作为一个欧洲人，你会更喜欢美国的医疗体系吗？（其二）

Christian Winter
As a European, would you prefer the US healthcare system?
No. As a German I pay a fixed percentage of my income and have almost all expenses paid. I pay a little more than 300 Euros a month although I have an above average income. I have to pay extra for glasses, dental prostheses or when I have to go to hospital. I would have to pay a little extra for prescxtion drugs or orthotics. But that’s about it. All in all really affordable.
The US health care system actually is not a health care system, it’s a scam to squeeze as much money out of the patients as possible and if it cannot be avoided at all treat a few of them. That’s what you get if you turn everything into a business scheme.
 
作为一名欧洲人，你会不会更倾向于美国的医疗体系？
不会。作为德国人，我支付一定比例的收入作为保险费，并且几乎所有的医疗费用都得到了覆盖。尽管我的工资高于平均水平，但我每月只需支付300多欧元。当然，我需要额外支付眼镜、牙科修复器械或住院治疗的费用。对于处方药或矫形器具，我也需要支付一些额外费用。但也就这些了。总的来说，费用非常合理。
美国的医疗体系实际上并不算是一个真正的医疗体系，它更像是一个骗局，目的是尽可能从患者身上榨取更多的金钱，而在无法避免的情况下才治疗少数患者，这就是当你把一切都变成商业计划时所得到的结果。
 
Yocheved Sier
Healthcare is the #2 reason I moved abroad from the US. In America, I would have to pay $800+ a month for the bare-bones basic plan, which barely covers anything. Now I pay $25 a month for a platinum plan which covers almost everything.
 
医疗保健是我离开美国移居海外的第二大原因。在美国，我每月要支付800多美元，却只能得到最基本的医疗保险计划，而且几乎什么都覆盖不了。现在我每月只需支付25美元，就能享受到几乎覆盖所有内容的白金计划。
 
Rohan Mehere
What was your #1 reason?
 
你离开美国移居海外的的第一大原因是什么？
 
Yocheved Sier
My parents live in America.
 
我的父母还生活在美国。
 
Stuart Holme
 I cannot believe how duped my fellow countrymen and women are right now. The blinders of American “exceptionalism” are opaque indeed.
 
我不敢相信我的同胞们现在被愚弄了。美国“例外论”的眼罩确实不透明。
 
Tim Chisell
National Insurance also covers pensions and certain welfare benefits. On the other hand, these things (and healthcare are also funded out of general taxation, so unfortunately it’s not as simple as NI = payment for healthcare. I believe that (in round figures), NHS funding is currently about 120 billion/pa, from a total government budget of around 2.1 trillion, so a little under 6% of total
 
国民保险还覆盖养老金和某些福利。另一方面，这些（包括医疗保健）也是通过一般税收资助的，所以不幸的是，并不是国民保险就等于支付医疗保健费用。我相信NHS的资金目前大约是每年1200亿英镑（大致数字），总政府预算约为2.1万亿英镑，约占总预算的不到6%。
 
Daniel Hyatt
10% in the UK (free if your out of work, under 25 in education, under 18 or an OAP). No Co-pays. Prescxtions cost a flat fee of ￡8.20 per prescxtion (free for out of work, under 25…etc)
Things not included in NHS is dental (costs ￡20 for a checkup, ￡50 for a filling, max cost is ￡200 for a root canal etc). Eye tests cost about ￡10 .
No fee to visit doctor, ER, to have an operation etc. No bills, no dealing with insurance companies and you don’t have to worry if your covered or not.
 
在英国，医疗费用是收入的10%（如果你失业、25岁以下在学、18岁以下或老年人则免费）。没有自付额。处方药的费用是每张处方8.20英镑（失业、25岁以下等免费）。
NHS不包括牙科（检查费用20英镑，补牙50英镑，根管治疗等最高费用200英镑）。眼科检查大约10英镑。
看医生、急诊室、做手术等没有费用。没有账单，不需要和保险公司打交道，也不需要担心你是否被覆盖。
 
Jennifer Maiko Bradshaw
We have no co-pays for doctor visits etc. We do pay out-of-pocket for prescxtion drugs.
 
我们看医生等没有自付额。我们确实需要自掏腰包支付处方药。
 
Teri Pre
I’m an American living and working in South Korea. I pay 5.08% of my pay into the healthcare system. There is a “co-pay” of about $3 when I go to a doctor. I’m also on a daily medication which costs about $4 for 100 tablets. In the US, 30 tablets cost about $10. And I can choose any doctor, including oriental medicine doctors. Oh…and the blood work I need 4 times a year? It’s about $20…which includes the $3 doctor fee. In the States, it’s double that…or more. Which healthcare system do I prefer?? Guess!
 
