人们是否夸大了美国医疗系统的问题，还是说如果你没有保险，情况真的那么糟糕？

Gerald Hawkins
My son was attacked and murdered at his college. When he was rushed to the emergency room before being pronounced dead, they processed him in as uninsured. Three days after his death we received two things from the hospital. The first was a bill for $38,000. He was there 7 minutes before being pronounced dead. The second item was a letter informing him (the deceased) that he was no longer welcome at that hospital as an “indigent person.” That is the way a crime victim is viewed in the American health care bureaucracy.

我的儿子在大学里遭到袭击并被谋杀。在被宣布死亡之前，他被紧急送往急诊室，医院将他作为无保险人员处理。在他去世三天后，我们收到了医院的两样东西。第一样是一张38,000美元的账单。他在那里待了7分钟就被宣布死亡。第二样是一封信，通知他（死者）他不再被欢迎作为“贫困人员”在那家医院就诊。这就是美国医疗官僚机构看待犯罪受害者的方式。

My son had to have insurance to get into college and be a student there. They knew he had insurance. They simply found it easier to ignore the insurance and degrade him as “indigent.” We had to go through the difficulty of connecting his insurance to the medical center’s billing department even while dealing with our grief and loss.

我儿子必须要有保险才能进入大学并成为那里的学生。他们知道他是有保险的。他们只是觉得忽略保险并将他贬低为‘贫困’更容易。我们不得不在处理悲痛和失落的同时，艰难地将他的保险与医疗中心的计费部门连接起来。

Later a bill arrived for $2,000 in ambulance services, billed separately, of course. Insurance eventually paid all but $100, but only after (again) I had to get his insurance connected to the ambulance company’s billing.

后来，我收到了一张2000美元的救护车服务账单，当然是单独计费的。保险公司最终支付了除100美元之外的所有费用，但前提是我必须再次将他的保险与救护车公司的账单系统连接起来。

Yes, the American health care “system” is absolutely as bad as can be.

是的，美国的医疗“系统”确实糟糕透顶。

Cris Larson
My husband had hit a deer and part of his truck bumper was torn; one day I was rushing past it and tore a hole open on my thigh. It wasn’t a big hole - maybe an inch long, but it had some weird fatty tissue hanging out. Weird. I didn’t think it was so bad - but we tried to close it up with band-aids and such, but the tissue kept popping out.

我丈夫撞到了一只鹿，他的卡车保险杠部分被撕裂了；有一天我匆忙经过时，大腿上被划开了一个洞。洞不大——大概一英寸长，但有一些奇怪的脂肪组织露出来。很奇怪。我当时觉得并不严重——我们试着用创可贴之类的东西把它合上，但组织总是弹出来。

A few months earlier, I had had to discontinue our insurance because the premium had become higher than my take-home pay.

几个月前，我不得不停止我们的保险，因为保费已经超过了我的实得工资。

The next day was Saturday, and I still couldn’t get the wound to close up. So we went to the nearby emergency room - this was before urgent care centers opened up. I kept telling the nurses it wasn’t bad but that I might need a stitch or two, and we wondered how much it would cost to have the doctor just look at it. We kept asking and asking about the cost, but nobody would give us a straight answer, or any answer at all, for that matter. We said we really wondered if it would be worth seeing someone for something relatively minor - the folks there convinced us to stay to be looked at.

第二天是星期六，我的伤口仍然无法愈合。于是我们去了附近的急诊室——这是在紧急护理中心开业之前。我一直告诉护士情况并不严重，但可能需要缝一两针，我们想知道让医生看一下要花多少钱。我们一再询问费用，但没有人给我们一个明确的答案，甚至没有任何回答。我们表示，我们真的想知道为了相对较小的问题去看医生是否值得——那里的人说服我们留下来接受检查。

We waited around two hours. The doctor came in, and said she couldn’t stitch it because we’d waited too long, but that she could give me a tetanus shot and a bandage. So I got a tetanus shot and a bandage. All done in about five minutes.

我们等了大约两个小时。医生进来后说，因为我们等得太久了，她不能缝合伤口，但她可以给我打一针破伤风疫苗并包扎一下。于是我打了破伤风疫苗并包扎了伤口。整个过程大约五分钟就完成了。

The cost? $11,000. That’s not a typo. Eleven. Thousand. Dollars.

