So, a little while ago, members of my family had three bits of minor surgery,
不久前，我的家人动了三次小手术，
about a half hour each, and we got three sets of bills.
每次手术约一个半小时，我们收到了三份帐单。
For the first one, the anesthesia bill alone was 2,000 dollars;
第一份账单上，光是麻醉就要两千美金；
the second one, 2,000 dollars; the third one, 6,000 dollars.
第二份账单，两千美金；第三份账单，六千美金。
So I'm a journalist. I'm like, what's up with that?
我是记者，所以我很好奇，这些费用是怎么来的？
I found out that I was actually, for the expensive one, being charged 1,419 dollars for a generic anti-nausea drug
在比较贵的帐单上，我发现其中一项非专利的抗呕吐药物就要1419美金，
that I could buy online for two dollars and forty-nine cents.
但其实我在网络上用2.49美金就能买到。
I had a long and unsatisfactory argument with the hospital, the insurer and my employer.
我向医院、保险公司以及我的雇主力争了很久，但结果并不让我满意。
Everybody agreed that this was totally fine.
大家都同意这样的做法完全没问题。
But it got me thinking, and the more I talked to people, the more I realized:
但它让我不断去思考一件事，而且我越和大家聊，就越了解到：
nobody has any idea what stuff costs in health care.
没人知道在医疗保健系统中的各项费用是多少。
Not before, during or after that procedure or test do you have any idea what it's going to cost.
在手术或检测之前、当中、之后，都不知道它会花多少钱。
It's only months later that you get an "explanation of benefits" that explains exactly nothing.
只有在几个月之后，你会收到《保险福利说明》，但它其实什么也没说清楚。
So this came back to me a little while later.
一阵子之后，我又想起了此事。
I had volunteered for a buyout from the New York Times, where I had worked for more than 20 years as a journalist.
在纽约时报当了二十年记者之后，我自愿买断工龄离职。
I was looking for my next act.
我在寻找我的下一个阶段。
It turned out that next act was to build a company telling people what stuff costs in health care.
结果，下一个阶段是去建立一家公司，来告诉大家在医疗保健中各个项目的费用。
I won a "Shark Tank"-type pitch contest to do just that.
我在一个类似“创智赢家”的商业计划比赛中赢得了这个机会。
Health costs ate up almost 18 percent of our gross domestic product last year, but nobody has any idea what stuff costs.
去年，健康支出占用了将近18%的国民生产总值，但没有人知道钱到底怎么花的。
But what if we did know? So we started out small.
但是，如果我们知道呢？我们从小规模做起。
We called doctors and hospitals and asked them what they would accept as a cash payment for simple procedures.
我们打电话给医生和医院，问他们如果简单的医疗处理可以用现金支付，价格是多少。
Some people were helpful. A lot of people hung up on us. Some people were just plain rude.
有些人很配合。很多人直接挂我们电话。有些人就是很没礼貌。
They said, "We don't know," or, "Our lawyers won't let us tell you that," though we did get a lot of information.
他们说：“我们不知道”或“我们的律师不允许我们告诉你”。不过我们依然得到了许多信息。
We found, for example, that here in the New York area,
比如，我们发现，在纽约地区，
you could get an echocardiogram for 200 dollars in Brooklyn or for 2,150 dollars in Manhattan, just a few miles away.
在布鲁克林，花200美金就可以做心脏超声波检查，在仅仅几英里外的曼哈顿却要2150美金。
New Orleans, the same simple blood test, 19 dollars over here, 522 dollars just a few blocks away.
新奥尔良，同样简单的血液检测，在这里是19美金，几个街区之外就是522美金。
San Francisco, the same MRI, 475 dollars or 6,221 dollars just 25 miles away.
旧金山，同样的磁共振成像，475美元，在25英里之外就要6221美元。
These pricing variations existed for all the procedures and all the cities that we surveyed.
所有的医疗程序都存在这样的价格差异，而且在我们调查的所有城市中都有。
Then we started to ask people to tell us their health bills.
接着，我们开始请大家告诉我们他们的医疗账单。
In partnership with public radio station WNYC here in New York, we asked women to tell us the prices of their mammograms.
我们和纽约的公共广播电台WNYC合作，请女性告诉我们她们做乳房X光成像的价格。
People told us nobody would do that, that it was too personal.
别人都跟我们说，没有人会这样做的，这些信息太私人化了。
But in the space of three weeks, 400 women told us about their prices.
但在三个星期内，有四百位女性为我们提供了这项信息。
Then we started to make it easier for people to share their data into our online searchable database.
接着，我们制作了线上可搜索数据库，让大家用更简便的方式把数据分享给我们。
It's sort of like a mash-up of Kayak.com and the Waze traffic app for health care.
很像医疗领域Kayak.com和Waze交通应用的融合版。
We call it a community-created guide to health costs.
我们称它是由社区共创出来的健康成本指南。
Our survey and crowdsourcing work grew into partnerships with top newsrooms nationwide
我们的调查和群众外包工作发展为和全国顶尖的新闻编辑部合作，
in New Orleans, Philadelphia, San Francisco, Los Angeles, Miami and other places.
包括在新奥尔良、费城、旧金山、洛杉矶、迈阿密以及其他地方。
We used the data to tell stories about people who were suffering and how to avoid that suffering, to avoid that "gotcha" bill.
