392: Someone Else's Money - This American Life

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00:00 00:00 Transcript Share This American Life Life Partners How to Listen Episodes Recommended About Overview Staff Announcements Fellowships Jobs Music Make Radio On The Road FAQ Submissions Merch Contact Us Our Other Shows Merch Follow Us Life Partners Subscribe to our newsletter Full episode Toggle Audio and Transcript Sync Transcript | Episode #392 | October 16, 2009 392: Someone Else's Money Note: This American Life is produced for the ear and designed to be heard.

00:00 00:00 文字记录 分享此 美国生活 生活伙伴 如何收听 剧集 推荐 关于 概述 员工公告 奖学金 工作 音乐 在路上制作电台 常见问题解答 提交 商品 联系我们 我们的其他节目 商品 关注我们 生活伙伴 订阅我们的时事通讯 整集 切换音频和文字记录同步 文字记录 | 内容第 392 集 | 2009 年 10 月 16 日 392：别人的钱 注：《美国生活》是为耳朵而制作的，旨在让人们听到。

If you are able, we strongly encourage you to listen to the audio, which includes emotion and emphasis that's not on the page.

如果可以的话，我们强烈建议您收听音频，其中包括页面上没有的情感和重点。

Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors.

文字记录是使用语音识别软件和人工转录员结合生成的，可能包含错误。

Please check the corresponding audio before quoting in print.

请在印刷版引用前检查相应的音频。

Prologue Ira Glass Here's how it works.

序言 Ira Glass 以下是它的工作原理。

You're a doctor, you help some patient, and you want to get paid for it.

你是一名医生，你帮助一些病人，并且你想为此获得报酬。

So you have to choose a code that describes what you did to put on the insurance form.

因此，您必须选择一个代码来描述您在保险表格上所做的事情。

And it's an arcane language of its own, with tens of thousands of codes.

它是一种自己的神秘语言，拥有数以万计的代码。

And just make things more confusing, every insurance company interprets the codes differently.

让事情变得更加混乱的是，每家保险公司对代码的解释都不同。

So even a simple procedure, the simplest procedure, giving somebody a shot, can become fantastically complex if you want to be reimbursed for it by insurance.

因此，如果您想通过保险获得报销，即使是一个简单的程序，最简单的程序，即给某人注射疫苗，也可能变得极其复杂。

Take the new swine flu vaccine.

服用新型猪流感疫苗。

The American Academy of Family Physicians put out a guide for physicians on how to code this.

美国家庭医师学会为医生提供了一份关于如何编码的指南。

CIGNA uses a new G9141 code, but Aetna wants you to use codes that indicate the age of the patient, 90465 to 90468 for kids, 90471 to 90474 for adults.

CIGNA 使用新的 G9141 代码，但 Aetna 希望您使用指示患者年龄的代码，儿童为 90465 至 90468，成人为 90471 至 90474。

The vaccine itself is free, but United Health Care wants you to say it costs $0.01 because its computers won't recognize a 0.

疫苗本身是免费的，但联合医疗保健公司希望您说它的价格为 0.01 美元，因为它的计算机无法识别 0。

And if you're giving somebody the swine flu shot at the same time as the regular flu shot, well then you do a 90470 plus the other codes.

如果您在注射常规流感疫苗的同时给某人注射猪流感疫苗，那么您需要输入 90470 加上其他代码。

Though if you used the 90470, you shouldn't use any codes written since the 2010 code book came out.

不过，如果您使用 90470，则不应使用自 2010 年代码书发布以来编写的任何代码。

Lost yet?

还迷路了吗？

There are things daily that are hard to code.

每天都有一些难以编码的事情。

People, when they come into your office, they come in with my arms feel weak.

人们，当他们走进你的办公室时，我的手臂感到虚弱。

Well, there is no code for that.

好吧，没有代码可以实现这一点。

Rob Lamberts is a doctor in suburban Georgia.

罗布·兰伯特是佐治亚州郊区的一名医生。

He also writes a blog called, "Musings of a Distractible Mind."

他还写了一个博客，名为“分散注意力的沉思”。

I mean, when you think about it, we have four physicians in our practice and two mid-levels.

我的意思是，仔细想想，我们有四名执业医师和两名中级医师。

And we have, I think, four full-time billing staff to help us figure out this whole process.

我认为我们有四名全职计费人员来帮助我们弄清楚整个过程。

Well, that's a lot of percent of money of our practice that's going towards just making sure our billing is working well.

嗯，我们实践中的很大一部分资金都用于确保我们的计费正常运转。

I suppose it helps the recession to have this complexity because it hires more people to do coding.

我认为这种复杂性有助于经济衰退，因为它雇佣了更多的人来编码。

Yeah, unfortunately.

是的，不幸的是。

Ira Glass There is no joke.

艾拉·格拉斯（Ira Glass） 这不是玩笑。

There are schools to teach you medical coding.

有些学校可以教你医学编码。

There are conferences whose seminars have titles like, "Keep Your 99214 and 99215 Use on the Up and Up." The American Association of Professional Coders-- and yes, there is such a thing-- says there are now 200,000 medical coders in the United States.

有些会议的研讨会标题为“让您的 99214 和 99215 不断使用”。美国专业编码员协会（是的，确实有这样的事情）表示，美国现在有 200,000 名医疗编码员。

And the Bureau of Labor Statistics says these jobs are on the rise.

美国劳工统计局表示，这些工作岗位正在增加。

They're going to rise 18% in a decade.

十年内它们将上涨 18%。

Quote, "faster than the average for all occupations."

引用：“比所有职业的平均水平都要快。”

Dr. Lamberts estimates that he and his partner spend 20% to 25% of their revenue on the billing department, and on codes that don't go through.

Lamberts 博士估计，他和他的合作伙伴将 20% 到 25% 的收入花在了计费部门以及未通过的代码上。

When they send in a wrong code, write 401 instead of 401.0, or we've got a modifier, or don't realize that they've changed the codes, the insurance company doesn't pay.

当他们发送错误的代码时，写401而不是401.0，或者我们有修改器，或者没有意识到他们已经更改了代码，保险公司不会付款。

He points out that you and I are paying for these armies of coders, who work with doctors and hospitals on one side, and insurance companies on the other.

他指出，你和我正在为这些编码员大军付费，他们一方面与医生和医院合作，另一方面与保险公司合作。

All this money spent that doesn't make anybody healthier.

花掉这么多钱并没有让任何人变得更健康。

And by the way, doesn't go to doctors.

顺便说一句，不去看医生。

What I'm being paid per visit has not really changed.

我每次访问获得的报酬并没有真正改变。

If anything, it's dropped a little bit.

如果有的话，那就是下降了一点。

Well today on our program we bring you the second of two hours that we're doing on health care in America.

今天，在我们的节目中，我们为您带来我们关于美国医疗保健的两个小时中的第二个小时。

The first was last week.

第一个是上周。

Today we look at the crazy Rube Goldberg system that we have for insurance in this country, where there's a code for an injury involving spacecraft, E845, but not one for weak arms.

今天我们来看看这个国家的疯狂鲁布·戈德堡保险系统，其中有涉及航天器的伤害代码，E845，但没有针对弱手臂的代码。

We look at how our insurance system affects everything else in our health care system.

我们研究我们的保险系统如何影响我们医疗保健系统中的其他一切。

From WBEZ Chicago it's This American Life distributed by Public Radio International, I'm Ira Glass.

来自芝加哥 WBEZ 的《This American Life》由国际公共广播电台发行，我是 Ira Glass。

Our show today in four acts.

我们今天的演出分四幕。

We guarantee you the most entertaining hour you're ever going to hear on the insurance industry.

我们保证您将享受到保险行业最有趣的时光。

Stay with us.

留在我们身边。

"Act One, One Pill, Two Pill, Red Pill, Blue Pill."

“第一幕，一粒药丸，二粒药丸，红色药丸，蓝色药丸。”

Today's show by the way, is a co-production with NPR News .

顺便说一下，今天的节目是与 NPR 新闻频道联合制作的。

We have three stories today from the Planet Money team of economics reporters.

今天我们有来自《金钱星球》经济记者团队的三个故事。

One thing that makes our insurance system so hard to understand is that so much of it is invisible to us.

使我们的保险系统如此难以理解的一件事是，其中有很多内容对我们来说是不可见的。

We get these insurance statements that are nearly incomprehensible with those insurance codes and prices that make no sense, and some things get covered, and some don't.

我们得到的保险声明几乎难以理解，保险代码和价格毫无意义，有些东西得到承保，有些则没有。

As President Obama's put it, "If we knew more about our health care choices, we'd choose better."

正如奥巴马总统所说，“如果我们更多地了解我们的医疗保健选择，我们就会做出更好的选择。”

If there's a blue pill and red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price?

如果有蓝色药丸和红色药丸，蓝色药丸的价格是红色药丸的一半，而且效果也一样，为什么不付半价呢？

Thing is, the fight over red pills and blue pills is decades old.

事实是，关于红色药丸和蓝色药丸的争论已经持续了几十年。

It's one of those things that our insurance companies are deeply involved in that we are barely aware of.

这是我们的保险公司深入参与但我们几乎没有意识到的事情之一。

Planet Money reporter Chana Joffe-Walt tells more.

《星球金钱》记者查娜·乔夫-沃尔特 (Chana Joffe-Walt) 讲述了更多内容。

Ted Sarah is in the middle of a war.

特德·莎拉正处于一场战争之中。

It's been going on for many years and involves billions of dollars.

它已经持续多年，涉及数十亿美元。

A lot of us are in this war, and like Ted, we don't even know it.

我们很多人都身处这场战争中，但像特德一样，我们甚至不知道这一点。

He stumbled onto the battlefield because he's got pimples.

他因为长了青春痘而跌跌撞撞地走上了战场。

Pimples and a card.

粉刺和一张卡片。

It is called the SOLODYN Patient Access Card.

它被称为 SOLODYN 患者访问卡。

What's it look like?

它看起来像什么？

Ted It looks like a little credit card.

特德 它看起来像一张小信用卡。

It's white and blue.

它是白色和蓝色的。

The SOLODYN Patient Access Card is just the latest weapon in this war.

SOLODYN 患者访问卡只是这场战争中的最新武器。

It's an arms race, really, that's been escalating for decades.

这实际上是一场军备竞赛，几十年来一直在不断升级。

There have been moves and counter-moves before.

之前已经有过动作和反动作。

This war, it is a war over drug copayments.

这场战争，是一场关于药品共付额的战争。

If you don't, say, run an insurance company, you probably hate copays.

例如，如果您不经营保险公司，您可能会讨厌自付费用。

They're a way to make you pay for your drugs at the pharmacy, even though you're insured.

即使您有保险，它们也是让您在药房支付药物费用的一种方式。

Which seems kind of evil, right?

这看起来有点邪恶，对吧？

But I tracked down an evil insurance VP, Eileen Wood, who actually was pretty personable.

但我找到了一位邪恶的保险副总裁艾琳·伍德（Eileen Wood），她实际上非常有风度。

And she said, no, no, no. Copays are an insurers special little way of yelling at us.

她说，不，不，不。共付额是保险公司对我们大喊大叫的一种特殊小方式。

There are drugs that cost $1,000, there are drugs that cost $5.

有些药物的价格为 1,000 美元，有些药物的价格为 5 美元。

When you're insured, you don't care.

当你有保险的时候，你就不在乎了。

You don't even know.

你甚至不知道。

So the insurers put a $30 copay on one and $10 copay on the other.

因此，保险公司为其中一个支付 30 美元的自付额，为另一笔支付 10 美元的自付额。

They're giving you a hint that there is a difference in the drug's total cost.

他们向您暗示药物的总成本存在差异。

And the consumer doesn't see that, and so we struggle to try to shine the light on that and get called the bad guy.

消费者看不到这一点，因此我们努力试图揭露这一点并被称为坏人。

Yeah, we do.

是的，我们愿意。

Chana Joffe-Walt So copays were basically a bad guy's way of doing something good for everyone.

Chana Joffe-Walt 因此，自付额基本上是坏人为每个人做好事的方式。

That's the way Eileen sees it, except for the bad guy thing.

艾琳就是这么看的，除了坏人之外。

Because if insurers could discourage us from buying expensive drugs, it's not just that they would save money, we would save money.

因为如果保险公司能够阻止我们购买昂贵的药物，那么不仅他们会省钱，我们也会省钱。

They could charge us less in premiums, which we all want.

他们可以向我们收取更少的保费，这是我们都希望的。

By the 1990s, insurance companies had it down.

到了 20 世纪 90 年代，保险公司的情况有所下降。

Copays were working really well.

