QA问答：美国人真的需要支付高昂的医院账单吗？

Genia Allard
My mother died in ICU from septic shock brought on by bacterial meningitis. Her hospital bed ALONE was $7,000 per night, and that didn't include any medication, special procedures, food, equipment. Her meager government-provided insurance didn't even cover the ambulance ride ($4,000), and hardly made a dent in the final bill. She lived for 10 days without ever waking up. Those 10 days in ICU cost more than it took her a decade to save from her part-time job. My brother was concerned we might lose our family farm trying to pay her medical bills, and this was all for a sudden crisis. I cannot even imagine what chronically ill people suffer, financially.

我母亲因细菌性脑膜炎引发的感染性休克在ICU去世。她仅病床的费用就高达每晚7000美元，这还不包括任何药物、特殊治疗、食物或设备。她微薄的政府提供的保险甚至没有覆盖救护车费用（4000美元），对最终账单几乎没有任何帮助。她在没有醒来的情况下活了10天。在ICU的这10天花费超过了她兼职工作十年所存的钱。我哥哥担心我们可能会因为支付她的医疗费用而失去我们的家庭农场，而这一切都是因为一场突发的危机。我甚至无法想象慢性病患者在经济上所遭受的痛苦。

Edit: I cannot believe I'm adding an edit after posting this less than 24 hours ago, but here we are. Anyone accusing me of lying about this experience in any way will be automatically blocked, muted, reported, and their comments dexed. Being accused of lying about the single most painful experience of my life (I held my mom's hand as she passed after life support was removed) wlll not be tolerated.

编辑：我简直不敢相信，在发布这条消息不到24小时后，我竟然要添加编辑内容，但事实就是如此。任何人如果以任何方式指责我在这段经历上撒谎，将自动被屏蔽、静音、举报，并且他们的评论将被删除。被指责在人生中最痛苦的经历上撒谎（我在移除生命支持后握着妈妈的手直到她去世）是绝对不能被容忍的。

Edit number two: okay, sorry. I'm disabling comments, something I almost never do. This answer wasn't meant to insult anyone, simply to illustrate how much it costs to die in this country. This is the experience of one family. I am well aware that there are people out there who actually benefit from the current shitty system, and so trolling, contradicting, and casting doubt and incredulity is an incentive to them.

编辑第二条：好的，抱歉。我将关闭评论，这是我几乎从未做过的事情。这个回答并不是为了侮辱任何人，只是为了说明在这个国家死亡的代价有多大。这是一个家庭的经历。我非常清楚，有些人实际上从当前糟糕的系统中受益，因此，挑衅、反驳和质疑对他们来说是一种激励。

Natalie Hunt
So now I can join this circus too. Growing up in Canada I never had to think about medical bills or even knew what they were (aside from dentistry).

所以现在我也能加入这个马戏团了。在加拿大长大的我从来不用考虑医疗账单，甚至都不知道它们是什么（除了牙科）。

But here I am living in Boston with excellent private health insurance and aside from moral qualms about private healthcare no real complaints about what I get in terms of medical care.

但在这里，我住在波士顿，拥有出色的私人医疗保险，除了对私人医疗保健的道德疑虑外，对于我所获得的医疗服务并没有真正的抱怨。

Well in September I was in a car accident. The car flipped over, I found myself strapped upside down in a car crowded with air bags. I was fine, the car wasn’t. Once me and my friend managed to extricate ourselves from the car we had minor scratches but that was about it.

九月份的时候，我遇到了一场车祸。车子翻了，我发现自己被安全带倒挂在车里，周围全是安全气囊。我没事，但车子报废了。我和朋友设法从车里脱身后，只有一些轻微的擦伤，仅此而已。

Well the emts arrived, so did everyone else (cops, neighbors, etc.…..). I told the medical people that I was fine and didn’t need to go to a hospital. They insisted, saying that I might have internal injuries. After a certain amount of back and forth I finally agreed to be taken to a hospital. Then the farce began. I had to be strapped into a gurney and a neck brace was attached - I WAS FINE, but this was standard procedure that couldn’t be deviated from. Then they drove us to MASS General, which is nowhere near where the accident happened. There was an emergency room about 3 blocks away from the accident, but the private ambulance could only take me to an approved in network hospital - which meant that the nearest hospital was off limits (imagine if this was an actual emergency wasting that much time getting someone to MASS general instead of going to the nearest emergency room).

好吧，急救人员到了，其他人也到了（警察、邻居等等……）。我告诉医护人员我没事，不需要去医院。他们坚持说，我可能有内伤。经过一番争论后，我终于同意被送往医院。然后闹剧开始了。我必须被绑在担架上，并戴上颈托——我明明没事，但这是标准程序，不能偏离。然后他们把我们送到了麻省总医院，那里离事故发生地很远。事故现场附近大约三个街区就有一个急诊室，但私人救护车只能把我送到网络内的医院——这意味着最近的医院被排除在外（想象一下，如果这是一个真正的紧急情况，浪费那么多时间把某人送到麻省总医院，而不是去最近的急诊室）。

Once at the hospital I was not allowed to walk in, I had to be wheeled in strapped to a gurney (the absurdity of this was not lost on any of the staff). I was rolling my eyes the entire time. At some point they finally allowed to me to get up and walk around. After sitting in a room for a while, a doctor came in did some very minor poking and prodding, gave me an ibuprofen tablet and told me I could go home.

