收益巨大且操作简单，现在连有组织的犯罪集团也参与其中。

There are reasonable estimates that the fraud is $120-$180 billion a year. This are astronomic numbers.

据合理估算，每年的欺诈金额在1200亿到1800亿美元之间，这是一个天文数字。

Comments are frequently made about how efficient Medicare and Medicaid are because they have such low administrative costs compared to insurance companies. (It's pretty difficult to scam insurance companies for large amounts of money.) But the administration of Medicare/Medicaid includes the Department of HHS and also various law enforcement arms of the federal government. That's not cheap. And it's apparently not very effective either.

人们经常称赞联邦医疗保险（Medicare）和 联邦医疗补助（Medicaid）的效率，因为与保险公司相比，它们的行政成本要低得多。（要从保险公司那里骗取大量资金相当困难。）但是，Medicare/Medicare的行政管理不仅涉及卫生及公共服务部（HHS），还包括联邦政府的多个执法机构。这并不便宜，而且显然效果也不尽人意。

4. Americans demand immediate access to technology. We want the ability to get an MRI tomorrow or that latest diagnostic test and treatment reported on CNN. That kind of access is incredibly expensive both in overhead — to build the facilities and purchase the machines — let alone the costs of the procedures.

美国民众期望能够即刻获得技术资源。他们希望能够迅速预约到磁共振成像，或者是在美国有线电视新闻网上看到的最新诊断测试和治疗方法。这种即时获取技术的能力，其代价极为昂贵，不仅包括建设医疗设施和购置昂贵设备的成本，还有执行这些程序所需的费用。

We Americans want these tests sometimes, even when they are considered not necessary for good health. We ask our doctors to rule out the 1 in 10,000 event. It's human nature to want the latest and greatest of everything. But its never free and this kind of medical care costs a tremendous amount of money.

即使有时候这些检查对于维持健康并非必要，美国人仍然希望进行这些检查。我们请求医生排除那些极小概率的事件。追求最新最好的一切是人类的本能。但它从来不是免费的，这种医疗服务需要花费大量的钱。

5. The wasteful practice of defensive medicine. In America there are enormous numbers of unnecessary tests and scans that are performed by a doctor to cover his/her ass just in case of a lawsuit. It's impossible to practice in America without facing the threat of litigation. I, and every doctor answering honestly, will admit to ordering defensive tests.

I've seen estimates of $600+ billion a year in unneeded tests and procedures done primarily to avoid litigation. That's a lot of money that could otherwise go to insuring the uninsured. Opponents to tort reform quote very small numbers because they only use the cost of defending lawsuits in their equation. But that's a drop in the bucket compared to what doctors in America waste so that no one will accuse them of "missing something."

美国存在一种防御性医疗的浪费做法。医生们为了避免可能的诉讼，会进行大量不必要的检测和扫描，这种做法造成了巨大的资源浪费。在美国，医生在执业时无法忽视诉讼的威胁，我以及每一位坦率的医生都会承认曾经开具过出于防御目的的检查单。

我见过估算显示，每年因不必要的检测和手术而浪费的金额超过6000亿美元，这些检测和手术主要是出于避免诉讼的考虑。这笔巨额资金本可以用于为未投保人群提供医疗保险。反对医疗事故改革的人在他们的论据中只提到了很小的数字，因为他们仅考虑了应对诉讼的费用。然而，与美国医生为了避免被控告“漏诊”而浪费的资金相比，这仅仅是沧海一粟。

原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处

6. Regulation and certification. The regulatory process in America has become so burdensome for hospitals, clinics and physicians that to meet compliance standards, a small army of administrators and attorneys are needed to go through them. After the ACA was implemented, many doctors had to join healthcare systems to navigate them. Over the past 10 years, our clinic administrative staff more than doubled. Similarly the hospital administrative staff have increased as well to meet regulatory requirements and pass the various inspections that accompany them. There are numerous fees and licenses involved in medical care today. There is a financial cost to this that gets passed on to insurance payers.

监管和认证。

对于医院、诊所和医生来说，美国的监管程序已经变得如此繁重，以至于为了达到合规标准，需要一小群管理人员和律师来通过这些程序。《平价医疗法案》实施之后，为了适应新的规章制度，许多医生选择加入了大型医疗系统。在过去十年里，我们诊所的行政管理人员数量翻了不止一番。医院同样扩充了行政团队，以确保符合各项规定并通过必要的各项检查。医疗行业如今需要处理大量的费用和许可证问题。这些相关的财务开销最终会转嫁到保险公司，由它们支付。