QA问答：美国人真的会因为担心随后产生的账单而避免去医院，即使在严重的情况下也是如此吗？

Stephen Samuel
Let me explain this from the north side of the border:

让我从边境的北边(即加拿大--译者注)来解释一下：

Science fiction convention in Vancouver, BC. We have the pool area all to ourselves. Paul (US American) falls and hits his head on a heater. oops!

在加拿大不列颠哥伦比亚省温哥华举行的科幻大会上。我们独享了泳池区域。保罗（美国人）摔倒并撞到了加热器上。哎呀！

For us Canadians, the next step is obvious. Head trauma -> hospital visit. It’s not an extremely high probability, but an untreated concussion can sometimes be deadly. Paul freaks out at the suggestion. For us Canadians, this counter-intuitive reaction is a possible sign that he’s suffered a concussion. His wife eventually explains that, the last time he went to a hospital with a headache, he left with the same headache and a $20,000 second mortgage to pay the hospital bill. Our astonishment shifted from his extreme reaction to the reason for his extreme reaction.

对我们加拿大人来说，下一步是显而易见的。头部创伤 -> 去医院。虽然不是极大概率，但未经治疗的脑震荡有时可能是致命的。保罗对这个建议感到恐慌。对我们加拿大人来说，这种反直觉的反应可能是他遭受了脑震荡的迹象。他的妻子最终解释说，上次他因为头痛去医院，结果带着同样的头痛和一笔2万美元的二次抵押贷款来支付医院账单离开了。我们的惊讶从他极端的反应转移到了他极端反应的原因。

It takes us about an hour to calm him down and convince him that Canadian hospitals are nowhere near as predatory as the US system. We finally take him to a hospital. The admitting nurse, on finding out that he’s not a Canadian resident asks for a credit card to pay for the treatment. Paul freaks out again. While others calm him down, I ask a few questions and am quickly able to explain that the cost is a $600 flat rate — whether he spends 1 hour in observation or 2 weeks in intensive care. He calms down again.

我们花了大约一个小时才让他平静下来，并说服他加拿大的医院远没有美国医疗体系那么掠夺性。我们最终带他去了医院。接待的护士发现他不是加拿大居民后，要求用信用卡支付治疗费用。保罗再次惊慌失措。当其他人安抚他时，我问了几个问题，并很快解释清楚费用是600加元的固定费率——无论他是在观察室待1小时还是在重症监护室待2周。他再次平静下来。

Knowing that the costs are well bounded, he OK’s his wife handing over the credit card, the security guards (who were worried about his hysterical reaction) calm down and go back to their normal posts. We wait about an hour or two for him to be examined … mostly waiting for an observation period, and we finally go back to the hotel.

得知费用是有限的，他同意妻子交出信用卡，保安们（原本担心他会歇斯底里）也冷静下来，回到了各自的岗位。我们等了一两个小时让他接受检查……主要是等待观察期结束，最后我们终于回到了酒店。

That was my first visceral experience of just how horrifying the US health care system is for people who have to live inside it. Other than the top 10% or so, most Americans have no idea just how soothing it is to know that you can visit the nearest hospital, etc., to have a medical issue looked at without worrying about what effect it will have on your budget.

那是我第一次切身感受到美国医疗体系对于必须生活在其中的人来说是多么可怕。除了大约前10%的人，大多数美国人并不知道能够去最近的医院等地方看医生而不必担心它会对你的预算产生什么影响是多么令人安心。

… and I really do mean nearest. Your ‘out of network’ issues are yet another layer of insanity that most Canadians can barely wrap our brains around.

……而且我真的是指最近的。你们的‘网络外’问题又是另一层疯狂，大多数加拿大人几乎无法理解。

I don’t know how you Americans live with your system. It’s barbaric.

我不知道你们美国人是怎么忍受你们的制度的。这太野蛮了。

I guess the bigger problem is too many of you don’t live because of that system.

我猜更大的问题是你们中有太多人因为那个系统而无法生活。

Tara Martel
In my job I often have to host one of my “opposite numbers” from the US and one such person was in the shape of “Mary” (name changed to prorect the innoccent) and one day she was working in the office and I noticed she could barely move her left arm. I asked her what happened and eventually I got it out of her that she had slipped getting off the bus and landed on it the day before. I asked the obvious question about hospital.

在我的工作中，我经常需要接待来自美国的“对应人员”，其中一位名叫“玛丽”（为保护无辜者，名字已更改）。有一天，她在办公室工作时，我注意到她几乎无法移动左臂。我问她发生了什么事，最终她告诉我前一天下车时滑倒，摔在了左臂上。我问了关于医院的显而易见的问题。

I sa a look of horror on her face and she blurted out that she would be “out of network”. So I told her a little white lie, I said that our “firm” would pick up the tab and she wouldn’t even have to pay a “copay”.

我看到她脸上露出惊恐的表情，她脱口而出她会“不在网络内”。所以我撒了个小谎，我说我们的“公司”会支付费用，她甚至不需要支付“共付额”。

So an ambulance was called and it was confirmed that she had broken her arm in two places. At the hospital she was looking around wide eyed. She was looking for somewhere to pay and couldn’t find it. As we were walking through to Radiology, we passed the end of a corridor that had a sign pointing towards the cashier. She seemed to be reassured by this that people did pay for treatment.

于是叫了救护车，确认她的手臂有两处骨折。在医院里，她睁大眼睛四处张望。她在寻找支付的地方，但没有找到。当我们走向放射科时，经过走廊尽头，那里有一个指向收银台的标志。她似乎因此感到安心，知道人们确实需要支付治疗费用。

After her xray and plaster cast she told me she wanted to swing by the cashier just to check that the bill was taken care of.

在她做完X光和打上石膏后，她告诉我她想顺便去收银台确认一下账单是否已经处理好了。

“Excuse me,” she said, “but I’ve just been treated for a broken ar and my friend said its been taken care of?”