价格？11,000美元。这不是打字错误。十一。千。美元。

Once I had recovered from the shock, I went back to the hospital to talk about payment. I told the man I couldn’t really afford it - and he chuckled and said that I should apply for charity care. I think I eventually ended up paying a couple thousand dollars for the doctor, ER, and medication cost.

当我从震惊中恢复过来后，我回到医院讨论付款事宜。我告诉那个人我确实负担不起——他笑了笑，说我应该申请慈善医疗。我想我最终为医生、急诊室和药物费用支付了几千美元。

The most telling thing about the whole experience was the cynical, wry chuckle from the payment administrator at my disbelief. It certainly sealed my belief that the entire American health “system” is a joke - a deadly serious nasty joke.

整个经历中最能说明问题的是，支付管理员对我难以置信的反应发出了愤世嫉俗、讽刺的轻笑。这无疑坚定了我的信念，即整个美国的医疗“系统”就是个笑话——一个极其严肃且令人不快的笑话。

Howard Forder
It is that bad if you don’t have insurance. As a Canadian visiting Florida, my wife had a dangerously high fever and was slurring her words and couldn’t get out of bed. I reluctantly called an ambulance. (not because I didn’t want her to receive medical help, but because we would have to take out a loan to pay for it). My wife is fine now, but listen to this:

如果没有保险，情况会很糟糕。作为一名访问佛罗里达的加拿大人，我的妻子发高烧，情况危险，说话含糊不清，无法起床。我勉强叫了救护车。（不是因为我希望她不接受医疗帮助，而是因为我们将不得不贷款来支付费用）。我的妻子现在没事了，但请听这个：

To make a long story short, she was in Emergency for 4 hours before they released her, fever down and ok to go home. Total hospital bill: $17,000 USD ($24,000 CAD). Surprise Doctors bill 45 days later $2000. Ambulance bill $1000 and a later bill from “TeamHealth” for two ghost doctor visits for $1800. She had a catscan which I would presume is the big expense, a saline drip, antibiotics and sent home. Only the wealthy can throw that kind of money around. The rest of us need a loan or mortgage our home.

长话短说，她在急诊室待了4个小时后才被允许出院，当时烧已经退了，可以回家了。总医院账单：17,000美元（24,000加元）。45天后收到了一份2,000美元的医生账单。救护车账单1,000美元，后来还收到了“TeamHealth”寄来的1,800美元账单，声称有两次“幽灵医生”的访问。她做了CT扫描，我猜这是最大的开销，还有生理盐水点滴、抗生素，然后就被送回家了。只有富人才能随意挥霍这么多钱，我们其他人需要贷款或抵押房子。

Our neighbor in Florida was in the hospital for 3 days and had a bill for $30,000. She had to sell her house and move in with her daughter. She won’t go back into the hospital as she can’t afford it.

我们在佛罗里达的邻居在医院住了3天，账单高达3万美元。她不得不卖掉房子，搬去和女儿同住。她不会再回医院，因为她负担不起。

Michael Mock
Oh, it’s that bad even if you DO have insurance, too.

哦，即使你有保险，情况也那么糟糕。

My appendix burst. I have “good” insurance (PPO Gold). For this, they billed me somewhere north of $18,000, despite my having a “$4000 maximum yearly out-of-pocket” clause on my insurance.

我的阑尾破裂了。我有“很好”的保险（PPO Gold）。尽管如此，他们还是向我收取了超过18,000美元的费用，尽管我的保险中有“每年最高自付额4,000美元”的条款。

I fought with the insurance company. They insisted I pay the full amount, because I went to the emergency room. I asked them to please list for me all the non-emergency ways your appendix can burst, and pointed out that if I’d gone in before it was a problem to have my appendix removed, that wouldn’t have been covered because it would have been “elective” surgery.

我与保险公司发生了争执。他们坚持要我支付全额费用，因为我去了急诊室。我请他们列出所有非紧急情况下阑尾可能破裂的方式，并指出如果我在问题出现之前就去切除阑尾，那将不会被覆盖，因为这将被视为“选择性”手术。

They still insisted I pay the full amount. To date I’ve paid $0 of that amount. Now they want to settle, if I’ll pay $2000. I asked why they wouldn’t just take $4000 from the start, and they said I had to pay the full amount.

他们仍然坚持要我支付全额。到目前为止，我支付了0美元。现在他们想要和解，如果我支付2000美元。我问他们为什么一开始不直接收取4000美元，他们说必须支付全额。

No matter the question, the answer seems to stay the same, and my response has remained consistent as well. I’ve cratered my credit rating on principle, and I don’t care.