我是一个生活在韩国的美国人。我参保医疗保健系统支付工资的5.08%。去看医生时有大约3美元的“自付额”。我每日也在服用一种药物，100片大约4美元。在美国，30片大约10美元。我可以选择任何医生，包括东方医学医生。哦...我每年需要做的四次血液检查，大约20美元——包括3美元的医生费用。在美国，费用是那个的两倍...或更多。我更喜欢哪种医疗保健系统？猜猜看！
 
George
I lived in the US for 2 years. Luckily whilst working for the British government, so they paid for a very high quality health insurance for us. ( which we could not have afforded ourselves)
Despite the gold plated health insurance, when my colleague had a (relatively minor) cycling accident, She had to prove insurance to the ambulance crew; at the emergency rooms; to the surgeon, we had to wait for the insurance bro confirm that she was covered, even though she had a completely valid insurance card and documents;
 
我在美国居住了两年。幸运的是，我那时为英国政府工作，因此他们为我们提供了一份非常优质的健康保险——这份保险的费用我们自己是无法承担的。
尽管我们拥有这样一份顶级的医疗保险，但当一位同事遭遇了一次（相对而言）小的自行车事故时，她不得不向救护车人员、急诊室的医生以及外科医生证明自己的保险有效性；我们还得等待保险公司确认她确实被保险覆盖——尽管她持有完全有效的保险卡和相关文件。
 
She had to get the insurance to agree to each follow up appointment.
The treatment, despite being in one of the best hospitals in New York, was not to UK standards; eventually she had to be taken back to the UK to have the botched repair to her wrist redone properly. It was discovered at that point, that though having paid for the better quality repair, the hospital had used substandard pins, and not actually carried out the complex repair that they had claimed. It took the British Government 5 years to get re-imbursed for the fraud, and to get damages to my colleague. ( whose wrist will never fully recover from the sub standard botched treatment)
 
她必须得到保险公司的同意才能进行每次后续预约复诊
尽管是在纽约最好的医院之一接受治疗，但治疗水平并没有达到英国的标准；最终，她不得不被送回英国，以便对她手腕的失败手术进行正确的修复。在那时发现，尽管支付了更高质量手术的费用，医院却使用了低标准的固定针，并且实际上并没有执行他们声称的复杂手术。英国政府花了5年时间才从这起欺诈案中获得赔偿，并为我同事争取到了损害赔偿。（她的手腕由于那次低标准的失败治疗，将永远无法完全康复）
 
Kenny MacLaren
No one with a functioning brain would ever choose the US healthcare system. You have to wonder why ordinary US citizens have to put up with substandard care which is really just a con to make some rich companies even richer. Why are US citizens not actively campaigning for a health service which treats their ailments rather than helping itself to their savings?
 
任何一个理智的人都绝不会选择美国的医疗体系。你不禁会问，为什么普通的美国民众要忍受这种质量低下的医疗服务，这实际上不过是一场骗局，目的是让一些富有的公司变得更加富有。为什么美国公民不积极争取一个真正能够治疗他们疾病的医疗服务，而不是让这个系统掠夺他们的积蓄？
 
Rebecca Pitts
We are actively campaigning, but we’re an oligarchy. Even if 90+% of the public want something, if the donor class sees no profit in it, we don’t get it. The donor class is composed entirely of people who either directly profit from or can trivially afford the current system. They will continue paying our Congress to keep it that way & right-wing pundits to fear-monger about rationing, conveniently burying the fact that our system is also rationing, but by wealth instead of need.
 
我们确实在积极争取改变，但我们的国家实际上是一个寡头统治。即使超过90%的公众支持某项政策，如果那些金主阶层认为其中无利可图，我们就无法实现它。金主阶层完全由那些直接从现行体系中获利或者能够轻易承担现行体系费用的人组成。他们会继续向国会支付资金以维持现状，并雇佣右翼评论员散布关于配给制的恐慌情绪，巧妙地掩盖了一个事实：我们的医疗体系实际上也在进行配给，只不过它是根据财富而不是需求来分配资源。
 
Laura Tebele
People in the USA aren't comparing it to the NHS, they're comparing it to what they hear about Canada's health care system, multi year waiting lists to get an MRI, people dying before they get needed surgery, having to travel to the US to get a diagnosis before a potential problen gets serious. And for medical professionals, getting paid ridiculously little. Whether or not any of this is valid is irrelevant, it's many people's viewpoint.
 