共付额运作得非常好。

The insurers felt like they were winning the war, which was pretty gratifying to people like Eileen Wood.

保险公司感觉他们正在赢得这场战争，这对像艾琳·伍德这样的人来说非常令人欣慰。

She had watched for years as drug companies came out with slightly tweaked versions of existing generics and sold them for 10 times the cost.

多年来，她一直看着制药公司推出对现有仿制药稍作调整的版本，并以 10 倍的价格出售。

Our doctors told us there was a drug to help us, we went out and got it, brand name, generic, whatever, and no one cared.

我们的医生告诉我们有一种药物可以帮助我们，我们出去买了它，品牌药，非专利药，等等，但没有人关心。

No one cared because no one saw it.

没有人关心，因为没有人看到它。

No one but Eileen.

除了艾琳，没有人。

Let's look at Kapidex-- oh, that's this one.

我们来看看 Kapidex——哦，就是这个。

I love this one.

我喜欢这个。

That's the Minocin, but this company-- this is the original Minocin--

那是米诺辛，但这家公司——这是最初的米诺辛——

Eileen works in a tidy office park in Albany, New York, for an insurance company called Capital Districts Physicians Health Plan, CDPHP.

艾琳在纽约州奥尔巴尼一个整洁的办公园区为一家名为首都地区医生健康计划 (CDPHP) 的保险公司工作。

And in her file cabinets, she's got plastic zipped-up pouches of her least favorite brand name drugs.

在她的文件柜里，有塑料拉链袋，里面装着她最不喜欢的品牌药物。

She collects them.

她收集它们。

Minocin, that one she's talking about, there's a generic version that costs about $50 a month.

她所说的米诺辛（Minocin）有一个通用版本，每月费用约为 50 美元。

Minocin PAC, which Eileen is now waving in my face is a newer brand name drug.

艾琳现在在我面前挥舞的米诺辛 PAC 是一种较新的品牌药物。

It costs $668.

售价 668 美元。

So what's different?

那么有什么不同呢？

It has a couple little extra items that are not prescription items in there.

它有一些额外的小物品，不是处方物品。

It has this lovely calming wipe, so that when your skin's all red and you can pat this on and it's supposed to bring the redness down.

它有一种可爱的镇静湿巾，所以当你的皮肤全红时，你可以轻拍它，它应该可以减轻红肿。

It's not a prescription item.

它不是处方药。

Calming serum and a calming mask.

镇静精华液和镇静面膜。

It's basically stuff you could buy over the counter.

基本上都是可以在柜台购买的东西。

But behind the scenes, it's--

但在幕后，却是——

And the only difference in this is that it has wipes?

唯一的区别是它有湿巾？

It has these.

它有这些。

That's it.

就是这样。

That's the only difference.

这是唯一的区别。

You could probably buy them for $10.

你可能可以花 10 美元购买它们。

So those three products are added to the Minocin PAC and I guess that must be what costs the extra $600, I'm not sure.

因此，这三种产品被添加到 Minocin PAC 中，我想这一定是额外花费 600 美元的原因，我不确定。

It's very slick.

它非常光滑。

Eileen has dozens of stories like this, that do seem ridiculous.

艾琳有几十个这样的故事，看起来确实很荒谬。

An acne medication that comes with green tea swabs?

绿茶棉签附带的痤疮药物？

It's kind of like a prescription for Viagra that comes with a Hustler magazine that costs an extra $500.

这有点像伟哥的处方，附带一本 Hustler 杂志，需要额外花费 500 美元。

Now, not all brand names are like this.

现在，并不是所有的品牌名称都是这样的。

There are brands that are better than existing generic options that are the only thing that work for some people.

有些品牌比现有的通用选项更好，这是唯一对某些人有用的东西。

And with copays, you can still get the brands, it's just the more expensive choice.

通过共付额，您仍然可以获得品牌产品，只是更昂贵的选择。

You want the green tea swabs?

你想要绿茶棉签吗？

You pay $40 of the $668 for it.

您需要支付 668 美元中的 40 美元。

If you just want Minocin generic, you pay $10 of the $50.

如果您只想购买米诺辛仿制药，则需支付 50 美元中的 10 美元。

The copay strategy worked so well that in 2003, generics passed the 50% mark.

自付费用策略非常有效，以至于 2003 年仿制药的使用率突破了 50% 大关。

Meaning more than 50% of the drugs people went and picked up from pharmacies were generics.

这意味着人们从药店购买的药物中有超过 50% 是仿制药。

It was probably around then that it happened.

事情大概就是在那个时候发生的。

The drug companies, they noticed.

他们注意到了制药公司。

People like Sally Beatty at Pfizer.

像辉瑞公司的莎莉·比蒂这样的人。

That's the company that makes, among other things, the world's most popular drug, Lipitor.

该公司生产世界上最受欢迎的药物立普妥等产品。

Sally, not a fan of copays.

莎莉，不喜欢自付费用。

Sally Beatty The issue with that is that we want treatment decisions to be made based on what the physician feels is medically best for the patient not just the cost to the patient, or what another player may decide is in their interest.

莎莉·比蒂（Sally Beatty）的问题是，我们希望根据医生认为对患者而言最有利的治疗决策来做出治疗决策，而不仅仅是患者的成本，或者其他玩家可能认为符合他们利益的决策。

Another player like Eileen Wood and her insurance industry buddies with their copays that were hurting the drug companies.

另一位玩家，比如艾琳·伍德（Eileen Wood）和她的保险业伙伴，他们的共付额正在损害制药公司的利益。

Lipitor was facing major competition from generics.

立普妥面临着仿制药的激烈竞争。

In July 2007, sales were down 13%.

2007年7月，销售额下降了13%。

Now, there is no approved generic for Lipitor.

目前，立普妥尚无获批仿制药。

Sally Beatty from Pfizer will say this three times in 15 minutes.

辉瑞公司的 Sally Beatty 会在 15 分钟内说三遍。

And what that means is that there is no drug that is chemically identical to Lipitor.

这意味着没有任何药物的化学性质与立普妥相同。

What there are, are generic drugs in the same class of cholesterol reducing drugs.

现有的降胆固醇药物属于同一类仿制药。

That's what Lipitor does, reduce cholesterol.

这就是立普妥的作用，降低胆固醇。

And those generics are effective for most people.

这些仿制药对大多数人来说都是有效的。

But there are some people who respond better to Lipitor.

但有些人对立普妥的反应更好。

And for some of those patients, a $40 copay stops them from getting the medication.

对于其中一些患者来说，40 美元的自付费用使他们无法获得药物。

And so in 2007, the pharmaceutical industry marshaled its counterattack, that mysterious card you heard at the beginning of this story, their central weapon-- coupons, a whole bunch of coupons.

于是在2007年，制药业发起了反击，就是你在故事开头听到的那张神秘的牌，他们的核心武器——优惠券，一大堆优惠券。

OK, so I've always sort of had a little bit of acne.

好吧，所以我总是有一点痤疮。

Enter: Ted Sarah, the paralegal with the card and the pimples.

输入：泰德·莎拉（Ted Sarah），一位拿着卡片和粉刺的律师助理。

Pimples that just a few months ago were in need of drugs.

几个月前的痘痘需要药物。

Yeah, it sort of comes and goes, and it generally-- when I'm sort of going through more periods of stress, either at work or just as a course of life, it sort of gets worse.

是的，它来来去去，一般来说，当我经历更多的压力时期，无论是在工作中还是在生活中，情况都会变得更糟。

Ted walked into the doctor's office.

特德走进医生的办公室。

She poked at him with gloved hands and told him, OK, we're going to put you on a couple topical creams and some antibiotics, a drug called Solodyn.

她戴着手套的手戳了戳他，告诉他，好吧，我们要给你涂一些外用药膏和一些抗生素，一种叫做 Solodyn 的药物。

Ted was tentative, but he mentioned he'd been on a generic before, worked pretty well, called minocycline.

泰德犹豫不决，但他提到他以前服用过一种名为米诺环素的仿制药，效果很好。

And the doc said, yeah, that's great.

医生说，是的，那太好了。

Basically that's the same as Solodyn, but Solodyn is time release.

基本上与 Solodyn 相同，但 Solodyn 是时间释放的。

That means, as opposed to minocycline, which you have to remember to take in the morning and in the evening, you only have to take Solodyn once a day.

这意味着，与您必须记住在早上和晚上服用的米诺环素相反，您只需每天服用一次 Solodyn。

It didn't really sound that big of a deal to me, but it is, I guess, to anyone, slightly easier to take one pill per day instead of two, so I went with it.

对我来说，这听起来没什么大不了的，但我想，对任何人来说，每天服用一粒药丸比每天服用两粒药丸稍微容易​​一些，所以我就这么做了。

And I asked, in terms of the cost of it, just to pay the extra money to take it once a day, if that was going to be a big difference.

我问，就其费用而言，只需支付额外的钱每天服用一次，这是否会产生很大的差异。

It wouldn't really be something I'd be interested in.

这确实不是我感兴趣的事情。

And then she presented this card.

然后她递出了这张卡片。

You remember the card.

你记得那张卡。

Ted It is called the Solodyn patient access card.

Ted 它被称为 Solodyn 患者访问卡。

It's actually called Solo-DINE not Solo-DIN.

它实际上被称为 Solo-DINE，而不是 Solo-DIN。

Who knows where they come up with these names?

谁知道他们从哪里想出这些名字的？

Point is, this is the moment, the moment that the drug makers weapon makes its way into the hands of its oblivious soldier, Ted.

重点是，这一刻，制药商的武器落入了其无知的士兵泰德手中。

Ted was going to get a deal.

特德打算达成协议。

The doctor explained that this card, it's a coupon.

医生解释说，这张卡，是优惠券。

Give it to the pharmacist and it should make your copay very affordable.

把它交给药剂师，它应该会让你的自付费用非常实惠。

Which is exactly what happened.

这正是发生的事情。

Without the card Ted's copay would have been $154.28.

如果没有这张卡，Ted 的共付额将为 154.28 美元。

But when Ted got to the pharmacy, he presented his card.

但当特德到达药房时，他出示了他的卡。

They went to ring it up at the register and when it came up the price was $10.

他们去收银台登记，结果显示价格是 10 美元。

That's pretty good for drugs.

这对毒品来说是非常好的。

Ted Yeah, it was great.

特德 是的，太棒了。

Solodyn access achieved.

已实现 Solodyn 访问。

Ted's insurance company was then charged $655 a month for Ted's once-a-day Solodyn.

随后，Ted 的保险公司每月为 Ted 每天一次的 Solodyn 收取 655 美元的费用。

For reasons too complicated to go into here, they only paid $514.

由于原因太复杂，无法在此一一阐述，他们只支付了 514 美元。

Minocycline, the one that you have to take twice a day costs $109 a month, total.

米诺环素是一种每天必须服用两次的药物，每月总共花费 109 美元。

$514, $109.

514 美元，109 美元。

Ted never saw those numbers.

特德从未见过这些数字。

So you think, OK, well Ted used a coupon because he didn't really know any better.

所以你会想，好吧，特德使用了优惠券，因为他真的不知道更好的办法。

He thought he was getting a deal.

他以为他达成了协议。

Who wouldn't go for that, right?

谁不会这么做，对吧？

But the doctor, what was up with the doctor handing out these cards?

但是医生，医生发这些卡片是怎么回事？

Luckily, Dr. Elena Allbritton, was generous enough to answer some questions.

幸运的是，埃琳娜·奥尔布里顿博士很慷慨地回答了一些问题。

Do you know the price difference between those two drugs?

你知道这两种药的价格差异吗？

I don't.

我不知道。

Chana Joffe-Walt Like Ted, and the majority of Americans, Dr. Allbritton has no idea what drugs actually cost.

与泰德和大多数美国人一样，查纳·乔夫-沃尔特 (Chana Joffe-Walt) 医生也不知道药物的实际价格是多少。

Not because she's lazy, but because these numbers are really hard to find out.

不是因为她懒，而是因为这些数字实在是太难查了。

The insurance companies, they all individually negotiate with drug companies.

保险公司，他们都是单独跟制药公司谈判。

And they each pay a slightly different amount.

他们各自支付的金额略有不同。

So no, Dr. Allbritton is not thinking about prices when prescribing, she's thinking, what is the best thing available for this patient?

所以不，奥尔布里顿医生在开处方时并没有考虑价格，她在想的是，对这位患者来说最好的东西是什么？

Solodyn is better.

索洛丁更好一些。

It's easier to take a pill once a day instead of twice.

每天服用一次药丸比服用两次更容易。

It's easier for Dr. Allbritton to get the dosage just right.