无论问题如何，答案似乎始终如一，我的回应也保持一致。我基于原则毁掉了我的信用评级，但我并不在乎。

Kathy Hakeem
I'm 72 years old. I can't afford my meds. The copay is over $200 per month. I worked my whole life since age 16. My Social Security so low that I don't have a spare $200 each month. Therefore I take half the meds per day that I am supposed to and chose which ones I can afford to get each month. I work most days but don't make enough to afford most anything. However I make $3 per month too much get any government help. I've already accepted that should I get sick,dieing is my only option. Health care in the US sucks unless you are rich.

我今年72岁。我负担不起我的药物费用。每月的自付额超过200美元。我从16岁起就一直工作。我的社会保障金很低，每个月没有多余的200美元。因此，我每天只服用应该服用的一半药物，并选择每个月能负担得起的药物。我大部分时间都在工作，但赚的钱不够支付大部分开销。然而，我每个月多赚了3美元，因此无法获得任何政府帮助。我已经接受了，如果我生病了，死亡是我唯一的选择。在美国，除非你富有，否则医疗保健很糟糕。

Something I clicked on made comments impossible but I can't figure out how to undo that. Sorry.

我点击了某个东西导致无法评论，但我不知道如何撤销这个操作。抱歉。

I had my appendix burst in August 2020, and I wrote about it here in Quora. My hubby transported me to Jorvi hospital, which is the central hospital of my hometown (Espoo, Finland). It also is a university hospital, which means the medicine students are instructed there, and new forms of treatment are beta tested there. I was operated the next morning.

我在2020年8月经历了阑尾破裂，并在Quora上写了关于此事的文章。我丈夫将我送到了我家乡（芬兰埃斯波）的中心医院Jorvi医院。这也是一所大学医院，意味着那里有医学生接受指导，并且新的治疗方法在那里进行测试。我在第二天早上接受了手术。

The good old Jussi Q. Veronmaksaja, the Finnish cousin of John Q . Taxpayer, paid the operation which saved my life. Its price to the Espoo taxpayers (in Finland, the health care is funded by the communal tax) was 3,000 euros.

善良的老Jussi Q. Veronmaksaja，芬兰版的John Q. Taxpayer，支付了拯救我生命的手术费用。对于埃斯波（芬兰）的纳税人来说，这项费用（在芬兰，医疗保健由社区税资助）是3000欧元。

Since there are some 300,000 inhabitants in Espoo, my life was saved by 3000/300,000 = 1 cents per every Espoo inhabitants. If half of us are net taxpayers, it is 2 cents per taxpayer.

由于埃斯波有大约30万居民，我的生命被拯救的成本是3000/300000 = 每个埃斯波居民1分钱。如果我们中有一半是净纳税人，那么每个纳税人的成本就是2分钱。

If I had had more time to act (rather than be curled up like a shrimp and agonied in pain), I could have opted a private hospital in Helsinki. The price would have been 3,500 euros. Since because of my stupid hobbies, which bear an elevated risk of injury and death, I am compelled to take a private health insurance, it would have covered 90% of the costs, making the price 350 euros for me - a lot but manageable. My private health insurance costs me 150 euros per year. Pricey, but manageable.

如果我有更多的时间行动（而不是像虾一样蜷缩着痛苦地呻吟），我本可以选择赫尔辛基的一家私立医院。价格将是3500欧元。由于我那些愚蠢的爱好，它们带来了较高的受伤和死亡风险，我不得不购买私人健康保险，这将覆盖90%的费用，对我来说价格将是350欧元——虽然不少，但可以承受。我的私人健康保险每年花费我150欧元。虽然昂贵，但可以承受。

I did a short inquiry about the prices of appendectomy in the USA, and the prices are between 30,000 to 70,000 USD. My jaw dropped. Do they make the instruments from platinum in the USA, or is this a particularly audacious case of arbitrage?, I pondered. In the USA, had I not had an insurance, it would have cost me literally an arm and a leg - and the worst case scenario would have been personal bankruptcy and becoming homeless.

