PBS高端访谈:医院收费差异巨大 疯狂背后寻求解决办法

 　　JEFFREY BROWN:Finally tonight: How much for that surgery or this ventilator?

　　The government today released data showing some of these costs for the first time, targeting what hospitals bill Medicare for the 100 most common procedures. And it turns out they can vary wildly from one hospital to another.

　　In Florida, for example, the University of Miami Hospital charges the government more than $78,000 dollars for a major joint¹ replacement². But the Mercy Hospital and Medical Center in Chicago charges about $36,000 dollars for a similar procedure.

　　Even within the same city, differences can be great. At the Advocate Illinois Masonic Medical Center, that procedure costs $73,000 dollars. The numbers are striking, but the picture is more confusing still, since Medicare, insurers and patients don't typically pay these sticker prices.

　　Barry Meier of The New York Times covered the story and joins us now.

　　Well, Barry, welcome to you.

　　We gave a couple of examples. Tell us more about these disparities. What jumped out at you?

　　BARRY MEIER,The New York Times: Well, first of all, thanks very much for having me on.

　　It's kind of like giving a group of high school kids calculators and say, OK, kids, add up these numbers as quickly as possible and make up whatever numbers you want. On the surface, it looks like madness, just a kind of chaos³ of numbers that don't make sense when you look at them either directly or in comparison to each other.

　　So the question is, what is the method to this madness? Are these numbers driving up hospital costs? Are they costing us more as private payers, as government payers? And one has to think that higher sticker prices invariably do lead to higher costs. So the question now becomes, what is the connection between these charges and the prices we actually do pay?

　　JEFFREY BROWN:And before you get to that, though, what explains the great disparities between and among hospitals even within the same city?

　　BARRY MEIER:As far as that goes, your guess is as good as mine. I mean, these hospitals come up with charges.

　　They're built on some base that they develop years and years ago. They play some cat-and-mouse game between insurers and payers like Medicare, where they keep lopping on higher and higher charges. Then they deduct⁴ something. Then they charge more. So they all have their own cost basis that they use, and that's what you see in the wide disparity.

　　None of these numbers have any relationship to reality.

　　JEFFREY BROWN:In your reporting, I saw they responded in various ways. Some are teaching hospitals. Some are working with, I guess, poorer populations, so there was that response at least to the numbers today.

　　BARRY MEIER:Right.

　　There is some justification⁶ for variation, for the exact—for the exact reasons that you said. And so you could see variations of, say, one to two times what the average payment might be. But, on average, what we were seeing nationally when we crunched⁷ the data was a four- to five-fold increase above the average.

　　And when we asked experts, like the official at Medicare that we interviewed, they have no clue as to why there's such a wide variation.

　　JEFFREY BROWN:Now, as we said, the government, Medicare, and insurers, they negotiate their own prices. So they're not actually paying the kinds of numbers that come out in this, right? I mean, to what degree is it a fiction? To what degree does it have real meaning for how much is actually paid?

　　BARRY MEIER:Well, I—that's the real question.

　　I mean, Medicare supposedly pays about 91 cents of what it cost a hospital to deliver a service. Insurers pay about 30 percent more than Medicare. So they're paying dramatically lower than what the hospitals are sending in as bills. But the question then becomes, is the amount that they're paying being effectively inflated⁸ because the hospitals are saying, well, it really costs us this or we charge some people this?

　　And are those—are those inflated bills showing up in the charges that are negotiated between Medicare or insurers and the hospitals?

　　JEFFREY BROWN:I see.

　　And what about for individuals, particularly uninsured individuals? How much would trickle⁹ down to them or would they have to pay?

　　BARRY MEIER:Well, they're—you know, they're seeing the full freight. They're seeing what—essentially the rack rate, you know, the highest price that the hospital will charge.

　　In some cases, they are being struck with those bills in court proceedings¹⁰. These are sort of the extraordinarily¹¹ high charges that may force people into bankruptcy¹². Other people simply don't pay the bill. And then the hospitals may write them down, write off those costs against their bottom line. So they're showing up perhaps as tax write-downs, and they're coming out of the public coffers in that way.

　　JEFFREY BROWN:Well, so, as you said at the outset here, this question that this plays into, of course, is the much larger issue of holding down costs. It's a very political issue.

　　Why are these numbers coming out now? How do they play into the current political debate? How will they be used or seen?

　　BARRY MEIER:Well, I think they play very strongly into the current political debate.

　　And that is, they open up the door to the fundamental question, which is what is the basis for the actual charge that—or the actual bill that Medicare is paying or an insurer is paying? You know, how are hospitals and health care providers, be it drug companies, medical device companies, justifying¹³ the prices that they charge?