奥尔布里顿医生更容易获得正确的剂量。

And Dr. Allbritton wants her patients to have the best.

奥尔布里顿医生希望她的患者得到最好的治疗。

I think if I can get a discount for most patients, I think it's great because the cost of medications can be very high.

我认为如果我能为大多数患者提供折扣，那就太好了，因为药物费用可能非常高。

It's like a free gift to them.

这对他们来说就像是一份免费礼物。

Dr. Allbritton just wants it to be easy for patients to access the drugs she thinks they need.

奥尔布里顿博士只是希望患者能够轻松获得她认为他们需要的药物。

Truthfully, she doesn't really want to keep track of all the prices.

说实话，她并不想记录所有的价格。

That's not her job.

那不是她的工作。

I just don't think that it's realistic to have that responsibility fall on the physician.

我只是认为让医生承担这个责任是不现实的。

I mean then are you going to start saying, well, should I really do this biopsy because I'm not really sure that it's really that significant of a difference in that mole and it might cost you $1,200 in the end if this doesn't get covered.

我的意思是，那么您是否会开始说，好吧，我真的应该进行活检吗？因为我不确定这颗痣的差异是否真的有那么显着，如果不涵盖在内，最终可能会花费您 1,200 美元。

I mean you don't want to start thinking about price tags with everything.

我的意思是你不想开始考虑所有东西的价格标签。

Actually, when people talk about how to reform health care in our country, this is one of the things they talk about changing.

事实上，当人们谈论如何改革我国的医疗保健时，这就是他们谈论的改变之一。

That doctors should know the prices of things, and at least play some role in deciding whether a time release version of a pill is worth $400 more to everyone.

医生应该了解药品的价格，并且至少在决定缓释版药物是否对每个人来说都值 400 美元以上方面发挥一定作用。

The maker of Solodyn is Medicis.

Solodyn 的制造商是 Medicis。

They wouldn't talk to me.

他们不肯跟我说话。

By the way, in the month since Ted started taking Solodyn, a generic version has come out.

顺便说一句，在 Ted 开始服用 Solodyn 的一个月内，通用版本已经问世。

And, the war has escalated.

而且，战争已经升级。

Another tactical maneuver.

又一个战术演习。

Drug makers used to just give cards to doctors.

制药商过去只给医生发卡片。

Now, they distribute them to patients too.

现在，他们也将它们分发给患者。

But pharmaceuticals did not announce their counterattack to insurers.

但制药公司并未宣布对保险公司进行反击。

Eileen Wood at CDPHP, she had to figure it out by putting much of her staff on a hunt, reporting back to her on what cards are out there, who put them out, and how people are getting them.

CDPHP 的艾琳·伍德 (Eileen Wood) 必须让大部分员工四处搜寻，向她报告市面上有哪些卡片、是谁发布的以及人们如何获得它们，从而弄清楚这一点。

Because they're like everywhere.

因为它们就像无处不在。

You can go online and get these.

您可以上网获取这些。

You can open up a women's magazine and get these.

你可以打开一本女性杂志并找到这些。

I mean they're everywhere.

我的意思是他们无处不在。

So this little purple card, is their way of saying, fine, you're going to put a $30 copay on us.

所以这张紫色的小卡片是他们表达的意思，好吧，你要向我们支付 30 美元的自付费用。

Take that.

拿那个。

Yes, that's exactly what's happening.

是的，这正是正在发生的事情。

They're trying to say, fine, you're promoting generic, CDPHP.

他们想说，好吧，你正在推广通用的 CDPHP。

We've got to do something about this.

我们必须对此做点什么。

We're going to waive our copay.

我们将免除自付费用。

We'll fix you.

我们会修复你的。

We'll be zero copay.

我们将零自付费用。

We'll be cheaper than you and we'll keep our market share.

我们会比你便宜，并保持我们的市场份额。

Eileen sounds a little crazy when she starts to talk like this.

艾琳这样说话的时候听起来有点疯狂。

Like multibillion dollar companies are setting out to punish her, personally, Eileen Wood, for her copays.

就像数十亿美元的公司正着手惩罚她个人，艾琳·伍德，因为她的共付额。

But when you think about it from her perspective, she is the only one who sees this stuff.

但如果你站在她的角度思考，她是唯一看到这些东西的人。

We don't.

我们不这样做。

We see a deal.

我们看到了一笔交易。

And like Ted, we like deals.

和特德一样，我们也喜欢优惠。

I can't argue with that argument, except to say there is a consequence for that.

我无法反驳这个论点，只能说这是有后果的。

Because what will you have to do if everybody gets the more expensive drug?

因为如果每个人都得到更昂贵的药物，你该怎么办？

We'd have to raise premiums.

我们必须提高保费。

I think there is no question about that.

我认为这是毫无疑问的。

It would have an impact on him and everybody that sits next to him.

这会对他和坐在他旁边的每个人产生影响。

At work.

在上班。

Eileen Wood At work and their families and so forth.

艾琳·伍德在工作中和他们的家庭等等。

Yes.

是的。

I don't want to pay more in premiums next year.

我不想明年支付更多的保费。

I don't want everyone around me to have to either.

我也不希望我周围的每个人都必须这样做。

Do you think your coworkers are going to hear this and go, well, thanks a lot, Ted?

你认为你的同事听到这个消息后会说，好吧，非常感谢，特德？

You and your fancy acne medicine.

你和你的奇特的痤疮药。

Probably.

大概。

But there I was sitting in the dermatologist's office and I have no idea.

但我坐在皮肤科医生的办公室里，我不知道。

Again, like I had never heard of this medicine, had no idea how much it costs.

再说一遍，就像我从未听说过这种药，也不知道它要花多少钱。

I know it's brand name, but I certainly never would have dreamed that it would have cost $655 sticker price.

我知道它是品牌名称，但我绝对不会想到它的标价会是 655 美元。

Looking at this war laid out like this, it's a view of a health care system that is comprised of enormous insurance companies throwing their weight around, just as enormous drug companies striking back, and then all these idiots in the middle-- us.

看看这场战争是这样展开的，这是一个由巨大的保险公司组成的医疗保健系统，就像巨大的制药公司反击一样，然后所有这些白痴在中间——我们。

You, me, and our doctors.

你、我和我们的医生。

Pesky interlopers who don't even know the price of the pills we're buying.

讨厌的闯入者甚至不知道我们购买的药丸的价格。

President Obama wants us to choose the blue pill and not the red pill.

奥巴马总统希望我们选择蓝色药丸而不是红色药丸。

Because the blue is just as effective, but half the price.

因为蓝色同样有效，但价格却只有一半。

But with these cards, which one is the blue one?

但是这些卡片中，哪一张是蓝色的呢？

We have no idea.

我们不知道。

Chana Joffe-Walt.

Chana Joffe-Walt.

Act Two: Let's Take Your Medical History Ira Glass Act Two, Let's Take Your Medical History.

第二幕：让我们记录您的病史 Ira Glass 第二幕，让我们记录您的病史。

If you think about it, it's very strange how we do insurance in our country.

如果你仔细想想，我们国家做保险的方式很奇怪。

Including, for example, the fact that most of us do not buy our own insurance.

例如，我们大多数人都不自己购买保险。

Our employers buy it for us.

我们的雇主为我们购买。

Whatever we're doing, it's not working so great.

无论我们在做什么，效果都不是很好。

Health costs are rising so fast that they're threatening our entire economy.

医疗费用上涨如此之快，以至于威胁到我们的整个经济。

A third of all health care is waste, unnecessary procedures and tests, according to the Dartmouth Atlas of Health.

根据达特茅斯健康地图集，三分之一的医疗保健是浪费、不必要的程序和测试。

How did we get here?

我们是怎么到这里的？

Alex Blumberg and Adam Davidson have been looking into that.

亚历克斯·布隆伯格和亚当·戴维森一直在研究这个问题。

The more you study the roots of our modern health care system, the more you realize that nobody ever planned for it to be this way.

您对现代医疗保健系统的根源研究得越多，您就越会意识到从来没有人计划过如此。

What we have right now is the result of lots of historical accidents over the last hundred years.

我们现在所拥有的一切是过去一百年来许多历史事故的结果。

So let's start at the beginning, at the turn of the last century, and get a sense of what health care looked like, let's say, circa 1900.

因此，让我们从上世纪初开始，了解一下 1900 年左右的医疗保健状况。

In a lot of ways the world then was starting to look like the one we have today.

从很多方面来说，当时的世界开始看起来像我们今天的世界。

There were electric lights going up in cities.

城市里出现了电灯。

Henry Ford produced the first car made in Detroit.

亨利·福特生产了第一辆在底特律制造的汽车。

The Boston Marathon was already four years old.

波士顿马拉松已经举办四年了。

But health care, health care was still basically stuck in the Middle Ages.

但是医疗保健、医疗保健基本上还停留在中世纪。

Some doctors in the US were still using leeches and bleeding people.

美国的一些医生仍在使用水蛭给病人放血。

There were medicines to mask your symptoms and relieve your pain, but there was nothing that could actually cure you.

有药物可以掩盖你的症状并减轻你的疼痛，但没有任何东西可以真正治愈你。

And hospitals, at least what we would think of as a hospital, they didn't really even exist.

而医院，至少是我们所认为的医院，实际上根本不存在。

There were things by that name, but they were basically poor houses for the sick.

确实有一些叫这个名字的东西，但它们基本上都是给病人住的简陋的房子。

Dark, dirty places where the indigent went to die.

黑暗肮脏的地方是穷人死去的地方。

But you know, there was a big plus side.

但你知道，这有很大的好处。

Health care was cheap.

Health care was cheap.

It was really, really cheap.

真的非常非常便宜。

They might kill you, but they didn't charge you very much to do it.

他们可能会杀了你，但他们并没有向你收取太多费用。

The average person spent $5 a year on health care.

平均每个人每年在医疗保健上花费 5 美元。

Even back then that wasn't very much.

即使在当时，这也不算多。

That's less than $100 a year in today's dollars.

按现在的美元计算，每年还不到 100 美元。

So, how do we get from that system, that pre-modern system, to our current health care system?

那么，我们如何从那个系统、那个前现代系统过渡到我们当前的医疗保健系统呢？

We got there in four simple steps.

我们通过四个简单的步骤实现了这一目标。

Step one: start curing some illnesses.

Step one: start curing some illnesses.

This year is the 100th anniversary of a remarkable discovery.

今年是这一非凡发现的 100 周年。

1909, the very first drug ever to actually cure an illness.

1909 年，第一种真正治愈疾病的药物。

It was something called Salvarsan, a treatment for syphilis.

这是一种叫做萨尔瓦散（Salvarsan）的药物，是一种治疗梅毒的药物。

And it was different from the usual potions and nostrums.

而且和一般的药剂和灵丹不同。

With Salvarsan, you took a pill and then you weren't sick anymore.

使用 Salvarsan，您服用一片药，然后就不再生病了。

More of these medicines followed and once health care actually starts to work, it launches a revolution.

随后出现了更多此类药物，一旦医疗保健真正开始发挥作用，就会引发一场革命。

In the 1910s and the 1920s, people start expecting their doctors to actually know how to cure them.

在 1910 年代和 20 年代，人们开始期望他们的医生真正知道如何治愈他们。

To actually have an education from some decent medical school.

实际上是从一些像样的医学院接受教育。

Maybe even to have a medical license.

Maybe even to have a medical license.

Melissa Thomasson is an economic historian at Miami University in Ohio.

梅丽莎·托马森是俄亥俄州迈阿密大学的经济历史学家。

She focuses on the history of modern health care and she says, the medical revolution was especially apparent in hospitals.

她专注于现代医疗保健的历史，她说，医疗革命在医院尤其明显。

Hospitals have a radical transformation in the early part of the 20th century.

20 世纪初，医院发生了根本性的转变。

So that instead of being these poor houses, these alms houses where unwed mothers and people with no family go, hospitals are actually marketing themselves as places to have babies, do appendectomies, take your tonsils out.

因此，医院不再是那些供未婚母亲和无家可归的人去的贫穷之家、救济院，而是实际上将自己推销为生孩子、做阑尾切除术、摘除扁桃体的地方。

They're focusing on, generally things with happy outcomes.

他们通常关注的是能带来幸福结果的事情。

Painting themselves as clean and full of sunshine.

把自己画得干净、充满阳光。

And not a dark, Victorian place for poor people to die.

而不是一个供穷人死去的维多利亚时代的黑暗地方。

All these clean hospitals with educated doctors and effective medicines, they cost more.