我做了一个关于美国阑尾切除术价格的简短调查，价格在3万到7万美元之间。我惊呆了。我在想，难道他们的手术器械是用铂金做的吗，还是这是一个特别大胆的套利案例？在美国，如果我没有保险，这将花费我一条胳膊和一条腿——最坏的情况将是个人破产和无家可归。

The cheapest private health insurances in the USA begin from 1200 USD per year - and they do have a cost ceiling and do not cover pre-existing conditions. In the USA, I would pay tenfold the amount of the private health insurance as I do in Finland - and having it to cover the costs is crapshoot.

美国最便宜的私人健康保险每年从1200美元起——它们确实有费用上限，并且不涵盖已有疾病。在美国，我将支付芬兰私人健康保险金额的十倍——而能否覆盖费用则是一场赌博。

Appendectomy is pretty much a basic surgery, it is approximately the same procedure all around the world, and the medicines and instruments used on it are approximately the same everywhere. I haven’t seen the American hospitals being five star hotels with hospital equipment either.

阑尾切除术基本上是一项基础手术，在世界各地的手术程序大致相同，使用的药物和器械也大致相同。我也没有见过美国的医院像五星级酒店一样配备医院设备。

Yes, the American health care system is indeed that bad. I call it rent-seeking.

是的，美国的医疗体系确实很糟糕。我称之为寻租。

LivinItUpandLivinItOutSitBackRelaxandLove

尽情享受，尽情生活，坐下来放松，去爱

Hi, my husband didn’t have health insurance when he was 24 he had a seizure and went in an ambulance to the ER. He was there maybe three hours and sent home.

你好，我丈夫24岁时没有健康保险，他有一次癫痫发作，被救护车送到了急诊室。他在那里大约待了三个小时，然后被送回了家。

TO THIS DAY (6 years later) He is still paying this little trip to the ER off! A collections agency came after him and ruined his credit unless he would pay $700/month towards a $12k debt to the hospital!!!! Wtf did they do in 3 hours that equals $12,000.00 dollars. FUCK YOU USA HEALTHCARE YOU TAKE ADVANTAGE OF PEOPLE WHO DONT HAVE INSURANCE

直到今天（6年后），他仍在偿还这次急诊的费用！一家催收机构找上了他，除非他每月向医院支付700美元以偿还12,000美元的债务，否则他的信用就会被毁掉！！！他们在3个小时里做了什么，竟然值12,000美元。去你的美国医疗体系，你们在剥削那些没有保险的人。

He got his payments down to $350 using like a money management company who negotiated and got the monthly payment down and even that is very expensive it’s more than his truck payment. He regrets ever going to the hospital that day. It ruined his credit score like A LOt since he was 24 he is now 30 and just getting his life together. The $12k really held him back.

他通过一家资金管理公司协商，将付款降至350美元，即便如此，这笔费用仍然非常昂贵，甚至超过了他的卡车付款。他后悔那天去医院。那次经历极大地损害了他的信用评分，从24岁到30岁，他一直在努力让生活重回正轨。那1.2万美元真的拖累了他。

Frank Vaughan
My wife and I had employer provided healthcare insurance. She got diagnosed with stage 4 breast cancer at age 52 and passed away 3 years later. She stayed working as long as possible to keep her insurance in force. The US system is a piecemeal labryinth. After it was all done I was let with over $200K in uncovered expenses. For instance, once diagnosed with cancer tumors in her brain, the insurance company denied coverage for chemo. Each chemo treatment was $18K every 2 weeks. The denials took almost 6 months to process and no one let us know. She had three surgeries and the anethesiologist on each one was not in network so had to pay the full bill ourselves. People here go bankrupt even if the have insurance.

我和我的妻子有雇主提供的医疗保险。她在52岁时被诊断出患有第四期乳腺癌，并在三年后去世。她尽可能长时间地工作以保持她的保险有效。美国的医疗系统是一个零散的迷宫。当一切结束后，我留下了超过20万美元的未覆盖费用。例如，一旦她被诊断出脑部有肿瘤，保险公司就拒绝支付化疗费用。每次化疗每两周需要1.8万美元。拒绝的决定花了近六个月的时间处理，而且没有人通知我们。她进行了三次手术，每次手术的麻醉师都不在保险网络内，所以我们不得不自己支付全额费用。即使有保险，这里的人们也会破产。

