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I cannot tell you how obsessed I am with this chart.
我简直无法跟你们形容，这个表让我多生气。
It shows exactly what is wrong with America's conversation about health care.
从这张表里，我们可看出美国医疗的问题。
On one level, you've seen this chart before.
首先，大家应该已经看过这张表了。
It shows health care spending as a share of the economy of a bunch of countries.
这张表显示了一些国家医疗支出在GDP中所占的比例。
There's Germany and France and Japan and Canada and oh! There's America.
有德国、法国、日本、加拿大，噢，还有美国。
But now I want to add something you haven't seen to this chart.
但，我想通过这张表给大家看点儿你们没有看到过的内容。
This is how much of that spending in each country is private and how much is public.
这是各个国家医疗费用中公共医疗保险支出和个人医疗保险支出的比例。
Here's what's amazing:
神奇的地方在于：
America's government spending on health care on programs like Medicaid and Medicare and the VA, our versions of socialized medicine,
美国政府在医疗补助、医疗保险以及退伍军人医疗保险等医疗项目，也就是美国版本的公费医疗制度上的投入
it's about the same size as these other countries.
一点儿也不比其他国家少。
These countries where the government runs the whole health care system!
而这些国家的政府承担了国家所有的医疗费用！
And then there's our private spending.
接下来我们说说个人承担的医疗费用。
It's the private insurance system that makes health care in America so expensive.
就是个人医疗保险抬高了美国的医疗费用。
Conventional wisdom says that the government is more expensive than the private sector.
按照传统的思路，我们会觉得政府承担的医疗费用应该比个人医疗费用要高。
"It can't say no. It's corrupt, it's inefficient, it's slow."
“因为政府必须要承担，更何况政府不仅腐败无能又效率低下。”
"If you want something done right you give it to the private sector."
“如果你想要办事效率高，那就找个人医疗保险。”
That is what we hear in America all the time.
这些话我们听得耳朵都要起茧子了。
And yet here we are, with the biggest private sector spending the most.
但是事实是，个人医疗保险才是最贵的保险。
Why is the free market so bad at controlling the cost of health care in the United States?
为什么自由市场在控制美国医疗费用上如此不堪？
If you look at the data on physician visits and hospital discharges, you can get rid of one theory.
看看就医和出院方面的数据，大家就会抛弃一个观念。
Americans don't consume more health care than people in these other countries.
美国的医保并不比其他国家完善。
We don't go to the doctor more than the Germans or the Japanese. In fact we go to the doctor less.
我们看医生的频率不但没有比德国人或是日本人更高，反而更低。
The difference between us and them is that we pay more.
我们和他们之间的差别就在于我们的医疗费用更贵，
Every time we go to the doctor for everything from an angioplasty to a hip replacement,
无论我们是去做血管成形术，还是置换髋关节；
from a c-section to a pain reliever.
也无论是做剖腹产还是买止疼药。
In America, the price for the same procedure at the same hospital,
在美国，即便是去同一家医院做同样的治疗方案，
it varies enormously depending on who is footing the bill.
最终的费用也会根据付费对象产生天壤之别。
The price for someone with public insurance like Medicare or Medicaid is often the lowest price.
有医疗补助或医疗保险的人付的医药费往往是最少的。
These groups he covers so many people that the government can demand lower prices from hospitals and doctors and they get those lower prices.
因为享有这些福利的人群非常大，所以政府能够要求医院或医生降价，最终也能拿到低价。
If the doctors and hospitals say 'No' they lose a ton of business.
如果医生或医院拒绝降价，他们就会失去大量生意。
They lose all those people on Medicare, all those people on Medicaid.
他们会失去所有享受医疗保险和享受医疗补助的病人。
But there are hundreds of private insurance companies.
然而，市面上还有数不清的商业保险公司。
And they each cover far fewer people than a Medicare or a Medicaid.
这些保险公司的客户比享有医疗保险和医疗补助的人少得多。
And each one has to negotiate prices and hospitals and doctors are on their own.
而且，这些公司都要自己去跟医院或是医生协商价格。
And if you're uninsured, you have even less leverage. Nobody is negotiating on your behalf.
如果你没有参保，那你会更亏，因为没有人帮你砍价。
So you end up paying the highest price.
这样一来，你付的医药费也是最贵的。
One study found that most hospitals charge uninsured patients four times as much as Medicare patients for an ER visit.
有研究表明，大多数医院向未参保患者收取的费用是享有医保病患的四倍。
Other countries, they don't have this problem.
其他国家则没有这一问题。
Instead of every private insurance company negotiating with every healthcare provider.
他们的商业保险公司不需要自己去跟每一家医院协商价格。
There's just this big list.
他们只有一个长长的清单。
The country, the central government, they go and they say,
国家，也就是中央政府出面去跟医生谈判，
"If you want to sell to us, to all of our people, then here's what you can charge for a checkup.
“如果你们想跟我们做生意，想跟我们的客户做生意，那你们可以按照这个标准收体检费，
Here is what you can charge for an MRI or a prescription for Lipitor.
然后按这些标准收核磁共振费、药方费。
And so then whether that bill goes to the heavily regulated private insurance companies in Germany
然后，不管这个账单是要送给德国那种严格管控的商业保险公司，
or directly to the government like in the UK,
还是直接送给英国这样的政府，
each country is telling the doctor or hospital or drug company how much that bill will be.
每个国家都清楚地规定了医生、医院或是药店的具体收费标准。
And because the government controls access to all of the customers.
因为政府掌握了所有的病患，
It's an offer that hospitals and doctors and pharmaceutical companies typically can't refuse.
所以，政府的要求，无论是医院、医生还是药店都不能拒绝。
"I'm going to make him an offer he can't refuse."
“我会提一个他无法拒绝的条件”