一到医院，我就被告知不能自己走进去，必须被绑在轮床上推进去（这种荒谬的做法所有工作人员都心知肚明）。整个过程我都在翻白眼。后来他们终于允许我站起来走动。在房间里坐了一会儿后，医生进来做了些非常轻微的检查和戳弄，给了我一片布洛芬药片，然后告诉我可以回家了。

As I had said the entire time, I was FINE.

正如我一直说的那样，我很好。

Well about a month later I got a bill. $1000 and change for the whole experience, and this was after my insurance company covered 75% of the cost. I remember looking at the bill in bewilderment, thinking how unnecessary the whole thing was. It felt like a racket, I was persuaded against my better judgement to go to a hospital where I received almost no care for injuries that didn’t exist all so that the ambulance company could make some money.

大约一个月后，我收到了一张账单。整个经历花费了1000多美元，这还是在我的保险公司支付了75%的费用之后。我记得我困惑地看着账单，想着这一切是多么不必要。这感觉像是一个骗局，我违背了更好的判断被说服去了医院，在那里我几乎没有得到任何治疗，因为伤害根本不存在，这一切只是为了让救护车公司赚点钱。

The issue for me is not the cost, I can afford to pay this, but the absurdity of it, the blatant price gouging and the fact that none of it was necessary really angers me.

对我来说，问题不在于成本，我付得起这个钱，但荒谬的是，明目张胆的价格欺诈以及这一切本不必要的事实让我非常愤怒。

It’s experiences like this that make me even more determined to move back to Canada. In light of the recent election, that desire is now almost an obsession. I’m going home, might take a year to fully organize everything, but I’m going.

正是这样的经历让我更加坚定了搬回加拿大的决心。鉴于最近的选举，这种渴望现在几乎成了一种执念。我要回家了，可能需要一年时间来完全安排好一切，但我会回去的。

Steve Aspesi
in 2010, my 12 year old threatened suicide while in a session with his therapist. He was defiant and refused to take it back. The doctor told us his hands were tied and we were to admit him to a lock down facility for adolescents.

2010年，我12岁的孩子在与治疗师的一次会谈中威胁要自杀。他表现得很叛逆，拒绝收回这句话。医生告诉我们他无能为力，我们必须将他送进一个青少年封闭式治疗机构。

On the way to the hospital, I kept thinking he would snap out of it and recant what he said, but he did not.

在去医院的路上，我一直在想他会突然清醒过来并收回他说的话，但他没有。

We signed some papers and left our 12 year old son there - and left crying.

我们签署了一些文件，把12岁的儿子留在那里，然后哭着离开了。

The next day I went to visit and while I was sitting with my son, a man dressed in white asks me to sign all kinds of forms that basically say “You hereby agree to accept responsibility for all the costs and fees……”. I politely asked, “What are the fees - what is the cost to be here each night?”. He said it was between me any my insurance provider. I pressed for a number and he said he did not know the cost. “I’m sorry, but I can’t just sign a blank check to you; I have to know what it costs - I have a 20% deductible”. Even though I knew my options were limited, I had the right to know what a hospital charged.

第二天我去探望，当我正和儿子坐在一起时，一位穿着白衣服的男人让我签署各种表格，基本上是说“您在此同意承担所有费用和收费的责任……”。我礼貌地问道：“费用是多少——每晚在这里的费用是多少？”他说这取决于我和我的保险公司。我坚持要一个具体的数字，但他说他不知道费用。“很抱歉，我不能就这样给你签一张空白支票；我必须知道费用是多少——我有20%的自付额。”尽管我知道我的选择有限，但我有权知道医院的收费标准。

The next day someone called and revealed the cost per day was $5,000 - just room and board. Doctor time and medication is extra. My out of pocket would be $1,000 per day, not including doctor time.

第二天有人打电话来，透露每天的费用是5000美元——仅包括食宿。医生的时间和药物费用另计。我每天自付的费用是1000美元，不包括医生的时间。

I told the woman over the phone that either my son comes home, or I refuse to pay the bill for one more day. Keep in mind, this was 14 years ago - I wouldn’t be surprised if the cost has doubled since then. When he was released he was put on some medication that was so over-prescribed, it almost killed him.

我在电话里对那个女人说，要么我儿子回家，要么我拒绝再支付账单一天。请记住，这是14年前的事——如果费用从那时起翻倍，我也不会感到惊讶。当他被释放时，他被开了一些过量处方的药物，这几乎要了他的命。

Fast forward to now, my son is a Paramedic who often deals with mental health crisis - he’s a wonderful caring person who works with a terribly unfair healthcare system.