Dianne Mclaren-Brighton
I have fairly good insurance. Back in mid September, I twisted my knee while walking my mother's dog. After waiting a few days to see if it would get better, I made an appointment to see my doctor ($20 copay) who diagnosed a torn meniscus and sent me to physical therapy. After two visits a week for three weeks ($25 copay per session), the physical therapist stopped treatment and sent me back to the doctor because I wasn't getting any better. This was in mid October. My doc (another $20 copay) sent me to get an MRI (copay unknown at this time, but it will be a ridiculous amount). The MRI appointment is scheduled for the 19th of November, almost as month after I made the appointment. That was the earliest I could get. If I need to see an orthopedic doctor (copay unknown but definitely over $100 since it's a specialist), it will take at least two, maybe three weeks to get an appointment. If I need surgery, it won't happen until early to mid January. I haven't met our deductible for this year, so I'm on the hook for a couple thousand dollars for the rest of this year. A surgery in January means I have to start over with the deductible. After surgery, there will be another round of physical therapy at $25 a session. So, a simple twisted knee will cost me four months of pain and several thousand dollars of copays and deductibles. Only in America.

我的保险还不错。九月中旬，我在遛我妈妈的狗时扭伤了膝盖。等了几天后，发现情况没有好转，于是预约了医生（自付20美元），医生诊断为半月板撕裂，并建议我去做物理治疗。每周两次，持续了三周（每次自付25美元），物理治疗师因为我没有好转而停止了治疗，并让我回去看医生。这是十月中旬的事。我的医生（又自付20美元）让我去做核磁共振（自付金额目前未知，但肯定是一笔不小的数目）。核磁共振预约在11月19日，几乎是在我预约后一个月。这是我能预约到的最早时间。如果我需要看骨科医生（自付金额未知，但肯定超过100美元，因为是专科医生），至少需要两到三周才能预约到。如果我需要手术，最早也要到一月中旬。我今年的免赔额还没有达到，所以今年剩下的时间我要自付几千美元。一月份的手术意味着我要重新开始计算免赔额。手术后，还要再进行一轮物理治疗，每次自付25美元。所以，一次简单的膝盖扭伤将让我经历四个月的痛苦和几千美元的自付费用。只有在美国才会这样。

Tessa Wolf
I'll answer with a story.

我会用一个故事来回答。

My father had pancreatic cancer, and after many surgeries and losing 60% of his pancreas, he survived. That was six years ago.

我父亲曾患有胰腺癌，经过多次手术并失去了60%的胰腺后，他活了下来。那是六年前的事了。

Two months ago he started presenting with odd symptoms and they were concerned that his cancer had returned. Of course this would be horrible news because aside from everything else, there would be no more pancreas to take. It would basically be a death sentence. We had to schedule something called an MRCP, which is a specialized MRI that focuses on the pancreas.

两个月前，他开始出现一些奇怪的症状，他们担心他的癌症复发了。当然，这将是可怕的消息，因为除了其他一切，已经没有更多的胰腺可以切除了。这基本上就是死刑。我们不得不安排一种叫做MRCP的检查，这是一种专门针对胰腺的核磁共振成像。

It was denied by insurance immediately, their excuse was that he didn't need it. Of course he needed it, so we had to file paperwork for an appeal to get a prior authorization code so that we could bypass the system and have it properly submitted to insurance. Because we had to do all of these things, it took about a month before we had the code and we could schedule the MRCP.

保险公司立即拒绝了，他们的借口是他不需要这个。当然他需要，所以我们不得不提交文件进行上诉，以获得事先授权代码，以便我们可以绕过系统并正确提交给保险公司。因为我们必须做所有这些事情，所以花了大约一个月的时间才拿到代码，我们才能安排MRCP。

Graham
I live in New Brunswick, Canada and am a low income senior. My drug plan is totally free for me so long as I'm collecting Guaranteed Income Supplement and my basic health insurance is $22 a month. I pay $5.05 per prescxtion up to a 3 month supply. I pay nothing to see ANY doctor. I'm a cancer patient and need salvage therapy. Again, zero cost to even stay at the hospital for 5 weeks of radiation. The only things I would have to pay anything for are non-medically required items like an annual check-up which would cost $40.

我住在加拿大新不伦瑞克省，是一名低收入老年人。只要我领取保障收入补助，我的药物计划就完全免费，我的基本健康保险每月22加元。每张处方我支付5.05加元，最多可供应3个月。我看任何医生都不需要支付任何费用。我是一名癌症患者，需要挽救治疗。再次强调，即使住院进行5周的放射治疗，我也不需要支付任何费用。我唯一需要支付的是非医疗必需的项目，比如年度体检，费用为40加元。

My American girlfriend is also a cancer patient. She is on disability Medicare. However, she is now so far in debt she'd never be able to pay…well into the 6 figures.

