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Every day in this country, families are forced to make impossible choices when it comes to their health care.
在这个国家的每一天，很多家庭在医疗上都要被迫做出艰难的抉择。
Like Kimberly, who said, "There was times I had to choose between my food and my pills.
就像金伯利所说，“有时候我得在食物与药物之间做出抉择。
It wasn't luxury stuff, because I didn't make that much. It was like, 'Can I get shampoo or conditioner?' Things you take for granted."
这些都不是奢侈品，因为我的收入没那么多。这问题的性质就像：‘我该买洗发剂还是护发素？’--本该是理所当然的事情。”
And Debbie, who said, "You put your medicine in one hand, your living costs in the other.
黛比也说：“一边是不得不吃的药，另一边是不得不花费的生活开销。
OK. Well, what am I going to do? Am I going to get my medicine or am I going to pay my bills?
好吧，那我该怎么做才对？我是该按时吃药，还是先支付生活开销？
Well, I can't live without my medicine, but I can't live if I don't pay my bills."
的确，我无法在没有药物的情况下生存，但我也无法在不支付生活开销的前提下生存。”
Ten thousand people die every month in this country, because they don't take the medicine that they need.
在这个国家，每个月都有多达一万人死于没有及时服用必需的药物。
More people die from not taking medications than opioid overdoses and car accidents combined.
因缺乏药物治疗的死亡人数，远远超过服用过量阿片类药物以及死于车祸意外的人数总和。
But you can't take medicine if you can't afford it.
但你确实无法获得你负担不起的药物。
Today, the average household spends 3,000 dollars a year on medications.
如今，每个家庭每年在医药方面平均要花费3000美元。
About a third of folks who are uninsured said that they stopped taking medicine as prescribed because of cost.
大约三分之一的人没有医疗保险，并因无法负担昂贵的药费而不得不停止服药。
Even folks with insurance, if they make under 35,000 dollars a year,
即使是有医疗保险的人们，如果他们的年收入低于3.5万美元，
half of them report skipping the medications if their insurance doesn't cover it.
且医疗保险没有覆盖长期的药物费用，一半的人也会选择不吃药物。
So there are 10 million adults like Kimberly and like Debbie who are forced to make impossible choices every day.
有一千万成年人正像金伯利、黛比一样，被迫每天做出这样的艰难取舍。
We all know that prescription drug prices are too high.
众所周知，当今的药物价格过于高昂。
And our health care system, that makes some folks uninsured and other folks underinsured,
而我们的医疗体系并没有给予那些没有医疗保险或是投保不足的人们
doesn't prioritize people who need access now and need medications now.
优先接受治疗或是优先服用药物的便利。
Ten million -- it's a big number, but it's also a solvable number,
一千万是个天文数字，但也是个可解的数字，
because there's also 10 billion dollars of perfectly good, unused medication that goes to waste.
因为与此同时，有价值一百亿美元完好无损且未使用过的药物被白白浪费了。
So this is an injustice on two sides: people not getting the medicine that they need to survive and to thrive,
这造成了两个方面的不公：一方面，人们无法得到他们赖以生存的药物；
and that very same medication being sent to a medical waste incinerator to be destroyed.
另一方面，同样的药物将会被送去医疗废料焚化炉，进行销毁。
This waste is unconscionable, but it also offers an opportunity.
这样的药物浪费是不合情理的，但同时也为我们提供了一个契机。
I started SIRUM, a not-for-profit technology company, with my cofounders Adam and George,
我与另外两位合伙人，亚当和乔治，共同成立了SIRUM这家非盈利科技公司，
to turn discarded medications into a lifeline, just like the medications in this warehouse.
目标是将废弃的药物转化为救人的生命线，就像这个仓库中的药物。
We may not be able to fix all the ways in which our health care system is failing us, but we can fix this one.
我们也许没办法解决医疗系统里的所有问题，但至少我们可以解决这个问题。
Medications come from manufacturers and wholesalers who have safety stock, and when it's short-dated, they destroy it.
一部分药物来自制造商和批发商的安全仓库，一旦有效期将至，它们就会被销毁。
It also comes from health care facilities like hospitals, pharmacies and nursing homes,
还有一部分药物来自医疗机构，如医院、药局和疗养院，
who end up with surplus when a patient stops taking medication or when they pass away.
尤其是病人因停止服用或是去世后所剩下的那部分。
We can use this untapped source of medications to supply all 10 million people who need medications. And we can do this today.
我们可以利用这些未开发的药物来源，满足那一千万人的药物需求。而今天我们做到了。
SIRUM gets surplus medications by putting recycling bins into these hundreds of facilities that have surplus.
SIRUM将在上百间医疗机构放置回收箱，来收集这些剩余药物。
They fill the bin, and when the box is full, SIRUM initiates a courier pickup to pick up that medication,
当回收箱装满剩余药物后，SIRUM便派快递公司前去领取这些药物，
and we handle the shipping, the tracking, the manifests and the tax receipt.