“打扰一下，”她说，“我刚刚因为手臂骨折接受了治疗，我朋友说已经处理好了？”

Being a London hospital he was used to Americans and he said “don’t worry, no one pays for emergency treatment at this hospital,”

作为一家伦敦医院，他已经习惯了美国人，他说：“别担心，在这家医院没有人需要为急诊治疗付费。”

I bundled her out before she could request it in writing!

在她提出书面请求之前，我就把她赶了出去！

She did say afterwards that she had heard that treatment is free at point of need but had always been lead to believe that there was a catch. She had been told that NHS hospitals were old and damp and only the private hspitals were clean and modern so she had genuinely believed that she was in a private hospital. She genuinely thought that they’d find a way to bill her.

她后来确实说过，她听说在需要的时候治疗是免费的，但她一直认为这其中一定有猫腻。她被告知NHS医院又旧又潮湿，只有私立医院才是干净和现代的，所以她真的以为自己是在私立医院。她真的以为他们会想办法向她收费。

William Brixius
Absolutely yes. I’ve been in Canada just shy of 8 years now and I still retain the Murkan habit of avoiding the doc at all costs, though I am slowly getting better about it. It’s an absolute trip at the clinic my family doc’s attached to — the reception desk is entirely bypassed on the way to the exit from the exam rooms. As in it isn’t even visible. STILL feels like I’m sneaking out without paying, every time.

绝对是的。我在加拿大已经快8年了，但我仍然保持着美国人那种尽量避免看医生的习惯，尽管我正在慢慢改善。我家庭医生所在的诊所简直让人难以置信——从检查室到出口的路上完全绕过了接待台。也就是说，接待台甚至都看不见。每次还是感觉像是没付钱就偷偷溜出去一样。

I grew up solidly middle class stateside, too, so it’s not just a poverty thing. I had insurance, but copays and this and that and the other thing add up. Went to the doc as a kid no problem, but once it was just me the only time I actively went to the doc was during grad school, when non-specialist services at the university clinic were already covered by my surprisingly reasonable basically socialized insurance through said university. Don’t get me started on the times I needed a specialist…massive wait for zero help and a massive bill for that nothing. Screw privatized healthcare, it’s pure evil.

我在美国也是在中产阶级家庭中长大的，所以这不仅仅是贫困问题。我有保险，但自付费用和各种杂项加起来也不少。小时候去看医生没问题，但一旦独立后，我唯一主动去看医生的时候是在研究生期间，那时大学诊所的非专科服务已经通过那所大学的基本上社会化且出奇合理的保险覆盖了。别提我需要专科医生的时候了……漫长的等待换来的却是零帮助，还要为这种无用的服务支付巨额账单。私有化的医疗体系真是纯粹的邪恶。

Myra Scott
My college-age son called me one day from his apartment and said he couldn’t breathe. He didn’t know what to do, he was gasping for air. He thought it was a heart attack.

我大学年龄的儿子有一天从他的公寓打电话给我，说他无法呼吸。他不知道该怎么办，他正在喘不过气来。他以为这是心脏病发作。

I headed for the car while talking him through some relaxation techniques. Told him I was on the way and would be there in 10 minutes.

我一边向他讲解一些放松技巧，一边朝汽车走去。告诉他我正在路上，10分钟后就能到。

He called 911 while I was enroute. When I got there, they were loading him into an ambulance. I hopped in next to him and off we went to the hospital where - after 5 hours because it was a slow day- he was basically diagnosed with anxiety.

他在我前往的途中拨打了911。当我到达时，他们正把他抬上救护车。我跳上车坐在他旁边，然后我们去了医院——因为那天很慢，所以等了5个小时——他基本上被诊断为焦虑症。

I work for an insurance company. I have company insurance that covers him.

我在一家保险公司工作。我有公司保险，这份保险也涵盖了他。

We have a $4500 deductible per person and a max $10,000 out-of-pocket deductible for the family… so before catastrophic coverage actually kicks in and pays anything, I have to spend $10,000.

我们每个人的免赔额是4500美元，家庭最高自付免赔额是10000美元……所以在灾难性保险开始支付任何费用之前，我必须先花费10000美元。

And since the ultimate diagnosis was not considered life-threatening, a lot of the treatment he was given was denied- so I pay for it, but it doesn’t count against that $10K out of pocket. Nearly $1000 alone for the ambulance ride.

由于最终的诊断并不被视为危及生命，他所接受的许多治疗都被拒绝了——所以我支付了费用，但这不计入那1万美元的自付费用中。仅救护车费用就将近1000美元。

This isn’t even a story of tragedy as we were lucky his symptoms were treatable. It’s a story about how a health situation can wipe out any available funds you have and put you into debt simply by having a health emergency.

这甚至不是一个悲剧的故事，因为我们很幸运他的症状是可以治疗的。这是一个关于健康问题如何耗尽你所有可用资金，并仅仅因为一次健康紧急情况就让你陷入债务的故事。

I have the most reasonable insurance a regular person can get, straight from my employer. I know how the system works.

我有普通人能得到的最合理的保险，直接来自我的雇主。我了解这个系统的运作方式。

But when your child is terrified and feels like he’s dying, you go get someone to look at it. Now. And the system makes money.

但当你的孩子感到极度恐惧，感觉像是要死了的时候，你会立即去找人来检查。现在。而这个系统就在赚钱。

Not just for the insurance company- everyone seems to give a pass to medical facilities and providers who charge 1000 times more than what they paid for a wrapping or an aspirin.

不仅仅是保险公司——似乎每个人都对医疗设施和提供者网开一面，他们收取的费用比他们为一块绷带或一片阿司匹林支付的费用高出1000倍。

Hospitals are profit centers. Doctor’s practices are profit centers. Emergency transportation is a profit center. Labs are profit centers. Every single thing in our medical system is owned by shareholders and investors. You know why? Because it’s a no-lose investment.

医院是盈利中心。医生的诊所是盈利中心。紧急运输是盈利中心。实验室是盈利中心。我们医疗系统中的每一样东西都由股东和投资者拥有。你知道为什么吗？因为这是一项稳赚不赔的投资。

People will pay $20 for a Tylenol; because they have no choice.