　　Don't forget, whatever the hospital is paying is basically an accumulation of what they're paying, say, for an artificial hip⁵ or a drug. And when you start digging down into those payments, you see that everywhere along the line, these prices are inflated. They don't make sense.

　　JEFFREY BROWN:All right, Barry Meier of The New York Times, thank you so much.

　　BARRY MEIER:My pleasure. Thank you.

　　JEFFREY BROWN:And there were some technical difficulties on that audio for the interview. We apologize for those.

　　And an online note: There's a $600,000 dollar discrepancy¹⁴ on what hospitals charge Medicare for the most expensive procedure. You can find out what that is and more on our Health page.

1 joint   

adj.联合的，共同的；n.关节，接合处；v.连接，贴合

参考例句：

• I had a bad fall,which put my shoulder out of joint.我重重地摔了一跤，肩膀脫臼了。
• We wrote a letter in joint names.我们联名写了封信。

2 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。

3 chaos   

n.混乱，无秩序

参考例句：

• After the failure of electricity supply the city was in chaos.停电后，城市一片混乱。
• The typhoon left chaos behind it.台风后一片混乱。

4 deduct   

vt.扣除，减去

参考例句：

• You can deduct the twenty - five cents out of my allowance.你可在我的零用钱里扣去二角五分钱。
• On condition of your signing this contract,I will deduct a percentage.如果你在这份合同上签字，我就会给你减免一个百分比。

5 hip   

n.臀部，髋；屋脊

参考例句：

• The thigh bone is connected to the hip bone.股骨连着髋骨。
• The new coats blouse gracefully above the hip line.新外套在臀围线上优美地打着褶皱。

6 justification   

n.正当的理由；辩解的理由

参考例句：

• There's no justification for dividing the company into smaller units. 没有理由把公司划分成小单位。
• In the young there is a justification for this feeling. 在年轻人中有这种感觉是有理由的。

7 crunched   

v.嘎吱嘎吱地咬嚼( crunch的过去式和过去分词 )；嘎吱作响；（快速大量地）处理信息；数字捣弄

参考例句：

• Our feet crunched on the frozen snow. 我们的脚嘎吱嘎吱地踩在冻雪上。 来自《简明英汉词典》
• He closed his jaws on the bones and crunched. 他咬紧骨头，使劲地嚼。 来自英汉文学 - 热爱生命

8 inflated   

adj.（价格）飞涨的；（通货）膨胀的；言过其实的；充了气的v.使充气（于轮胎、气球等）( inflate的过去式和过去分词 )；（使）膨胀；（使）通货膨胀；物价上涨

参考例句：

• He has an inflated sense of his own importance. 他自视过高。
• They all seem to take an inflated view of their collective identity. 他们对自己的集体身份似乎都持有一种夸大的看法。 来自《简明英汉词典》

9 trickle   

vi.淌，滴，流出，慢慢移动，逐渐消散

参考例句：

• The stream has thinned down to a mere trickle.这条小河变成细流了。
• The flood of cars has now slowed to a trickle.汹涌的车流现在已经变得稀稀拉拉。

10 proceedings   

n.进程，过程，议程；诉讼(程序)；公报

参考例句：

• He was released on bail pending committal proceedings. 他交保获释正在候审。
• to initiate legal proceedings against sb 对某人提起诉讼

11 extraordinarily   

adv.格外地；极端地

参考例句：

• She is an extraordinarily beautiful girl.她是个美丽非凡的姑娘。
• The sea was extraordinarily calm that morning.那天清晨，大海出奇地宁静。

12 bankruptcy   

n.破产；无偿付能力

参考例句：

• You will have to pull in if you want to escape bankruptcy.如果你想避免破产，就必须节省开支。
• His firm is just on thin ice of bankruptcy.他的商号正面临破产的危险。

13 justifying   

证明…有理( justify的现在分词 )； 为…辩护； 对…作出解释； 为…辩解（或辩护）

参考例句：

• He admitted it without justifying it. 他不加辩解地承认这个想法。
• The fellow-travellers'service usually consisted of justifying all the tergiversations of Soviet intenal and foreign policy. 同路人的服务通常包括对苏联国内外政策中一切互相矛盾之处进行辩护。

14 discrepancy   

n.不同；不符；差异；矛盾

参考例句：

• The discrepancy in their ages seemed not to matter.他们之间年龄的差异似乎没有多大关系。
• There was a discrepancy in the two reports of the accident.关于那次事故的两则报道有不一致之处。