而运送、追踪货单及税务事宜都由我们自己处理。
Medicine donors want to donate because it's actually cheaper and easier than the highly regulated medicine destruction process.
药物捐赠者之所以愿意捐赠，是因为这相较于管控严格的药物销毁过程来得更加便宜、方便。
And there are strong tax incentives to actually donate.
再加之，药品捐赠者能享有更多的税务津贴。
We then deliver those donated medications to people who need it.
然后，我们将这些捐赠药物送给那些有需要的人们。
A new prescription comes in, and our platform matches that patient need with the inventory that's available.
每收到一份新的药方，我们都会对病患的需求和平台现有的药物存量进行匹配。
Our platform then generates a warehouse pick list, the medications are picked and the prescriptions filled.
我们的平台会提供仓库药物提取清单，并依照药方来配药给病患。
We are building the 21st-century pharmacy experience that low-income families deserve.
我们正在打造一个为低收入家庭服务的21世纪药局。
Patients can register in under five minutes and have access to over 500 different medications,
患者只需不到5分钟的时间便能完成注册，搜索超过500多种药物，
a stable list of medications for everything from heart disease to mental health conditions,
包括了从心脏病到身心健康的一系列药物清单，
actually representing over 75 percent of all prescriptions prescribed in the United States today.
其中囊括了全美国超过75%的药方。
We also partner with a network of doctors, nurses and case managers at community health centers and free clinics that refer patients to the service.
我们还与社区卫生中心和免费诊所的医生、护士和病例管理人员组成的网络合作，向患者推广我们的服务。
We make it as easy for these health care providers to have a prescription filled with donated medications
我们也为医护人员提供便利，让他们用这些捐赠药物为病患开药方，
as it is to send a prescription to a local pharmacy.
几乎与将药方发送给当地的药房无异。
And patients can pick up medications on-site at one of our partners or have medications delivered directly to their home.
患者可直接通过我们其中一方合作伙伴领取药物，或者要求把药物递送到家。
By circumventing the traditional supply chain,
通过规避传统的药物供应链，
we're able to offer flat, transparent pricing -- about two dollars for a month's supply of most medications.
我们的收费平价又透明--大部分药物的一个月收费大约只有两美金。
And that allows a predictable, affordable price that folks can actually budget for.
如此一来，就能提供一个可预测且相当实惠的价格，让人们能将医药费用列入日常花销。
We've already supplied enough medication for 150,000 people. But we can do more.
我们已经满足了15万人的药物需求。但我们能做的还有很多。
Our goal is to reach one million people with approaching a billion dollars of unused medicine in the next five years,
我们的目标是在接下来的五年，将价值十亿美元的未使用药物提供给一百万人，
scaling our program to 12 states.
并将这个计划扩大至十二个州。
At this scale, we can actually cover communities that are home to 40 percent of the 10 million people who lack consistent, affordable access.
这一规模让我们得以覆盖那些缺乏持续且可负担药物供应的一千万人口社区中40%的患者。
Our direct service to one million people will drive price competition for so many more.
我们为这一千万人所提供的服务会引发更多的药物价格竞争。
Walmart launched one of the only price innovations in pharmacy in 2006,
沃尔玛曾于2006年推出了极其罕见的药物创新价格活动，
by offering a limited list of medications for a flat fee of four dollars.
只需支付四美元的固定费用，就可以购买有限种类的药物。
This sparked incredible change. It sparked competitors to offer other lists and price match guarantees.
这引发了令人难以置信的变革，也激起了同行竞争者相继推出平价且具有品质保证的药物。
By targeting transparent, affordable medications into these new states,
除了将这些价格实惠、透明的药物引进这些新的州，
we can actually drive regional price competition that drives down the prices for entire low-income communities.
实际上就推动了地区性的价格竞争，从而降低了药物价格，让整个低收入群体获益。
Our health care system is complex. It is daunting. It feels impossible to make headway.
我们的医疗体系非常复杂，令人望而却步，任何改变似乎都遥不可及。
But we can completely reimagine medicine access.
但我们完全可以重塑供药环节。
By using surplus medications as a beachhead to force change into this multibillion dollar industry,
除了通过使用剩余药物作为立足点，迫使这个价值数十亿美元的产业进行改革，
we can create radical access to medications based on a fundamental belief
我们也可以凭借一个基本信念，来创造一个激进的药物供给体系，
that people who live in one of the wealthiest nations in the world can and should have access to medicine that they need to survive and to thrive.
即一个最富裕国家的人民有能力、也有资格获取他们所需的药物来维系生命和健康。
I do not pretend to have all of the answers to fix all of the problems in our health care system.
我并不是说，我们有办法解决我们医疗保健系统中所有的问题。
But getting medications to the millions of people who need it to live a healthy life, saving medicine to save lives
但为数百万人提供药物，让他们能够活得健康，避免药物被销毁的同时又能拯救生命，
that is something we can do today. Thank you.
这就是我们今天能做到的事情。谢谢。