人们会花20美元买泰诺，因为他们别无选择。

People will call an ambulance; because they have no choice.

人们会叫救护车，因为他们别无选择。

People will go to the emergency room when they have an emergency; because they have no choice.

人们在紧急情况下会去急诊室；因为他们别无选择。

It’s a monopoly that has no choice but to pay dividends to investors- maybe over time, maybe on payment plans, but they will chase that blood money until they get it.

这是一个垄断企业，它别无选择，只能向投资者支付股息——可能是随着时间的推移，也可能是通过分期付款计划，但他们将追逐那笔血汗钱，直到他们得到它。

We sure do!

我们当然会！

I pay more than $1000 a month for “good insurance, and last month I fell. I knew something was wrong and instead of going to the ER, I went to urgent care because it would be so much cheaper.

我每月支付超过1000美元购买“优质保险”，上个月我摔倒了。我知道有些不对劲，但没有去急诊室，而是去了紧急护理中心，因为那样会便宜很多。

It almost killed me.

这几乎要了我的命。

You see, I had broken three ribs and punctured a lung. I was bleeding into my chest cavity and the longer I waited to see the cheap doctor, I was losing my ability to breathe. At one point a lady sat next to me. She took one look at me and screamed at the front desk to call an ambulance. I told them it would cost too much and I would drive myself.

你看，我断了三根肋骨，还刺穿了肺。我的胸腔内出血，而我等待看便宜医生的时间越长，我的呼吸能力就越弱。有一次，一位女士坐在我旁边。她看了我一眼，就对着前台尖叫着要叫救护车。我告诉他们那太贵了，我会自己开车去。

Luckily for me, they stopped me from driving and the ambulance soon arrived.

幸运的是，他们阻止了我继续开车，救护车很快就到了。

I stayed in the hospital for 3 days and demanded to be released because I couldn’t afford to be there any longer. I was released AMA and I got lucky that I had someone at home to care for me. It has taken weeks for me to be able to take a breath without pain, and while my doctor wanted to see me at the two-week mark, I waited until 4 weeks to see her.

我在医院住了三天，并要求出院，因为我再也负担不起住院费用了。我是在医生不同意的情况下出院的，幸运的是家里有人照顾我。我花了几个星期才能无痛地呼吸，虽然医生希望我在两周后复诊，但我等到四周后才去见她。

I am now waiting for the bills to arrive. I know that my deductible for the year is $17,000 and that will be what I will have to pay before the full insurance kicks in, but I will STILL have more deductibles to pay!!

我现在正在等待账单的到来。我知道我今年的免赔额是17,000美元，这是我在全额保险生效之前必须支付的金额，但我仍然需要支付更多的免赔额！！

Our system is BROKEN!! The MAIN reason people file for bankruptcy is medical bills, and we are supposedly a first-world nation!!!!

我们的系统崩溃了！！人们申请破产的主要原因是医疗账单，而我们竟然是一个所谓的第一世界国家！！！！

People are so damn worried about paying for everyone to get medical care that they would rather go bankrupt than pay LESS than we do now for actual care! They seem to forget that they are already paying for roads, schools, first responders and so much more, but heaven forbid they pay for medical!

人们非常担心为每个人支付医疗费用，以至于他们宁愿破产，也不愿支付比我们现在实际支付的更少的费用！他们似乎忘记了他们已经为道路、学校、急救人员等支付了费用，但天哪，他们竟然不愿意为医疗支付费用！

It would be CHEAPER FOR EVERYONE!!!

这对每个人来说都会更便宜！！！

PLUS our politicians are in the pockets of the insurance companies who will lose billions if we were to have universal healthcare. So, we continue to see the decline in our health, die earlier, and lose mothers during childbirth at a rate higher than some third-world nations, and all people can think of is “Well at least I didn’t pay for someone else to live”.

此外，我们的政客被保险公司收买，如果我们实行全民医保，这些公司将损失数十亿美元。因此，我们继续看到健康状况的下降，寿命缩短，母亲在分娩时的死亡率高于一些第三世界国家，而所有人能想到的只是‘至少我没有为别人的生命买单’。

Absolute stupidity!

绝对的愚蠢！

The other day, I was at a supermarket. An elderly gentleman was lying on the floor, face down, and didn’t respond to voices or sounds. I and another guy stood by him, not sure what to do. I asked the other guy, “Should we call an ambulance for him?” The guy said, “Maybe we should wait and see if he gets up on his own. We don’t know if he has insurance.”

前几天，我在一家超市里。一位老先生脸朝下躺在地上，对声音或喊叫没有反应。我和另一个人站在他旁边，不确定该怎么做。我问那个人：“我们应该为他叫救护车吗？”那个人说：“也许我们应该等等，看看他能不能自己起来。我们不知道他有没有保险。”

That’s what you need to know about American health care. We saw a person needing medical help, but we were hesitant about getting him help because we didn’t know if this potentially life-saving help might bankrupt him. In the US, around 650,000 people file for bankruptcy each year due to medical bills. This is more than 60% of all personal bankruptcies.

这就是你需要了解的美国医疗保健。我们看到一个人需要医疗帮助，但我们犹豫是否要帮助他，因为我们不知道这种可能救命的帮助是否会让他破产。在美国，每年大约有65万人因医疗账单而申请破产。这占所有个人破产的60%以上。

Eventually, the store clerk called an ambulance; I assumed, due to liability issues, that they were obligated to call for help.

最终，店员叫了救护车；我猜想，由于责任问题，他们有义务呼叫帮助。

I watched the paramedics move the guy into an ambulance. I hope he’s alright and he has insurance to pay for the ER visit.

我看着医护人员将那个人抬上了救护车。我希望他没事，并且他有保险来支付急诊室的费用。

Susan Shepherd
This is why my family has a ‘tradition’ of driving themselves to the hospital for chest pains…we can't afford the ambulance.