美国人民并没有将他们的医疗体系与英国国家健康服务（NHS）相比较，而是与他们所听闻的加拿大医疗体系相比较，比如要等待多年才能排到核磁共振成像检查，有人在等待必需手术时去世，或者不得不前往美国以在潜在问题变得严重之前获得诊断。对于医疗专业人员来说，他们得到的报酬却低得惊人。无论这些说法是否属实，这都是许多人的看法。
 
Maryte Danute
Canuck here. I've only ever had to wait a couple months for an mri and that's because it wasn't super urgent. As for huge waiting lists that is also propaganda. Canadian doctors don't make as much as American doctors, but they don't start their careers with huge student debt nor do they need to shell out for very expensive malpractice insurance, nor have to deal with multiple insurance companies meaning they have a larger support staff to pay.
 
我是法裔加拿大人，我等待核磁共振成像检查的时间最多也就几个月，那是因为情况并非特别紧急。关于所谓的长等待名单，那也是宣传的一部分。加拿大医生的收入确实不如美国医生高，但他们在职业生涯起步时不会有巨额的学生债务，也不需要支付昂贵的医疗事故保险，而且他们不需要与多家保险公司打交道，这意味着他们需要支付的辅助人员费用较少。
 
Len Gasper
Because the politicians make to much money off keeping the status quo in place. And most likely they pay nothing for their health care. One other point most politicians are lawyers.
 
政客们因为维持现状而获得了大量的金钱。而且他们很可能为自己的医疗保健支付的费用微乎其微。另外，大多数政客都是律师出身。
 
Robert Smelt
No one with a functioning brain would vote for Trump or support the current Republican party but yet there they go…..
 
任何理智的人都不应该投票给特朗普或支持现在的共和党，但现实却是他们确实这么做了。
 
Robert Christiansen
last year 4 million people visited the US for health care. 16% from the EU. They had no insurance and paid full cost. The year before Mick Jagger came to new york for his heart surgery. He paid $300,000+ for his care although it was “free” back home in the UK
 
去年有400万人来美国就医，其中16%来自欧盟。他们没有保险，需要自费支付全部费用。前一年，米克·贾格尔（Mick Jagger）来到纽约进行心脏手术。尽管在英国他的手术是免费的，但他在这里支付了超过30万美元的医疗费用。
 
Zoe-Jane Sutherland
 I am grateful for the fact that I can receive treatment for my asthma and anxiety/depression for free at point of purchase/acquirement and that if I do fall seriously ill, I know that I can receive treatment for that condition and not be bankrupted as I’ve already contributed to the NHS in the UK through taxes and national insurance payments over the years.
 
 我感到非常庆幸，因为我可以在接受哮喘和焦虑/抑郁治疗时不需要支付费用，而且如果我真的病得很重，我知道我能够得到必要的治疗而不会因此破产。这是因为我多年来通过纳税和国民保险为英国的国家医疗服务体系（NHS）做出了贡献。
 
  As I said, I have asthma and I have heard and read countless stories where people with asthma cannot afford preventer and relief inhalers and only go for treatment when their asthma makes them critically ill. I like knowing that even if I were to go bankrupt, I’d still be eligible for free anti-depressants. Fuck the US health care business, because it is a business out the fleece people for as much money as possible and giving as little healthcare in return.
 
正如我所说，我有哮喘，我听了不少、也读了不少哮喘患者因买不起预防和急救用的吸入器，只有在哮喘发作到危及生命时才去治疗的故事。我感到欣慰的是，即便我破产了，我仍然能够获得免费的抗抑郁药物。我对美国医疗保健行业的做法感到愤慨，因为它更像是一个以剥削人们、尽可能多地获取金钱而提供尽可能少医疗服务的行业。
 
Hans Mulders
I am a Dutch national who has lived in the US since 1984. The US healthcare system is without a doubt the most uncaring stupid system in the world. A little background, I've lived in and partaken in three different universal healthcare systems in the world: the Dutch, French and German so I know a thing or two about socialized medicine. It really is fantastic and very affordable.
 
我是一名荷兰人，自1984年起就居住在美国。毫无疑问，美国的医疗保健体系是世界上最不人性化、最愚蠢的体系。背景是这样的，我曾在全球三个不同的全民健康保险体系中生活并享受过服务：荷兰、法国和德国，所以我对公共医疗体系颇有了解。它真的非常棒，而且非常经济实惠。
 
Monty Lovering
The Lancet published a survey of healthcare systems.
18 of the top 20 were Western European. The US was in as No. 35.
 