快进到现在，我的儿子是一名急救员，经常处理心理健康危机——他是一个非常关心他人的人，却在一个极其不公平的医疗系统中工作。

Ruth Rann
It depends on how you define “outrageous”. For whatever reason and I don’t understand all of it, but it includes laws and psychology, medical providers have found it advantageous to bill far more than what they expect to be paid. Then one of these things happens to the bill:

这取决于你如何定义“离谱”。出于某些原因，我无法完全理解，但这些原因包括法律和心理学，医疗服务提供者发现开出远高于他们预期支付的账单是有利的。然后，账单上会发生以下情况之一：

It goes to someone with no insurance and little to no money. For hospitals, these are generally ER bills or bills to treat people who came in through the ER and needed more treatment to be stable. Generally these end up written off as bad debt. You can’t get money that people don’t have.

这些费用通常由没有保险且几乎没有钱的人承担。对于医院来说，这些通常是急诊室的账单或治疗通过急诊室进入并需要更多治疗以稳定病情的患者的账单。通常这些最终会被作为坏账核销。你无法从没有钱的人那里得到钱。

It goes to someone with no insurance and some money. Hospitals generally negotiate a substantial discount as long as you pay regularly.

它适用于没有保险但有一些钱的人。只要你定期付款，医院通常会协商一个大幅度的折扣。

It goes to someone with insurance. The insurance company has already negotiated a substantial discount off the rack rate. How much you have to pay at that point depends on your policy. Sometimes the hospitals will negotiate a discount on your portion if you pay immediately.

它适用于有保险的人。保险公司已经协商了一个大幅度的折扣，比挂牌价低很多。你最终需要支付多少取决于你的保单。有时，如果你立即支付，医院也会为你应支付的部分协商折扣。

It goes to someone who chose to use an out-of-network provider, or who chose to get care despite it not being covered by their insurance policy (like a face lift). Usually the cost for this was pre-negotiated and pre-paid.

这适用于那些选择使用非网络内提供者的人，或者选择接受保险政策不涵盖的护理（如面部拉皮手术）的人。通常，这种费用是预先协商和预付的。

Gina McFarlane
Yes. When my twin daughters were born, the health insurance provided by my employer had a $10,000. deductible. My twins arrived premature and spent weeks in the neonatal ICU. i paid $20,000. in 2006. And I was informed by the insurance company that my daughters and I were uninsurable due to preexisting conditions upon their discharge. My daughters had no health issues at all after their discharge, they fortunately just needed fed to grow during their hospitalization. The twins were declared uninsurable due to being born at 35 weeks. They claimed I was uninsurable due to infertility, despite having no desire to have more children at age 38 and having received no fertility treatments covered by insurance.

是的。当我的双胞胎女儿出生时，我雇主提供的健康保险有一万美元的免赔额。我的双胞胎早产，并在新生儿重症监护室度过了几周。我在2006年支付了两万美元。保险公司通知我，由于预先存在的条件，我的女儿和我在她们出院后无法获得保险。我的女儿们在出院后没有任何健康问题，幸运的是，她们在住院期间只需要喂养以促进生长。双胞胎因为35周出生而被宣布无法获得保险。他们声称我无法获得保险是因为不孕，尽管我在38岁时没有生育更多孩子的愿望，也没有接受过保险覆盖的生育治疗。

Glenn Paul Gosbee
I got bit once, about 10 years ago, breaking up my dog and another dog at the dog park. It wasn't a bad bite, my dog had accidentally got me while I was trying to grab the other dogs collar. It was a single puncture from one of her teeth, honestly not worth getting excited over, but I figured it was a good idea to go to the ER and make sure it didn't need stitches or anything. I spent 4 hours waiting for someone to come clean it with saline, then put some steri-strips on it, that's all they did.

大约10年前，我在狗公园里试图分开我的狗和另一只狗时被咬了一次。咬得并不严重，我的狗在我试图抓住另一只狗的项圈时不小心咬到了我。她的牙齿留下了一个小洞，老实说并不值得大惊小怪，但我觉得去急诊室确保不需要缝合或其他处理是个好主意。我花了4个小时等待有人来用生理盐水清理伤口，然后贴了一些无菌胶带，这就是他们所做的全部。

For that visit, and the very minimal contact or actual work done, the hospital charged me $600 and then I got another bill a month later from the physician contracting firm the hospital uses for another $1000 dollars. This is not an exaggeration, I still have the bills because they were that ridiculous.

那次就诊，以及非常少的接触或实际完成的工作，医院向我收取了600美元，然后一个月后，我又收到了医院使用的医生承包公司的另一张1000美元的账单。这不是夸张，我仍然保留着这些账单，因为它们太荒谬了。

So total bill for a minor puncture wound that was treated with a saline rinse and some breathable sterile tape, was $1600. I'll let you decide if that seems like an outrageous bill or not.

所以，对于一个用生理盐水冲洗和一些透气无菌胶带处理的小穿刺伤，总费用是1600美元。我让你来决定这是否是一个离谱的账单。

Guess how much my appendectomy cost?