我的美国女友也是一位癌症患者。她享有残疾医疗保险。然而，她现在负债累累，根本无法偿还……债务已经高达六位数。

Is the US good? They may have good hospitals but the actual healthcare is below average developed world standards. You have only 2 politicians who will do something about it…Bernie and Elizabeth. Democratic Socialism is NOT Communism. It is far from it. The US already has many social democratic features…roads, fire and police departments, Medicare, the VA, etc.

美国好吗？他们可能有好的医院，但实际的医疗水平低于发达国家的平均水平。你们只有两位政客会为此做点什么……伯尼和伊丽莎白。民主社会主义不是共产主义。它远非如此。美国已经有许多社会民主的特征……道路、消防和警察部门、医疗保险、退伍军人事务部等。

Medicare for All, otherwise known as Universal Healthcare or Single Payer, is the only way to repair the US system. It really is simple. You pay very minimal co-pays on prescxtions, but you don't pay a thing for virtually anything else. You will have to get, either through your employer or privately, supplemental insurance which will cost $20 to $60 per month…private will cost more…which covers non-medically necessary things like glasses, crutches, walkers, some home care, etc. Under Bernie's plan, many of these things will be covered as well.

全民医疗保险，也被称为全民医疗或单一支付者，是修复美国医疗体系的唯一途径。这其实很简单。你在处方药上只需支付很少的共付额，但几乎其他所有东西都不用支付。你必须通过雇主或私人方式获得补充保险，每月费用在20到60美元之间……私人保险会更贵……这些保险涵盖非医疗必需的东西，如眼镜、拐杖、助行器、一些家庭护理等。在伯尼的计划下，许多这些东西也将被涵盖。

Yes, you will pay a little more in taxes but far less in total than half than what you're paying now in co-pays, deductibles, and insurance. If you lose your job you still have full healthcare and hospitalization at NO CHARGE. There's no more falling through the cracks, no networks, no bill collectors, no checking at the door for insurance coverage, no dying because you can't afford a doctor or hospital. Please, don't listen to Republican lies. They're only protecting the rich.

是的，你将在税收上多支付一些，但总体上比你现在支付的共付额、免赔额和保险费用少得多。如果你失业了，你仍然可以免费享受全面的医疗和住院服务。不再有遗漏，没有网络限制，没有讨债人，没有在门口检查保险覆盖范围，没有因为负担不起医生或医院而死亡。请不要听信共和党的谎言。他们只是在保护富人。

And, as far as prescxtion medication is concerned, ours is so much cheaper. My girlfriend was on Xeralto and, when January happened, her deductable popped up. After insurance, it was going to be $460. The exact same prescxtion here in NB AT FULL PRICE is under $100. Are you being ripped off? Of course you are. You have the only FOR PROFIT system in the developed world.

而且，就处方药而言，我们的价格要便宜得多。我的女朋友在使用Xeralto，当一月份到来时，她的免赔额出现了。在保险之后，费用将是460美元。而在新不伦瑞克省，同样的处方药，全价也不到100美元。你是否被宰了？当然是的。你拥有的是发达世界中唯一的以营利为目的的医疗体系

Mariluz 8a
My sister in law Judy is a GP in Spain. She’s also a professional-level complainer, if you listen to her you’ll get the notion that nothing in the system works. Last week she was complaining about not having paper records in her office; our regional healthcare service went off-paper more than ten years ago, the horror, how dare they.

我的嫂子朱迪在西班牙是一名全科医生。她也是一个专业级别的抱怨者，如果你听她说话，你会觉得系统中的一切都不起作用。上周她还在抱怨她的办公室里没有纸质记录；我们地区的医疗服务在十多年前就实现了无纸化，真是可怕，他们怎么敢这样。

Several years ago she was horrified about a case they’d studied in a medical congress. Remember the Nile virus scare? The case was about a 42yo patient whose treatment had accumulated more medical errors than she’s seen in 25 years of medical school, residency and job. The delays due to paperwork crap alone were unthinkable: things such as “different services in the same hospital are actually different businesses, so taking a specific scan took three days just to process the paperwork and authorizations”. The patient ended in a wheelchair and with a list of symptoms that in Spain would have given him access to getting a basic chair and a motorized bed from the healthcare system (a better chair can be rented or bought), free visits from nurses several times per week…