我们用资料来讲述人们所经受的苦难，以及要如何避免那些苦难，避免那些负担不起的帐单。
A woman in New Orleans saved nearly 4,000 dollars using our data.
新奥尔良的一位女子用我们的资料省下了近四千美元。

A San Francisco contributor saved nearly 1,300 dollars by putting away his insurance card and paying cash.
一位旧金山的民众说他省下了近1300美元，而他只是不使用保险卡，改用现金支付。
There are a lot of people who are going to in-network hospitals and getting out-of-network bills.
有很多人都会去保险机构指定的医院，却收到了不能被报销的帐单。
And then there was the hospital that continued to bill a dead man.
还有医院会一直给死去的人寄账单。
We learned that thousands of people wanted to tell us their prices.
我们发现，有上千人想要告诉我们他们支付的价格。
They want to learn what stuff costs, find out how to argue a bill,
他们想要知道各个项目的价格，以及如何针对帐单进行申诉，
help us solve this problem that's hurting them and their friends and families.
以协助我们解决这个在伤害他们家人朋友的问题。
We talked to people who had to sell a car to pay a health bill, go into bankruptcy, skip a treatment because of the cost.
我们交谈的对象包括必须要通过卖车来支付医疗账单的人、破产的人、因为费用太高而无法接受治疗的人。
Imagine if you could afford the diagnosis but not the cure.
想像一下，如果你能负担得起诊断，却负担不起治疗会怎样。
We set off a huge conversation about costs involving doctors and hospitals,
我们引发了关于成本的热烈讨论，参与的人有医生、医院，
yes, but also their patients, or as we like to call them, people. We changed policy.
是的，还有他们的病人，或者，我们直接称他们为老百姓。我们改变了政策。
A consumer protection bill that had been stalled in the Louisiana legislature for 10 years passed after we launched.
在路易斯安纳有一个消费者保护法案已经停滞了十年，在我们开始行动之后，就通过了。
Let's face it: this huge, slow-rolling public health crisis is a national emergency.
让我们面对现实吧：这个巨大的、推动缓慢的公共健康危机是全国性的紧急事件。
And I don't think government's going to help us out anytime soon.
我想短期内政府不会协助我们。
But what if the answer was really simple: make all the prices public all the time.
但是如果答案其实很简单呢：让所有的医疗价格常年公开。
Would our individual bills go down? Our health premiums?
我们个人的帐单金额会下降吗？保费呢？
Be really clear about this: this is a United States problem.
大家要很清楚一点：这是美国的问题。
In most of the rest of the developed world, sick people don't have to worry about money.
在大多数其他的发达国家中，生病的人不用担心钱的问题。
It's also true that price transparency will not solve every problem.
的确，价格透明并不会解决所有问题。
There will still be expensive treatments, huge friction from our insurance system.
仍然会有昂贵的治疗存在，保险系统会有很大的阻力。
There will still be fraud and a massive problem with overtreatment and overdiagnosis.
仍然会有诈欺，也会有过度治疗与过度诊断的重大问题。
And not everything is shoppable. Not everybody wants the cheapest appendectomy or the cheapest cancer care.
不是所有东西都是可以比价的。并不是所有人都想要最便宜的阑尾切除手术，或最便宜的癌症护理。
But when we talk about these clear effects, we're looking at a real issue that's actually very simple.
但是，当我们谈到这些清楚的效果时，我们在看的其实是很简单的真实议题。
When we first started calling for prices, we actually felt like we were going to be arrested.
我们在刚开始向大家询问价格的时候，真的觉得我们会被逮捕。
It seemed kind of transgressive to talk about medicine and health care in the same breath,
同时谈及医学和医疗保健，似乎是有点越界，
and yet it became liberating, because we found not only data but also good and honest people out there in the system
但后来我们释然了，因为我们找到的不仅仅是数据，还有在体制中的好人、正直的人，
who want to help folks get the care they need at a price they can afford. And it got easier to ask.
他们想要协助大家获得他们所需的照料，并且是以他们付担得起的价格。然后开口询问也变得容易了。
So I'll leave you with some questions. What if we all knew what stuff cost in health care in advance?
所以，我想留给各位一些问题。如果我们都事先知道医疗保健各个项目的成本，那会怎样？
What if, every time you Googled for an MRI,
如果说每次你用谷歌搜寻磁共振成像，
you got drop-downs telling you where to buy and for how much, the way you do when you Google for a laser printer?
就会得到列表，告诉你在哪里可购买、多少钱，就像你在网上搜寻激光打印机那样一目了然呢？
What if all of the time and energy and money that's spent hiding prices was squeezed out of the system?
如果把花在隐藏价格上的所有时间、精力、金钱都从系统中排除出去呢？
What if each one of us could pick the $19 test every time instead of the $522 one?
如果我们每个人每次都能选择19美元的检测，而不是522美元的呢？
Would our individual bills go down? Our premiums?
我们个人的帐单金额会下降吗？保费呢？
I don't know, but if you don't ask, you'll never know.
我不知道，但如果你不问，就永远不会知道。
And you might save a ton of money.
你可能可以省下一大笔钱。
And I've got to think that a lot of us and the system itself would be a lot healthier. Thank you.
我认为，我们很多人以及体制本身都会变得更健康。谢谢。