猜猜我的阑尾切除术花了多少钱？

20,000 USD

20,000美元

I was uninsured at the time. I was a university student from a poor family, trying to do something no one in my family had ever done before. The worst part of the whole experience wasn’t the amazing university doctor who really listened to me and didn’t write off my symptoms as period pain, or the hilarious doctor at the hospital that did my ultrasound and gave me a tour of my organs, or the poor nurse I yelled at after the surgery when she woke me up for the 4th time in the night. It wasn’t even the surgery scars, being poked 11 times before finding a good vein, or projectile vomiting because I don’t do well with morphine. The worst part, was that I thought my education would be over. I thought I’d have to drop out to try to pay the bill. Fortunately, that never happened, but it was a very real possibility. I knew others who had needed to drop out due to medical bills.

我当时没有保险。我是一名来自贫困家庭的大学生，试图做一些我家人从未做过的事情。整个经历中最糟糕的部分不是那位非常认真倾听我、没有把我的症状当作经痛而忽视的出色的大学医生，也不是在医院给我做超声波检查并带我参观我的器官的搞笑医生，甚至不是手术后我因为她在晚上第四次叫醒我而对她大喊大叫的可怜护士。也不是手术疤痕，被戳了11次才找到好静脉，或者因为我对吗啡反应不好而喷射性呕吐。最糟糕的部分是，我以为我的教育会结束。我以为我不得不辍学来支付账单。幸运的是，这从未发生，但这确实是一个真实的可能性。我知道其他人因为医疗账单而不得不辍学。

My favorite part of the multiple bills that rolled in afterward was a line item entitled “no cost medicine” which was listed as 150 USD.

在随后收到的多张账单中，我最喜欢的部分是一个名为“无费用药物”的项目，标价为150美元。

It’s stupid. Criminally stupid, what Americans have to put up with from the health care system.

这是愚蠢的。美国人不得不忍受医疗系统的做法，简直是犯罪性的愚蠢。

Ali Ziegler
My kid brother sliced his middle finger down to the bone back in 1975. The cost to take him to the emergency room and get his finger stitched up was a hundred bucks. I only knew this because my dad was livid over this unecessary cost and brought it up every chance he got (‘’I know you need new shoes but your brother just blew a hundred bucks on stupidity”) Dad would not beleive the state of medical care now.

1975年，我的小弟弟把中指切到了骨头。带他去急诊室并缝合手指的费用是一百美元。我只知道这一点，因为我父亲对这种不必要的费用非常愤怒，并且每次有机会都会提起这件事（“我知道你需要新鞋，但你弟弟刚刚因为愚蠢花了一百美元”）。父亲现在不会相信医疗保健的现状。

Two years ago, a friend’s son cut his finger in exactly the same way (whittling) and the same place (middle finger above the knuckle.) It cost a little over three thousand dollars, all told. WHAT has happened to the state of medicine that in less than fifty years, the cost has gone up thirty times? Not thirty percent, THIRTY TIMES. If gas had increased that much in the same period, we’d now be paying $100 a gallon. If the average home went up 30 times from what it was back then, it would now cost over a mllion dollars just to get a starter/fixer upper.

两年前，我朋友的儿子以完全相同的方式（削木头）和相同的位置（中指指节上方）割伤了手指。总共花费了三千多美元。医学界到底发生了什么，在不到五十年的时间里，费用上涨了三十倍？不是百分之三十，而是三十倍。如果汽油在同一时期上涨了那么多，我们现在每加仑要支付100美元。如果普通住宅的价格从那时起上涨了三十倍，那么现在仅仅购买一个起步房/待修房就要花费超过一百万美元。

Here’s an honest firsthand account of what medicine is like in the good old US of A: I went in for what was supposed to be a routine hysterectomy in 2007. Had what I thought was good insurance. Skipping all the gory details, my intestines were damaged during the surgery, resulting in a second surgery just 27 days later. This led to more damage, for which I was hospitalized another 30 days waiting for my body to heal itself or have a third surgery. Was finally sent home for what I thought was for good. Within four days I almost had a heart attack and was back in the hospital for observation for yet another week.

这是关于美国医疗状况的真实第一手记录：2007年，我去做了一次本应是常规的子宫切除术。我以为自己有很好的保险。跳过所有血腥的细节，手术中我的肠道受损，导致仅仅27天后又进行了第二次手术。这导致了更多的损伤，为此我又住院了30天，等待我的身体自愈或进行第三次手术。终于，我以为可以永远回家了。然而，四天内我几乎心脏病发作，又回到医院观察了一周。

We recieved bills almost daily for this medical debacle for over a year. Some bills from doctors I’d never heard of before. The hospital never truly gave a complete itemized bill, but I did see one where I was charged fifty bucks for a ‘patient care kit” which was a toothbush, a tiny tube of toothpaste, a comb and a thin pair of socks. Is it any wonder that when the dust cleared, my overall total was about a THIRD OF A MILLION dollars. At least, that’s what it woulld have been if we did not have “good insurance”. When the insurance company, hospital, doctors, labs, myriad tests and all and sundry were said and done, we still owed over $30,000.