所有这些干净的医院都有受过教育的医生和有效的药物，但它们的费用更高。

Also, since they actually work, more and more people start using them.

此外，由于它们确实有效，越来越多的人开始使用它们。

The cost to provide health care is increasing, the demand for health care is increasing.

提供医疗保健的成本不断增加，对医疗保健的需求不断增加。

All of which means health care is now more expensive.

所有这些都意味着医疗保健现在更加昂贵。

A lot more.

还有很多。

Which brings us to step two of how you get to our modern health care system.

这让我们进入了如何获得现代医疗保健系统的第二步。

Step two: have a great depression.

第二步：极度抑郁。

It's hard to imagine what our modern health care system would be like if it wasn't for the Great Depression.

很难想象如果没有大萧条，我们的现代医疗保健系统会是什么样子。

By the 1920s, even before the crash, the cost of health care had gotten so high that a lot of people stopped going to the hospital unless they were so sick they had no choice.

到了 20 年代，甚至在经济崩溃之前，医疗保健费用就已经变得如此之高，以至于很多人不再去医院，除非他们病得很严重，别无选择。

An official at Baylor University Hospital in Dallas, Texas, noticed that most of their hospital beds were going empty every night because of that high cost.

德克萨斯州达拉斯贝勒大学医院的一名官员注意到，由于费用高昂，他们的大部分病床每天晚上都空着。

But he also noticed that Americans, on average, were spending more on cosmetics than on medical care.

但他也注意到，美国人平均在化妆品上的支出高于医疗保健上的支出。

He said specifically-- I have the quote right here, "We spend a dollar or so at a time for cosmetics and do not notice the high cost.

他具体说——我这里有一句话，“我们一次花一美元左右买化妆品，但没有注意到成本很高。

The ribbon counter clerk can pay $0.50, $0.75, or $1.00 a month, yet it would take about 20 years to set aside a large hospital bill."

丝带柜台职员每月可以支付 0.50 美元、0.75 美元或 1.00 美元，但需要大约 20 年才能拨出一大笔医院账单。”

So Baylor Hospital wanted to figure out how to get ribbon counter clerks and anyone else they could find in Dallas to pay for health care like they pay for lipstick, a tiny bit every month.

因此，贝勒医院想弄清楚如何让缎带柜台职员和他们在达拉斯能找到的其他人支付医疗费用，就像他们支付口红费用一样，每月一点点。

Baylor started small.

贝勒从小做起。

They offered a deal to a group of public school teachers in Dallas.

他们向达拉斯的一群公立学校教师提出了一项协议。

They told them, you pay us $6 a year.

他们告诉他们，你每年支付 6 美元。

That's just $0.50 a month, cheaper than rouge, and we'll give you up to 21 days of hospital visits a year.

每月只需​​ 0.50 美元，比 rouge 便宜，而且我们每年将为您提供最多 21 天的医院就诊时间。

The math was simple.

数学很简单。

In any given year, only a few of the teachers would need a hospital visit.

在任何一年中，只有少数教师需要去医院就诊。

A few hospitals copied the Baylor approach, and then the Depression hit.

一些医院效仿了贝勒的做法，然后大萧条袭来。

Almost every hospital in the country saw their patient load disappear.

该国几乎每家医院的病人数量都消失了。

All their patients were broke.

All their patients were broke.

So the Baylor idea became hugely popular.

因此，贝勒的想法变得非常受欢迎。

And eventually, it got a name: Blue Cross.

And eventually, it got a name: Blue Cross.

Again, Melissa Thomasson.

Again, Melissa Thomasson.

The genius in marketing this by Blue Cross is marketing it to groups of workers.

Blue Cross 营销这一点的巧妙之处在于向工人群体进行营销。

You know, when I actually started studying this stuff, I got interested in it because I wondered why we have an employment-based health insurance plan.

你知道，当我真正开始研究这些东西时，我对此很感兴趣，因为我想知道为什么我们有基于就业的健康保险计划。

It doesn't seem very logical.

这看起来不太符合逻辑。

But it comes right out of Blue Cross selling insurance to groups of people who probably wouldn't need it.

但这正是 Blue Cross 向可能不需要保险的人群销售保险的结果。

That is, people who were healthy enough to work.

That is, people who were healthy enough to work.

I see.

我懂了。

So how did that work?

那么这是如何运作的呢？

Blue Cross representatives went around to factories and what did they do?

蓝十字代表走访了工厂，他们做了什么？

Right.

正确的。

Exactly.

确切地。

They went around to factories.

他们去了工厂。

Here, give your employees this benefit.

Here, give your employees this benefit.

And it appealed to corporations then because the '20s and the '30s is the great period of corporate welfare capitalism too.

它对当时的企业很有吸引力，因为20世纪20年代和30年代也是企业福利资本主义的伟大时期。

Employers want to improve their workers' lives.

Employers want to improve their workers' lives.

They're starting to offer other benefits, like pensions and group life insurance at this time too.

他们此时也开始提供其他福利，例如养老金和团体人寿保险。

The Baylor plan, this Blue Cross plan, fulfilled two goals.

贝勒计划，即蓝十字计划，实现了两个目标。

They got people spending their money on health care, and it also got them to use health care more.

他们让人们把钱花在医疗保健上，也让他们更多地使用医疗保健。

To visit the hospital, to see it as a place where you go even if you weren't at death's door.

去医院看看，把它视为一个你要去的地方，即使你还没有濒临死亡。

By the middle of the Depression, there are Blue Cross programs in most states.

到大萧条中期，大多数州都有蓝十字计划。

So by the start of World War II, this employer-based health insurance is spreading.

因此，到第二次世界大战开始时，这种以雇主为基础的健康保险正在蔓延。

But still only around 9% of Americans have it.

But still only around 9% of Americans have it.

It's still pretty obscure.

It's still pretty obscure.

It's nothing like our modern system.

It's nothing like our modern system.

To get to our modern system you need another step.

要进入我们的现代系统，您需要另一个步骤。

Step three: go to war.

第三步：开战。

If the Great Depression inadvertently inspired employer-based health insurance, World War II accidentally spread the idea everywhere.

如果说大萧条无意中激发了以雇主为基础的医疗保险，那么第二次世界大战则无意中将这种想法传播到各处。

Again, economic historian, Melissa Thomasson.

Again, economic historian, Melissa Thomasson.

The war economy is an entirely different ball game.

战争经济是一种完全不同的游戏。

Think of government rationing on all levels.

Think of government rationing on all levels.

And so what they tell people is you legally cannot raise prices.

所以他们告诉人们的是，在法律上你不能提高价格。

You can't raise wages.

你无法提高工资。

At the same time, lots of people are joining the military and labor is scarce.

与此同时，大量的人参军，劳动力稀缺。

So you can't find workers.

So you can't find workers.

Can you imagine in today's environment, you can't find workers who can work for you.

您能想象在今天的环境中，您找不到可以为您工作的工人吗？

You can't lure them by increasing wages.

You can't lure them by increasing wages.

And at the same time, you need to produce enormous amounts of stuff for the war effort?

与此同时，您需要为战争生产大量的物资吗？

Exactly.

确切地。

So what's a poor employer to do?

So what's a poor employer to do?

They turn to fringe benefits.

他们转向附带福利。

And they just started offering more and more generous health insurance plans, and pensions, and everything else actually.

他们刚刚开始提供越来越慷慨的健康保险计划、养老金以及其他一切。

So you would say, Rosie, come work at my riveting factory because I can offer you this boutique insurance package versus--

所以你会说，罗西，来我的铆接工厂工作吧，因为我可以为你提供这个精品保险套餐，而不是——

Exactly.

正是如此。

Alex Blumberg The war sets the stage for step four, the final step in the transformation to the health care system we have today.

亚历克斯·布隆伯格 这场战争为第四步奠定了基础，这是我们今天的医疗保健系统转型的最后一步。

This step plays out over a number of years and it starts, like all the other steps, almost completely by accident, in a bureaucrat's office at the Internal Revenue Service.

这一步骤持续了数年，并且像所有其他步骤一样，几乎完全是在国税局官僚办公室中偶然开始的。

Now, this bureaucrat is one of the key figures, it turns out, in our American health insurance saga.

现在，事实证明，这位官僚是我们美国健康保险传奇中的关键人物之一。

But his or her name has been lost to history.

But his or her name has been lost to history.

What we do know is in 1943, this bureaucrat, or possibly a panel of bureaucrats-- we don't even know that-- made a routine ruling.

我们所知道的是，在 1943 年，这个官僚，或者可能是一个官僚小组——我们甚至不知道——做出了一项例行裁决。

Possibly in response to a question from an accountant at some company.

可能是为了回答某公司会计师的问题。

The ruling was, at least in some cases, employers don't have to pay taxes on health insurance premiums for their workers.

该裁决是，至少在某些情况下，雇主不必为其工人缴纳健康保险费税。

Now this ruling, it was actually vaguely worded and pretty confusing.

现在这个裁决，其实措辞含糊，相当混乱。

But the response was huge.

But the response was huge.

Because what it seemed to imply was, you get a huge tax break for offering health insurance to your workers.

因为它似乎意味着，为员工提供健康保险可以获得巨额税收减免。

Now I want to jump in here and really focus on this.

现在我想跳到这里并真正关注这一点。

Because this is such a perfect case study in how we get a health care system that nobody ever planned for.

因为这是一个完美的案例研究，说明我们如何建立一个从未有人计划过的医疗保健系统。

Accountants notice that they can get their firms a tax break, so more and more employers get in on the deal.

会计师注意到他们可以为公司提供税收减免，因此越来越多的雇主参与其中。

Soon they start demanding the government set it into law.

很快他们开始要求政府将其纳入法律。

And in 1954, Congress does just that.

1954 年，国会正是这样做的。

They pass the Updated Internal Revenue Code, which clearly and unambiguously states employers don't have to pay taxes on health insurance premiums.

他们通过了更新的国内税收法，该法明确无误地规定雇主不必为健康保险费缴税。

And if you don't think a tax law change can have a huge impact on health care, Melissa Thomasson has some data for you, pal.

如果您认为税法变更不会对医疗保健产生巨大影响，梅丽莎·托马森（Melissa Thomasson）可以为您提供一些数据，朋友。

Just look at how the number of people with employer-based health insurance changes over time.

只要看看拥有雇主健康保险的人数如何随时间变化即可。

You start from 9% of the population in 1940 to 63% of the population in 1953.

从 1940 年占人口的 9% 到 1953 年占人口的 63%。

Everybody starts getting in on it.

每个人都开始参与其中。

It just grows like gangbusters.

它的增长就像势如破竹。

And by the 1960s, roughly 70% of the population is covered by some kind of private-- what the AMA would say, "voluntary health insurance plan."

到了 20 世纪 60 年代，大约 70% 的人口都享受某种私人保险——美国医学会 (AMA) 所说的“自愿健康保险计划”。

So employer-based health insurance, which only started because Baylor University was able to sell to teachers in Texas, and which spread because of government price controls and tax breaks, that became our system.

因此，以雇主为基础的健康保险才开始出现，因为贝勒大学能够向德克萨斯州的教师出售产品，并由于政府的价格控制和税收减免而得以传播，这成为了我们的体系。

Employer-based insurance is a horrible system.

基于雇主的保险是一个可怕的系统。

I mean, why would you want your employer buying your health insurance?

我的意思是，您为什么希望您的雇主为您购买健康保险？

Why on earth would you want your employer buying your groceries?

您到底为什么希望您的雇主购买您的杂货？

You certainly wouldn't want that.

你肯定不希望这样。

Just imagine it.

想象一下吧。

Your employer has a contract with a grocery store.

您的雇主与杂货店签订了合同。

You go in, you pay your $20 copay, and then you get to take whatever you want.

你进去后，支付 20 美元的自付费用，然后你就可以拿走你想要的任何东西。

You'd probably go home with a lot more groceries, and you wouldn't skimp on the luxuries.

你可能会带着更多的杂货回家，而且你不会在奢侈品上吝啬。

Why get hot dogs when you can have lobster?

既然可以吃龙虾，为什么还要吃热狗呢？

And from the grocery store's point of view, it would have no incentive to keep prices down.

从杂货店的角度来看，它没有动力压低价格。

Your plan is paying the bill.

你的计划是支付账单。

Pretty soon they might get so high that people without employer provided food plans could no longer afford to eat.

很快，他们可能会变得如此之高，以至于那些没有雇主提供食物计划的人再也买不起饭了。

They'd call Congress, demand universal food coverage.

他们会打电话给国会，要求全民食品覆盖。

To economists like Thomasson, that's exactly the system we have with health.