这就是为什么我家有一个‘传统’，当有人胸痛时，自己开车去医院……我们付不起救护车的费用。

Why I get admitted to a hospital at almost midnight for symptoms that started shortly after noon. When the attending asked why I had waited sk long to seek medical assistance, I said I had to finish my work shift, get paid, & then locate someone who could drive me to the hospital (I was unable to drive myself by that point). I couldn't afford the ambulance.

为什么我几乎在午夜时分因中午后不久出现的症状而入院。当主治医生问我为什么等了这么久才寻求医疗帮助时，我说我必须完成我的工作班次，拿到工资，然后找到一个可以开车送我去医院的人（那时我已经无法自己开车了）。我负担不起救护车的费用。

I left the hospital with no diagnosis, just the knowledge that I ‘probably’ wasn't contagious, because I couldn't afford to remain in hospital any longer.

我离开了医院，没有诊断结果，只知道我‘可能’没有传染性，因为我无法承担继续住院的费用。

It's why one family member bought a used wheelchair: they couldn't afford the knee replacement they desperately needed and was trying to hold out-in excruciating pain- until they would be old enough to qualify for Medicare.

这就是为什么一个家庭成员买了一辆二手轮椅：他们负担不起他们迫切需要的膝关节置换手术，并且试图在极度痛苦中坚持，直到他们达到有资格享受医疗保险的年龄。

It's why I'm far more accustomed to helping someone put their dislocated shoulders back into place.

这就是为什么我更习惯于帮助别人把脱臼的肩膀复位。

Most Healthcare options in the USA are a joke.

美国的大多数医疗保健选择都是笑话。

I know a lot of people will say, ‘X country has Universal Healthcare, & it has [X] problems! It's not perfect!

我知道很多人会说，‘X国家有全民医疗保健，但它有[X]问题！它并不完美！’

They're right. It's not perfect. However, it's better than what most of the USA has accessible.

他们是对的。它并不完美。然而，它比美国大多数地方所能提供的要好。

It's astounding how many politicians can't seem to grasp that a HEALTHY population is a PRODUCTIVE population- & that it's much easier to keep someone healthy than to care for them later.

令人震惊的是，许多政客似乎无法理解一个健康的人口就是有生产力的人口——而且保持一个人的健康比以后照顾他们要容易得多。

Then again, considering how many of the USA's politicians get paid (by one means or another) by the private health insurance companies & pharmaceutical companies, & how little they seem to care about their constituents…maybe it's not surprising at all.

再次考虑到美国有多少政客通过某种方式从私人健康保险公司和制药公司那里获得报酬，以及他们似乎多么不关心他们的选民……也许这根本不足为奇。

Aurolyn Luykx
Absolutely. A few months ago I fainted at a friend’s house a few hours after giving blood. My friend, alarmed, called the EMTs. Even though I was only at the ER about an hour (not admitted), the bill was nearly $15,000. My insurance paid 90% of that but now I have a bill for $1500 because I fainted. I told my friend that if that happens again, don’t call the EMTs.

绝对是这样。几个月前，我在献血后几小时在朋友家晕倒了。我的朋友很惊慌，叫了急救人员。尽管我在急诊室只待了大约一个小时（没有被收治），账单却接近15,000美元。我的保险支付了其中的90%，但现在我有一张1,500美元的账单，因为我晕倒了。我告诉我的朋友，如果这种情况再次发生，不要叫急救人员。

I once observed a GOP Congressman who was holding a town hall meeting (keep in mind the audience was overwhelmingly made up of his SUPPORTERS). At one point a constituent asked him a question about health care costs, and he replied “No one dies in the U.S. from lack of access to health care.” The crowd ROARED in indignation; they knew from hard experience that that statement was false.

我曾目睹一位共和党国会议员在举行市政厅会议（请记住，观众绝大多数是他的支持者）。有一次，一位选民向他提出了一个关于医疗费用的问题，他回答说：“在美国，没有人会因为无法获得医疗服务而死亡。”人群愤怒地咆哮起来；他们从亲身经历中知道，这种说法是错误的。

For decades Americans have been speculating about why people in ALL other comparably wealthy countries have longer lifespans. Could it be the effects of red wine, walkable cities, longer vacations, the Mediterranean diet??? Turns out it was access to health care all along. Insurance company lobbies own both parties, though Biden has made some strides in limiting their extortionary practices. The U.S. won’t get universal health care until the people demand it.

几十年来，美国人一直在猜测为什么所有其他相对富裕国家的人们寿命更长。是因为红酒的影响、可步行的城市、更长的假期、地中海饮食吗？结果发现，一直以来都是医疗保健的获取问题。保险公司的游说团体控制着两党，尽管拜登在限制他们的勒索行为方面取得了一些进展。美国不会实现全民医疗保健，直到人民要求它。

Bart Crunk
My kid had appendicitis, and needed surgery. I live in a rural area with small hospitals. There was only one surgical team in that particular hospital, and as they were in surgery, it would have been 12 hours before they could operate on my son. As he was VERY thin, getting the pain meds regulated was very difficult.

我的孩子得了阑尾炎，需要手术。我住在一个农村地区，那里只有小型医院。那家医院只有一个手术团队，而他们当时正在手术中，需要12个小时后才能为我的儿子进行手术。由于他非常瘦，调节止痛药非常困难。

They decided to transfer him to another hospital by ambulance. The bill for transporting him was $1,400, and insurance didn’t cover it as it wasn’t deemed “medically necessary”. I suppose he was just supposed to be in pain for 12 hours.

他们决定用救护车将他转移到另一家医院。运送他的费用是1400美元，而保险没有覆盖这笔费用，因为这不被认为是“医疗必要的”。我想他可能只是应该忍受12小时的痛苦。

My wife ran into a similar situation when her gall bladder decided to make its escape. It was during Covid so finding a surgical team at any nearby hospital took a while. They were going to transfer her to another hospital by ambulance, so she discharged herself against medical orders. I had concerns that insurance might not cover her ER visit as we left against orders, but they did. I drove her to another hospital to avoid another ambulance charge.