我们几乎每天都收到这场医疗灾难的账单，持续了一年多。有些账单来自我从未听说过的医生。医院从未真正提供过完整的详细账单，但我确实看到过一张账单，上面写着“病人护理包”收费50美元，里面包括一把牙刷、一小管牙膏、一把梳子和一双薄袜子。难怪当尘埃落定时，我的总费用大约是30万美元。至少，如果我们没有“好的保险”，那将是这个数字。当保险公司、医院、医生、实验室、无数测试等等都结算完毕后，我们仍然欠了超过3万美元。

We eventually ended up having to file for bankruptcy, and by the time the entire mess was resolved, I was permanently on four different meds, unable to work my old job, my husband couldn’t deal so he abandoned me and our son. The life I had was DESTROYED.

我们最终不得不申请破产，等到整个烂摊子解决时，我永久性地依赖四种不同的药物，无法从事以前的工作，我丈夫无法承受这一切，于是他抛弃了我和我们的儿子。我曾经的生活被彻底摧毁了。

It has made me intensly fearful of all things medical. Oh, not for the pain and intrusion. For the “what in the hell is this going to cost me?” Two years ago I brushed off the worst headache I’ve ever had. Thought it would go away. It didn’t. I was certain this would lead to yet another bankruptcy or me losing my house, but my daughter ignored me and dragged in to the doctor. Good thing she did—turns out I’d suffered a Transient Ischemic Stroke. The state of medicine in the US almost killed me, had I waited any longer.

这让我对所有医疗相关的事情感到极度恐惧。哦，不是因为疼痛和侵入性。而是因为“这到底会花我多少钱？”两年前，我忽视了我有史以来最严重的头痛。以为它会自己消失。但它没有。我确信这会导致又一次破产或失去我的房子，但我女儿没理会我，硬是把我拖去看医生。幸好她这么做了——结果发现我遭受了一次短暂性脑缺血发作。如果我等得更久，美国的医疗状况几乎要了我的命。

Until our government does something about the filthy, disgusting incestuous relationships between the insurance companies, big pharma, hospitals and sundry, how many people will die because they were too afraid to go to the hospital because of the beyond exorbitant fees?

在我们的ZF采取措施解决保险公司、大型制药公司、医院和其他机构之间肮脏、令人作呕的勾结关系之前，有多少人会因为害怕医院的高昂费用而不敢去医院，最终导致死亡？

Could you imagine someone with cancer dealing with this nightmare? Or a family with a severely disabled child? Or virtually any of the bad things that happen to good people? The thought makes me sick to my stomach, how much money is made off the pain and suffering of others.

你能想象一个患有癌症的人如何应对这场噩梦吗？或者一个有严重残疾孩子的家庭？或者任何发生在好人身上的坏事？想到这些，我就感到恶心，竟然有如此多的钱是从他人的痛苦和苦难中赚取的。

So everything you’ve heard about the cost of medicine here is likely true, and probably much worse.

所以，你在这里听到的关于药品成本的一切很可能都是真的，而且可能更糟。

Julia Rieke
This maybe isn’t outrageous, but it is to me.

这也许并不算离谱，但对我来说是的。

I had a small surgery to remove a tumor from my pinkie finger. It was rather large (probably the size of an acorn). I paid my deductible (which was $1500.) I also paid an additional $250 to the doctor’s office. Then, after the surgery, I received a bill because “they used a compression device during the surgery that was not pre-approved by your insurance.” $1500. I also received another $1200 bill because “they sent the tumor to be tested at an out of network lab.” I also received a $22 bill for something else (not sure what).

我做了一个小手术，从我的小指上切除了一个肿瘤。它相当大（大概有橡子那么大）。我支付了我的免赔额（1500美元）。我还向医生的办公室额外支付了250美元。然后，手术后，我收到了一张账单，因为“他们在手术中使用了一个未经你保险公司预先批准的压缩设备”，费用是1500美元。我还收到了另一张1200美元的账单，因为“他们将肿瘤送到了网络外的实验室进行检测”。我还收到了一张22美元的账单，不清楚是什么费用。

This is WITH insurance. I pay $400/month to cover my daughter and me. My job also pays part of the insurance premium so it’s actually over $400/month. I’m not sure how much they pay. So around $4500 was my out of pocket cost for a very simple surgery that probably took the doctor 10 minutes to complete.

这是包含保险的情况。我每月支付400美元来覆盖我和我女儿的保险。我的工作也支付部分保险费，所以实际上每月超过400美元。我不确定他们支付了多少。所以，一次非常简单的、可能只花了医生10分钟完成的手术，我的自付费用大约是4500美元。

In my opinion, it’s not my fault they sent the tumor to an out of network place to be tested, and it’s certainly not my fault that they used a compression device that was not pre-approved (while I was under sedation).

在我看来，他们把肿瘤送到网络外的地方进行检测不是我的错，而且他们在我处于镇静状态时使用了未经预先批准的压缩设备也绝对不是我的错。

Crazy!

疯狂！

Caroline Zelonka
It’s a bit complicated. Most, if not all, hospitals are required by law to provide emergency care to anyone without payment up front. So if you have a heart attack, break a bone, go into labor, or even have strep throad, you can go in and be seen, though you may have to wait a really long time. (I’ve personally waited 8 hours in a sprawling suburb, and longer waits are very common in urban environments.)