对于托马森这样的经济学家来说，这正是我们的健康体系。

We, the consumers, are totally separated from the cost of what we're consuming.

我们作为消费者，与我们所消费的商品的成本完全无关。

We get tests and procedures we don't need because, well, why not?

我们得到了不需要的测试和程序，因为，为什么不呢？

We're not paying for it a la carte.

我们不按菜单付费。

Our employer's paying for part of it.

Our employer's paying for part of it.

Our government is paying for part of it through those tax incentives.

我们的政府正在通过这些税收优惠支付部分费用。

Melissa Thomasson says that what we have combines the worst of the market and the worst of government.

梅丽莎托马森说，我们所拥有的结合了市场和政府最糟糕的情况。

Markets are usually really good at controlling costs.

市场通常非常擅长控制成本。

When they work best, products come into existence, like cellphones, or stockings.

当它们发挥最佳作用时，产品就会出现，例如手机或袜子。

They start expensive and then they get cheaper and better.

它们一开始很贵，然后变得更便宜、更好。

But markets don't guarantee that everyone can afford the things they need.

但市场并不能保证每个人都能买得起他们需要的东西。

Government can be good at that, ensuring universal access.

政府可以擅长这一点，确保普遍获得服务。

But when you're paying for everybody, it's hard to control costs.

但当你为每个人付费时，就很难控制成本。

For Melissa Thomasson, she says that either extreme, a competitive market system where consumers know what price they're paying, what they're getting, which would probably drive the price of health care down, or a government run system, which would cover everyone would be better than the accidental mixture that we have today.

对于梅丽莎·托马森（Melissa Thomasson）来说，她说，无论是极端的竞争性市场体系（消费者知道他们支付的价格、得到的东西，这可能会压低医疗保健价格）还是政府运行的体系（覆盖所有人）都比我们今天所拥有的意外混合物要好。

A really expensive system that doesn't cover us all.

一个非常昂贵的系统并不能覆盖我们所有人。

Alex Blumberg and Adam Davidson from the Planet Money team.

来自 Planet Money 团队的 Alex Blumberg 和 Adam Davidson。

Coming up, a journey to the very frontier of health insurance.

接下来，我们将踏上健康保险最前沿的旅程。

That's in a minute.

就在一分钟之内。

From Chicago Public Radio and Public Radio International, when our program continues.

当我们的节目继续进行时，来自芝加哥公共广播电台和国际公共广播电台。

This American Life , I'm Ira Glass.

这个美国生活，我是艾拉·格拉斯。

Today's show, Someone Else's Money.

今天的节目是《别人的钱》。

Stories about the insurance industry and how it shapes everybody's health care.

关于保险业及其如何影响每个人的医疗保健的故事。

This is the second of two programs that we're doing explaining health care in America.

这是我们正在开展的解释美国医疗保健的两个项目中的第二个项目。

And both are co-productions with NPR News .

这两部影片都是与 NPR 新闻频道联合制作的。

If you missed last week's show, you can hear it on the Internet for free.

如果您错过了上周的节目，您可以在互联网上免费收听。

We've arrived at act three of our program.

我们已经进入了计划的第三幕。

"Act Three, Insurance?

“第三幕，保险？

Ruh Roh!"

鲁鲁鲁！”

We have a story for you know about the newest frontier for health insurance, a place where it's just starting out, although you can hear it right there.

我们有一个关于健康保险最新前沿的故事，虽然您可以在那里听到，但它才刚刚开始。

There it is.

就在那里。

Here's Dave Kestenbaum from the NPR Planet Money team.

请听 NPR Planet Money 团队的 Dave Kestenbaum 的报道。

If you can't tell from all the beeps, this is an operating room.

如果你无法从所有的蜂鸣声中辨别出来，那就是手术室。

On the table, one of the millions of this country's uninsured.

在桌子上，他是这个国家数百万没有保险的人之一。

The patient lies motionless connected by tubes and wires to various machines.

病人一动不动地躺着，通过管道和电线连接到各种机器。

The surgeon is about to make a cut just below the knee.

外科医生即将在膝盖下方切开一个切口。

The operation this patient's having done is one I've had done, or close to it.

这位患者所做的手术是我做过的，或者接近的。

We both tore the interior cruciate ligament that holds the knee together.

我们都撕裂了将膝盖固定在一起的内部十字韧带。

Actually, I've had two operations, both knees, and this is his second also.

事实上，我做过两次手术，都是膝盖手术，这也是他的第二次手术。

There's one big difference though, he's a dog.

但有一个很大的区别，他是一只狗。

The bill for the surgery?

手术费用是多少？

About $3,500 per knee.

每个膝盖大约3,500美元。

Looking around this veterinary hospital, you realize pet health care, more and more, is looking a lot like human health care.

环顾这家兽医医院，你会发现宠物的医疗保健越来越像人类的医疗保健。

This is Chesapeake Veterinary Surgical Specialists in Annapolis, Maryland.

我是马里兰州安纳波利斯的切萨皮克兽医外科专家。

In the next room, a weimaraner has been knocked out and is being prepped for surgery.

隔壁房间里，一只威玛猎犬已被击倒，正在准备手术。

Actually, he's being vacuumed.

事实上，他正在被吸尘。

It turns out, when a dog is unconscious, you can vacuum it.

事实证明，当狗失去知觉时，你可以用吸尘器给它吸尘。

Down the hall, dogs with cancer are getting chemotherapy.

大厅里，患有癌症的狗正在接受化疗。

The knee surgeon, Dr. Daran Roa, says not long ago, places like this just did not exist.

膝盖外科医生达兰·罗亚医生说，不久前，这样的地方还不存在。

The numbers of surgeons and internists and cardiologists and large mega practices like this across the country has gotten astronomical.

全国范围内外科医生、内科医生、心脏病专家以及类似的大型诊所的数量已经成为天文数字。

25 years ago, you couldn't find a surgeon but at a university.

25 年前，除了大学之外你找不到外科医生。

And then, if you were lucky.

然后，如果你幸运的话。

But now there's thousands of them.

但现在已经有数千人了。

And so pet health care is now crossing a magic threshold, one human health care crossed long ago.

因此，宠物医疗保健现在正在跨越一个神奇的门槛，人类医疗保健很久以前就跨越了这一门槛。

It's getting good and it's getting expensive.

It's getting good and it's getting expensive.

Expensive enough that people start thinking, wouldn't it be nice if someone else paid for this?

价格太贵了，以至于人们开始思考，如果其他人为此付钱不是很好吗？

Wouldn't it be nice to have insurance?

Wouldn't it be nice to have insurance?

Only a handful of pet owners that come here have pet insurance.

只有少数来到这里的宠物主人拥有宠物保险。

Nationwide it's a few percent or so.

Nationwide it's a few percent or so.

But the business is growing rapidly at a pace of 15% or 20% a year.

但该业务正以每年 15% 或 20% 的速度快速增长。

And you wonder if pet health care is about to import one of the major problems with human health care.

您想知道宠物医疗保健是否会成为人类医疗保健的主要问题之一。

My name is Dennis Drent and I'm the president and CEO of Veterinary Pet Insurance Company.

我叫丹尼斯·德伦特，是兽医宠物保险公司的总裁兼首席执行官。

And you're the largest pet insurance company in the United States, right?

你们是美国最大的宠物保险公司，对吧？

We are, yes.

我们是，是的。

By a lot.

很多。

By a lot.

很多。

Knock wood we stay that way.

Knock wood we stay that way.

Veterinary Pet Insurance, VPI, is a subsidiary of Nationwide Insurance.

兽医宠物保险 (VPI) 是全国保险公司的子公司。

And Dennis Drent comes from the car insurance, house insurance world.

丹尼斯·德伦特来自汽车保险、房屋保险领域。

Do you have pet?

你有宠物吗？

Dennis Drent I have two.

丹尼斯·德伦特 我有两个。

I have two miniature dachshunds.

I have two miniature dachshunds.

They're 10 years old, Willie and Charlie.

They're 10 years old, Willie and Charlie.

And, are they insured?

而且，他们有保险吗？

Dennis Drent Absolutely.

丹尼斯·德伦特 绝对的。

And I'll tell you why.

我会告诉你原因。

The veterinarians have something called stop treatment, which is a concept where they actually measure how much will somebody spend on medical procedures until they'll say it's too much and we're just going to put the pet down.

兽医有一种叫做“停止治疗”的概念，他们实际上会衡量某人在医疗程序上花费多少钱，直到他们说这太多了，我们才会把宠物放下。

So I was talking with my wife one night saying, OK, Susan, how much would you spend?

所以有一天晚上我和我的妻子谈话说，好吧，苏珊，你愿意花多少钱？

What's your stop treatment point?

What's your stop treatment point?

And we got to $10,000 and she wasn't even close to stopping treatment.

我们筹到了 10,000 美元，但她还差点停止治疗。

And I know, being in this business now, that you can run up bills over $10,000 pretty easily.

我知道，现在从事这一行业，您的账单很容易就会超过 10,000 美元。

So at that point our dogs have been insured ever since.

所以从那时起我们的狗就已经投保了。

Let's just back up there.

Let's just back up there.

That idea of stop treatment level, how much would you pay to save your cat or your dog?

停止治疗水平的想法，你愿意花多少钱来拯救你的猫或你的狗？

That is the hardest question you can ask a pet owner.

这是你可以问宠物主人的最难的问题。

But let's face it, most people have a number.

But let's face it, most people have a number.

And it's a number that the industry measures.

这是行业衡量的数字。

In 1997, it was $576.

1997 年为 576 美元。

In 2007, just 10 years later, it more than doubled to $1,451.

2007 年，仅仅 10 年后，它就增加了一倍多，达到 1,451 美元。

Insurance for a dog per month is something like $35.

一只狗每月的保险约为 35 美元。

Dennis Drent sees pet insurance as a win-win.

Dennis Drent sees pet insurance as a win-win.

Actually, a win-win-win.

其实，是三赢。

Pets' lives get saved, the insurance company makes a little money, and the vets also make more money.

宠物的生命得到了挽救，保险公司赚了一点钱，兽医也赚了更多钱。

But that win-win-win in the human health care world, it creates big problems.

但在人类医疗保健领域的这种三赢，却产生了很大的问题。

Doctors feel free to order more tests, patients don't care because they're not paying the bill.

医生可以随意安排更多的检查，但病人并不关心，因为他们不付帐单。

Everyone is so busy winning the system wastes money.

每个人都忙于赢得系统浪费金钱。

I found a report that was refreshingly blunt about the money that veterinarians can make from all this.

我发现一份关于兽医可以从这一切中赚到的钱的报告令人耳目一新。

It was put together by the National Commission on Veterinary Economic Affairs.

它是由国家兽医经济事务委员会整理的。

It's hard to imagine the American Medical Association putting out something like this for doctors.

很难想象美国医学会会为医生提供这样的东西。

The report says on page four that with pet insurance, clients quote, "likely will use your services even more often and opt for more advanced medical procedures." It points out that insurance can reduce quote, "price resistance on the part of the client." Quote, "with cost concerns removed, clients become more engaged and more responsive."

该报告在第四页称，客户引用宠物保险“可能会更频繁地使用您的服务并选择更先进的医疗程序。”它指出保险可以降低报价，“客户方面的价格阻力”。引用：“随着成本问题的消除，客户会变得更加积极参与，反应更加迅速。”

I read that part of the report to Dennis Drent, who said, "yeah, that's right."

我把报告的这一部分读给丹尼斯·德伦特听，他说：“是的，没错。”

Historically, veterinarians haven't made as much money as, for example, doctors.

从历史上看，兽医赚的钱没有医生那么多。

So we're trying to make them help them understand that through insurance they can make more money.

因此，我们试图让他们了解，通过保险他们可以赚更多的钱。

And by making more money, they can afford better procedures, better equipment, and provide better care for the animals.

通过赚更多的钱，他们可以负担得起更好的手术、更好的设备，并为动物提供更好的照顾。

So again, I keep getting back to this win-win all around.

所以，我再次不断地回到这种双赢的局面。

Ready for me to go?

准备好让我走了吗？

A big fat thank-you from me and VPI for all you do for pets and their peeps every day.

我和 VPI 衷心感谢你们每天为宠物及其窥视者所做的一切。

This is Susan Markham, who also works for VPI, the pet insurance company.

我是苏珊·马卡姆 (Susan Markham)，她也在宠物保险公司 VPI 工作。

I tagged along when she made her pitch to a veterinary hospital outside of Atlanta.

当她向亚特兰大郊外的一家兽医医院推销时，我跟着她。

The staff sat around listening politely, some in scrubs, eating barbecue that the pet insurance company had paid for.