我妻子也遇到了类似的情况，当时她的胆囊出了问题。那是在新冠疫情期间，所以在附近的医院找到手术团队花了一些时间。他们打算用救护车将她转移到另一家医院，所以她违背了医生的指示自行出院了。我担心保险公司可能不会支付我们违背指示离开后的急诊费用，但他们还是支付了。我开车送她去了另一家医院，以避免再次产生救护车费用。

And that’s what healthcare is like in the US.

这就是美国的医疗保健情况。

When I was a kid I was getting sick at school everyday. Stomach pain, vomiting, just sick. I managed to hide it from my dad for almost a week as I knew it would anger him. Sick kids and Dr visits cost money and caused problems he didn’t wish to deal with. Finally I was too sick to get off the sofa and go to my bed. I cried and begged Mom to stay with me as I knew in my heart I was going to die and I was scared. Dad finally noticed and yelled at Mom for not doing something about it. The called the ER who told us to get there immediately. So after a middle of the night drive from our rented farmhouse, in a blizzard, to the hospital in the nearest town, we made it to the ER. I went into convulsions on the way up to the OR. Ruptured appendix with peritonitis. Ended up on the hospital for 3 weeks. All that could have been avoided if heath care wasn’t so expensive. Btw Dad had to file bankruptcy after that. So how is US health care better again?

当我还是个孩子的时候，我每天都在学校生病。胃痛、呕吐，就是生病了。我设法瞒了爸爸将近一个星期，因为我知道这会让他生气。生病的孩子和看医生要花钱，还会带来他不想处理的问题。最后，我病得太重了，无法从沙发上起来去床上。我哭着求妈妈陪着我，因为我知道我快要死了，我很害怕。爸爸终于注意到了，并责骂妈妈没有采取行动。他们打电话给急诊室，急诊室告诉我们立即过去。于是，在深夜，我们从租住的农舍出发，冒着暴风雪，开车到最近城镇的医院，终于到了急诊室。我在去手术室的路上开始抽搐。阑尾破裂并发腹膜炎。最终在医院住了三个星期。如果医疗费用不那么昂贵，这一切本可以避免。顺便说一下，爸爸之后不得不申请破产。那么，美国的医疗保健到底好在哪呢？

Heather Scott
I have cancer. I went to one of those free screenings. They referred me to an oncologist who takes patients without insurance. The receptionist advised just the consult would be $350, if they decided to run any tests, etc. I would be billed separately. If I had a bill it would need to be paid in full before my next visit or any treatments could start. Treatments would need to be paid for in advance and depending on the treatment I could expect to pay anywhere from $20k-100k. There's a ton of other costs and the nearest treatment center is 9 and a half hours away, meaning I would need to find somewhere to stay nearby for several weeks. I don't have it like that. Instead, I'm working on paying for my final costs since it's slightly cheaper and doable and one less thing for my family to deal with after.

我得了癌症。我去了一次免费筛查。他们把我转诊给了一位接收无保险患者的肿瘤科医生。接待员建议，仅咨询费用就要350美元，如果他们决定进行任何测试等，我会被单独收费。如果有账单，我需要在下次就诊或开始任何治疗之前全额支付。治疗需要提前支付，根据治疗的不同，我预计需要支付2万到10万美元。还有很多其他费用，而且最近的治疗中心要9个半小时的车程，这意味着我需要在附近找个地方住上几周。我没有那样的条件。相反，我正在努力支付我的最终费用，因为这稍微便宜一些，而且可行，也能让我的家人在之后少处理一件事。

Max Cady
My health insurance is $1K/month with a $7K deductible for an 80/20 coverage. I can only use a specific hospital system. A couple years ago, post knee-replacement surgery, I developed an infection. In a matter of minutes, I went from limping to unable to walk, had shortness of breath and irregular heartbeat. We had to call an ambulance. We requested they take me to an in network hospital- Sorry, you go to closest hospital.

我的健康保险每月1000美元，自付额为7000美元，保险比例为80/20。我只能使用特定的医院系统。几年前，在膝盖置换手术后，我感染了。在几分钟内，我从跛行变成了无法行走，呼吸急促，心跳不规律。我们不得不叫救护车。我们请求他们带我去网络内的医院——抱歉，你得去最近的医院。

I was admitted after a 15 hour stint in the ED. I was inpatient at this unit for five days. The insurance company refused to cover anything as 1) their doctor did not classify my ED treatment as emergent. 2) My inpatient care was out of network. ED bill for 15 hours, pain meds,xray/ct, & antibiotics-$18,000. The inpatient total was over$120K. I had to fight with doctors, hospital admin, insurance companies and their doctors over an 8 month period to get this settled. I was threaten with collection agencies and legal action.

我在急诊室待了15个小时后被收治入院。我在这个病房住院了五天。保险公司拒绝支付任何费用，因为1）他们的医生没有将我的急诊治疗归类为紧急情况。2）我的住院治疗不在网络内。15小时的急诊账单，包括止痛药、X光/CT和抗生素，费用为18,000美元。住院总费用超过12万美元。我不得不与医生、医院管理人员、保险公司及其医生斗争了8个月才解决这个问题。我收到了催收机构和法律行动的威胁。

In the end, I paid my deductible plus another $27k for treatment. All this is above the $12K I already paid for insurance. USA - the only first world country where a person can go bankrupt from medical debt!

最终，我支付了我的免赔额以及另外2.7万美元的治疗费用。所有这些都在我已经支付的1.2万美元保险费用之上。美国——唯一一个一个人可能因医疗债务而破产的发达国家！

Leah
A couple months ago, my daughter and her husband were in the US. They were brought to a restaurant by their hosts.

几个月前，我的女儿和她的丈夫在美国。他们的主人带他们去了一家餐厅。

At the restaurant, just in front of the door, there was a woman on the ground, who seemed to be having a seizure or something. She was foaming at the mouth and seemingly unconscious or unable to communicate. People were walking around her to get in.