这有点复杂。大多数（如果不是全部）医院都被法律要求为任何人提供紧急护理，而无需预先支付费用。所以，如果你心脏病发作、骨折、分娩，甚至患有链球菌性喉炎，你都可以去医院就诊，尽管你可能需要等待很长时间。（我个人在郊区等待了8个小时，而在城市环境中，更长的等待时间非常常见。）

However, unless you are literally dying, passed out, or in extreme distress, they’ll make you fill out a bunch of forms, and get your ID, social security number, and insurance card on file. (Again, I’d gone in once with a severe corneal infection in both eyes — barely able to see and in tons of pain — and I still had to go through that rigamarole.)

然而，除非你真的快要死了、昏迷了或处于极度痛苦中，否则他们会让你填写一大堆表格，并记录你的身份证、社保号码和保险卡。（再说一次，我曾经因为双眼严重的角膜感染去看病——几乎看不见，疼痛难忍——但我仍然不得不经历那些繁琐的手续。）

If you are or remain indigent, you could theoretically get away with not paying, but everyone else will incur medical debt. And even a simple ER visit can cost at least $1200.

如果你一直或仍然贫困，理论上你可以不支付医疗费用，但其他人将承担医疗债务。即使是简单的急诊室访问，费用也可能至少为1200美元。

Now if your condition isn’t too bad — strep throat, say — you can choose to visit a private urgent care center. Which are usually very reasonable. Many groceries and big box stores with pharmacies have in-store urgent care clinics which specialize in minor injuries, infections, and common ailments. The last time I went I paid $200 for the visit, about $100 for an x-ray, and whatever the medication cost.

如果你的病情不太严重——比如链球菌性喉炎——你可以选择去一家私人的紧急护理中心。这些中心通常收费合理。许多有药房的杂货店和大卖场都设有店内紧急护理诊所，专门处理轻微损伤、感染和常见疾病。上次我去的时候，看诊费用是200美元，X光检查大约100美元，还有药物的费用。

However, these clinics do not receive public funding and are not required to treat patients who cannot pay up front. This is part of the reason emergency room waits are so long, because many broke Americans are forced to use them for everything. This includes labor and delivery.

然而，这些诊所没有获得公共资金，也不被要求治疗那些无法预先支付费用的患者。这是急诊室等待时间如此之长的部分原因，因为许多身无分文的美国人被迫将急诊室用于所有情况，包括分娩。

But back to the hospital bill. They have your info and will send you a bill, and if you can’t pay it, it will go into collections just like a delinquent credit card bill.

但回到医院账单的问题。他们有你的信息，会给你寄账单，如果你无法支付，它就会像拖欠的信用卡账单一样进入催收程序。

Consider yourself lucky if all you owe is $2000 or so. If they admit you to hospital, you’re looking at $10,000 per night at the very least. Surgery? Tack on another few thou. God forbid you have something complex, like cancer, because your debt could easily skyrocket into the millions.

如果你只欠2000美元左右，那就算你幸运了。如果他们让你住院，你每晚至少要花费1万美元。手术？再增加几千美元。天啊，如果你得了复杂的病，比如癌症，因为你的债务很容易飙升到数百万美元。

Of course, some hospitals have funds — supported by charitable donations — to ease the burden on needy patients. Many pharma companies have programs that offer free medication to those under a certain income level. And on the state level, poorer folks can go on public health plans like Washington’s Apple Health, but there’s a waiting list so if you’re pregnant you better apply sooner rather than later.

当然，一些医院有资金——由慈善捐款支持——来减轻贫困患者的负担。许多制药公司都有计划，为收入低于一定水平的人提供免费药物。在州一级，较贫困的人可以加入像华盛顿州的Apple Health这样的公共健康计划，但有一个等待名单，所以如果你怀孕了，最好尽早申请。

After age 65, there is Medicare, of course. Now not all doctors or clinics take Medicare patients but hospitals are required to do so.

65岁之后，当然有医疗保险。现在并非所有医生或诊所都接受医疗保险患者，但医院被要求这样做。

Medical debt is one of the top reasons Americans file for personal bankruptcy and it’s a fucking shame.

医疗债务是美国人申请个人破产的主要原因之一，这真他妈的可耻。

Paul Johnson
Some of them, yes.

其中一些，是的。

What’s absolutely outrageous about the American system is that you can buy insurance, so effectively play by the rules as created, and still end up absolutely screwed.

美国制度中绝对令人愤慨的是，你可以购买保险，从而有效地按照既定规则行事，却仍然可能陷入绝境。

There’s a couple of areas that cause severe hardship, even if you are insured.

有几个领域即使你投保了，也会造成严重的困难。

Copays & annual “out of pocket” maximums can be huge.

共付额和年度“自付”上限可能非常高。

In Network and Out Of Network healthcare providers.

网络内和网络外的医疗保健提供者。

The first one is fairly easy to understand. Most insurance, whether it’s for a house, car, or healthcare, has the notion of a co-pay, where the insured pays the first portion of a cost, then the insurance pays the rest. This is a fairly good way of preventing frivolous claims, but they have also become a way to lower monthly premiums for insurance.