几年前，她在一次医学大会上研究的一个案例让她感到震惊。还记得尼罗河病毒的恐慌吗？这个案例是关于一名42岁的患者，他的治疗过程中累积的医疗错误比她25年的医学院学习、实习和工作中所见的还要多。仅仅因为文书工作导致的延误就令人难以置信：例如“同一家医院的不同部门实际上是不同的业务，因此进行一次特定的扫描需要三天时间来处理文书和授权”。患者最终坐上了轮椅，并出现了一系列症状，在西班牙，这些症状本可以让他从医疗系统中获得一把基本轮椅和一张电动床（更好的轮椅可以租用或购买），每周几次的护士免费探访……

What I don’t ever expect to tell Judy is that I happen to know that man’s WIDOW. I know that he lost his job due to his illness. I know that she lost her job due to his illness, as well. I know they lost their home. I know that one day she got home and found him dead of complications, not from Nile, but from the other illnesses he caught while hospitalized.

我从未期望告诉朱迪的是，我恰好认识那个男人的遗孀。我知道他因为生病而失去了工作。我也知道她因为他的病而失去了工作。我知道他们失去了家园。我知道有一天她回到家，发现他死于并发症，不是尼罗河，而是他在住院期间感染的其他疾病。

I know that in Spain he would have been autopsied. I know that in the US she had to beg for money to bury him.

我知道在西班牙，他会被进行尸检。我知道在美国，她不得不乞讨钱来埋葬他。

I don’t know, is that bad?

我不知道，这很糟糕吗？

Alvin Grissom II
When I was in my twenties, I had to get questionable short-term health insurance in between jobs because no insurance company would cover me due to mild, undiagnosed symptoms. (I now know they were food allergies.)

在我二十多岁的时候，由于轻微的、未确诊的症状（我现在知道是食物过敏），没有保险公司愿意为我提供保险，所以我不得不在工作之间购买有问题的短期健康保险。

At one point, I was having heart palpitations, so I went to a cardiologist for examination. (I know now that the culprit was again food allergies.) They did some basic stress tests and observations of my heart. The pre-insurance bill was in the range of $60,000.

有一次，我出现了心悸的症状，于是我去看了心脏病专家进行检查。（我现在知道罪魁祸首又是食物过敏。）他们做了一些基本的心脏压力测试和观察。保险前的账单在6万美元左右。

I had to have surgery on my shoulder after a skating accident in my early 30s. I had the graduate student health insurance, which constantly fought with my healthcare provider about covering basic services. It was so bad that the administrator actually called the insurance company over the phone while I sitting was next to them to get to them to follow through.

我在30岁出头时因滑冰事故不得不进行肩部手术。我当时有研究生健康保险，但它经常与我的医疗服务提供者就基本服务的覆盖问题发生争执。情况非常糟糕，以至于管理员实际上在我坐在旁边时打电话给保险公司，要求他们履行承诺。

This was a 30 minute routine surgery to fix a chronically dislocating shoulder. Without insurance, it would have cost, if memory serves, over $50,000. I (by which I mean my parents, because I didn’t have this kind of money as a grad student) had to pay about $6,000 of that.

这是一个30分钟的常规手术，用于修复长期脱臼的肩膀。如果没有保险，据我记忆，费用将超过50,000美元。我（这里指的是我的父母，因为作为研究生我没有这么多钱）不得不支付其中的大约6,000美元。

These are just two examples.

这仅仅是两个例子。

MamaSquid
It’s that bad even if you DO have insurance. We have insurance - really good insurance — but our healthcare costs are about $20,000 a year including premiums. I have an insured friend who lost about $50,000 out of pocket when she got cancer. Health care is one of the most broken things about the US, and one of the most unjust things, since people who don’t have a lot of means are more likely to suffer chronic illness and frequent hospitalizations. So the less money you have, and the sicker you are, the more you have to spend on healthcare. Pretty twisted.

即使你有保险，情况也很糟糕。我们有保险——非常好的保险——但我们的医疗费用每年大约为2万美元，包括保险费。我有一个有保险的朋友，她得了癌症后自掏腰包损失了大约5万美元。医疗保健是美国最糟糕的事情之一，也是最不公正的事情之一，因为经济条件不好的人更有可能患上慢性病并频繁住院。所以，你越没钱，病得越重，你不得不在医疗保健上花费的钱就越多。这真的很扭曲。