《柳叶刀》发布了一项医疗保健系统调查。
在前20名中，有18个是西欧国家。美国则排在第35位。
 
The more expensive of the European systems - which offer Universal coverage and low or no deductible - cost $5k pa per capita. Some are around $3k. The money comes from tax, and sometimes an additional but affordable personal premium. For example in the UK it’s all in tax, in the Netherlands it’s tax and about €100 per month from those in employment.
The US costs $10k, mostly from individual or employer contributions. And it leaves millions uninsured and millions more with high deductibles.
 
那些更昂贵的欧洲医疗系统——它们提供全民医保，且自付额低或没有——每人每年的花费大约是5000美元。有些国家甚至只有3000美元。这些资金主要来源于税收，有时还包括一些额外但可负担的个人保费。例如，在英国，费用全部包含在税收中；在荷兰，除了税收外，还有在职人员每月大约100欧元的保费。
而美国每人每年的花费是10000美元，主要来自个人或雇主的贡献。即便如此，仍有数百万人没有保险，更多人面临高额自付额。
 
This means the US pays $1.5 trillion a year more for shittier healthcare than if it had a European system. That’s like twice the defence budget.
So no, I would not prefer the US system.
 
这意味着美国每年在医疗保健上的花费比拥有类似系统的欧洲国家多出1.5万亿美元。这相当于国防预算的两倍。
所以，不，我不会倾向于选择美国的医疗系统的。
 
Chris Golya
A recent Harvard University study showed that medical expenses account for approximately 62 percent of personal bankruptcies in the US. Interestingly, the study also showed that 72 percent of those who filed for bankruptcy due to medical expenses had some type of health insurance, thus debunking the myth that only the uninsured face financial catastrophes due to medical-related expenses.
 
最近哈佛大学的一项研究显示，在美国，大约62%的个人破产是由医疗费用引起的。更值得注意的是，研究还发现，在因医疗费用导致破产的人群中，有72%的人实际上拥有某种健康保险，这打破了一个普遍的误解，即只有未投保者才会因医疗费用而面临财务崩溃。
 
Ga?tan Gates Perrault
In my experience most people are effectively underinsured when it comes to healthcare. Even today with the ACA, the popular plans carry high deductibles in the $5–10k range for a family.
Googling around for how many American household actually have the $5–10k sitting a bank account, that number is well under 50%. It's worse if you consider that accidents in December can easily max out two years worth of deductibles.
If your “protection against catastrophe” is an insurance plan that that will leave you broke anyways, that's technically underinsured. Even if it's all many people can afford.
 
根据我的经验，大多数人在医疗保健方面实际上保险覆盖不足。即便是在平价医疗法案（ACA）实施的今天，流行的保险计划对于家庭来说，自付额仍然高达5000到10000美元。
如果你在网上搜索，会发现实际上拥有5000到10000美元存款的美国家庭比例远低于50%。如果考虑到12月份发生的意外可能会迅速耗尽两年的自付额上限，情况就更加严峻。
如果你的“灾难防护”保险计划最终会让你身无分文，那么实际上你就是保险不足。即便这已经是许多人所能负担的全部保险了。
 
Andrew McKenzie
Just to give an example for you readers on Quora: Here in the US, I have to pay $5,400 a year in health care premiums, set to be $6,300 next year, out of my salary, to cover my family. And my employer pays the insurer the same amount on top of that.
 
我给Quora的读者们举个例子：在美国，我每年需要从我的工资中支付5400美元作为健康保险费用，明年这个费用将上涨到6300美元，用以覆盖我全家的保险。同时，我的雇主也要支付相同数额给保险公司。
 
Despite these massive premiums, I still have to pay a $40 co-pay out of pocket (or more) on any visit that isn’t a routine check-up. Kid gets sick? $40 out of pocket [out of a $200 charge]. If it’s the emergency room, the co-pay is $100. Surgery or hospitalization requires coinsurance (i.e. I pay a percentage, up to 20% on some procedures) until I reach my annual deductible of $3,800, set to rise next year, too.
 
尽管我已经支付了高额的保险费，但我仍然需要为任何非例行体检的就诊支付40美元（或更多）的自付费用。孩子生病了？需要额外支付40美元（总费用200美元中的自付部分）。如果是去急诊室，自付费用则是100美元。手术或住院治疗则需要支付共保费用（即我需要支付一定比例的费用，有些手术高达20%），直到我达到年度免赔额3800美元，而这个免赔额明年还会增加。
 
And I have “good” insurance. I also don’t get much choice in providers: Only two choices are possible, because that’s who my employer has negotiated with. Most employers only negotiate with one.
Yea America…
 
我拥有的算是“优质”保险。然而，在选择医疗服务提供者方面，我的选择并不多：只有两个选项，因为这是我的雇主协商好的合作伙伴。大多数雇主通常只与一家保险公司协商。
是的，这就是美国……