工作人员坐在周围礼貌地听着，有些人穿着工作服，吃着宠物保险公司付了钱的烧烤。

Now in a lot of markets, you could just make the pitch, this will make you a lot of money, and that would work really well.

现在在很多市场，你只需进行推销，这会让你赚很多钱，而且效果非常好。

But it turns out, animal doctors, like people doctors, don't like thinking that money matters to them.

但事实证明，动物医生和人类医生一样，不喜欢认为金钱对他们很重要。

Their job after all, is supposed to be about something bigger: saving lives.

毕竟，他们的工作应该是为了更大的事情：拯救生命。

And Susan Markham's pitch has nothing to do with profit.

苏珊·马卡姆的宣传与利润无关。

She has a much more powerful weapon: kittens.

她有一个更强大的武器：小猫。

A particular kitten named Minnie.

A particular kitten named Minnie.

A young mother and her 8-year-old son brought Minnie in.

一位年轻的母亲和她 8 岁的儿子把米妮带了进来。

He was crying; he'd stepped on Minnie's leg and it was fractured.

他在哭；他踩到了米妮的腿，腿骨折了。

And Dr. McCarthy said, good news.

And Dr. McCarthy said, good news.

She'll go home with you tomorrow.

明天她会和你一起回家。

You won't notice that anything has happened to her six months from now.

六个月后你不会注意到她发生了任何事情。

She'll heal up and be just fine.

She'll heal up and be just fine.

But sadly that young mother declined that treatment.

但遗憾的是，这位年轻的母亲拒绝了这种治疗。

Who can tell me why she might have done that?

谁能告诉我她为什么这么做？

The story has a bad ending.

这个故事有一个糟糕的结局。

The owner felt she couldn't afford to get Minnie's leg fixed.

主人觉得她无力承担修复米妮腿的费用。

And overnight, she took Minnie to be euthanized.

一夜之间，她把米妮送去安乐死。

So Minnie's mom spent much more to have a very upset family and son, and a dead kitten than she would have had she had pet insurance.

因此，米妮的妈妈为了拥有一个非常沮丧的家庭和儿子，以及一只死去的小猫，花了比她购买宠物保险更多的钱。

And she would have had a well kitten.

她会生出一只健康的小猫。

Veterinarians are animal people.

兽医是动物人。

And one thing they hate possibly more than anything else is having to kill an animal they can fix.

他们最讨厌的一件事可能就是必须杀死他们可以修复的动物。

Which of course, is the upside to insurance.

这当然是保险的好处。

It saves lives.

它可以拯救生命。

Veterinarians have been wary of pet insurance though.

不过，兽医对宠物保险一直持谨慎态度。

They're afraid it will become more like human health care.

他们担心它会变得更像人类的医疗保健。

In particular, they're afraid of three letters: HMO.

他们尤其害怕三个字母：HMO。

Managed care.

管理护理。

They don't want an insurance company telling them how to practice medicine.

他们不希望保险公司告诉他们如何行医。

But these kind of presentations do seem to work.

但这类演示似乎确实有效。

So I've got these for you.

所以我给你准备了这些。

David Kestenbaum Susan leaves a pile of pet insurance brochures and giveaway pens on the table.

大卫·凯斯滕鲍姆·苏珊在桌子上留下了一堆宠物保险手册和赠品笔。

And prizes.

还有奖品。

And I'm going to leave you another one in case you want that to be in reception or if you want to give it to a client or--

我会给你留另一张，以防万一你想把它放在接待处或者你想把它送给客户，或者——

Win, win, win.

赢，赢，赢。

So if you're trying to decide how you feel about this whole thing, whether insurance is distorting pet health care, sending us into a world where lots of dogs will be getting $7,000 knee surgeries, or whether it's meeting a need, or both.

因此，如果你想决定你对这整件事的感受，保险是否扭曲了宠物医疗保健，让我们进入一个许多狗将接受 7,000 美元的膝盖手术的世界，或者它是否满足了需求，或者两者兼而有之。

I think it's time to meet someone who actually has pet insurance.

我认为是时候去见见真正拥有宠物保险的人了。

We first noticed that something was up with Harriet in March.

我们第一次注意到哈丽特的情况是在三月份。

This is Kristen Zorbini Bongard, she lives in Janesville, Wisconsin.

这是克里斯汀·佐比尼·邦加德 (Kristen Zorbini Bongard)，她住在威斯康星州简斯维尔。

I started doing some snuggle time with Harriet and noticed that she had a lump.

我开始和哈丽特依偎在一起，发现她有肿块。

Before we go any further into the surgeries and the tests, I have to tell you that Harriet is a hedgehog.

在我们进一步进行手术和测试之前，我必须告诉你哈丽特是一只刺猬。

A hedgehog with health insurance.

有健康保险的刺猬。

If that seems crazy to you, you do not know Kristen, and you do not know hedgehogs.

如果你觉得这很疯狂，那么你不了解克里斯汀，也不了解刺猬。

One of the many great things about hedgehogs, she says, is that they can roll up into little balls.

她说，刺猬的众多优点之一就是它们可以卷成小球。

It's adorable.

很可爱。

It's a very wonderful thing to see.

这是一件非常美妙的事情。

When you turn them over on their backs, all of a sudden, all you see is quills.

当你把它们翻过来时，突然之间，你看到的全是羽毛笔。

And it's a wonderful defense mechanism.

这是一个很棒的防御机制。

That's what it is.

就是这样。

But then all of sudden, you see a nose pop out, and two eyes, and maybe the front two paws.

但突然间，你会看到一个鼻子伸出来，还有两只眼睛，也许还有两只前爪。

And then some ears.

然后是一些耳朵。

It's a very cute thing to watch.

这是一件非常可爱的事情。

Dogs will trust just about anyone, she says, but hedgehogs, you have to earn their trust.

她说，狗几乎会信任任何人，但刺猬，你必须赢得它们的信任。

And she likes that.

她喜欢这样。

So Harriet had a lump and Kristin brought her into the vet.

哈丽特身上长了一个肿块，克里斯汀带她去看兽医。

A test showed the lump was cancerous.

测试显示肿块是癌性的。

The vet, she says, told her this in a calm, factual way.

她说，兽医以冷静、实事求是的方式告诉了她这一点。

And Kristen scheduled a date for surgery.

克里斯汀安排了手术日期。

The anesthesia that they give is a gas anesthesia.

他们给予的麻醉是气体麻醉。

Usually what they do is they put a giant mask over the entire hedgehog.

通常他们所做的就是给整个刺猬戴上一个巨大的面具。

I see.

我懂了。

Kristen Zorbini Bongard Yeah, it's rather funny to watch.

Kristen Zorbini Bongard 是的，看起来很有趣。

The lump came right out, but there were complications.

肿块很快就出来了，但出现了并发症。

It seems like she had a reaction to the sutures and she has ripped open the sutures a couple times.

她似乎对缝合线有反应，并且已经撕开缝合线好几次了。

Had to be stapled shut.

必须用订书机钉起来。

And we actually ended up going in and doing the full surgical suite to see if there was anything left in there that was bothering her.

事实上，我们最终进去做了完整的手术室，看看是否还有什么东西困扰着她。

She did end up healing, but continues to scrape at it infrequently.

她最终确实痊愈了，但仍然很少刮伤。

And so we've had to do some experimenting on her.

所以我们必须在她身上做一些实验。

She's on some hedgehog-- and I say "hedgehog" loosely-- anti-psychotics.

她正在服用某种刺猬——我宽泛地说“刺猬”——抗精神病药。

Meaning they weren't developed for hedgehogs?

这意味着它们不是为刺猬开发的？

Oh no. And as far as we know, we don't actually know that any other hedgehogs have ever been prescribed anti-psychotics.

哦不。据我们所知，我们实际上并不知道任何其他刺猬曾经被开过抗精神病药。

So Harriet gets 0.06 milliliters of medicine twice a day, and she's back to her snugly self?

那么哈丽特每天服用两次 0.06 毫升的药物，她就恢复了原来的状态了吗？

Yeah, she is very snugly.

是的，她非常贴心。

She's very snugly.

她非常贴身。

So how much did that cost?

那么这花了多少钱？

Do you actually have the bill?

你真的有账单吗？

I do.

我愿意。

In the beginning the bills were relatively low.

一开始，账单相对较低。

You know, $374, $150, $366.

你知道，374 美元、150 美元、366 美元。

And VPI paid 70% of the first bill, 60% of the second bill, 43% of the third bill.

VPI支付了第一笔账单的70%，第二笔账单的60%，第三笔账单的43%。

VPI is the pet insurance?

VPI是宠物保险吗？

Kristen Zorbini Bongard Yes.

克里斯汀·佐比尼·邦加德 是的。

Health insurance for a hedgehog costs about $80 a year.

刺猬的健康保险每年费用约为 80 美元。

And in the end, VPI put out $802 for Harriet's care.

最后，VPI 拿出 802 美元用于 Harriet 的护理。

Kristen and her husband had to pay the rest, $1,911.20 of their own money.

克里斯汀和她的丈夫必须自掏腰包支付剩下的 1,911.20 美元。

Kristen says she's not rich.

克里斯汀说她并不富有。

She says things are actually kind of tough for her and her husband.

她说，对于她和她的丈夫来说，事情实际上有点艰难。

She says, like a lot of people, they've been scaling back.

她说，像很多人一样，他们一直在缩减规模。

And at the same time, she says having insurance did make her spend more on Harriet than she would have without insurance.

与此同时，她表示，与没有保险相比，拥有保险确实让她在哈丽特身上花的钱更多。

On the other hand, it saved Harriet's life.

另一方面，它救了哈丽特的命。

I wish you had Harriet there, you could bring her up to the phone.

我希望哈里特也在场，你可以让她接电话。

Oh yeah.

哦，是的。

I can mimic the noise she would make.

我可以模仿她发出的声音。

Go ahead.

前进。

Kristen Zorbini Bongard [UNINTELLIGIBLE PHRASE] That's pretty much it.

Kristen Zorbini Bongard [难以理解的短语] 差不多就是这样。

I asked Kristen about the downside of insurance, that it can lead to all kinds of unnecessary tests and procedures.

我向克里斯汀询问保险的缺点，它可能会导致各种不必要的测试和程序。

And she agreed that could be a problem for certain pets.

她也同意这对某些宠物来说可能是一个问题。

That's an interesting argument.

这是一个有趣的论点。

I can see how that could be, especially for dogs or cats.

我可以想象这是怎么回事，尤其是对于狗或猫来说。

How come?

怎么会？

Kristen Zorbini Bongard Hey, you know, we have this new vaccine, why don't we try it on Rover?

Kristen Zorbini Bongard 嘿，你知道，我们有这种新疫苗，为什么我们不在 Rover 上尝试一下呢？

Hey, sure.

嘿，当然。

Why not?

为什么不呢？

No skin off my back.

我的背上没有皮肤。

It's covered by my insurance.

它由我的保险承保。

But I guess for me, as a hedgehog owner, there's just not that much to do.

但我想对我来说，作为刺猬的主人，没有那么多事可做。

Yes.

是的。

Yeah, she is.

是的，她是。

That's not covered by insurance, though.

不过，这不在保险范围内。

We pay for that out of pocket.

我们自掏腰包支付费用。

I know she's on anti-psychotics.

我知道她正在服用抗精神病药物。

Oh my gosh, I know.

天哪，我知道。

How can you tell if a hedgehog is psychotic?

如何判断刺猬是否患有精神病？

Oh my God.

我的天啊。

I was curious to know what an actual economist made of all this, so I called up Tim Harford.

我很好奇真正的经济学家是如何看待这一切的，所以我打电话给蒂姆·哈福德。

Hi, David, how are you?

嗨，大卫，你好吗？

David Kestenbaum OK.

大卫·凯斯滕鲍姆 好的。

Tim writes a column for The Financial Times called, "Dear Economist," where people write in with all kinds of crazy questions.

蒂姆为《金融时报》撰写了一篇名为“亲爱的经济学家”的专栏，人们在专栏中提出各种疯狂的问题。

OK, dear economist, I have a letter I wrote out here to you.

好的，亲爱的经济学家，我有一封写给您的信。

Sure.

当然。

David Kestenbaum Dear economist, is health insurance for pets good or bad?

David Kestenbaum 亲爱的经济学家，宠物健康保险是好是坏？

That's it.

就是这样。

That's the whole question.

这就是整个问题。

Like any good economist, I'm going to say yes and no. How's that?

像任何优秀的经济学家一样，我会说“是”和“不是”。怎么样？

Harford was a little shocked by the whole hedgehog thing.