第一个相对容易理解。大多数保险，无论是房屋、汽车还是医疗保险，都有共同支付的概念，即被保险人支付费用的第一部分，然后保险公司支付剩余部分。这是防止轻率索赔的一种相当好的方式，但它们也已成为降低保险月费的一种方式。

The problem is, the copays can be huge. If you have a copay of, for example, 10%, then you get cancer and the entire treatment can easily be north of $250,000, then you suddenly have a bill for $25,000 (the 10% copay).

问题是，自付额可能非常巨大。例如，如果你的自付比例是10%，然后你得了癌症，整个治疗费用很容易超过25万美元，那么你突然会有一张2.5万美元的账单（即10%的自付额）。

Now, you can get policies with small copays, but the premiums for them are more expensive. My company plan had a standard copay of $20 for whatever the treatment was. So when my wife got cancer, we paid $20 and the insurance picked up the rest. But my policy cost $27,000 a year for a family of four, so you can start to understand why people elect to have higher copays, because they need to get the cost of the insurance policy to something they can actually afford to pay each month.

现在，你可以选择小额自付额的保险计划，但保费更贵。我公司的计划对任何治疗都有20美元的标准自付额。所以当我妻子得了癌症时，我们支付了20美元，剩下的由保险公司承担。但我的保险计划每年要花费27,000美元，适用于四口之家，所以你可以开始理解为什么人们选择更高的自付额，因为他们需要将保险计划的费用降低到他们每月实际能够支付的水平。

Then we have the problem of in-network and out of network providers. Most insurance companies have hospital “chains” that they regard as in-network. The “in-network” hospitals will have discounted rates that the insurance companies have negotiated with them, so the insurance companies want you to use in-network hospitals. And this lixs, again, to the copay system. I mentioned that I had a copay of $20, but that was for in-network treatment. Fortunately the number of “in-network” hospitals for my plan was large, so I could always choose a healthcare provider I wanted. But if I went out of network, my copay was $50.

然后我们还有网络内和网络外提供者的问题。大多数保险公司都有他们认为属于网络内的医院“连锁”。这些“网络内”医院会有保险公司与它们协商的折扣率，所以保险公司希望您使用网络内医院。这又链接到了共付系统。我提到我有20美元的共付额，但那是针对网络内治疗的。幸运的是，我的计划中“网络内”医院的数量很多，所以我总是可以选择我想要的医疗服务提供者。但如果我去网络外的医院，我的共付额是50美元。

As I’ve mentioned, I had very low copays because I had such an expensive policy, some out of network copays can be absolutely astronomic.

正如我所提到的，由于我有一份非常昂贵的保单，我的自付费用非常低，一些网络外的自付费用可能高得惊人。

And that becomes a huge problem in the case of emergency. If you’re unconscious, you want the ambulance to take you to the nearest hospital, not the nearest in-network hospital (and, of course, if you’re unconscious, you can’t exactly look up what is and is not in network).

这在紧急情况下会成为一个大问题。如果你失去了意识，你希望救护车把你送到最近的医院，而不是最近的网络内医院（当然，如果你失去了意识，你无法确切地查找哪些医院在网络内，哪些不在）。

So then random chance kicks in. You’re unconscious because you’ve been in an accident, and you may end up with a copy that’s a couple of hundred dollars, or you might have one that’s tens of thousands.

然后随机性就发挥作用了。你因为事故而失去意识，最终可能会得到一份价值几百美元的副本，也可能会得到一份价值数万美元的副本。

As a result, we end up with people having to declare bankruptcy because of medical debt, even though they’ve played by the rules, purchased insurance, attempted to always use in-network providers.

结果，我们最终看到人们因为医疗债务而不得不宣布破产，尽管他们遵守了规则，购买了保险，并试图始终使用网络内的医疗服务提供者。

They still end up screwed by the healthcare system.

他们最终还是被医疗体系坑了。

Something has to change.

必须有所改变。

Mitchell Schoenbrun
number of years ago my brother had an accident in which he broke bones in his wrist. After the ER patched him up he saw a doctor who made an appointment to do surgery at a “surgi-center”. He made inquiry and found that his insurance would pay for all of this.

几年前，我的兄弟在一次事故中手腕骨折。急诊室为他处理后，他去看了一位医生，医生安排他在“手术中心”进行手术。他询问后发现，他的保险将支付所有这些费用。

The surgery took about an hour. A few weeks later he received a bill for $25,000 for use of the facility. He was in a panic. He called to find out what happened. In the intervening month the insurance company decided to no longer pay for surgery done at this surgi-center. My brother called the surgi-center to complain, why had no one told him about this. The response was, OK forget it.

手术大约进行了一个小时。几周后，他收到了一张25,000美元的设施使用账单。他感到恐慌，打电话去了解情况。在这期间的一个月里，保险公司决定不再支付在这家手术中心进行的手术费用。我哥哥打电话给手术中心抱怨，为什么没有人告诉他这件事。对方的回应是，好吧，忘了它吧。

HMMm. While this sounds like a happy ending, consider what this means. The surgi-center was billing his insurance an outrageous amount, $25,000/hr for use of a facility. This did not include the doctors fee of course. But their net cost to provide this service was so small, or maybe their net profit was so high, that they could afford to just forget it. The medical industry has become a firehose pumping money from people to corporations.