在餐厅里，就在门前，地上躺着一位女士，她似乎正在发作癫痫或其他什么症状。她口吐白沫，看起来已经失去意识或无法交流。人们从她身边走过进入餐厅。

Someone decided to call 911, and some emergency services came (I don’t know which exactly). They proclaimed she needed an ambulance and to be taken to the hospital immediately.

有人决定拨打911，一些紧急服务来了（我不知道具体是哪些）。他们宣布她需要救护车，并立即被送往医院。

Someone near her cried out- she doesn’t have insurance! So they stood up and said, “Oh, okay. Well… try to keep her hydrated.” …. and left.

她旁边有人喊道——她没有保险！于是他们站起来说：“哦，好吧。嗯……尽量让她保持水分。”……然后离开了。

My daughter was raised in France, so she found this shocking, and had trouble eating, seeing the woman on the ground in this state the whole time. I was raised in the US, and am quite accustomed to this. I am used to avoiding any healthcare as long as possible to avoid the cost. But for some other countries, it is completely insane.

我的女儿在法国长大，所以她对此感到震惊，并且难以进食，看到那个女人一直处于这种状态。我在美国长大，对此已经非常习惯了。我习惯尽可能长时间地避免任何医疗保健，以避免费用。但对于其他一些国家来说，这完全是疯狂的。

C.S. Friedman
A couple of years ago I had just gone onto Medicare so I had good insurance for the first time in my life. Before that I had an Obamacare policy with a $6000 deductible and shitty coverage.

几年前我刚加入医疗保险，那是我人生中第一次有了不错的保险。在此之前，我有一份奥巴马医改政策的保险，免赔额高达6000美元，而且保障很差。

One day my shin seemed swollen and tender and hot. Time passed and It wasn't going away. It struck me that there was a small chance it could be a blood clot and I should have it checked out ASAP.

有一天，我的小腿似乎肿胀、疼痛且发热。时间过去了，情况并没有好转。我突然想到，这有可能是血栓，应该尽快去检查。

Went to the emergency room of the local hospital, where they told me they didn't think it was that, but they would run some tests to make sure. Some really expensive tests with complicated machines. I also had an exhaustive blood panel done. As I sat there in their clinic waiting for someone to come to draw my blood, it suddenly hit me that if this had happened two years earlier, I would be crying in that chair. The knowledge of how many thousands of dollars this trip would cost me would be overwhelming.

去了当地医院的急诊室，他们告诉我他们认为不是那样，但他们会做一些检查来确认。一些非常昂贵的检查，使用复杂的机器。我还做了一次全面的血液检查。当我坐在他们的诊所里等待有人来抽血时，我突然想到，如果这件事发生在两年前，我会在那把椅子上哭泣。知道这次就诊会花费我数千美元，这种想法会让我感到难以承受。

A year later I had symptoms that might be a heart attack. I wasn't sure, but better safe than sorry. That required an ambulance, because they didn't want you to d tbhrive if you might be having a heart attack. That ride usually cost 1500. The best insurance I had ever been able to buy only reduced it to $500. Then there were x-rays, blood tests, EKGs, all sorts of stuff. Who knew it was so hard to be sure someone was not having a heart attack? (I wasn't).

一年后，我出现了可能是心脏病的症状。我不确定，但安全总比后悔好。这需要叫救护车，因为他们不想让你冒险，以防你可能是心脏病发作。那次救护车通常要花费1500美元。我买过的最好的保险也只能将其减少到500美元。然后还有X光、血液检查、心电图等各种检查。谁知道要确定一个人是否没有心脏病发作这么难？（我没有）。

Both times I asked myself if I would have come to the hospital with my old insurance. The answer in both cases was, probably not. I would have waited a little longer to see if the pain resolved on its own. Stupidest thing you can do with a heart attacking m, but that is how things work in the US. Many people who do go to the hospital have someone drive them instead of calling an ambulance, which means thy can't be tested it treated on the way. But ambulance use is not covered by most policies, and never completely covered.

两次我都问自己，如果我有以前的保险，我是否会来医院。两次的答案都是，可能不会。我可能会再等一会儿，看看疼痛是否会自行消失。对于心脏病发作来说，这是最愚蠢的做法，但这就是美国的情况。许多去医院的人都是让别人开车送他们，而不是叫救护车，这意味着他们无法在途中接受检查或治疗。但大多数保险都不包括救护车的使用，而且从来不会完全覆盖。

And I am not poor. For people who are, there is no choice. They will deal with wounds and sickness as long as they possibly can without help. If there is a free clinic it will require a long, stressful wait, and not with the kind of care or facilities that I experienced. And that is true even for people who have some insurance, because deductibles are often so high.

我并不贫穷。对于那些贫穷的人来说，他们别无选择。他们会尽可能地自己处理伤口和疾病，而不寻求帮助。即使有免费诊所，也需要长时间、紧张的等待，而且无法得到我所经历的那种护理或设施。即使对于那些有一些保险的人来说，这也是事实，因为免赔额通常很高。

Medical care is something many Americans go without for as long as they can.

医疗保健是许多美国人尽可能长时间避免的东西。

Al Klein
Some probably do.

有些人可能会。

On the night of April 2, I opened a package of hamburger patties, to have one for supper. It had been in the freezer, at -15° F, for about 14 months. By 3 AM, I felt as if I had poisoned myself, so I started drinking (soda and water) a lot.

在4月2日晚上，我打开了一包汉堡肉饼，准备吃一个作为晚餐。这包肉饼已经在零下15华氏度的冷冻室里放了大约14个月。到了凌晨3点，我感觉自己好像中毒了，于是开始大量喝水（苏打水和清水）。

By Sunday morning, April 6, I asked my neighbor to drive me to the ED. (I’d sooner die than get behind the wheel in that much pain.) I happen to be covered by the VA for anything Medicare doesn’t cover.