哈福德对整个刺猬事件感到有点震惊。

He's not an animal lover.

他不是一个动物爱好者。

He says his parents cats used to spray his books.

他说他父母的猫经常喷他的书。

But when I explained how pet insurance worked, he actually got excited.

但当我解释宠物保险如何运作时，他实际上很兴奋。

From an economic perspective, he says, we've set up a better system for our pets than we have for ourselves.

他说，从经济角度来看，我们为宠物建立了一个比我们自己更好的系统。

One that could actually contain costs.

一种实际上可以控制成本的方法。

He likes that owners have to pay part of say, pet surgery.

他喜欢主人必须支付部分费用，比如宠物手术费用。

More than that $20 copay some of us have to cough up when we go to the doctor.

当我们去看医生时，我们中的一些人不得不咳出超过 20 美元的自付费用。

He says that forces people who have insurance to think about how much things cost.

他说，这迫使有保险的人考虑东西的成本。

He also likes that pet insurance is not bundled with our jobs.

他还喜欢宠物保险不与我们的工作捆绑在一起。

People can comparison shop, buy it on the open market, find the plan that gives them exactly what they need.

人们可以比较商店，在公开市场上购买，找到适合他们所需的计划。

You're making me very hopeful actually, David.

事实上，你让我充满希望，大卫。

I now have a vision that people are going to see pet insurance, maybe they'll see that there's a better way.

我现在的愿景是人们会看到宠物保险，也许他们会发现有更好的方法。

Maybe pet insurance is going to be the beacon that inspires us to reform human health care insurance.

也许宠物保险将成为激励我们改革人类医疗保险的灯塔。

The real downside, he says, is that pet insurance, human health insurance, they're all insurance.

他说，真正的缺点是宠物保险、人类健康保险，它们都是保险。

And insurance fundamentally, is a lousy way to pay for things.

从根本上来说，保险是一种糟糕的支付方式。

It separates people from the money they're spending.

它将人们与他们所花的钱分开。

Which inevitably leads to us winding up with tests and drugs and procedures we don't really need, just to be safe.

这不可避免地导致我们为了安全而接受我们并不真正需要的测试、药物和程序。

But there's one important difference between health insurance for pets and health insurance for us.

但宠物的健康保险和我们的健康保险之间有一个重要的区别。

With pets, I think we're used to the idea that they're going to die at some point.

对于宠物，我想我们已经习惯了它们迟早会死去的想法。

We all have that stop treatment level.

我们都有停止治疗水平。

And that alone will probably keep spending from getting too out of hand.

仅此一点就可能防止支出过于失控。

But if my wife gets in a car accident, or my kids, my stop treatment level?

但如果我的妻子或我的孩子出了车祸，我的治疗水平会停止吗？

It doesn't exist.

它不存在。

I want that insurance company to meet me at the hospital loading dock with a truck full of money.

我希望保险公司开着一辆装满钱的卡车到医院装货码头接我。

Lots and lots of money.

很多很多的钱。

David Kestenbaum.

大卫·凯斯滕鲍姆。

Act Four: Sorry Johnny...

第四幕：对不起，约翰尼……

It's Only Business.

这只是生意。

Ira Glass "Act Four, Sorry Johnny, It's Only Business."

艾拉·格拉斯“第四幕，对不起，约翰尼，这只是生意。”

Last week on our show, one of our producers, Sarah Koenig, did a story about the insurance industry and health care costs, where she talked to some of the people who run the insurance company, Aetna, and to an economist who studies all this.

上周在我们的节目中，我们的制片人之一莎拉·科尼格（Sarah Koenig）做了一个关于保险业和医疗保健成本的故事，其中她与保险公司安泰保险（Aetna）的一些经营者以及一位研究这一切的经济学家进行了交谈。

And she found out some things about the economics of the insurance industry that were so illuminating and counter-intuitive that we asked her to put together another story about what she learned, starting with Aetna.

她发现了一些关于保险业经济学的事情，这些事情非常有启发性，但又违反直觉，因此我们要求她整理另一个故事来讲述她所学到的知识，从 Aetna 开始。

Back in 2001, Aetna was a company on the verge of collapse.

早在2001年，Aetna还是一家濒临倒闭的公司。

It had bought up three other big companies to become the biggest health insurer in the country.

它收购了另外三家大公司，成为该国最大的健康保险公司。

It covered 21 million people.

它覆盖了2100万人。

But its cash flow problem was so dire it had to cut costs or go under.

但其现金流问题非常严重，以至于不得不削减成本或破产。

And the thing it did to stay solvent has been making the rounds of left leaning media lately.

最近，它为保持偿付能力所做的事情一直在左倾媒体上流传。

Because on its face it's kind of shocking.

因为从表面上看，它有点令人震惊。

Wendell Potter, a former health insurance executive for Cigna, talked about it on Bill Moyers.

Cigna 前健康保险高管温德尔·波特 (Wendell Potter) 在比尔·莫耶斯 (Bill Moyers) 节目中谈到了这一点。

Eight million policyholders?

八百万投保人？

Wendell Potter Eight million people.

温德尔·波特 八百万人。

Men, women, and children.

男人、女人和孩子。

Yes.

是的。

Potter quit the insurance business last year and is now spreading the word pretty effectively about all the tactics insurance companies use to avoid paying for sick people's treatment, so they can boost their own profits.

波特去年退出了保险业务，现在正在非常有效地传播保险公司用来避免支付病人治疗费用的所有策略，这样他们就可以增加自己的利润。

They intentionally had this program to purge these accounts.

他们故意有这个程序来清除这些帐户。

Eight million fewer people were enrolled in Aetna's plans.

参加 Aetna 计划的人数减少了 800 万人。

Many of them, undoubtedly, joined the ranks of the uninsured because their employers had been purged.

毫无疑问，他们中的许多人加入了没有保险的行列，因为他们的雇主遭到了清洗。

Went up.

上去了。

Sarah Koenig Not only did the stock go up, it quadrupled in value.

莎拉·科尼格 (Sarah Koenig) 这只股票不仅上涨，而且价值也翻了两番。

And the story of Aetna's turnaround became something of a Wall Street legend.

安泰保险扭亏为盈的故事也成为了华尔街的传奇。

Potter also used Aetna as an example when he spoke to a US senate committee in June.

波特在 6 月份向美国参议院委员会发表讲话时也以 Aetna 为例。

The implication of course, is that Aetna singled out its sickest and therefore, most expensive patients, and dumped them.

当然，这意味着安泰保险挑选出了病情最严重、因此费用最高的病人，并将他们抛弃。

It sounds really bad.

听起来真的很糟糕。

It's the kind of story we've gotten used to hearing about insurance companies.

这是我们已经习惯听到的关于保险公司的故事。

But the truth of this story is a little more complicated, a little less Machiavellian, and tells you a lot about how the insurance industry works.

但这个故事的真相有点复杂，不那么马基雅维利式的，它告诉你很多关于保险业如何运作的信息。

If you ask Jack Rowe, the Aetna CEO who engineered the turnaround, Aetna's main problem in 2001, was that it simply wasn't charging enough for its health plans.

如果你问促成这一转变的 Aetna 首席执行官杰克·罗 (Jack Rowe)，你会发现 Aetna 在 2001 年的主要问题是它的健康计划收费不够。

Customers weren't paying enough in premiums to cover what Aetna was paying out for their medical claims.

客户支付的保费不足以支付安泰保险为其医疗索赔支付的费用。

The entire year of 2001, Aetna wound up losing a million dollars a day.

2001 年全年，安泰保险每天损失 100 万美元。

So his solution, or at least a big part of it, was to raise premiums on those accounts by 10%, 20%, 30%.

所以他的解决方案，或者至少是其中的很大一部分，是将这些账户的保费提高 10%、20%、30%。

In some cases, they shot up by more than 50%.

在某些情况下，它们的涨幅超过 50%。

Many, many customers who couldn't pay the increased rates dropped Aetna's insurance.

许多无法支付增加的费率的客户放弃了 Aetna 的保险。

And Aetna did one other thing, something he says you have to do if you're in this situation.

安泰保险还做了另一件事，他说如果你处于这种情况，你就必须这样做。

What you do is you get out of the markets that you cannot effectively price your products in.

你所做的就是退出那些你无法有效定价你的产品的市场。

And what were those markets for you guys?

对你们来说这些市场是什么？

Well, the most important characteristic, what did they have in common, Jack?

好吧，最重要的特征是，他们有什么共同点，杰克？

The answer is that they were in markets in which we did not have very significant presence.

答案是，他们所处的市场是我们没有非常重要的影响力的市场。

So that the contracts that we had with the doctors and the hospitals were not as favorable as that of our competitors.

因此，我们与医生和医院签订的合同并不像我们的竞争对手那样优惠。

This is the heart of how Jack Rowe explains what happened back in 2001.

这是杰克·罗 (Jack Rowe) 解释 2001 年发生的事情的核心内容。

Contrary to what his critics allege, Jack Rowe says Aetna did not drop customers because they were sick.

与批评者的说法相反，杰克·罗表示，安泰保险并没有因为客户生病而拒绝他们。

It dropped them because they were expensive.

它放弃了它们，因为它们很昂贵。

You're assuming that the patients are more expensive because they're sick.

你假设病人因为生病而更贵。

And the fact is the patients were more expensive because we were paying the doctors and the hospitals more for the same services than our competitors were.

事实上，患者的费用更高，因为我们为相同的服务向医生和医院支付的费用比我们的竞争对手更高。

So Aetna simply folded in places where it was, say, fourth or fifth in the market and couldn't hack it against the bigger guys.

因此，安泰保险只是在市场排名第四或第五的地方放弃了，无法与更大的公司抗衡。

But taking a former CEO's word for all this didn't seem wise.

但听从一位前首席执行官的话似乎并不明智。

So I ran Jack Rowe's explanation by Uwe Reinhardt, a health care economist at Princeton University.

因此，我查阅了普林斯顿大学医疗保健经济学家乌韦·莱因哈特 (Uwe Reinhardt) 杰克·罗 (Jack Rowe) 的解释。

When he's talking about, we didn't have good contracts with hospitals, does that ring true to you?

当他谈到我们与医院没有签订良好的合同时，您认为这是真的吗？

Oh, yes.

哦是的。

The insurance market is quite fragmented, which means that in a market, unless you have a large market share, you really don't have any market power in bargaining with doctors and hospital over prices.

保险市场相当分散，这意味着在一个市场中，除非你拥有很大的市场份额，否则你真的没有任何市场力量与医生和医院讨价还价。

In other words, in a market where everyone can cut their own deal, the big insurer who brings a hospital a lot of patients, say, 75,000 a year, has a lot of leverage.

换句话说，在一个每个人都可以自行达成交易的市场中，为医院带来大量患者（例如每年 75,000 名患者）的大型保险公司拥有很大的筹码。

It can demand discounted rates from the hospital.

它可以向医院要求折扣费率。

Because the hospital can't survive without those 75,000 sick people.

因为没有这 75,000 名病人，医院就无法生存。

But to cover all its costs, the hospital's overhead, the hospital has to make up for that money it's not getting from the discounted guys.

但为了支付所有费用，即医院的管理费用，医院必须弥补没有从折扣人员那里得到的钱。

So it sticks higher prices to the littler insurers who have no leverage.

因此，它向没有杠杆作用的小型保险公司收取更高的价格。

Because the hospital can live without their, say, 600 patients.

因为医院可以在没有 600 名患者的情况下生存。

The little guy either has to eat the higher costs or pull out of that market.

小家伙要么必须承担更高的成本，要么退出这个市场。

This is called the cost shift in the business.

这称为业务成本转移。

And that is what happens in spades in the private insurance industry.

这就是私人保险行业中确实发生的情况。

It is a constant game of shifting costs from one payer to the other.

这是一场将成本从一个付款人转移到另一个付款人的持续游戏。

So that's one thing, the more competitors you have in this insurance industry, the weaker each will be in bargaining with doctors and hospitals.

所以这是一回事，在这个保险行业的竞争对手越多，每个人在与医生和医院讨价还价时的实力就越弱。

So in the health insurance world, more competition does not necessarily equal lower prices for consumers.

因此，在健康保险领域，更多的竞争并不一定等于对消费者来说更低的价格。

This is one of the many things Reinhardt told me that blew my mind.

这是莱因哈特告诉我的众多令我震惊的事情之一。

That ran counter to everything I assumed about how the free market is supposed to work.

这与我对自由市场应如何运作的所有假设背道而驰。

Another thing he told me was that there was a period when insurers were able to successfully bargain hospital prices down.