嗯，虽然这听起来像是一个圆满的结局，但请考虑一下这意味着什么。手术中心向他的保险公司收取了高得离谱的费用，每小时2.5万美元的设施使用费。这还不包括医生的费用。但他们的净成本如此之低，或者他们的净利润如此之高，以至于他们可以轻易地忘记这笔费用。医疗行业已经成为一条将人们的钱输送到企业的消防水带。

Shawn Yasutake
Not just hospital bills. A few years ago, we had a terrible year for wildfires and the air was thick with smoke for several weeks. The irritation from the smoke caused me to have a series of serious nosebleeds over a period of couple months. A couple of them took literally 20+ minutes to resolve and required medical intervention. The first time I had a really serious nosebleed, I was attending a class in a small town in New Mexico. I had to call the local paramedic squad to help out. They were able to get the nosebleed stopped and said at that point that I didn’t have to take any further care. That resulted in an $700+ bill from the county for their medical care.

不仅仅是医院账单。几年前，我们经历了一个严重的野火年，空气中弥漫着浓烟，持续了几周。烟雾的刺激导致我在几个月内多次出现严重的鼻出血。其中有几次鼻血真的流了20多分钟才止住，并且需要医疗干预。第一次出现非常严重的鼻出血时，我正在新墨西哥州一个小镇上课。我不得不叫当地的急救队来帮忙。他们成功止住了鼻血，并说那时我不需要进一步的治疗。结果，我收到了县里700多美元的医疗账单。

A couple weeks later, I had another bad bleed in my home town, this one lasting at least 30 minutes. We called the paramedics and at the insistence of my wife, who was present with me, I took an ambulance ride to the hospital to get checked out. The weird thing—and the most infuriating thing about the entire ordeal—was that the paramedics were from a private company which was contracted to provide medical services to the county. This private company, the only one in the entire county, was considered “out of network” by my insurance company. As such, the insurance didn’t cover the ambulance ride which, for a 15 minute trip, cost me about $1850. That didn’t even include the emergency room charges ($200 for the copay plus about $1400 for the care). Two nosebleeds cost me about $4000 to treat. That was for a total of about three hours of care.

几周后，我在家乡又经历了一次严重的出血，这次至少持续了30分钟。我们叫了急救人员，在我妻子的坚持下，她当时和我在一起，我乘坐救护车去医院检查。奇怪的是——也是整个经历中最令人气愤的事情——急救人员来自一家私人公司，这家公司与县里签订了提供医疗服务的合同。这家私人公司是全县唯一的一家，却被我的保险公司视为“网络外”的机构。因此，保险不覆盖这次救护车费用，15分钟的车程花了我大约1850美元。这还不包括急诊室的费用（200美元的共付额加上大约1400美元的护理费用）。两次鼻出血的治疗花了我大约4000美元。总共大约三个小时的护理。

The “health insurance” system in the US is a total scam. It’s a profit maximization tool for the corporations with no regard for the health and welfare of the policy-holders.

美国的“医疗保险”系统完全是个骗局。它是企业追求利润最大化的工具，完全不顾及投保人的健康和福利。

Jamal
The short answer is yes we pay outrageous hospital, at least in theory and it depends on what you call outrageous.

简短的回答是，是的，我们支付高昂的医院费用，至少在理论上是这样，这取决于你所说的“高昂”是什么意思。

Most people have insurance to cover truly outrageous hospital bills which can range from a 10’s of thousands to occasionally a several million dollars. You are legally obligated to pay the bill, but in most cases public or private insurance covers most of the cost but not all so the annual cost exposure can be significant..

大多数人都有保险来支付真正高昂的医院账单，这些账单可能从数万美元到偶尔的数百万美元不等。你法律上有义务支付账单，但在大多数情况下，公共或私人保险会覆盖大部分费用，但并非全部，因此年度费用负担可能相当大。

For many people used to paying nothing at the point of service or nearly nothing then most Americans face outrageous bills. These include significant copays for office visits and even most with insurance face high deductibles of $1000–8000 before insurance kicks in as well as max out of pocket costs. I’m a retiree on Medicare. Those on the standard plan pay 20% of every bill. My plan covers some preventative care but nothing else until the $3k threshold and then it’s 80% coverage until $7k when the plan covers 100%.

对于许多习惯于在服务时无需支付或几乎无需支付费用的人来说，大多数美国人面临的账单令人震惊。这包括就诊时的高额共付费用，即使大多数有保险的人在保险生效前也面临1000至8000美元的高额自付额，以及最高自付费用。我是一名享受医疗保险的退休人员。那些使用标准计划的人需要支付每笔账单的20%。我的计划涵盖一些预防性护理，但在达到3000美元门槛之前不涵盖其他费用，之后在达到7000美元之前提供80%的覆盖，达到7000美元后计划将覆盖100%。