到了4月6日星期天早上，我请邻居开车送我去急诊室。（我宁愿死也不愿在那么痛的情况下开车。）我恰好有退伍军人事务部的保险，可以覆盖医疗保险不覆盖的部分。

It turned out that my gall bladder had had a party, grown a deathstar stone and been shredded better than the finest pulled pork. (It took the surgeon over an hour to clean out the rot, plus the normal hour it should have taken.)

结果发现我的胆囊举办了一场派对，长出了一颗死星般的结石，并且被切得比最细的拉猪肉还要碎。（外科医生花了一个多小时清理腐烂部分，再加上正常情况下应该花费的一个小时。）

At that point, though, I’d have gone to the ER if I had known that it would cost me $100k. (I wouldn’t be a happy camper, but I’m lucky in that I can pay that much.)

不过，如果我知道那会花掉我10万美元，我早就去急诊室了。（我不会是个快乐的露营者，但幸运的是我能付得起那么多钱。）

But a lot of Americans don’t have one week of net pay in the bank, so they ignore things until they get so serious that $100k would be cheap for what they need. Then they have to file for bankruptcy.

但是很多美国人银行里连一周的净收入都没有，所以他们一直忽视问题，直到问题变得非常严重，以至于10万美元对他们来说都是便宜的。然后他们不得不申请破产。

George Sawyer
You bet. I only go when I feel like I have no choice.

你说得对。我只有在觉得别无选择的时候才会去。

I recently cut my hand badly. I was afraid I had cut a tendon or I would not have gone at all.

我最近严重割伤了手。我担心自己割断了肌腱，否则我根本不会去医院。

I was driven by a friend to the emergency room. They encouraged me to go to the emergency room when I spoke of going to the far less expensive, walk-in ‘urgent care’ clinic.

一位朋友开车送我去急诊室。当我提到要去费用低得多的‘紧急护理’诊所时，他们鼓励我去急诊室。

I even asked the doctor who stitched up my hand if I should have gone to Urgent Care, because of the cost difference. I’m sitting on the table, bleeding, asking the doctor if I could have saved money. He said they might have sent me back to the emergency room.

我甚至问给我缝合手的医生，我是否应该去紧急护理中心，因为费用不同。我坐在桌子上，流着血，问医生我是否可以省点钱。他说他们可能会把我送回急诊室。

It was not as bad as it looked. Only two stitches, no x-rays, no tests (just taking my temperature and blood pressure). The doctor probably spent 15 minutes total with me - he was friendly, helpful, informative, and I’m told his sewing was unusually good.

情况并没有看起来那么糟糕。只缝了两针，没有拍X光片，也没有做其他检查（只是量了体温和血压）。医生总共可能只花了15分钟和我在一起——他友好、乐于助人、信息丰富，而且我被告知他的缝合技术异常出色。

The visit was over $2,000 US, my health insurance paid about $1,400, I had to pay a bit over $600.

这次访问的费用超过2000美元，我的健康保险支付了大约1400美元，我不得不支付了600多美元。

In case you are wondering, I pay about $178 per month towards my health insurance, my employer pays the rest.

如果你想知道，我每月支付大约178美元的健康保险费用，其余部分由我的雇主支付。

I know two co-workers facing heavy medical bills from emergency surgery this summer.

我知道今年夏天有两位同事因紧急手术而面临沉重的医疗费用。

If you spend a few minutes with google, you’ll see that about 500,000 Americans declare bankruptcy each year from medical debt. It is the leading cause of bankruptcy in America.

如果你花几分钟时间在谷歌上搜索，你会发现每年大约有50万美国人因医疗债务而宣布破产。这是美国破产的主要原因。

Alex Calet
An NHS ambulance call-handler who is a US citizen and was formerly an ambulance driver in New York said recently on British TV that in the US the job was easy, because it cost so much that people would not call an ambulance, so he and the others used to sit round playing cards between jobs. Now in the UK he says that he sees the amount of work our NHS ambulance staff have to do he will never go back. He now feels he is doing a proper job, helping people who need it. I haven’t seen the background stats, but Dr Adam Kay says in his book “Undoctored” that two-thirds of US bankruptcies have health care bills as a contributing factor and less than half of Americans could afford an unexpected medical bill of $1000, which would be lucky to cover a sprained ankle.

一位NHS救护车调度员，他是美国公民，曾担任纽约的救护车司机，最近在英国电视上表示，在美国这份工作很容易，因为费用太高，人们不会叫救护车，所以他和同事们经常在任务之间坐着打牌。现在在英国，他说看到我们的NHS救护车工作人员必须完成的工作量，他永远不会回去。他现在觉得自己在做一份真正的工作，帮助需要帮助的人。我还没有看到背景统计数据，但亚当·凯医生在他的书《Undoctored》中说，三分之二的美国破产案都有医疗账单作为促成因素，不到一半的美国人能够负担得起1000美元的意外医疗账单，这幸运的话可能只够支付扭伤脚踝的费用。

Francis Vincent
 The clue is in a little known statistical fact. No other wealthy industrialized country has such a high percentage of citizens dying from conditions/complaints which could have been prevented from swift medical interventions. A direct result of a reluctance to obtain medical or pharmaceutical support because of perceived financial implications.

线索在于一个鲜为人知的统计事实。没有其他富裕的工业化国家有如此高比例的公民死于本可以通过快速医疗干预预防的疾病/不适。这是因担心财务影响而不愿寻求医疗或药物支持的直接结果。

Edward Meeker
I won't tell you any story because every time someone asks a question like this, stories flood in. The amazing thing is that the best solution we have so far is the Affordable Care Act. It is a half ass solution to what is a major problem. A problem that almost every other industrial nation in the world has solved by creating some sort of socialized system. We need to tell these fu¢kers (insurance companies, pharma, and all the institutions) that use human suffering to make profit to just fu¢k off. When are we going to realize that the suffering from suffering is just not needed.