他告诉我的另一件事是，有一段时间保险公司能够成功地压低医院价格。

It was in the mid '90s when big insurance companies got a lot tougher about cutting costs, and started ramming contracts down hospitals' throats.

上世纪 90 年代中期，大型保险公司在削减成本方面变得更加强硬，并开始强行向医院强行签订合同。

Contracts hospitals found it hard to live by.

合同医院发现难以维持生计。

So in response, hospitals and other health care providers beefed up and consolidated, forming these huge health care systems that could effectively fight back against the large insurers.

因此，作为应对措施，医院和其他医疗保健提供者加强并整合，形成了这些庞大的医疗保健系统，可以有效对抗大型保险公司。

And the argument was always beautifully put.

而且这个论点总是表达得很漂亮。

The consolidation was to have more coordinated patient care.

合并是为了提供更加协调的患者护理。

This it was all just bullshine.

这一切都只是牛市而已。

What they really wanted is to have a powerful block to negotiate with the insurer.

他们真正想要的是有一个强大的力量与保险公司进行谈判。

Most health economists will tell you, the hospital sector probably is too consolidated, too powerful.

大多数健康经济学家会告诉你，医院部门可能过于整合、过于强大。

What that means is that big insurers are less and less able to resist rate hikes demanded by big providers.

这意味着大型保险公司越来越无力抵制大型提供商要求的加息。

Plus the very act of negotiating all these rates with all these different hospitals is expensive.

另外，与所有这些不同的医院协商所有这些费率的行为本身就是昂贵的。

Imagine now, Aetna has a huge number of people who all year long go around bargaining over prices with each hospital and doctor.

现在想象一下，安泰有大量的人，他们常年奔波于各个医院和医生讨价还价。

And out comes a pricing system that is simply laughable.

结果出现了一个简直可笑的定价体系。

Why should, for example, in California, if you look at WellPoint, as an insurer, for an appendectomy for some hospitals they pay them maybe $1,500.

例如，在加利福尼亚州，如果你看看 WellPoint，作为一家保险公司，为一些医院进行阑尾切除术，他们可能会支付 1,500 美元。

In other hospitals, they pay $13,000.

在其他医院，他们支付 13,000 美元。

Explain to me where that could possibly make any sense at all.

向我解释一下这在哪里可能有任何意义。

And that is why I just say the insurance industry is congenitally weak in bargaining with the supply side of the American health sector.

这就是为什么我刚才说保险业在与美国医疗卫生部门的供给方讨价还价方面先天薄弱。

And the result has been that we're spending twice as much per capita on health care than most countries without, however, the commensurate benefits that go with that.

结果是，我们在医疗保健上的人均支出是大多数国家的两倍，然而，却没有相应的福利。

Now pick your favorite theory.

现在选择你最喜欢的理论。

A, Americans are really dumb, or B, American suppliers are unbelievably clever.

A，美国人真的很蠢，或者B，美国供应商聪明得令人难以置信。

This isn't at all the picture we got from President Obama's big health care speech in September.

这根本不是我们从奥巴马总统九月份的大型医疗保健演讲中得到的画面。

When he characterized the lack of competition among insurance companies as the problem.

当他将保险公司之间缺乏竞争描述为问题时。

Without competition, the price of insurance goes up, and quality goes down.

没有竞争，保险价格就会上涨，质量就会下降。

And it makes it easier for insurance companies to treat their customers badly.

这使得保险公司更容易恶劣地对待他们的客户。

That's the foundation for his argument for a public insurance option.

这是他支持公共保险选择的论点的基础。

That more competition will keep the big guys in check.

更多的竞争将使大公司受到控制。

An additional step we can take to keep insurance companies honest is by making a not for profit public option available in the insurance exchange.

为了保持保险公司的诚实，我们可以采取的另一个步骤是在保险交易所提供非营利性的公共选项。

I don't think he does.

我不认为他这样做。

I wish I had a half hour with him to explain it to him.

我希望能有半个小时的时间和他在一起向他解释。

If you pit hundreds of little insurers against each other, what makes any one think that each of them has enough market clout to bargain successfully with a hospital?

如果让数百家小型保险公司相互竞争，是什么让任何人认为他们中的每一家都有足够的市场影响力与医院成功讨价还价？

So I don't think this public health plan, adding yet one more competitor, is going to bring costs down at all.

因此，我认为这项公共卫生计划，增加了一个竞争对手，根本不会降低成本。

I don't think many economists would actually buy that argument.

我认为很多经济学家实际上不会接受这个论点。

Reinhardt says if the public health plan was able to get low rates, Medicare-style rates from doctors and hospitals, one result could be that the hospitals would just shift their costs over to the private insurers, who would either absorb them, or in some cases, pass them on to customers in the form of higher premiums.

莱因哈特表示，如果公共卫生计划能够从医生和医院获得低费率，即医疗保险式的费率，结果可能是医院只会将成本转嫁给私人保险公司，后者要么吸收这些费用，要么在某些情况下以更高保费的形式将其转嫁给客户。

There's a lot of disagreement about that right now.

目前对此存在很多分歧。

About how or if the public option would affect cost shifting.

关于公共选择如何或是否会影响成本转移。

In any case, Reinhardt thinks we should consider a whole other way.

无论如何，莱因哈特认为我们应该考虑一种完全不同的方式。

What the president at some point-- maybe not now, he's busy.

总统在某个时候——也许不是现在，他很忙。

But at some point, needs to talk about is the virtue of an all payer system, like Maryland.

但在某些时候，需要讨论的是像马里兰州这样的全付款系统的优点。

Look to Maryland as where America ought to be.

将马里兰视为美国应有的地位。

In Maryland, for the past 30-plus years, a state commission has set prices for all procedures at all hospitals.

在马里兰州，过去 30 多年来，州委员会为所有医院的所有手术制定了价格。

There's no cost shifting.

没有成本转移。

So that every single person who ends up in the hospital, regardless of whether they've got private insurance, Medicare, Medicaid, or no insurance at all, gets the same price.

这样一来，每个最终住院的人，无论他们是否有私人保险、医疗保险、医疗补助，或者根本没有保险，都会得到相同的价格。

Beth Sammis is a deputy commissioner at the Maryland Insurance Administration.

贝丝·萨米斯 (Beth Sammis) 是马里兰州保险管理局的副局长。

So the bill is just, you came in, you had an appendectomy.

所以账单只是，你进来了，你做了阑尾切除术。

The price of the appendectomy is x amount, and that's the bill that goes out.

阑尾切除术的价格是 x 金额，这就是支出的账单。

Everyone is treated fairly.

每个人都受到公平对待。

So, regardless of their market share, no insurance company gets a discount.

因此，无论保险公司的市场份额如何，都没有一家保险公司能获得折扣。

And no insurance company gets screwed.

而且没有一家保险公司会被搞砸。

I mean we think that one of the strengths of our system is that they are not competing on hospital prices.

我的意思是，我们认为我们系统的优势之一是他们不会在医院价格上进行竞争。

And thus, in order to be able to differentiate themselves within the marketplace, they have to pay more attention to things that are within their own control.

因此，为了能够在市场中脱颖而出，他们必须更加关注自己控制范围内的事情。

Care management and how efficient they are in delivering the benefits.

护理管理以及他们提供福利的效率。

So wait, the crazy commies in Maryland think insurance companies should compete on quality, not quantity?

那么等等，马里兰州的疯狂共产主义者认为保险公司应该在质量而不是数量上竞争？

But Maryland is just one state.

但马里兰州只是其中一个州。

If the whole country operated like Maryland, Aetna might not have had to drop 8 million customers back in 2001.

如果整个国家都像马里兰州那样运作，Aetna 可能不必在 2001 年失去 800 万客户。

Instead, for the former CEO, Jack Rowe, it was the only solution that made practical sense.

相反，对于前首席执行官杰克·罗来说，这是唯一具有实际意义的解决方案。

And that strategy was a big success.

这个策略取得了巨大的成功。

Things haven't been as heady since then.

从那以后事情就没那么令人兴奋了。

This past July, Aetna released its second quarter earnings and the company's profits were down 28%.

今年7月，Aetna公布了第二季度财报，该公司利润下降了28%。

Aetna's chief executives assured Wall Street they'd right the ship in the next year by cracking down on excessive claims.

安泰保险的首席执行官向华尔街保证，他们将在明年通过打击过度索赔来扭转局面。

And by turning to their old standby, pretty much every company's standby, raising premiums.

通过转向他们的旧备用金，几乎每家公司的备用金，提高了保费。

An analyst for Barclays estimates Aetna will lose 600,000 members in the next year to meet its profit goals.

巴克莱银行的一位分析师估计，为了实现其利润目标，Aetna 将在明年失去 60 万名会员。

It's the same strategy they used in 2001.

这与他们在 2001 年使用的策略相同。

Aetna's options haven't changed because our health care system hasn't changed.

Aetna 的选择没有改变，因为我们的医疗保健系统没有改变。

Uwe Reinhardt, the health care economist, says we shouldn't blame insurance companies for how this business works.

医疗保健经济学家乌韦·莱因哈特 (Uwe Reinhardt) 表示，我们不应该因为这项业务的运作方式而责怪保险公司。

Insurance executives are not evil people.

保险高管不是坏人。

If you ever had a brew with Jack Rowe, you would find that.

如果你曾经和杰克·罗一起酿造过啤酒，你就会发现这一点。

They're not evil people, but this is the game into which they are thrust.

他们不是邪恶的人，但这就是他们被推入的游戏。

For them, given the thin margins they work on, this is all they can really do.

对于他们来说，考虑到他们的利润微薄，这就是他们真正能做的。

In fact, I once wrote a paper bringing out the worst in an otherwise good people.

事实上，我曾经写过一篇论文，揭露了原本善良的人身上最糟糕的一面。

It was a paper delivered to the insurance industry.

这是一份提交给保险业的论文。

And I said, you're all good guys.

我说，你们都是好人。

You go to church and synagogue, but you do some awfully mean things.

你去教堂和犹太教堂，但你却做了一些非常卑鄙的事情。

And you do them because you're in a structure that makes you do these things.

你做这些事情是因为你所处的结构让你做这些事情。

That story from Sarah Koenig.

莎拉·柯尼格的故事。

Credits Ira Glass Our program was produced today by Jane Feltes and myself with Alex Blumberg, Sean Cole, Sarah Koenig, Lisa Pollak, Alissa Shipp and Nancy Updike.

图片来源 Ira Glass 我们今天的节目由 Jane Feltes 和我本人以及 Alex Blumberg、Sean Cole、Sarah Koenig、Lisa Pollak、Alissa Shipp 和 Nancy Updike 共同制作。

Our senior producer is Julie Snyder.

我们的高级制片人是朱莉·斯奈德。

Production help from Aaron Scott.

亚伦·斯科特提供制作帮助。

Seth Lind is our production manager.

塞思·林德 (Seth Lind) 是我们的生产经理。

Emily Condon is our office manager.

艾米丽·康登 (Emily Condon) 是我们的办公室经理。

Our music consultant is Jessica Hopper.

我们的音乐顾问是杰西卡·霍珀。

[ACKKNOWLEDGEMENTS] Planet Money is a co-production of our program and NPR News.

[致谢] Planet Money 是我们的节目和 NPR 新闻的联合制作。

If you like the kind of stories you heard today, you can hear jargon free explanations just like it about what's going on in the economy and in the health care system.

如果您喜欢今天听到的这类故事，您可以听到关于经济和医疗保健系统中正在发生的事情的无行话解释。

You can hear them three times a week on their podcasts, www.npr.org/money.

您可以每周在他们的播客上听到他们的声音 3 次：www.npr.org/money。

This American Life is distributed by Public Radio International.

《美国生活》由国际公共广播电台发行。

WBEZ management oversight for our program by our boss, Mr. Torey Malatia.

我们的老板 Torey Malatia 先生对我们的项目进行 WBEZ 管理监督。

You know, when you roll him into a little ball he makes the most adorable noise.

你知道，当你把他卷成一个小球时，他会发出最可爱的声音。

Seriously, it sounds like this.

说真的，听起来是这样的。

[UNINTELLIGIBLE PHRASE] So snugly.

[难以理解的短语] 如此舒适。

I'm Ira Glass, back next week with a program that will not mention health care at all on This American Life .

我是艾拉·格拉斯（Ira Glass），下周带着一个完全不会提及医疗保健的节目《美国生活》回来。

This American Life is produced in collaboration with WBEZ Chicago and delivered to stations by PRX The Public Radio Exchange.

《This American Life》与 WBEZ Chicago 合作制作，并由 PRX 公共广播电台传送到各电台。