我不会告诉你任何故事，因为每次有人提出这样的问题，故事就会泛滥成灾。令人惊讶的是，我们目前最好的解决方案是《平价医疗法案》。这是一个对重大问题的不完全解决方案。世界上几乎每个其他工业化国家都通过创建某种社会化系统解决了这个问题。我们需要告诉这些利用人类痛苦来牟利的混蛋（保险公司、制药公司以及所有机构）滚蛋。我们什么时候才能意识到，痛苦带来的痛苦是不必要的。

Bill Baldwin
Yes. My wife was in the hospital with COVID. After 2 weeks the insurance company told us if she stayed longer than that we would have to pay for the entire hospital bill ourselves. This could have easily been in the hundreds of thousands of dollars, so we had no choice but to leave over the obxtions of the doctor. Fortunately, we were able to supply oxygen at home since she has lung damage due to asthma. A week later we were forced to go to the hospital again because our at home equipment could not keep up. The copay was $3400 for the two hospital stays.

是的。我妻子因COVID住院。两周后，保险公司告诉我们，如果她住院时间超过两周，我们将不得不自行支付全部住院费用。这笔费用可能高达数十万美元，所以我们别无选择，只能不顾医生的反对离开医院。幸运的是，由于她因哮喘导致肺部损伤，我们能够在家中提供氧气。一周后，我们被迫再次去医院，因为我们的家用设备无法跟上需求。两次住院的自付费用是3400美元。

Joy Freeman
I hear people complaining all the time about the cost of healthcare and health insurance. If you are lucky enough to have Medicare and can afford a good Supplemental policy without deductibles you will be well covered and not need to worry about further costs. Otherwise the deductibles alone will be burdensome.

我经常听到人们抱怨医疗保健和医疗保险的费用。如果你有幸拥有医疗保险，并且能够负担得起没有免赔额的良好补充保险，那么你将得到很好的保障，无需担心进一步的花费。否则，仅免赔额就会成为负担。

The United States is the only wealthy, industrialized nation that does not provide universal health care.

美国是唯一一个不提供全民医疗保健的富裕工业化国家。

Pete Cresswell
Dunno from “Serious", but I avoid ambulance calls and hospitals as much as possible.

不知道“严肃”是什么意思，但我尽可能避免救护车呼叫和医院。

I actually have pretty good medical insurance by USA standards - but my fear is of being treated or transported by some out-of-network provider and waking up broke.

实际上，按照美国的标准，我有相当不错的医疗保险——但我担心的是被一些不在网络内的医疗服务提供者治疗或转运，然后醒来发现自己破产了。

Ward Chartier
I’ve lived and worked in 6 countries on three continents. In all of them I was aware of people who postponed or skipped treatment because of out of pocket costs that would come from seeing a doctor or going to a hospital.

我在三个大洲的六个国家生活和工作过。在所有这些地方，我都意识到有人因为看医生或去医院需要自付费用而推迟或跳过治疗。

Lorinda Morgan
Yes. I have covid right now. Last night my husband wanted to take me to the emergency room because my breathing was labored. I refused. I can't afford to both miss work AND go to the ER. So I am home. Hoping for the best.

是的。我现在感染了新冠病毒。昨晚我丈夫想带我去急诊室，因为我的呼吸很困难。我拒绝了。我既无法承担误工的损失，也无法承担去急诊室的费用。所以我在家里。希望一切顺利。

Mark Rose
Even when insured, Americans may have to pay large co-pays and deductibles that can prevent them from being able to afford needed care. Often they have to decide if they are sick enough to rack up debt they can’t pay.

即使有保险，美国人可能仍需支付大额共付额和免赔额，这可能会使他们无法负担所需的医疗。通常，他们必须决定是否病到足以承担无法偿还的债务。

Mike
No but many people do avoid taking the ambulance because of the cost .Some people find ways to sue the hospital for money . It usually worked because the hospital didn't have the time to fight the lawsuit. Now they require you to sign a waiver for any liability even before any care is done

不，但许多人因为费用问题避免叫救护车。有些人想办法起诉医院以获取赔偿。这通常奏效，因为医院没有时间应对诉讼。现在他们要求你在接受任何治疗之前签署一份免责协议。

The fact is American is the only first world country that doesn’t have some sort of free health care and higher education. It seems they want their citizens to be unhealthy and uneducated so they are more dependent on the government for everything.

事实是，美国是唯一一个没有某种免费医疗和高等教育的发达国家。似乎他们希望他们的公民不健康且未受教育，以便他们在各方面更加依赖政府。

Mike Conte
Of course they do. You never know what bills will come in and you can’t fight them and expect to win. The collectors will break you. If you can’t afford to replace a $600 refrigerator are you going to risk a $10,000 charge because you broke your arm?

当然他们会。你永远不知道会有什么账单到来，你无法与之抗争并期望获胜。收债人会把你压垮。如果你连更换一台600美元的冰箱都负担不起，你会因为摔断了胳膊而冒10000美元的风险吗？

Kathleen Jones
Yes. That is why US citizens have a lower life expectancy than similar citizens of other developed countries in Europe. They are so frightened of medical bankruptcy, choosing health over rent or feeding their families that they let small things fester or go unchecked. It is horrible that the GOP cares more about big pharma than US citizens.

是的。这就是为什么美国公民的预期寿命低于欧洲其他发达国家的类似公民。他们非常害怕医疗破产，选择健康而不是支付房租或养家糊口，以至于让一些小问题恶化或得不到检查。令人震惊的是，共和党更关心大型制药公司而不是美国公民。

Tialisa Chapman
over a 1000 bucks for 2 stitch's you can dang well bet we avoid it. thats food for a long time, , most times its something big & that generally means food & rent go unpaid & it just cycles, then there the harassment, they even harass people in the family that have nothing to do with the patient, & they will come back AFTER YEARS to get payments. so yep we avoid it as much as possible

为了两针就花了一千多美元，你完全可以打赌我们会尽量避免。那可是一段时间的食物钱，大多数时候都是大问题，通常意味着食物和房租无法支付，然后就陷入了恶性循环。还有骚扰，他们甚至会骚扰与病人无关的家人，而且他们会在多年后回来要钱。所以是的，我们会尽可能避免。